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임의재,이동준,김문철,이상준,김명화 인제대학교 2009 仁濟醫學 Vol.30 No.-
Abdominal aortic aneurysms rarely occur with cancerous lesion but occasionally with gastrointestinal malignancy, and need absolute blood pressure control to prevent rupture. A 71 year old male who complained dizzness and hematochezia. He has been managed for hypertension, stable angina and abdominal aortic aneurysm which diagnosed 2months ago. He was diagnosed as advanced gastric adenocarcinoma and subtotal gastrectomy was performed. General anesthesia was scheduled and epidural catheterization was performed to controll intraand post operative pain and minimize hemodynamic change to prevent aneurysmal rupture 37.5mg of Ropivacaine was injected through epidural catheter before anesthesia and infusion of remifentanyl and propofol was performed during general anesthesia. The blood pressure was maintained between 95/50 and 145/95 and did not significantly increased. The general-epidural combined method was successfully performed and we are report this case with a brief review of the literature.
Propofol-remifentanil 마취와 Sevoflurane-remifentanil 마취 시 중심체온 변화의 차이
임의재 ( Ui Jae Im ),이동준 ( Dong Jun Lee ),김문철 ( Mun Cheol Kim ),이정석 ( Jeong Seok Lee ),이상준 ( Sang Jun Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6
Background: Hypothermia following the induction of anesthesia is caused by core to peripheral redistribution of body heat. It has been reported that propofol causes more severe hypothermia than sevoflurane by inhibiting thermoregulatory vasoconstriction during surgical procedures. Therefore, we evaluated the induction and maintenance of anesthesia with intravenous propofol to determine if it causes more core hypothermia than inhaled sevoflurane. Methods: Forty-five patients who underwent hysterectomy were divided into two groups randomly, a propofol-remifentanil (PR) anesthesia group and a sevoflurane-remifentanil (SR) anesthesia group. Each group was subjected to anesthetic induction with either 1.5 mg/kg propofol or inhalation of 5% sevoflurane, respectively. Anesthesia in the former group was maintained with propofol while it was maintained with sevoflurane in the latter group. Specifically, 6-10 mg/kg/hr propofol, 3 L/min medical air, 2 L/min O2, and 0.25 mg/kg/hr remifentanil were used in the PR group for maintenance, while 1.5 vol% sevoflurane, 3 L/min medical air, 2 L/min O2 and 0.25 mg/kg/hr remifentanil were used for maintenance in the SR group. We measured the core temperature 8 times, prior to induction and 10, 20, 30, 45, 60, 75 and 90 minutes after induction. Results: Core temperatures decreased in both the PR and SR group during surgical operation, but there was no significant difference between the two groups. Conclusions: Anesthesia induced and maintained by propofol did not cause a greater degree of hypothermia than sevoflurane. (Korean J Anesthesiol 2009; 57: 704∼8)
오른쪽 빗장밑정맥을 이용한 중심정맥도관술에서 환자의 키와 중심정맥카테터의 깊이의 관계
이동준,임의재,김기태 대한중환자의학회 2011 Acute and Critical Care Vol.26 No.3
Background: Location of the tip of a central venous catheter (CVC) within the pericardium has been associated with potentially lethal cardiac tamponade. The purpose of this study was to show the relationship between the height of patients and the depth of CVC. Methods: We enrolled 262 adult patients into this study. All patients were divided to three groups according to the height; Group S, M and L. Central venous catheterization was performed through the right subclavian vein and the CVC was fixed at the depth of 15 cm from the skin. The distance between the CVC tips and the carina was measured by chest X-ray and was analyzed. Results: The mean (SD) tip position placed via the right subclavian vein was 0.04 (1.6) cm above the carina; Group S, 0.01 (1.8) above the carina, Group M, 0.16 (1.4) above the carina, and Group L, 0.16 (1.8) below the carina. CVC locations could be predicted with a margin of error between 3.1 cm below the carina and 3.2 cm above the carina in 95% of patients. There was no significance difference among the three groups. Conclusions: The relationship between the height of patient and the depth of CVC was low. Because many of the CVC tips were positioned below the carina regardless the height of patients on routine 15 cm-length method, it is recommended not to use the routine 15 cm method with right subclavian CVC placement as far as possible.
이상준,이동준,김문철,임의재,김명화 인제대학교 2009 仁濟醫學 Vol.30 No.-
During anesthesia, unexpectedly endotracheal tube obstruction cause seriouscomplications which require early diagnosis and immediate management. Endotracheal tube obstruction with foreign body is rare. 74 year old man was scheduled for open lung biopsy. The patient was intubated with a 7.5 mm reinforced endotracheal tube and turned to the right lateral position. After 30 minute, signs of partial endotracheal obstruction was observed including high airway pressure and decreased end-tidal CO2. A suction catheter was not deeply advanced. A wheezing - like sound was heard. We temporarily stopped the operation and turned the patient to supine. We exchanged the tube with another one and found impacted mucous secretions at the distal tip of the tube.