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임상연구 : Propofol 정맥마취하 고용량의 Fentanyl 투여 시 Epinephrine 시험용량의 유용성
구남훈 ( Nam Hoon Koo ),전윤석 ( Yun Seok Jeon ),김용철 ( Yong Chul Kim ),임영진 ( Young Jin Lim ),박상리 ( Sang Lee Park ),함병문 ( Byung Moon Ham ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Background: The aim of this study is to determine the effect of high dose fentanyl on the test dose containing 15μg epinephrine during propofol anesthesia. Methods: One hundred patients with ASA physical status 1 were randomized to receive 2 mg/kg propofol with or without 10μg/kg fentanyl at the induction of anesthesia (n = 50 each). Anesthesia was maintained with propofol 8 mg/kg/h and 67% nitrous oxide in oxygen. Each group of patients were further divided into a test dose group receiving 1.5% lidocaine 3 ml plus epinephrine 15μg or a saline group receiving 3 ml of isotonic saline (n = 25 each). Heart rate (HR) and systolic blood pressure (SBP) were monitored for 4 min after intravenous injection of the study drugs. Results: In the propofol and the propofol-fentanyl group, the intravenous injection of the test dose produced a HR increase ≥ 20 bpm (conventional HR criterion) in 25 and 23 out of the total 25 patients, respectively. Therefore, in the propofol-fentanyl group, sensitivity, specificity, positive predictive value, and negative predictive value were 82%, 100%, 100%, and 92.6%. According to the modified HR criterion (HR increase ≥ 10 bpm), all the values were 100%. All patients receiving test dose developed SBP increase ≥ 15 mmHg. Conclusions: Our results indicate that both HR increase ≥ 10 bpm or SBP increase ≥ 15 mmHg are clinically applicable during propofol-nitrous oxide anesthesia with 10μg/kg fentanyl. (Korean J Anesthesiol 2006; 51: 411~4)
증례보고 : 체외순환 없는 관상동맥 우회술 중 발생한 승모판막 전방이동에 의한 좌심실 유출로 폐쇄로 인한 저혈압
설태경 ( Tai Kyung Seol ),이종환 ( Jong Hwan Lee ),윤승주 ( Seung Zhoo Yoon ),전윤석 ( Yun Seok Jeon ),박재현 ( Jae Hyon Bahk ),김기봉 ( Ki Bong Kim ),김종성 ( Chong Sung Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Systolic anterior motion of the mitral valve (SAM) is well known in the concentric left ventricular hypertrophy or post mitral valvuloplasty. However, SAM has not been reported in Off-pump coronary artery bypass surgery (OPCAB). Preoperatively, SAM in combination with a left ventricular outflow tract obstruction leads to severe cardiovascular destabilization. Moreover, a diagnosis of SAM is very important because the administration of conventional therapy to hypotension can aggravate SAM. We report a patient with un-identified left ventricular wall hypertrophy or mitral valve regurgitation, who was diagnosed with SAM by TEE during OPCAB. This report describes the diagnostic and therapeutic strategies for the perioperative management of SAM. (Korean J Anesthesiol 2007; 53: 242~5)
임상연구 : 경막외 마취를 이용한 각성하 관상동맥우회술
김진태 ( Jin Tae Kim ),이종환 ( Jong Hwan Lee ),윤승주 ( Seung Zhoo Yoon ),최주연 ( Ju Yeon Choi ),전윤석 ( Yun Seok Jeon ),박재현 ( Jae Hyon Bahk ),김기봉 ( Ki Bong Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Background: Recently, awake coronary artery bypass graft (ACAB) with spontaneous ventilation has been performed under thoracic epidural anesthesia (TEA) without general anesthesia. We report our first experiences of 12 cases of ACAB with full median sternotomy under TEA. Methods: Between March and September 2005, 12 patients underwent ACAB under TEA. The thoracic epidural catheter was placed at the level of T1 and/or T8 vertebral body according to surgical plan. Seven to fifteen milliliter of 2% lidocaine and sufentanil 1.66μg/ml was administered through the epidural catheter. Results: There were 11 male and 1 female patients, aged 67 ± 7 years. In 10 (83.3%) patients, pneumothorax was observed during surgical intervention. During the operation, 5 patients needed to be received general anesthesia because of respiratory distress caused by pneumothorax (n = 3), bowel protrusion (n = 1) or bleeding (n = 1). Mean length of stay in intensive care unit and hospital stay were 1.5 ± 1.2 days and 6.3 ± 1.7 days, respectively. Conclusions: Our initial experience confirms the feasibility of performing ACAB under TEA. However, high rate of conversion to general anesthesia and development of pneumotorax should be considered. Therefore, the actual and potential risks of ACAB under TEA should not be underestimated. (Korean J Anesthesiol 2006; 51: 421~5)
증례보고 : 대동맥판막과 상행대동맥 치환술 중 치명적 뇌경색이 발생한 환자에서 대뇌산소포화도와 경정맥 산소포화도의 변화
최은수 ( Eun Su Choi ),김재헌 ( Jae Hun Kim ),길남수 ( Nam Su Gil ),이종환 ( Jong Hwan Lee ),전윤석 ( Yun Seok Jeon ),김경환 ( Kyung Hwan Kim ),박재현 ( Jae Hyon Bahk ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Despite reductions in surgical mortality, neurologic sequelae remain a devastating complication after cardiac surgery with cardiopulmonary bypass. Neurologic complications may be induced by a massive air embolism during cardiopulmonary bypass, even with extensive monitoring. This report describes a patient who had a fatal cerebral infarct during aortic valve and ascending aorta replacement surgery. We monitored jugular venous O2 saturation (SjvO2) and cerebral oximetry using near-infrared spectroscopy in the perioperative period. The operation and anesthesia were uneventful until the deep hypothermic total arrest for the replacement of the ascending aorta. However, restarting the cardiopulmonary bypass after deep hypothermic total arrest produced a brief (less than 10 seconds) but large amount of air in the root cannula. At this time, although cerebral oximetry did not show any changes, the SjvO2 decreased to 21% for about 3 minutes and then normalized. At 8 hours after surgery, the patient showed seizures and severe edema in both cerebral hemispheres on the MRI. The patient died 21 days after surgery. (Korean J Anesthesiol 2009;56:102~5)
증례보고 : 총대동맥활치환술 이후 혈액투석을 받은 환자에서 발생한 헤파린 기인성 혈소판 감소증 -증례보고-
정희진 ( Hee Jin Jeong ),김재광 ( Jae Kwang Kim ),최주연 ( Ju Yeon Choi ),윤승주 ( Seung Zhoo Yoon ),전윤석 ( Yun Seok Jeon ),박경운 ( Kyoung Un Park ),박재현 ( Jae Hyon Bahk ),안혁 ( Hyuk Ahn ),김종성 ( Chong Sung Kim ),김용락 ( 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Heparin-induced thrombocytopenia (HIT) is an immunologically mediated complication of heparin therapy resulting in the consumption of platelets and a catastrophic thromboembolism. Both the clinical and laboratory features are important for a diagnosis of HIT. There have been 3 case reports of suspected HIT in Korea. However none have satisfied the laboratory features. We experienced a case of HIT, which satisfied both clinical and laboratory features, in a patient who received heparin during continuous veno-venous hemodiafiltration (CVVHD) used to treat acute renal failure that developed after a total aortic arch replacement with a cardiopulmonary bypass. The decreased platelet count and obstruction of extracorporeal filter of CVVHD by the blood clot was observed while receiving unfractionated heparin. The serum from the patient contained the anti heparin-platelet factor 4 antibody, and the condition was thus diagnosed as HIT. Argatroban, which is a direct thrombin inhibitor, was used to treat the thrombosis. (Korean J Anesthesiol 2006; 50: 600~4)