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증례보고 : 개심술 마취에서 동맥압 파형분석을 이용한 심박출량과 중심정맥 산소포화도
김태엽 ( Tae Yop Kim ),권원경 ( Won Kyoung Kwon ),윤창룡 ( Chang Yong Yoon ),김혜경 ( Hae Kyoung Kim ),김준석 ( Jun Seok Kim ),지현근 ( Hyun Keun Chee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1
The determination of arterial pressure wave-derived cardiac output (APCO) and central venous O2 saturation (ScvO2) has been introduced as a less invasive procedure for monitoring cardiac function and oxygen delivery. We have used an APCO sensor (FloTrac(TM)) and a monitor for ScvO2 (Vigileo(TM)) in two cases of cardiac valve surgery, where placement of pulmonary artery catheter (PAC) was not applicable due to unfavorable cardiac structure (case 1) and was contraindicated due to an unstable cardiac conduction disorder and arrhythmia (case 2). In case 1, monitoring of APCO was started from the beginning of anesthesia induction and a ScvO2 monitoring central venous catheter was inserted just after anesthesia induction. APCO, ScvO2 and other hemodyanamic information such as arterial BP, CVP, and data obtained from transesophageal echocardiography (TEE) during the pre-cardiopulmonary bypass (CPB) period were measured. APCO and ScvO2 during the post-CPB period showed a reliable correspondence with continuous cardiac output (CCO) and mixed venous O2 saturation (SvO2) as measured by PAC at the end of CPB. In case 2, APCO and ScvO2 were monitored instead of CCO and SvO2. The values of APCO showed a good correlation to intraoperative COs indirectly calculated by the velocity-time integral of the aortic outflow determined in the TEE examination. We experienced that monitoring APCO and ScvO2 is useful for anesthesia management in cardiac valve surgery and can be an alternative to CCO and SvO2 if the placement of PAC and the thermodilution method are not applicable. (Korean J Anesthesiol 2007; 53: 109~14)
임상연구 : Desflurane 흡입 마취가 Sevoflurane과 달리 수술 후 장관 기능의 회복을 지연시키는가?
김덕경 ( Duk Kyung Kim ),김혜경 ( Hae Kyoung Kim ),우남식 ( Nam Sik Woo ),김태엽 ( Tae Yop Kim ),권원경 ( Won Kyoung Kwon ),김양렬 ( Yang Lyoul Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
Background: Sympathetic nervous hyperactivity presents in response to surgical stress has been implicated as an important component of postoperative ileus. Because desflurane induces sympathetic activation, the effects of desflurane and sevoflurane on the recovery of bowel function were compared. Methods: Forty patients undergoing a laparoscopic appendectomy were randomly assigned to receive either sevoflurane (Group S, n = 20) or desflurane (Group D, n = 20). The anesthetic, operative, and postoperative pain managements were standardized. The CRP (C-reactive protein), total leukocyte count, and ratio of the neutrophil to leukocyte counts were measured preoperatively and 12 hours postoperatively. The mean arterial blood pressure (MABP), heart rate, and end-tidal anesthetic concentration were measured at 10-min intervals during the surgery. The degree of postoperative pain, 11-graded surgical difficulty score, time to the first passage of flatus and first oral intake of clear fluid, as well as the postoperative hospital stay were also evaluated. Results: Finally, 16 and 17 subjects in Groups S and D were included the analyses. There were no significant differences in the MABP, heart rate, and end-tidal anesthetic concentration between the two groups. The clinical and laboratory parameters related to the severities of inflammation and surgical trauma were similar in both groups. There were no significant differences in the times to the first passage of flatus and first oral intake of clear fluid and the postoperative hospital stay between the two groups. Conclusions: Although desflurane induces sympathetic activation, unlike sevoflurane, it does not delay the return of bowel function following a laparoscopic appendectomy. (Korean J Anesthesiol 2007; 52: 630~6)
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)
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 : 원발성 신부전이 동반된 간부전 환자의 간이식술의 마취 관리
김덕경 ( Duk Kyung Kim ),김혜경 ( Hae Kyoung Kim ),김태엽 ( Tae Yop Kim ),임정애 ( Jeong Ae Lim ),김양렬 ( Yang Lyoul Kim ),장성환 ( Sung Whan Jang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Renal failure frequently accompanies advanced hepatic failure. Even if adequate renal function is not considered as a prerequisite for transplant candidacy, impaired renal function prior to liver transplantation has been regarded as an independent risk factor of graft dysfunction and mortality. Liver transplantation in such a patient also presents a number of challenges to the anesthesiologists. Optimal fluid therapy, prompt and aggressive correction of electrolytes and metabolic disturbances, careful selection of anesthetic techniques and agents, and close monitoring of cardio-respiratory function help reduce the graft failure and perioperative mortality. In such cases, continuous renal replacement therapy (CRRT) is used with increasing frequency during or after the surgery. So, anesthesiologists need to understand the basic principles, potential applications, and anesthetic implications of several CRRT options. We therefore present the anesthetic experience in a patient with hepatic failure combined with primary renal failure, successfully managed during or after liver transplantation. (Korean J Anesthesiol 2007; 53: 547∼553)