중심정맥압 측정 카테테르 위치이상 3 예 보고

이상귀,윤영무 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.6

중심정맥압은 혈액량, 정맥tone, 우심장의 기능을 나타내는 지표러서, 중심정맥압을 측정하기 위해서는 상지의 말초혈관, 내외경정맥, 쇄골하정맥 등을 통해서 카테테르 중심정맥내로 삽입하여야 한다. 그러나 카테테르 삽입조각 또는 카테테르 자체에 의해서 감염, 신경 또는 주위조직 손상, 혈종, 혈전성 정맥염, 공기 색전증, 카테테르 색전증, 수흉 등의 각종 합병중이 발생할 수 있다. 따라서 이런 합병증을 예방하기 위한 각종 카테테르 거치 방법이 소개되어 있기는 하나, 아직까지 이러한 합병증을 완전히 없앨 수 있는 방법 및 카테테르 재료는 소개되어 있지 않다. 저자들은 개심슬시 중심정맥압을 관찰하기 위해서 우쇄골하정맥, 우내경정맥을 통해 각각 삽입한 카테테르의 위치이상 3예를 경험하엿는데, 제1예에서는 우내경정맥에 삽입한 카테테르가 우내경정맥내에서 2회 회전한후 우내경정맥동을 향해 카테테르 끝이 제 4 경추 부위에 위치하고 있었으며, 제 2예에서는 우내경정맥에 삽입한 카테테르가 제 3늑간 부위에서 우내경정맥쪽으로 역행하여 제 1흉추부위에 위치하고 있었고, 제 3예에서는 우쇄골하정맥으로 삽입한 카테테르가 우내경정맥으로 삽입되어 카테테르끝이 제 5경추부위에 위치하였다.

Respiration apparatus comprising fixing string: a new design of double (head and neck) straps for patient face mask

이상귀,두아람 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.66 No.6

Noise robustness of synchronization in a unit network

이상귀,Shigeru Tanaka,김승환 한국물리학회 2005 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.46 No.4

Recently, various studies have focused on the synchronization phenomenon in the nervous system. In this paper,we focused our attention on the underlying mechanism of synchronization and the robustness of synchronization through a simple unit network of globally coupled excitatory cells. Our network model with various numbers of neurons exhibits synchronized activities that originate from strong lateral excitatory connections. The degree of synchronization is quantified by the measure of the peak height of the power spectrum (PHPS). We find that the synchronization in the firing activities is a robust phenomenon against variations in the noise intensity even though the firing rate is sensitive to such variations. Our study on the robustness of synchronization can be a basis for a study on the role of synchronization in information processing.

대퇴동맥 도관법 시행시 절단된 동맥내 도관

이상귀,주찬웅,고성훈,황정한 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5

Arterial cannulation for constant monitoring of arterial pressure and blood gase analyses has become commonplace in the care of the critically ill patients. The radial artery is often regarded as causing a negligible complication risk because of extensive collateral arterial flow in the hand. One of other alternative sites for arterial cannulation is femoral artery. Femoral artery cannulation has a high degree of success in very small, critically ill children. It should be considered an acceptable alternative to small- vessel cannulation when the latter is not technically achievable, or in the unstable patient where rapid establishment of reliable artery access is necessary. Arterial cannulation may cause many complications: arterial catheters can directly injure the vessels, resulting in thrombosis, occlusion, distal embolization or ischemia. Local insertion site complications, such as hematoma, hemorrhage, and infection may occur. Arterial catheter may also be a source of systemic sepsis. We report an unusual case of unintentional release of a catheter fragment into the external iliac artery in a 7-month (7.8 kg) male patient with tetralogy of Fallot, which was inadvertently inserted during right femoral artery cannulation. The catheter fragment was successfully retrieved with the Amplatz Goose Neck microsnare under fluoroscopy without any problems. (Korean J Anesthesiol 1998; 35: 1007∼1011)

각성상태하 언어피질 지도화시 후두마스크를 이용한 마취관리

이상귀,오광조 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.2

Epilepsy surgery is performed in patients with epilepsy of focal origin and seizures which are refractory to medical treatment. Electrophysiologic mapping of the epileptic foci and other cortical areas (e.g., language, memory, sensorimotor) is frequently used to maximize the resection of the epileptogenic lesion while minimizing the neurologic deficits. For language area mapping, general endotracheal anesthesia can not be used because a patient can not vocalize. So awake craniotomy is frequently used. However, during awake craniotomy for language area mapping with local infiltration anesthesia and intravenous sedation and narcotics supplementation analgesia, respiratory arrest or depression and hypoxemia may occur. The airway securement is crucial to the patients. As an alternative to tracheal tubes, laryngeal mask airway can secure the airway and does not interference the vocalization. We could successfully performed the language area mapping in a 17-year-old male patient with laryngeal mask airway under deep intravenous anesthesia with local infiltration anesthesia of the scalp. (Korean J Anesthesiol 1999; 36: 340∼344)

호기말 이산화탄소분압측정기가 유용하게 사용된 두 가지 증례

이상귀,김진송,강승관,이준례 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.3

Background: Mechanisms of secondary injury (post-ischemic injury) in the central nervous system have cently reported in a vast of amount of experiments. Among many factors which give rise to post-ischemic neuronal damage, glial deterioration probably mediated by calcium paradox, could be another of the aggravating deleterious factars to the already ischemic neurophil. Methods: Here we have designed experiment to investigate calcium paradox in astroglial cell line, humsn asttocytoma U1242MG. Intracellular calcium alterations in experimental cells were monitored by using calcium indicating dye fura-2 and epifluorescent photometry system. Results: Intracellular free calcium changes during reperfusion phase after exposure to low calcium led to a prampt increase in intracellular calcium level after 10 and 30 minutes. The way of calcium entry during the reperfusion phase was mediated by the revase mode of Na+/Ca2+ exchanger. Cells that had a reduction of reperfusate calcium to 10 uM increased cell viability. Also we observed an inverse relationship between major enzymatic activity in the astrocytoma cells (i.e., glutamine synthetase activity) and the duration of reperfusion in the the same protocols. Conclusions: A relatively small amount of intracellular calcium increase by the reverse mode of Na+/Ca2+ exchanger during the reperfusion period is related to a limitation of enzyme activity and viability 24 hours later. (Korean J Anesthesiol 1996; 30: 384~391)

미추마취에 병발된 회음부 일측마취

이상귀 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.6

미추마취는 1901년 소개된 경막외마취의 일종으로 무통분만, 수술후 통증 및 암성통존의 치료, 항문, 회음부 및 하복부 수술시 성인 또는 소아를 불문하고 현재 널리 이용되고 있는 비교적 안전한 부위마취방법이다. 그러나 가끔 전산중독반응, 태아두부손상, 분만지연, 지주막하마취 및 이에 동반되는 동맥저혈압 등의 합병증과 마취가 전혀 되지 않거나 불확실한 부문적인 마취만 되는 경우도 있을 수 있다. 저자는 치핵제거술은 받기 위한 42세 여자 환자에게 천골열공을 정확하게 찬은 후 19gauge 바늘로 미추마취를 정확하게 시행했으나 좌측 항문 및 회음부의 외옵부신경이 분포하는 지역 마취가 되고 우측은 전혀 마취가 되니 않은 1예를 경험하였기에 보고하며, 이는 아마도 경막외강의 정중앙 존재하는 막(plica mediama dorsalis)에 의한 것이라 생각된다.

성인 및 소아에서 요골동맥카테터 삽입술을 위한 받침대

이상귀,오경학,최현규 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.1

Lee fiberoptic intubating airway for facilitating orotracheal fiberoptic intubation

이상귀,A Ram Doo 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.4

후두거상법은 기관내삽관이 용이하도록 후두경소견을 개선하는가 ?

이상귀 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.3

Background: The larynx is longitudinally stretched and anteriorly displaced by inducing the general anesthesia and muscle paralysis, thus the laryngoscopic visualization might become difficult during direct laryngoscopy. The study was designed to assess the efficacy of the $quot;laryngeal lift$quot; maneuver in improving the laryngoscopic visualization to facilitate tracheal intubation. Methods: Following the induction of general anesthesia and muscle paralysis, the laryngoscopic views of 287 patients were evaluated while the laryngeal lift by which the cricoid cartilage was displaced 0.5 cm posteriorly and 1.0∼1.5 cm cephaladly were performed. One hundred and three patients with grade 2-4 laryngoscopic veiw were analysed. The laryngoscopic view which was described by Cormack and Lehane was classified from grade l to grade 4. The postoperative complications such as dysphasia and/or dyspnea were also observed. Results: Seventy four patients of 81 patients with the laryngoscopic view of grade 2 were improved by one grade. Twenty one patients of 22 patients with the laryngoscopic view of grade 3 were improved by more than one grade. However, the laryngoscopic views of eight patients out of 103 patients were not improved. The tracheal intubation was successful in all patients. The overall, grade 2 and grade 3 improvement rate of laryngoscopic view was 92.2%, 91.4% and 95.5% respectively. The improvement rate by one grade and two grade was 89.3% and 2.9% respectively. Conclusions: The laryngeal lift had the high improvement rates of laryngoscopic view without any complications. Thus it is concluded that the laryngeal lift is a useful maneuver for improving laryngoscopic view during direct laryngoscopy with curved blade of laryngoscope.