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이보라,장준흠,이신영,송종욱 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.2
Sutureless aortic valve replacement was performed in a 72-year-old female patient with severe aortic stenosis who had undergone coronary revascularization and pacemaker implantation. After valve excision, decalcification was deliberately incompletely performed at the commissure of the left- and non-coronary cusp to obtain a regular and circular annular margin. After implantation of the stented valve, no paravalvular leakage was noted on water irrigation testing. Upon weaning from cardiopulmonary bypass, a moderate degree of paravalvular leakage was observed by transesophageal echocardiography at the junction of the left- and non-coronary cusp. Instead of removing the valve and performing more complete decalcification to implant a larger valve, secondary balloon dilatation and warm sterile water irrigation were performed to allow further expansion and fixing of the metal alloy stent around the aortic wall to minimize the duration of aortic cross-clamp. No paravalvular leakage was observed thereafter and the patient was discharged without any complications.
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Cyanide toxicity during cardiopulmonary bypass with small dose of nitroprusside -a case report-
안소운,정금희,박서민,백인찬,장준흠,홍용우 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.2
Sodium nitroprusside (SNP) is an anti-hypertensive drug, commonly used to decrease the systemic vascular resistance and lower the blood pressure. When the amount of cyanide generated by the SNP exceeds the metabolic capacity for detoxification, cyanide toxicity occurs. Under general anesthesia and cardiopulmonary bypass (CPB), it may be difficult to detect the development of cyanide toxicity. In cardiac surgical patients, hemolysis, hypothermia and decreased organ perfusion, which emphasize the risk of cyanide toxicity, may develop as a consequence of CPB. In particular, hemolysis during CPB may cause an unexpected overproduction of cyanide due to free hemoglobin release. We experienced a patient who demonstrated SNP tachyphylaxis and cyanide toxicity during CPB, even though the total amount of SNP administered was much lower than the recommended dose. We therefore report this case with a review of the relevant literature.
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신동욱 ( Dong Wook Shin ),장준흠 ( Junheum Jang ),강화자 ( Wha Ja Kang ) 경희대학교 경희의료원 2014 慶熙醫學 Vol.29 No.1
The burned patient has many problems like dehydration, oliguria and protein defficiency. Because homeostatic controls are markdly impaired, the cardiovascular system may be unable to respond to the changes in body position frequently necessary during surgical procedures. Especially when the burn involves the head, neck, and upper chest, the mucous membrane of the respiratory tract may be edematous and pulmonary atelectasis may be present. And shock, hyperdynamic circulation, decreased serum albumin concentration, increased α1-acid-glycoprotein concentration, and altered receptor sensitivity change the respose to various drugs. The response to depolarizing and nondepolarizing muscle relaxants remains unaltered during 24 hours after burn injury. However, after first day, the response remain altered by the various mechanism. Doctors must always keep in mind that the understandings of pathophysiology and anesthetic management management in burned patient are important.
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경요도 절제술을 시행받는 환자에서 초음파기를 이용한 폐쇄신경 차단 - 서혜부 주름부위 접근법
길현주 ( Hyun Jue Gill ),전덕희 ( Duk Hee Chun ),백인찬 ( In Chan Baek ),장준흠 ( Jun Heum Jang ),신동욱 ( Dong Wook Shin ),강화자 ( Wha Ja Kang ) 경희대학교 경희의료원 2014 慶熙醫學 Vol.29 No.1
연구배경: 경요도절제술을 시행받을 환자 중에서 초음파기와 신경 자극기를 이용하여 폐쇄신경 차단 을 시행하는 것이 환자에게 안전하고 효과적인지 알 아보고자 한다. 방법: 척추 마취하 경요도절제술을 시행 받는 26 명의 환자들에게 초음파기와 신경 자극기를 사용하 여 폐쇄신경 차단을 시행하였다. 초음파로 해부학적 구조를 확인하고 근수축 확인 후 1% lidocaine 10 ml 를 폐쇄신경의 anterior와 posterior branch에 각각 투 여하였다. 초음파기를 이용하여 해부학적 위치감별 에 걸리는 시간, 전체 신경차단에 걸리는 시간, 바늘 깊이, 수술 중 근수축의 정도, 실패율, 합병증등을 평가하였다. 결과: 초음파기를 이용하여 fascial plane을 감별하 는 데 걸리는 시간은 21±14.9초, 폐쇄신경의 anterior branch와 posterior branch를 확인하는 데 걸리는 시간 은 각각 39.6±27.4와 24.3±11.7초였으며 전체 신경차 단에 걸리는 시간은 174±65.1초, 바늘 깊이는 anterior branch가 4.8±0.8 cm, posterior branch가 6.2±1.1 cm였 다. 실패율은 anterior branch가 2/26 (7.7%), posterior branch가 7/26 (26.9%)이었다. Grade 1의 근수축은 22/26 (84.7%)에서 나타났으며 폐쇄신경술의 성공률 은 23/26 (88.5%)이었다. 결론: 서혜부 위치에서 초음파로 신경의 위치를 확인하는 방법은 쉬우나 초음파와 신경 자극기를 사 용한 폐쇄신경 차단술의 성공률은 큰 차이가 없었다.
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