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혈흉환자에서 흉강 내에 잘못 거치된 쇄골하정맥 도관 : 증례보고 A case report
진희철 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
During the central venous catheterization, intravascular placement of the catheter is often confirmed by aspiration of blood through the catheter. We experienced a malpositioning of subclavian cathter into intrapleural cavity although blood has been aspirated successfully through the catheter in the patient with hemothorax. In the patient with hemothorax, we strongly recommend that chest X-ray film must be checked after a central venous catheterization.
거대한 갑상선 종양으로 인한 기관내삽관 실패 : 증례보고 A case report
진희철 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2
A 34-year-old, 109 kg, man presented for total thyroidectomy. The thyroid mass was large, compressing the airway diffusely, especially at the level of the vocal cord. Because the finding of the chest PA view was thought to be possible for the endotracheal intubation, we didn't predict the difficult intubation. We attempted direct rigid laryngoscpic intubation at first. Despite being able to see the tip of epiglottis, tracheal intubation was impossible. We failed in the intubation for about 1 hour, although we tried several techniques including lightwand, LMA and fiberoptic bronchoscopy At that time, we reviewed the neck CT scan. The finding of the neck CT scan revealed that the trachea was tortuous and impossible for the endotracheal intubation, and then we performed the emergency tracheostomy and proceeded to the thyroidectomy.
동정맥루술을 시행받는 만성신부전 환자에서 기관내 삽관 전 투여된 Fentanyl, Esmolol 또는 Lidocaine이 혈압과 심박수에 미치는 영향
진희철,이영훈,김순임 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.6
Background: The primary objective of this study was to determine the effect of fentanyl, esmolol, and lidocaine on arterial blood pressure (BP) and heart rate (HR) following endotracheal intubation (ETI) and during an operation in patients with chronic renal failure (CRF) undergoing an arteriovenous fistula (AVF). Methods: Sixty CRF patients who underwent creation of an AVF were analyzed for this study. Before ETI, the patients were randomly placed in a control group (CONT, n=15)m fentanyl group (FENT, 2 ㎍/kg, n=15), esmolol group (ESM, 1 ㎍/kg, n=15), or lidocaine group (LID, 1 ㎍/kg, n=15) and then each drug was administered before ETI. HR and BP were measured before intubation (baseline), after intubation, immediately after surgical incision (A-Inc), 15 min (A-Inc15) and 30 min (A-Inc30) after surgical incision. Mean arterial pressure was controlled between 20% of the pre-intubation value with the control of inspired fraction of isoflurane, and with ephedrain or clonidine. Results: The HR was not different among groups. The elevation of BP following ETI in FENT was less than in CONT. BP was lower in FENT at A-Inc, A-Inc15, and A-Inc30 than in CONT, ESM, or LID. The administered dose of clonidine was not different among groups, but that of ephedrine was larger in FENT than in CONT. Conclusions: In CRF patients undergoing an AVF, esmolol 1 ㎍/kg and lidocain 1 ㎍/kg could not prevent the elevation of BP and HR following ETI. The elevation BP after ETI was blunted by fentanyl 2 ㎍/kg, but it decreased BP and HR during the operation and increased the requirement of ephedrine. It is cincluded that further studies must be made about the administration of a shorter acting opioid and of a larger does of esmolol and lidocaine for preventing elevation of BR and HR in CRF patients undergoing an AVF. (Korean J Anesrhesiol 2002; 43: 735~741)
경식도도플러가 복강경담낭저러제술시 혈역학적 감시장치로소 유용한가 ?
진희철,김지은,배재영,박욱 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.3
Is An Esophageal Doppler Monitor Useful in Hemodynamic Monitoring during a Laparoscopic Cholecystectomy? Jae Yeoung Bae, M.D., Ji Eun Kim, M.D., Hee Cheol Jin, M.D. and Wook Park, M.D. Department of anesthesiology, College of Medicine, Soon Chun Hyang University, Seoul, Korea Background: To measure hemodynamic changes during a laparoscopic cholecystectomy (LC), we used a new, noninvasive esophageal doppler monitor (EDM). Methods: Under general anesthesia, 17 patients undergoing a LC were prepared by inserting an EDM probe into the exophagus. Cardiac indes (CT), corrected flow time (FT_c), systemic vascular resistance (SVR), mean arterial pressure (MAP), and heart rate (HR) were measured 6 times-before pneumoperi-toneum, 5 minutes after pneumoperitoneum, 5, 15, and 30 minutes after the reverse trendelenberg position and after exsufflation of CO_2 gas. Complication and insertion time of the EDM were also reorded Data was analyzed using a repeated measure ANOVA. Results: CO_2 gas insufflation resulted in an abrupt increase of SVR (51%), MAP (17%) and a decrease of CI (29%), FT_C (13%). These changes were gradually restored, except the MAP. HR was not changed significantly. These findings correlated well with other studies using a thermodilution technique or transesophageal echocardiography. There was no complication with the EDM and insertion time was 182 ?? 32.3 xec. Conclusions: Since MAP and HR do not offer accurate hemodym\namic information during pneu-moperitoneum., other adequate cardiovascular monitors are required. An EDM can be used during LC because it provides CI and FT_c by a simple and noninvasive method. (Korean J Anesthesiol 2001; 41: 274~279)
진희철,김승우,이수림,최재인,윤재복,류서현,장민기 한국품질경영학회 2018 한국품질경영학회 학술대회 Vol.2018 No.-
개발된 무기체계의 총수명주기는 늘어나고 있으나, 전자기술의 급속한 발전 속도에 따라 무기체계 수명주기 내 단종부품과 위조부품이 다수 발생하고 있다. 이는 무기체계 총수명주기 비용 증가를 초래하였고 ‘15년 국방부는 부품단종관리 업무 지시를 하달하게 되었다. 해당 지시에는 국방과 관련하여 사업기관, 개발기관, 시제/양산업체, 품질보증기관, 소요군 등 국방획득과 관련한 대부분의 기관에 역할을 부여하고 있다. 품질보증기관인 국방기술품질원은 부품단종 전문연구기관으로 지정되어 있다. 하지만 해당 지시에는 실제 업무 담당자가 실질적인 도움을 받을 수 있는 업무 방안이 결여되어 실무자가 부품단종과 위보부품관리 업무를 하기 위한 구체적인 도움을 받지 못하여 해당 업무를 구체적으로 수행하지 못하였다. 이에 국방기술품질원은 국외 부품단종 및 위조부품 관리 업무 실태 및 규정을 검토하여 부품단종 및 위조부품관리 업무 요소를 식별하였고 해당 업무를 수행하기 위한 가이드북을 작성하였다. 또한 부품단종 및 위조부품관리 계획서를 작성하기 위한 한국형 부품단종 및 위조부품관리 계획서 표준(안)을 제시하여 개발기관 및 시제/양산업체가 관련 업무 계획서 작성 시 도움이 될 수 있도록 하였다.