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The Usage Pattern of Neuromuscular Blocker at Intensive Care Unit
Jun Gol Song,Hwa Sung Jung,Jae Do Lee,Yoon Kyung Lee,Hong Seuk Yang Korean Society of Critical Care Medicine 2006 Acute and Critical Care Vol.21 No.1
BACKGROUND: The neuromuscular blocker is helpful to intubate the patients and reduce the amount of anesthetic agent. It also used at intensive care unit (ICU) to maintain airway patency, to achieve proper ventilatory care, etc. This survey is to determine the neuromuscular blocker usage patterns in ICU settings. METHODS: Three hundred general hospitals with ICU settings were chosen. We designed a 10 itemed questionnaire which has several subquestions with multiple choices and sent it to them. After three months, forty seven hospitals returned the questionnaire and we made careful analysis with it. RESULTS: The most frequent indication of neuromuscular blocker was to facilitate the mechanical ventilation (80.9%). Vecuronium was the most common neuromuscular blocker used (97.9%). Only 6.4% of them used peripheral nerve stimulator and the rest of them (89.4%) used clinical information to determine the degree of neuromuscular blocker. The respondents reported that recovery from muscle relaxation was needed on a periodic basis for regular neurological examinations (59.6%) in ICU settings. All respondents used the sedatives or narcotics with neuromuscular blocker and only 6.4% used reversal agents. CONCLUSIONS: Although the rate of reply was not much (15.7%), we could get the current usage pattern of neuromuscular blocker at ICU. We recommend using short to intermediate acting neuromuscular blocker than long acting agents. Continuous infusion with careful dosage titration by peripheral nerve stimulator would be helpful to achieve rapid recovery. Additional sedatives and narcotics are beneficial to reduce the amount of neuromuscular blocker and to make patients comfortable as well.
Jun Gol Song,Yoon Kyung Lee,Jae Do Lee,Eun Ho Lee,Ji Hyun Park,Mijeung Gwak,Gyu Jeong Noh 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3
Background: The femoral arteries (FA) and femoral veins (FV) are useful access sites for diagnostic and interventional procedures. In adults, the usual puncture sites are 1-3 cm distal from the inguinal crease. In children, however, the optimal puncture site vessels are not known. The aim of our study was to assess the number of branches and bifurcation sites of the femoral vessels in children by using ultrasonography. Methods: Color Doppler ultrasonography was used to determine bifurcation sites of the FA and FV, relative to the inguinal crease, in 48 children (median age, 4 yr; median weight, 18.7 kg) with American Society of Anesthesiologists (ASA) Physical Status (PS) score 1-2 and who were scheduled for general anesthesia. Results: The numbers of FAs and FVs at the inguinal crease were 1.83±0.39 and 1.08±0.29, respectively, in infants, and 1.83±0.58 and 1.0±0.0, respectively, in 10-year-old children. The bifurcation site of the FA in infants and those aged 10 years was 0.78±0.30 cm and 1.47±0.27 cm proximal to the inguinal crease, respectively (P<0.05), whereas the bifurcation site of the FV in these two age groups was -0.96±0.27 cm and -2.29±1.09 cm distal to the inguinal crease, respectively (P<0.05). Conclusions: In children, the FA frequently bifurcates proximal to the inguinal crease, whereas the FV bifurcates distal to the inguinal crease. However, there are anatomical differences among age groups, so care should be taken to avoid complications during femoral vessel cannulation. (Korean J Anesthesiol 2009; 56: 290~4)
임상연구 : Ketamine 마취유도가 압반사의 심박수 조절에 미치는 영향
송준걸 ( Jun Gol Song ),신원정 ( Won Jung Shin ),전인구 ( In Gu Jun ),강수진 ( Su Jin Kang ),최병문 ( Byung Moon Choi ),윤미옥 ( Mi Ok Youn ),김태희 ( Tae Hee Kim ),김영국 ( Young Kug Kim ),허인영 ( In Young Huh ),강성식 ( Seong S 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
Background: It is reported that ketamine increases central sympathetic activity as well as catecholamine reuptake inhibition. However, little has been known about baroreflex control of heart rate in ketamine anesthetized humans. Thus, the aim of this study was to analyze the effect of ketamine on spontaneous baroreflex sensitivity (BRS) during ketamine induction of anesthesia. Methods: Beat-by-beat arterial blood pressure and electrocardiogram at 5 min before and 10 min after ketamine administration (2 mg/kg) were recorded in twenty healthy living liver transplant donors. Spontaneous BRS was assessed by sequence method and transfer function analysis method. Results: Spontaneous BRS assessed by sequence method, BRSsequence, decreased from 13.7 ± 6.3 to 7.8 ± 4.5 ms/mmHg (P < 0.001). Spontaneous BRS assessed by low frequency transfer function method decreased from 10.9 ± 5.4 to 7.0 ± 4.1 ms/mmHg and by high frequency transfer function method from 14.8 ± 9.2 to 8.7 ± 8.8 ms/mmHg, respectively (P < 0.05). Conclusions: The spontaneous BRS was decreased during ketamine induction of general anesthesia. These results suggest that anesthesia induction with ketamine impairs baroreflex control of heart rate, which may provoke hemodynamic instability. (Korean J Anesthesiol 2006; 51: 528~34)
증례보고 : 경요도전립선절제술 중 발생한 방광천공에 의한 경요도절제후증후군
송준걸 ( Jun Gol Song ),김영국 ( Young Kug Kim ),김영욱 ( Young Uk Kim ),서형석 ( Hyung Seok Seo ),강금내 ( Kum Nae Kang ),황규삼 ( Gyu Sam Hwang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
A transurethral resection of the prostate (TURP) is often performed to treat benign prostatic hypertrophy or prostatic carcinoma. Transurethral resection syndrome (TURS) is a rare but serious complication of TURP that has two different causes: (1) intravascular absorption of the irrigation fluid through the open prostatic venous sinus (TURP syndrome); and (2) intraperitoneal extravasation of the irrigation fluid through perforation of the bladder. In general, a laparotomy, repair of injury, or conservative approach such as bladder drainage, percutaneous drainage of the abdomen combined with medical treatment are performed to manage TURS attributed to the latter mechanism. We report a patient with TURS, who showed a gradual onset of hyponatremia after bladder perforation and intraperitoneal extravasation of the irrigation fluid, and was treated successfully using a conservative approach. (Korean J Anesthesiol 2007; 53: 254~8)
증례보고 : 중뇌동맥 경색증 환자의 마취유도 직후 경식도 심초음파에 의해 진단된 좌심방 혈전 -증례보고-
송준걸 ( Jun Gol Song ),황규삼 ( Gyu Sam Hwang ),김영국 ( Young Kug Kim ),성승혜 ( Seung Hye Sung ),최인철 ( In Cheol Choi ),황재현 ( Jai Hyun Hwang ),조성강 ( Sung Kang Cho ),한성민 ( Sung Min Han ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
Stroke is one of the most common causes of death; in particular, cardiac source of embolism may be responsible for 15-20% of ischemic strokes. Here we report a case of left atrial thrombus diagnosed by transesophageal echocardiography (TEE) immediately after induction of general anesthesia in a patient with infarction of the middle cerebral artery. In this case, an emergent craniectomy was cancelled and medical treatment was performed. This case report shows that TEE taken in the operating room may play an important role in the change of treatment plan in a patient displaying acute mental change. (Korean J Anesthesiol 2007; 52: 702~6)
증례보고 : Budd-Chiari Syndrome 환자의 간이식 수술 중 예상 밖의 대량출혈
송하나 ( Ha Na Song ),정성문 ( Sung Moon Jeong ),서영주 ( Young Joo Seo ),김희영 ( Hee Yeong Kim ),전혜영 ( Hye Young Jeon ),최재문 ( Jae Moon Choi ),송준걸 ( Jun Gol Song ),함경돈 ( Kyung Don Hahm ),황규삼 ( Gyu Sam Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Budd-Chiari syndrome (BCS) is a heterogenous group of disorders characterized by obstruction of hepatic venous outflow. Severe liver cirrhosis and limited cardiac reserve in patients with BCS makes them less tolerant to liver transplantation. We experienced two cases of massive bleeding during living donor liver transplantation in patients with BCS. Blood products and fluids were rapidly infused with a rapid infusion system, final infusion volume in these two patients were 177 L and 193 L, and the use of Cell Savers allowed for the patient`s blood products to be saved. The patients were managed successfully and recovered uneventfully with advanced monitoring, including monitoring of their jugular venous oxygen saturation and continuous cardiac output. Therefore, rapid infusion systems and Cell Savers, along with advanced monitoring, are necessary in the event of massive bleeding during liver transplantation. (Korean J Anesthesiol 2007; 53: 796∼802)
Synthesis of the Composite Additive Fine Powders for ZnO Varistor by Low-Temperature Combustion
Chol-Nam Ri,Chol-Jun Kim,Song-Gol Kim,Myong-Hak Kim 성균관대학교(자연과학캠퍼스) 성균나노과학기술원 2019 NANO Vol.14 No.5
The composite oxide additive containing Mn, Ni, Cr and Co elements for the ZnO varistor was successfully synthesized through the low-temperature combustion synthesis approach. The combustion reaction was carried out using nitrate mixtures of Mn, Ni, Cr and Co as oxidants and hydrazine as fuel. Herein, hydrazine acts as a bidentate bridge ligand, and it forms a complex with metal nitrate. Controlling the pH value of reactant solution by adding the hydrazine had a considerable effect on the combustion characteristics of the precursor and the final synthesized powder properties. The results of the XRD, FT-IR, SEM and TEM analysis indicated that the suitable pH value for synthesizing the composite additive powder with fine grain size and good crystallinity was 7. The precursor prepared at pH = 7 exhibited steady and slow combustion characteristics, and its yield rate achieved ca. 100%. With this method, the composite additive fine powder suitable for improvement of the electrical characteristics of ZnO varistor can be synthesized simultaneously on a large scale.
A case report : Accelerated idioventricular rhythm associated with desflurane anesthesia
Ji Youn Bang,Jun Gol Song,Young Soo Park,Hong Seuk Yang 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
Accelerated idioventricular rhythm is defined as a ventricular rhythm of 60-100 beats per minute or a ventricular tachycardia that does nor exceed 120 beats per minutes. Although, it rarely converts to a fatal arrhythmia like ventricular fibrillation, it needs to be differentiated from AIVR, which is from another origin. AIVR may occur due to ischemic heart disease (ST elevated myocardial infarction), cardiomyopathy, rheumatic fever and digitalis intoxication. We report here on a case of AIVR that was related to desflurane administration. (Korean J Anesthesiol 2009;56:571~3)
( Young Kug Kim ),( In Gu Jun ),( Su Jin Kang ),( Jun Gol Song ),( Jae Hyuk Choi ),( Gyu Sam Hwang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
Although combined superficial and deep cervical plexus (CP) block has been used frequently as regional anesthesia for carotid endarterectomy, it is unclear whether it results in better intraoperative cardiovascular outcome than superficial CP block alone. In this case report, we present a patient who experienced unexpected severe hypertension (267/144 mmHg), accompanied by vagal blockade and vascular sympathetic activation after combined CP block. (Korean J Anesthesiol 2006; 51: S 20~3)
임상연구 : 심박수 변이도, 혈압 변이도 및 압반사 민감도를 이용한 간경화 환자의 심혈관 자율신경계 평가
윤미옥 ( Mi Ok Youn ),강수진 ( Su Jin Kang ),전인구 ( In Gu Jun ),신원정 ( Won Jung Shin ),최병문 ( Byung Moon Choi ),도경준 ( Kyung Jun Do ),조선준 ( Sun Joon Cho ),최재혁 ( Jae Hyuk Choi ),송준걸 ( Jun Gol Song ),허인영 ( In You 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
Background: Liver cirrhosis is associated with several hemodynamic abnormalities, including an impairment of autonomic nervous system reflexes, but very few have compared the disease severity with cardiovascular autonomic dysfunction assessed by spectral analysis of blood pressure and electrocardiogram. The aim of this study was to investigate the relationship between Child-Turcotte-Pugh (CTP) score and autonomic indices in patients with liver cirrhosis using the heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS). Methods: Fifty patients scheduled for liver transplantation recipients under general anesthesia were enrolled in the study. Beat-to-beat blood pressure and RR interval were measured for five minutes before anesthesia induction. HRV and BPV were estimated by power spectral analysis of RR interval and systolic blood pressure. BRS was estimated by both the sequence method (Sequence BRS) and high frequency (HF) gain of transfer function analysis (HF BRS). Results: Significant inverse correlations between CTP score and Sequence BRS (r = -0.61), HF BRS (r = -0.59), low frequency (LF) and HF power of HRV (r = -0.57, r = -0.46), LF power of BPV (r = -0.37) were found. However, no significant correlations were observed between CTP score and LF/HF ratio of HRV (r = -0.02) and HF power of BPV (r = 0.27). Conclusions: These results showed that autonomic dysfunction assessed by spectral analysis was associated with increasing severity of liver cirrhosis. Further study will be needed to clarify relationship between our findings and hemodynamic fluctuations during anesthesia for liver transplantation. (Korean J Anesthesiol 2006; 50: 655~62)