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증례보고 : 모야모야병 환자에서의 심폐회로를 가동하지 않는 관상동맥우회로 이식술 중 뇌산소포화도 감시
김성협 ( Seong Hyop Kim ),김태엽 ( Tae Yop Kim ),이현하 ( Hyun Ha Lee ),윤태균 ( Tae Gyoon Yoon ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4
We report a case using cerebral oxygen saturation (rCbO2) for off-pump coronary artery bypass graft (OPCAB) surgery in a patient with co-existing Moyamoya disease. The rCbO2 with the routine monitoring for OPCAB surgery were monitored intraoperatively. In spite of infusing nimodipine (0.2 μg/kg/min) and maintaining the end-tidal CO2 tension at 35-40 mmHg, a sudden reduction in the right-side rCbO2 from the base line value of 70-80%/78-83% (Left/Right) to 70-72%/65-70% was developed during the harvesting of the vascular graft. We increased the rate of phenylephrine infusion to increase systemic and cerebral perfusion pressure, and both rCbO2 values were elevated to 80%/70% within 3 minutes. However, the preferential reduction in the right-side rCbO2 compared with the left-side value was not corrected. While suspecting cerebral ischemia due to cerebral vascular spasm, we administered nimodipine 2 mg bolus and increased infusion rate to 0.5 μg/kg/min. Finally, the preferential rCbO2 reduction in the right-side was corrected and both rCbO2 reached 84%/91%. We concluded rCbO2 monitoring is useful for detecting an intraoperative episode of cerebral ischemia and maintaining the optimal cerebral perfusion during OPCAB surgery with Moyamoya disease. (Korean J Anesthesiol 2009;56:433~7)
증례보고 : Loeys-Dietz Syndrome 환아에서 대동맥판막 역류증 수술의 마취 관리
김성협 ( Seong Hyop Kim ),백승우 ( Seung Woo Baek ),권원경 ( Won Kyoung Kwon ),김덕경 ( Duk Kyung Kim ),윤태균 ( Tae Gyoon Yoon ),임정애 ( Jeong Ae Lim ),우남식 ( Nam Sik Woo ),김태엽 ( Tae Yop Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
Loeys-Dietz Syndrome (LDS) is a recently described autosomal dominant aortic aneurysm syndrome with widespread systemic involvement. It is characterized by the triad of 1) arterial tortuosity and aneurysms, 2) hypertelorism, and 3) bifid uvula or cleft palate. A 12-year-old boy with LDS was scheduled to undergo correction of aortic valve regurgitation due to aortic annuloectasia. We report our clinical experiences of a case of LDS patient with brief review of related literatures and relevant anesthetic problems. (Korean J Anesthesiol 2009;57:371∼5)
증례보고 : 체외순환 없는 관상동맥 우회술 도중 호기말이산화탄소분압에 의해 조기 발견된 파열된 폐 낭포
김성협 ( Seong Hyop Kim ),윤태균 ( Tae Gyoon Yoon ),강주은 ( Joo Eun Kang ),오충식 ( Chung Sik Oh ),김덕경 ( Duk Kyung Kim ),김태엽 ( Tae Yop Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Capnography is monitoring of concentration or partial pressure of CO2 in respiratory gases. It provides information about CO2 production, pulmonary perfusion, alveolar ventilation, respiratory patterns and elimination of CO2 from the anesthesia circuit and ventilator. Thus it gives us a rapid and reliable method to detect life threatening conditions such as malposition of tracheal tube, ventilatory failure, circulatory failure and defective breathing circuits. Authors experienced that change of capnogram during off pump coronary artery bypass grafting surgery helped early detecting ruptured bulla and prevented intraopertive or postoperative pneumothorax. (Korean J Anesthesiol 2009;56:83~6)
복부 가스괴저 환자의 마취 유도 과정에서 발생한 심정지 -증례보고
김덕경 ( Duk Kyung Kim ),김성협 ( Seong Hyop Kim ),윤태균 ( Tae Gyoon Yoon ),장성환 ( Sung Whwan Jang ),이준희 ( Jun Hee Yi ),주영 ( Young Joo ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
We report here on a fatal case of abdominal gas gangrene. Two days after gastrectomy, a 56-year-old man presented with intractable abdominal pain and fever of a sudden onset, which quickly progressed over several hours to septic shock. Despite of the unexplained gas collections in the abdominal muscle, fascia, and subcutaneous layers on computed tomography scan, its clinical significance was overlooked. Emergency laparotomy was initially scheduled because of concern that there may have been a perforated viscus. At the time of monitoring for the anesthesia, we noticed marbled skin discoloration and the subcutaneous emphysema had spread on his flank. Shortly after the initial suspicion of gas gangrene, cardiac arrest developed during the arterial line cannulation. Despite prompt resuscitation measures, including the administration of catecholamines and the application of extracoporeal membrane oxygenation, he eventually died. Anesthesiologists need to understand this fulminant disease because extensive debridement under general anesthesia is essential for the treatment of abdominal gas gangrene. (Korean J Anesthesiol 2009; 57: 127~31)