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심재항,심재철 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.3
Background : Lumbar plexus block was used not only for the proposal of lower limb surgery, but also for that of pain control in the pain clinic. The aim of our study was to evaluate the motor, sensory function and the anatomic parameters after posterior approach of the lumbar plexus block with the help of a nerve stimulator. Methods : 30 patients of low back pain radiating to lower extremities were randomized into two groups. We performed the psoas compartment block guided by C-arm fluoroscope. With the pateints in prone position, a 100 mm insulated needle was introduced at the surface of L5 transverse process. Stimulation of femoral nerve was used to optimize the needle placement at the center of lumbar plexus (Dancing Patella). 1% mepivacaine hydrochloride (0.2 ml/kg) solution in group 1 (n=11) and 0.5% mepivacaine hydrochloride (0.2 ml/kg) solution in group 2 (n=19) were then injected. We measured the minimal current, distance of puncture site from midline, distance from skin to transverse process, distance from skin to the point of maximal twitch, and distance from transverse process to the point of maximal twich. Motor and sensory functions were measured at 5, 15, 30, 45, 60, 90 and 120 min after procedure. Results : Anatomical parameters were as follows; distance of puncture site from midline was 42.6 5.6 mm, distance from skin to transverse process was 52.9 ± 7.0 mm, distance from skin to the point of maximal twitch was 68.8±5.6 mm, and distance from transverse process to the point of maximal twich is 15.9±3.9 mm. Difference in attenuated motor function(hip adduction, knee extension) was observed between two groups (P<0.05). Hip adduction and knee extension were recovered 60 min after injection in group 1. In group 2, knee extension was attenuated above 2 hours. We observed significant hip flexion attenuation 90 and 120 min (group 1 and group 2, etc) after injection Sensory blockade was recovered 120 min after injection in both groups. Conclusions : It is suggested that above mentioned anatomiparameters would be useful for the safe blockade. We found that recovery of attenuated hip flexion is crucial for the discharge criteria of ambulating outpatient with the low back pain. (Korean J Anesthesiol 1999; 36: 422∼430)
심재항,신우종,이상훈 대한마취통증의학회 2010 Korean Journal of Anesthesiology Vol.59 No.-
A 25-year-old woman was diagnosed with a ruptured ectopic pregnancy. During laparoscopic surgery, the patient was in the Trendelenberg position (20o degrees). Massive froth in the endotracheal tube was observed at the end of surgery. A portable chest x-ray, checked at the end of the operation, showed diffuse haziness in both upper lung fields. After one hour of aggressive treatment with drugs and positive mechanical ventilation, the amount of froth in the endotracheal tube was reduced considerably. Considering the symptom and radiologic findings, we concluded that diffuse bilateral upper lung field haziness was due to atypical pulmonary edema. We speculated that the rapid improvement of pulmonary edema was due to redistribution of fluid to the lowest part of lung by immediate reversing the patient's Trendelenberg position, along with aggressive treatment.
심재항,전우재,조상윤,최규호 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.2
Background: A “difficult airway” can be simulated with an extrication collar, which restricts cervical motion and mouth opening. The purpose of this study is to compare the efficacy of the GlideScope and the McGrath in difficult airway simulation. Methods: Patients were randomized using computer-generated numbers and were placed into the GlideScope group or the McGrath group. The total intubation time was defined as the time measured from when the anesthesiologist picks up the device to the time at which three successive end-tidal CO2 values are acquired after intubation. Results: There was no significant difference in total intubation time between the two groups (73.0 ± 25.3 sec vs. 72.3 ± 20.9 sec, P = 0.92). The success rates of the first intubation attempt did not differ between the two groups (82.8% vs. 83.3%, P = 0.95). Conclusions: Our results suggest that there are no significant differences in the intubations with GlideScope and Mc- Grath using vascular forceps and tube exchangers in difficult intubation scenarios.