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최준권 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.2
With the field of neuroradiological procedures consistently expanding, breaking the border between the medical and surgical treatment, anesthetic involvement in those procedures is also increasing, which underscores the importance of related anesthesia management. The objective of this study is to review the closing or open endovascular procedures for intracranial aneurysm, arteriovenous malformation, acute ischemic stroke, and carotid stenosis and related anesthetic implications.
Delirium in the intensive care unit
최준권 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.3
Delirium is a serious complication that commonly occurs in critically ill patients in the intensive care unit (ICU). Delirium is frequently unrecognized or missed despite its high incidence and prevalence, and leads to poor clinical outcomes and an increased cost by increasing morbidity, mortality, and hospital and ICU length of stay. Although its pathophysiology is poorly understood, numerous risk factors for delirium have been suggested. To improve clinical outcomes, it is crucial to perform preventive measures against delirium, to detect delirium early using valid and reliable screening tools, and to treat the underlying causes or hazard symptoms of delirium in a timely manner.
증례보고 : 진단받지 않은 후두개 낭종으로 인한 어려운 기관 내 삽관
이정혁 ( Jeoung Hyuk Lee ),최준권 ( Jun Gwon Choi ),윤동일 ( Dong Il Yoon ),이영민 ( Young Min Lee ),인준용 ( Jun Yong In ),정승현 ( Seung Hyun Chung ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
An epiglottic cyst is a common form of laryngeal cysts which are rare causes of upper airway obstruction. A congenital laryngeal cyst always causes neonatal respiratory distress, but an acquired cyst shows very wide spectrum of symptoms such as no specific complaints, dysphagia, respiratory difficulty, or even death according to its size, location, or age. From anesthesiologists` point of view, an asymptomatic undiagnosed laryngeal cyst is a major concern. Unexpectedly, it can cause difficult airway such as ‘cannot intubate` or `cannot intubate and cannot ventilate` situation during anesthesia. Recently we discovered an undiagnosed epiglottic cyst obscuring laryngeal inlet, leading to difficult intubation during general anesthesia for decompression and fusion of lumbar vertebrae. Fortunately, mask ventilation was possible, and after failed attempts of direct laryngoscopy, we could perform oral fiberoptic bronchoscope-aided intubation. He was discharged 10 days later with no harmful events. (Korean J Anesthesiol 2009;56:567~70)
손종찬,김종성,김용락,최준권 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2
Background : Although blood is very important therapeutic agent in bleeding patients, it may transmit disease, cause an adverse reaction in the recipients, raise the cost of patient care. Since the misuse and inappropriate use of blood is common, we are to review the transfusion practice in our hospital and to reduce unnecessary blood transfusion. Methods : During a 10-month period from June 1994 through March 1995, 347 patients received blood transfusion during the operation. Among them, we reviewed retrospectively the charts of 211 patients available. We analyzed the transfusion pattern of 47 patients whose postoperative hematocrit exceeded 32 percent to determine the magnitude and cause of unnecessary blood transfusion. Results: The patients of postoperative hematocrit over 32 percent were 119 patients out of 211 patients(56.4%). The main cause of overtransfusion was no reevaluation of the patients hematocrit after the prior unit was given. Conclusions : Guidelines for transfusing patients must be constructed based on acceptable intraoperative hematocrits. Unnecessary transfusion can be decreased when the transfusion done according to the guidelines, insisting on each reevaluation of the hematocrit prior to the administration of unit of blood. (Korean J Anesthesiol 1997; 32: 240∼243)
윤탁,김용식,이남영,김세현,최준권,이정혁,정인원,Youn, Tak,Kim, Yong Sik,Lee, Nam Young,Kim, Se Hyun,Choi, Jun Gwon,Lee, Jeoung Hyuk,Chung, In Won 대한생물정신의학회 2017 생물정신의학 Vol.24 No.3
Electroconvulsive therapy (ECT) has been recognized effective as primary or secondary treatments for major psychiatric disorders including depression and schizophrenia, as well as psychiatric emergency such as suicide, food refusal and catatonia, and so on. Medicines used in anesthetic induction for ECT, cause various reactions in autonomous, hemodynamic, and neuromuscular systems. The anesthetics also affect the duration, threshold, and intensity of seizures evoked with electric stimuli, and thus modify the seizure quality in ECT. Individual characteristics of age, sex, weight, comorbid physical disorders, and medications should also be considered for optimal clinical response after ECT. When preparing for anesthesia, adequate anesthetic agents and muscle relaxants, and rapid recovery should be carefully considered. We conducted a case-series study to address practical issues that are frequently encountered during ECT anesthesia with reviews of updated journals in order to provide practical helps to clinicians who are preparing ECT for their patients.
어린이에서 O2-Propofol 마취시 Rocuronium 의 근이완효과와 혈압 및 심박수에 미치는 영향
손종찬,김종성,김성덕,김용락,황정원,최준권 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2
Background : Rocuronium(ORG 9426) is a new steroid nondepolarizing neuromuscular blocking drug with fast onset and intermittent duration of action. Its effects on vital signs are controversial. We studied onset, clinical duration, recovery index of rocuronium and its effects on blood pressures and heart rates. Methods : We selected thirty healthy children who would receive inguinal herniorrhaphy and allocated them to 2 groups(control and rocuronium group). Without premedication or with oral medication of PocralTM (20 mg/kg), they administrated propofol(2.5 mg/kg) intravenous for loss of consciousness and we maintained anesthetic states with 20 mg/kg/hr of propofol. After 2 minutes, we checked BP(SBP/ DBP/MBP) and HR at every minutes and checked TOF, T1 height compare to control, T4 to T1 at every twenty seconds. We injected intravenously rocuronium(0.8 mg/kg, 2ED95) to rocuronium group and nothing to control group. We determined intubation time(from injection to 90% depression of maximal block), onset time(to maximal depression or T1=0), clinical duration(to T1=25%) and recovery index(from T1=25% to T1=75%). Results : In children, intubation time was 93.8sec, onset time was 146.2sec, clinical duration was 34.6min, recovery index was 15.4min. SBP, DBP, MBP and HR were not changed independent of injection of rocuronium. Conclusion : Rocuronium is a muscle relaxant with rapid onset and intermittent clinical duration in children. It does not affect BP and HR. (Korean J Anesthesiol 1997; 32: 235∼239)
이윤석,윤동일,이영민,김경옥,인준용,최준권,조훈영,이정혁,정승현 대한의학회 2009 Journal of Korean medical science Vol.24 No.6
The aim of this study was to develop a nonlinear mixed-effects model for the increase in cerebral oximetry (rSO2) during the rapid introduction of desflurane, and to determine the effect of hypocapnia and N2O on the model. Twelve American Society of Anesthesiologist physical status class 1 and 2 subjects were allocated randomly into an Air and N2O group. After inducing anesthesia, desflurane was then increased abruptly from 4.0 to 12.0%. The PETCO2, PETDESF and rSO2 were recorded at 12 predetermined periods for the following 10 min. The maximum increase in rSO2 reached +24-25% during normocapnia. The increase in rSO2 could be fitted to a four parameter logistic equation as a function of the logarithm of PETDESF. Hypocapnia reduced the maximum response of rSO2, shifted the EC50 to the right, and increased the slope in the Air group. N2O shifted the EC50 to the right, and reduced the slope leaving the maximum rSO2 unchanged. The N2O-effects disappeared during hypocapnia. The cerebrovascular reactivity of rSO2 to CO2 is still preserved during the rapid introduction of desflurane. N2O slows the response of rSO2. Hypocapnia overwhelms all the effects of N2O.