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증례보고 : 잠금장치가 안 된 Penlon Sigma Delta Anesthetic Vaporizer (Sevoflurane)에서의 가스누출
이승윤 ( Seung Yun Lee ),서성호 ( Sung Ho Suh ),조재훈 ( Jae Hoon Cho ),임정애 ( Jeong Ae Lim ),이경민 ( Kyoung Min Lee ),우남식 ( Nam Sik Woo ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
We present a case of an anesthetic gas leak through the valve of the Selectatec back bar during a surgical procedure. The Selectatec Vaporizing System is a quick-change system consisting of anesthetic vaporizers of the ``Tec models`` of the Ohmeda machine that are seated on a compatibility manifold block located on the back bar of the anesthetic machine. In order to prevent a leak and a failure of vapor delivery, the "Tec models series" can only be turned ``on`` when the locking lever is turned to the ``lock`` position. However in this case, the control knob was rotated despite the back bar locking mechanism not being engaged, and a gas leak developed through the unlocked valves in Selectatec back bar. The Penlon Sigma Delta Anesthetic Vaporizer (sevoflurane) in a Datex-Ohmeda Aestiva/5 anesthesia machine can be turned ``on`` when the locking lever is maintained at the ``unlock`` position. (Korean J Anesthesiol 2006; 51: 230~2)
증례보고 : 원발성 신부전이 동반된 간부전 환자의 간이식술의 마취 관리
김덕경 ( Duk Kyung Kim ),김혜경 ( Hae Kyoung Kim ),김태엽 ( Tae Yop Kim ),임정애 ( Jeong Ae Lim ),김양렬 ( Yang Lyoul Kim ),장성환 ( Sung Whan Jang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Renal failure frequently accompanies advanced hepatic failure. Even if adequate renal function is not considered as a prerequisite for transplant candidacy, impaired renal function prior to liver transplantation has been regarded as an independent risk factor of graft dysfunction and mortality. Liver transplantation in such a patient also presents a number of challenges to the anesthesiologists. Optimal fluid therapy, prompt and aggressive correction of electrolytes and metabolic disturbances, careful selection of anesthetic techniques and agents, and close monitoring of cardio-respiratory function help reduce the graft failure and perioperative mortality. In such cases, continuous renal replacement therapy (CRRT) is used with increasing frequency during or after the surgery. So, anesthesiologists need to understand the basic principles, potential applications, and anesthetic implications of several CRRT options. We therefore present the anesthetic experience in a patient with hepatic failure combined with primary renal failure, successfully managed during or after liver transplantation. (Korean J Anesthesiol 2007; 53: 547∼553)
증례보고 : Loeys-Dietz Syndrome 환아에서 대동맥판막 역류증 수술의 마취 관리
김성협 ( Seong Hyop Kim ),백승우 ( Seung Woo Baek ),권원경 ( Won Kyoung Kwon ),김덕경 ( Duk Kyung Kim ),윤태균 ( Tae Gyoon Yoon ),임정애 ( Jeong Ae Lim ),우남식 ( Nam Sik Woo ),김태엽 ( Tae Yop Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
Loeys-Dietz Syndrome (LDS) is a recently described autosomal dominant aortic aneurysm syndrome with widespread systemic involvement. It is characterized by the triad of 1) arterial tortuosity and aneurysms, 2) hypertelorism, and 3) bifid uvula or cleft palate. A 12-year-old boy with LDS was scheduled to undergo correction of aortic valve regurgitation due to aortic annuloectasia. We report our clinical experiences of a case of LDS patient with brief review of related literatures and relevant anesthetic problems. (Korean J Anesthesiol 2009;57:371∼5)
제왕 절개술시 음악이 산모의 혈역학적 변화와 혈중 Cortisol 에 미치는 영향 및 인지와 상기에 미치는 영향
김성협,임정애,강포순,우남식,김혜경 건국대학교 의과학연구소 2003 건국의과학학술지 Vol.13 No.-
Light plane of general anesthesia for cesarean section is usually applied to the mother for the fetal safety. The mother have increased awareness and recall due to stress under light anesthesia. Music is widely used to help patient relax, diverting their attention from unpleasant and stressful situation. It eliminates noise of operating room. Our aim of study was to find the effect of music on maternal cardiovascular response, stress response, intraoperative awareness and recall. Forty patients undergoing cesarean section with general anesthesia were allocated randomly to either control group (n=20) (group 1) or music group (n=20) (group 2). Patients of group 2 listened to music by head phone during an operation. The blood pressure, heart rate, intraoperative awareness using isolated forearm technique OFT), postoperative recall, plasma cortisol level and patient's satisfaction were assessed. Systolic blood pressure and heart rate were decreased significantly in the group 2 than group 1 at 1 minute before intubation and 5 minute after extubation (P<0.05). The incidence of followed commands were 9(45%), 13(65%) in group 1 and 8(40%), 12(60%) in group 2 at 1 minute after intubation and 2 minute after extubation. The incidence of "made reaching movement" were 15(75%), 13(65%), 4(20%) in group 1 and 13(65%), 10(50%), 1 (5%) in group 2 at 1 minute, 2 minute and 3 minute after intubation. Postoperative recall such as auditory perception and dream were 6(30%), 200%) in group 1 and 200%), 4(20%) in group 2. The plasma cortisol level was significantly elevated in the group 1 than group 2 at 30 minute after intubation and 10 minute after arrival at the recovery room (P<0.05). Patients showed good satisfaction with music in group 2. It was found that the playing music to the mother during a cesarean section under general anesthesia decreased anxiety and stress response. This technique may help patients to protect from unwanted and perhaps distorted information by blocking noise in the operating room.
지주막하 마취시 두통예방을 위한 경막외 자가혈액 봉합법에 대한 효과
김윤수,강포순,이예철,임정애,이근상 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5
Background: Post-dural puncture headache (PDPH) is one of the well-known complication of spinal anesthesia. Epidural blood patch is the treatment of choice for PDPH but is rarely used for the prevention of PDPH after spinal anesthesia. The purpose of this study is to observe the effectiveness of epidural blood patch for prevention of PDPH and to evaluate the complications after epidural blood injection. Methods: Three hundred patients (ASA I or II) receiving spinal anesthesia were studied. They were randomly devided into two groups. Patients in Group I, the control group, were maintained in a supine position for 24 hour after spinal anesthesia. Patients in Group II, the study group, received 3 ml of autologous blood in the epidural space after spinal anesthesia. PDPH was evaluated for 5 days. The incidence, location, onset, and duration of headache in the patients presenting with PDPH were measured for 5 days, and the complications following epidural blood patch in Group II were observed for 2 weeks. Results: The incidence of PDPH in group I was 11%, but 0% in group II. There were no specific complications following epidural blood patch in Group II. Conclusions: This study suggest that the 3 ml epidural autologous blood patch is an useful method for the prevention of PDPH in patients with spinal anesthesia. (Korean J Anesthesiol 1998; 35: 933∼938)
이규창,강포순,우남식,임정애,박영주,이예철 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.4
The continuous epidural anesthesia is an effective method for postoperative pain control and improvement of pulmonary function. A 39-year-old man was scheduled for postoperative intestinal obstruction. After adhesiolysis under the general anesthesia, epidural anesthesia was done for postoperative pain control. Because an accidental dural puncture was noticed, the adjacent interspace of epidural anesthesia was tried and catheter was inserted. Respiratory depression, hypotension, loss of consciousness and cardiac arrest were developed about 20 minutes after the first injection of 1% lidocain 10ml. Endotracheal intubation was performed and the respiration was controlled using 100% oxygen. Self respiration and alert mentality returned after 180 minutes. No CSF leakage, delayed onset time, severe hypotension, complete recovery may be the result of subdural anesthesia and postoperative hypoxia. But radiological examination was not performed.
찬송가와 독경이 수술실에서 마취전 환자의 불안에 미치는 영향
김성곤,강포순,이예철,임정애 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.6
Background: Most surgical patients experience preoperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contribute to postoperative pain. Music has been recognized as a way to reduce anxiety and fear. The effect of hymn and sutra-chanting on the preanesthetic patient's anxiety in the operating room were studied. Methods: 98 patients were divided into two groups according to the religionist or atheism. Group I(n=50, religionist) and Group II(n=48, atheism) listened to hymn or sutra-chanting according to the patients religion and choice. At ward, hemodynamic variables including systolic and diastolic blood pressure and pulse rate were measured as control values. Hemodynamic variables and measurements of anxiety score with Hamilton anxiety rating scale were made at pre-music and post-music in the operating room. Also, patients response to the music was measured on the postoperative 5-6th day. Results: There were no difference between ward, pre-music, and post-music in terms of systolic pressure, diastolic pressure and pulse rate except the systolic pressure at pre-music that is grater than that of controls in both groups. Both group, anxiety score at post-music was significantly lower than that of pre-music (10.2±3.4 vs 4.4±2.9, 11.0±3.2 vs 5.7±3.1). At post-musie, anxiety score in Group I showed significant reduced compaired with Group II (p$lt;0.05). Patients showed relatively good satisfaction with music in both groups. Conclusion: The results suggest that music with hymn and Sutra-chanting were effective to reduce preanesthetic anxiety in both religionist group and atheism group.