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증례보고 : 호흡부전을 야기한 주산기 심근병증을 동반한 근긴장성 이영양증
심행선 ( Haeng Seon Shim ),신명근 ( Myoung Keun Shin ),조진용 ( Jin Yong Cho ),김인규 ( In Kyu Kim ),이성호 ( Seong Ho Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
Myotonic dystrophy is an autosomal-dominant inherited neuromuscular disorder that`s characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, the heart, lung and intestine. Its most common complication is postoperative respiratory failure. We encountered a patient who developed sudden unexpected peripartum cardiomyopathy (PPCM) and respiratory failure due to presumed myotonic dystrophy after cesarean section. We report here on our clinical experience with this malady and we include a brief review of the medical literature on myotonic dystrophy. (Korean J Anesthesiol 2009;57:376∼80)
증례보고 : 진단되지 않은 계류 척수 증후군 환자의 척추마취와 관련된 후유증
심행선 ( Haeng Seon Shim ),이성호 ( Seong Ho Lee ),박현식 ( Hyun Sik Park ),김인규 ( In Kyu Kim ),신명근 ( Myoung Keun Shin ),김재호 ( Jae Ho Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1
Tethered cord syndrome is a form of spinal dysraphism, with a low-lying conus frequently associated with an intraspinal lipoma, diastematomyelia or fibrous band. The clinical manifestations include spine abnormalities, such as spina bifida, or various neurological symptoms involving the lower extremities and sphincters. Herein, our experience of a 42-year-old female tethered cord syndrome patient, with deficit, paresthesia and incontinence following spinal anesthesia for anti-incontinence surgery, is reported with a brief review of literature. (Korean J Anesthesiol 2007; 53: 115~8)
노인환자의 수면내시경에서 혈관통 감소에 효과적인 Propofol과 Thiopental의 조합
심행선(Haeng Seon Shim),양근영(Geun Young Yang),신명근(Myoung Keun Shin) 대한임상노인의학회 2011 대한임상노인의학회지 Vol.12 No.4
연구배경: 고령화 인구의 증가와 질병의 관심도의 증가로 인해 상부 위장관 내시경 검사가 증가하고 있으나 검사에 대한 불안감, 검사 시의 고통 및 불쾌한 기억들로 인해 검사받기를 두려워하는 경향이 있기 때문에 환자에게 불편감과 고통을 줄여주기 위해 수면 내시경이 널리 사용되고 있다. Propofol은 수면 유도과 기억상실 효과를 가지면서도 짧은 반감기로 인한 빠른 의식 회복으로 외래방문 환자를 대상으로 사용하기에 적절한 약제로 알려져 있지만 정주통으로 인해 환자의 만족도가 저하될 수 있기 때문에 본 저자들은 propofol을 정주하기 전에 thiopental을 투여하여 그 효과를 혈역학적 변화와 만족도 등으로 대조군과 비교 연구하였다. 방법: 본 연구 대상은 위내시경 검사가 예정된 환자 중에서 60세 이상인 남녀 환자 60명으로 하였고 propofol을 단독 투여한 군(Group P)과 propofol과 thiopental (Group PT)을 조합하여 투여한 군으로 각각 30명씩 무작위로 배정하여 나누어 분류하였다. 안정 상태에서 수축기 혈압과 심박수를 기록하고 내시경실에서는 맥박산소계측기로 심박수와 산소포화도를 지속적으로 관찰하여 기록하였다. 주입 시 발생하는 통증여부를 각각 기록하였고 시술이 끝난 후 환자의 만족도 조사를 하였다. 결과: 연령, 체중, 성별에는 유의한 차이가 없었다(Table 1). 주사 시 동통은 P군에 비해 PT군에서 의의있게 감소하였으며(P<0.05) (Table 2), 혈역학적 변화와 환자의 만족도에는 양군에서 유의한 차이가 없었다(Table 3). 결론: 노인들을 위한 상부위장관 수면 내시경에서 propofol을 단독 투여한 군(Group P)보다 propofol과 thiopental (Group PT)을 조합하여 투여한 군이 주사 시 통증이 줄어들어 환자의 불안감과 불쾌감을 줄여주었고 혈역학적인 변화와 환자의 만족도에는 유의한 차이가 없어 추천할 수 있는 수면유도제의 조합으로 사료되어진다. Background: As elderly patients with the UGI (upper gastrointestinal) diseases have increased, need of the sedative agents also increase for satisfactory sedation and reducing anxiety. The purpose of this study was to assess the incidence of pain on injection and patient satisfaction when using a combination of propofol-thiopental as compared with propofol alone. Methods: Sixty patients aged ≥60 years scheduled for sedative UGI endoscopy were randomly allocated to group P (propofol alone) or group PT (combination of propofol and thiopental). Pulse rate, oxygen saturation, incidence of pain on injection and patient satisfaction were assessed. Results: There was a significant decrease of the incidence of the pain on injection in group PT compared with group P (P<0.05). There were no significant differences in hemodynamic index between the two groups. There were no significant differences in patient satisfaction between the two groups in the recovery room. Conclusion: We conclude that combination of propofol-thiopental during sedative UGI endoscopy in geriatric patients was significant reduction in pain on injection than propofol alone.
Clinical Analysis of Acute Laryngotracheal Injuries
심행선 ( Haeng Seon Shim ),김동준 ( Dong Joon Kim ),김정연 ( Jeong Yeon Kim ),김명구 ( Myung Gu Kim ) 중앙대학교 의학연구소 2018 中央醫大誌 Vol.43 No.1
Background and Objectives: Recently, the incidence of laryngotracheal injuries has increased steadily with the increase in traffic collisions and mechanization. Acute laryngotracheal injury is relatively uncommon but has the potential for rapid progression and can become life-threatening. Early diagnosis and appropriate airway management are essential for avoiding significant morbidity and mortality. We investigated our cases with laryngotracheal injuries to present the clinical findings and evaluate their correct management. Subjects and Method: A retrospective chart review was done of all patients who had been treated for acute laryngotracheal injuries from January 2000 to March 2016. The patients were studied with attention to gender and age distribution, mode of injury, clinical signs and symptoms, injury mechanisms and causes, degree of injury, treatment and outcomes after the treatment. Results: Thirty-two patients with laryngotracheal injuries were included in the study. Twenty-six cases were categorized as blunt traumas, and the other six were penetrating traumas. Acute laryngotracheal injuries were more common in males, and odynophagia and voice changes were the most common symptoms. Seventeen patients were managed conservatively, and fifteen underwent surgery. Twenty-two patients recovered their normal voices, and ten were assessed as fair. All patients showed good airway outcomes after appropriate treatment. Conclusion: Immediate recognition of acute external laryngotracheal injury and expedient appropriate management are essential to good functional recovery from these potentially lethal injuries. Chung-Ang J Med 2018; 43(1): 1-5