외상성 뇌손상으로 감압 두개골 절개술을 시행 받는 환자에서 혈중 lactate 값과 사망률의 상관관계

정월선,이동철,장영진,박춘곤,조윤이 대한마취통증의학회 2015 Anesthesia and pain medicine Vol.10 No.3

Background: The patients with traumatic brain injury showed ischemia due to increased intracranial pressure. This study evaluated the relationship of pre-anesthetic serum lactate level with in-hospital mortality. Methods: The archived medical records of 121 patients were retrospectively reviewed. Demographics and preoperative serum lactate level were analyzed. Results: Of the 121 patients, 32 patients expired in the hospital after decompressive craniectomy. Preoperative serum lactate levels were 3.2 ± 2.2 mmol/L in the survivors and 5.4 ± 3.0 mmol/L in the dead (P = 0.001), and the receiver operating characteristic curve revealed that a cut off value of 3.60 mmol/L was reasonable for predicting mortality. Conclusions: Preoperative serum lactate level is highly correlated with in-hospital mortality after decompressive craniectomy in traumatic brain injury.

견관절경 수술에서 과량의 세척액 사용으로 생긴 경부 부종과 흉막 삼출 -증례 보고-

정월선,김홍순,이경천,곽현정 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.3

As a result of advanced surgical techniques, arthroscopy for shoulder surgery is becoming more common. Although serious complications from the absorption of fluid during shoulder arthroscopy are rare, significant absorption of irrigation fluid does occur during the procedure. This report describes a case of severe neck edema and pleural effusion following shoulder arthroscopy in a patient who received a large amount of arthroscopy fluid for irrigation.

임상연구 : 견관절경 수술 환자에서 자세 변화에 따른 혈역학과 가스 교환 지수의 변화

정월선 ( Wol Seon Jung ),김홍순 ( Hong Sun Kim ),김종찬 ( Jong Chan Kim ),박연수 ( Yeon Soo Park ),곽현정 ( Hyun Jeong Kwak ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1

Background: Sevoflurane and propofol have different cardiorespiratory effects on postural changes. The purpose of this study was to compare the effects of sevoflurane and propofol on hemodynamics and gas exchange index when patients are raised from the supine position to the beach chair position. Methods: Forty patients requiring beach chair position for shoulder surgery were randomly assigned to receive sevoflurane (end-tidal concentration 1 vol%, n = 20) or propofol (target concentration 3μg/ml, n = 20). Hemodynamic variables and arterial blood gas analysis data were recorded and gas exchange indices were calculated before induction (baseline), 20 min after endotracheal intubation (supine position), and 20 min after beach chair position. Results: There were significant decreases in mean arterial pressure, central venous pressure, and central venous oxygen saturation after beach chair position. There were no significant changes in gas exchange indices after the position changes. There were no significant differences between groups in hemodynamics and gas exchanges indices. Conclusions: Raising healthy patients from the supine to the beach-chair position produced a significant decrease in hemodynamic indices with little changes in gas exchange indices. However, the effects of sevoflurane and propofol on the both hemodynamic and gas change indices were not significantly different. (Korean J Anesthesiol 2007; 52: 23~8)

Anesthetic experience of Benedikt syndrome complicating lumbar spine involved multiple myeloma -A case report-

이지연,정월선,이세련,조윤이 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.2

Benedikt syndrome is characterized by ipsilateral ophthalmoplegia with contralateral hemichorea due to a midbrain lesion. A 67-year-old male with Benedikt syndrome underwent corpectomy at L1 and anterolateral interbody fusion at T12-L2 due to pathologic bursting fracture at L1 involving multiple myeloma. He had a history of traumatic subarachnoid hemorrhage and subdural hemorrhage 8 months before surgery. Magnetic resonance image of the brain revealed intracranial hemorrhage from thalamus to midbrain. Target controlled infusion with propofol and remifentanil were administered for anesthetic induction and maintenance and close hemodynamic and neurologic monitoring led to successful anesthetic management.

A comparison of general anesthesia versus axillary brachial plexus block for hand and wrist surgery in the view of patient satisfaction

이미금,정월선,김홍순,이동철,장영진 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.1

Background: We evaluated whether the analgesic superiority ofregional block over general anesthesia improves patient satisfaction. Methods: Patients were anesthetized with either general anesthesia(GA) (n = 30) or axillary brachial plexus block (BPB) (n = 30). GA was standardized to include induction with propofol and alfentaniland maintenance with desflurane in an oxygen/nitrous oxidemixture. BPB was performed using an axillary perivascular approach,and 1.5% lidocaine 20 ml with epinephrine (1 : 200,000) and0.5% levobupivacaine 20 ml were injected. Pain scores and numbersof times pushing the patient-controlled analgesia (PCA) buttonwere measured preoperatively and at 2, 6, and 24 hours after theend of surgery. On the first day after the operation, one of ourresearchers visited the patients to document their opinions of theiranesthetic experiences and their satisfaction scores. Results: Group BPB had lower visual analog scale scores at 2hours and 6 hours postoperatively. Numbers of times pushing thePCA button was also lower in Group BPB within the first 2 hoursand between 2–6 hours postoperatively. However, patient satisfactionscores were not statistically different between the two groups(84 ± 11 vs. 88 ± 12, P = 0.177). Conclusions: BPB provided superior analgesia after upper limbsurgery compared to GA, but for a complete understanding ofpatients’ satisfaction, detailed consideration of factors such assedation would be necessary.

삼첨판 수술 시 발생한 매듭지어진 폐동맥 카테터 -증례 보고-

이경천,정월선,김용범,이지연 대한중환자의학회 2012 Acute and Critical Care Vol.27 No.1

The use of pulmonary artery catheter can be helpful in managing patients after cardiac surgery. Nevertheless, there is a risk of serious complications, such as knotting. A 61 year old man underwent tricuspid valve replacement under cardiopulmonary bypass (CPB). After implantation of a stented tissue valve in the tricuspid valve, repositioning of the catheter was performed. After weaning from CPB, an abnormal pattern of pulmonary artery pressure was suddenly observed on the monitor. Resistance was met when removing the catheter with the balloon deflated, at a 20 cm distance from the tip of the catheter. Chest radiography showed a knot in the catheter within the right brachiocephalic vein. Superior vena cava opened and the distal part of the catheter with the knot was successfully removed.

Hypercapnic Respiratory Failure Immediate After Bariatric Surgery

조윤이,정월선,박희연,장영진 대한비만학회 2012 The Korean journal of obesity Vol.21 No.3

흉부나 상복부 수술과 이에 동반한 전신마취는 일시적인 가스교환의 이상과 부적절한 호흡역학을 동반한 폐기능 장애가수반될 수 있으며 이는 비만한 환자에서 더 심각하게 나타날수 있다. 비만 저환기 증후군을 가진 37세 여환이 복강경 하위소매절제술을 시행받았다. 환자는 복강경 수술을 위한 복강내 이산화탄소 주입 후 교정되지 않는 심각한 호흡성 산증이있었고, 술 후 각성 후 고이산화탄소 혈증을 동반한 호흡 부전을 경험하였다. 이에 저자들은 비만환자들의 수술 및 마취 중나타나는 생리적 변화에 대한 중요성을 인식하고 가능한 합병증에 대하여 참고문헌과 함께 기술하였다.

정맥마취 후 회복기의 산소유량이 심박수 변이도에 미치는 영향

김홍순,정월선,채수민,방민석,이경천 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.1

Background: Oxygen increases the cardiac vagal tone, blood pressure, systemic vascular resistance and vascular tone in healthy adults. This study assessed the autonomic tone according to different oxygen flow rates via different types of masks with using the heart rate variability (HRV) in the PACU after total intravenous anesthesia (TIVA). Methods: We prospectively studied 27 patients after TIVA in the PACU. The 5 L group received oxygen via a simple mask with an oxygen rate of 5 L/min and the 10 L group received oxygen via a mask with a reservoir bag at a rate of 10 L/min in the PACU. We evaluated the HRV at the point of stabilization before anesthesia (BL), 5 min in the PACU (PACU 5), 30 min in the PACU (PACU 30) and 60 min in the PACU (PACU 60). Results: In the 5 L group, the nuHF was increased to 42.4 ± 24.2at 60 min in the PACU as compared with 27.1 ± 19.1 at 5 min in the PACU. In the 5 L group, the LFHFr was decreased to 2.3± 2.1 at PACU 60 as compared with 6.6 ± 9.7 at PACU 5 and the nuLF was decreased to 56.9 ± 23.2 at PACU 60 as compared with 72.9 ± 19.0 at PACU 5. There were no significant changes between the two groups at PACU 5, PACU 30 and PACU 60. The oxygen saturation was increased at PACU 60 compared with PACU 5 in the two groups. Conclusions: These finding indicates that 1 h of oxygen administration with 5 L/min during emergence from anesthesia increased the relative vagal tone, and the arterial blood pressure is stable irrespective of the oxygen flow rate.

Discrepancy between the Demand and Supply of Intensive Care Unit Beds in South Korea from 2011 to 2019: A Cross-Sectional Analysis

조누리,정월선,박희연,강진모,고대식,최상태 연세대학교의과대학 2021 Yonsei medical journal Vol.62 No.12

Purpose: Intensive care unit (ICU) bed availability is key to critical patient care. In many countries, older patients generally account for a significant proportion of hospitalizations and ICU admissions. Therefore, considering the rapidly increasing aging population in South Korea, it is important to establish whether the demand for critical care is currently met by available ICU beds. Materials and Methods: We evaluated a 9-year trend in ICU bed supply and ICU length of stay in South Korea between 2011 and 2019 in a population-based cross-sectional analysis, using data from the Korean Health Insurance Review & Assessment Service and Statistics database. We described the changes in ICU bed rates in adult (≥20 years) and older adult (≥65 years) populations. ICU length of stay was categorized similarly and was used to predict future ICU bed demands. Results: The ICU bed rate per 100000 adults increased from 18.5 in 2011 to 19.5 in 2019. In contrast, the ICU bed rate per 100000 older adults decreased from 127.6 in 2011 to 104.0 in 2019. ICU length of stay increased by 43.8% for adults and 55.6% for older adults. In 2019, the regional differences in the ICU bed rate nearly doubled, and the ICU length of stay increased six-fold. The ICU bed occupancy rate in South Korea is expected to rise to 102.7% in 2030. Conclusion: The discrepancy between the demand and supply of ICU beds in South Korea requires urgent action to anticipate future ICU demands.

Total intravenous anesthesia for Kartagener’s syndrome -A case report-

조윤이,정월선,김홍순,Sang-Ho Byen,이경천 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.4

Kartagener’s syndrome (KGS) is an autosomal recessive disorder which possible to link the occurrence of abnormal ciliary movement and abnormal position of the body organs. Considering the fact that airway ciliary function plays an important role in the primary pulmonary defense mechanism, prevent the ciliodepressant actions are also important for anesthetic management. We described successful anesthetic management of a 44-year-old male scheduled for endoscopic sinus surgery who had a history of frequent epistaxis,anosmia and situs inversus totalis. Anesthesia was induced and maintained with propofol and remifentanil using a target controlled infusion device.