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증례보고 : HELLP 증후군이 동반된 자간전증 산모의 제왕절개술 후 진단된 뇌내출혈
송재격 ( Jae Gyok Song ),김석곤 ( Seok Kon Kim ),은종현 ( Jong Hyun Eun ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
Intracerebral hemorrhage (ICH) is one of very dangerous complications of preeclampsia/eclampsia. We experienced postoperative ICH in a 39-year-old woman with preeclampsia and HELLP syndrome. The paturient complained severe headache and upper abdominal pain with nausea and vomiting. Her initial blood pressure was 190/120 mmHg and her heart rate was 80 beat/min. The diagnosis of preeclampsia with HELLP syndrome was confirmed by the severe hypertension and the laboratory findings. She was drowsy at the emergency room but she lost consciousness when transferring to the operation room. Caesarean section was done under general anesthesia. After the operation she could not recover self-respiration and consciousness. Her brain CT showed ICH in the basal ganglia with intraventricular hemorrhage and severe brain edema. She expired one the 5 th post operative day due to brain death and multiple organ failure. Early diagnosis is the key to treating ICH. (Korean J Anesthesiol 2009;56:592~6)
증례보고 : 폐외 결핵농양 환자의 기관내 삽관 중 발견된 후두개결핵 의증
송재격 ( Jae Gyok Song ),권민아 ( Min A Kwon ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4
Epiglottic tuberculosis without pulmonary involvement is an uncommon disease that has rarely been described in Korea. We report here a case of a 36 year-old man with a recurrent tuberculosis abscess in his thigh. He had been treated with steroids for systemic lupus erythematosus, and he suffered from recurrent tuberculosis abscess in the thigh where he had received total hip replacement arthroplasty. When inducing general anesthesia for incision and drainage, we noticed a destroyed epiglottis. After consultation with an otolaryngologist, we concluded that the patient has had epiglottic tuberculosis and precautions against tuberculosis infection were taken. The surgery ended without event. The patient recovered safely and was transferred from the operating room directly to the general ward. In this paper, we also discussed the epiglottic tuberculosis and precautions that were taken to prevent tuberculosis infection of the healthcare workers in the operating theater. (Korean J Anesthesiol 2009;56:457~61)
증례보고 : 위암환자의 위전절제술 중 발생한 심장의 무맥박 전기 활동
송재격 ( Jae Gyok Song ),엄우식 ( Woo Sik Eom ),정해정 ( Hae Jeong Jeong ),조대순 ( Dae Soon Cho ),신혜영 ( Hye Young Shin ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Pulseless electrical activity refers to a heterogeneous group of cardiac rhythm disorders, all characterized by pulselessness in the presence of some type of electrical activity other than ventricular tachycardia or ventricular fibrillation. We experienced a case of sudden pulseless electrical activity and cardiac arrest during hetastarch infusion in general anesthesia in an adult who had total gastrectomy. We report this experience with a brief review of literature. (Korean J Anesthesiol 2007; 52: 246~9)
증례보고 : 병적 비만환자에서 쇄골상차단법으로 시행한 상완신경총 차단 후 발생한 호흡곤란
송재격 ( Jae Gyok Song ),김석곤 ( Seok Kon Kim ),전대근 ( Dae Geun Jeon ),권민아 ( Min A Kwon ),유진희 ( Jin Hee Yoo ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4
A 57-year-old woman with morbid obesity (BMI: 37.39) was scheduled for ligament reconstruction with tendon interposition of the carpometacarpal joint. A difficult supraclavicular brachial plexus block was performed using a 22-gauge regional block needle with a nerve stimulator and 40 ml of 1% mepivacaine. Approximately 10 minutes after the injection, she complained dyspnea, shortness of breath and right mid-thoracic pain. Her oxygen saturation decreased from 100% to 95%. Diagnostic workup revealed right diaphragmatic elevation caused by phrenic nerve block. General anesthesia was induced because of the unsuccessful brachial plexus block and dyspnea with chest pain. She recovered without any residual complications and was discharged on the third postoperative day. Phrenic nerve block is a common complication in supraclavicular brachial plexus block but it is usually not severe and reassurance is enough to control it. However, pre-operative physical conditions that may lead to decreased respiratory reserves, such as morbid obesity should be considered as a risk factors when conducting supraclavicular brachial plexus block. (Korean J Anesthesiol 2009;57:511∼4)
Propofol의 청각뇌간반응과 뇌교 청신경핵 부위 절편에서의 시냅스후전류에 대한 효과 사이의 상관성 연구
강봉진 ( Bong Jin Kang ),김석곤 ( Seok Kon Kim ),이관우 ( Gwan Woo Lee ),권민아 ( Min A Kwon ),송재격 ( Jae Gyok Song ),안승철 ( Seung Chul Ahn ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
Background: Although there have been reports showing the changes of the auditory brainstem response (ABR) waves by propofol, no detailed studies have been done at the level of brainstem auditory circuit. So, we studied the effects of propofol on the postsynaptic currents of the medial nucleus of the trapezoid body (MNTB)-lateral superior olive (LSO) synapses by using the whole cell voltage clamp technique and we compared this data with that obtained by the ABR. Methods: 5 rats at postnatal (P) 15 days were used for the study of the ABR. After inducing deep anesthesia using xylazine 6 mg/kg and ketamine 25 mg/kg, the ABRs were recorded before and after intraperitoneal propofol injection (10 mg/kg) and the effects of propofol on the latencies of the I, III, and V waves and the I-III and III-V interwave intervals were evaluated. Rats that were aged under P11 were used in the voltage clamp experiments. After making brainstem slices, the postsynaptic currents (PSCs) elicited by MNTB stimulation were recorded at the LSO, and the changes of the PSCs by the bath application of propofol (100 μM) were monitored. Results: We found small, but statistically significant increases in the latencies of ABR waves III and V and the interwave intervals of I-III and III-V by propofol. However, no significant changes were observed in the glycinergic or glutamatergic PSCs of the MNTB-LSO synpases by the application of propofol (100 μM). Conclusions: Glycinergic or glutamatergic transmission of the MNTB-LSO synapses might not contribute to the propofol-induced changes of the ABR. (Korean J Anesthesiol 2009;56:552~8)