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임상연구 : 소아에서 술 전 미추차단은 적절한 마취 심도 유지를 위한 Sevoflurane의 요구량을 감소시킨다
송장호 ( Jang Ho Song ),이홍식 ( Hong Sik Lee ),김병건 ( Byung Gun Kim ),임현경 ( Hyun Kyoung Lim ),신혜란 ( Helen Ki Shinn ),정성미 ( Sung Mee Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Background: It is generally known that neuraxial anesthesia for adults reduces the demand for hypnotics needed for adequate sedation. Therefore, this study examined the effect of a preoperative caudal block on the general anesthetic requirements for an adequate depth of anesthesia in children. Methods: Twenty children aged 3-5 years, who were set to undergo inguinal herniorraphy, were divided into 2 groups of 10 children each, normal saline and lidocaine groups. Tracheal intubation was performed. After setting up the bispectral index (BIS) monitor, a caudal block was administered to both groups differently, normal saline 0.7 ml/kg was administered to the normal saline group and 1.5% lidocaine 0.7 ml/kg was administered to lidocaine group. The end-tidal concentration of sevoflurane was maintained at 1.5 vol% for 10 minutes in the first patient in both groups, and the BIS value, was measured 6 times every 10 seconds, and averaged. When the BIS was ≥ 50, the end-tidal concentration of sevoflurane was increased by 0.2 vol% in the subsequent patient. When the BIS was less than or equal to 50, the end-tidal concentration of sevoflurane was decreased by 0.2 vol% in the subsequent patient. The MACBIS50 in both groups was calculated using probit analysis. Relative median potency analysis was used to compare the results in both groups. Results: The MACBIS50 of sevoflurane was significantly lower with a 1.5% lidocaine caudal block (1.40 vol% [95% CI, 1.25- 1.55 vol%]) compared with the normal saline group (1.77 vol% [95% CI, 1.61-2.00 vol%]). Conclusions: A preoperative caudal block reduces the demand for sevoflurane required for an adequate depth of anesthesia, as measured by the BIS in children. (Korean J Anesthesiol 2007; 52: 29~33)
증례보고 : 소아 환자에서 Sevoflurane 마취 후 발생한 급성 간 손상
송장호 ( Jang Ho Song ),임현경 ( Hyun Kyoung Lim ),이춘수 ( Choon Soo Lee ),백완기 ( Wan Ki Baek ),윤정원 ( Jung Won Yoon ),신혜란 ( Helen Ki Shinn ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Postoperative hepatotoxicity may develop from many causes. One of them is direct injury to the liver cell due to anesthetic agents. Each agent has different hepatotoxic risk. Sevoflurane is known to have a very low potential for hepatotoxicity. We report a case of severe hepatic dysfunction after anesthesia with sevoflurane in a pediatric patient who underwent cardiopulmonary bypass surgery. (Korean J Anesthesiol 2007; 53: 781∼4)
정소영(So Young Chung),송장호(Jang Ho Song),이미라 대한통증학회 1994 The Korean Journal of Pain Vol.7 No.1
This report documents a case of paraplegia which apparently occurred following epidural injection of triamcinolone(40mg) and 0.125% bupivacaine(10ml). The patients condition was progressive until she experienced paraplegia and dissociative sensory loss below T5(Rt) and T10(Lt) dernatomes, along with urinary and fecal incontinence lasting 24 hours. CT and MRI were normal. Three months after the onset of paraplegia, the patient could only slightly move her legs. After 8 months of the initial paraplegia, she was able to walk with assistance, and to perceive pinrick sensation in her right leg, and tingling in her left leg. She could also void and defecate. At 16 months, paraplegia and sensory loss were slightly recovered. The cause for this paraplegia is still unknown, but it may be from exacerbation of pre- existing disease, acute transverse myelitis, anterior spinal artery syndrome, or neurotoxicity.
증례보고 : 내경 정맥을 통한 중심 정맥 도관술시 발생한 의인성 척추 동정맥루
신혜란 ( Helen Ki Shinn ),송장호 ( Jang Ho Song ),한정욱 ( Jeong Uk Han ),고희창 ( Hee Chang Ko ),조병권 ( Byung Kwan Cho ),음선형 ( Son Hyoung Eum ),정종권 ( Jong Kwon Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Iatrogenic vertebro-vertebral arteriovenous fistula (AVF) is an uncommon complication resulting from various procedures such as central venous catheter insertion. The incidence may be underestimated since the diagnosis is not easy because of its rarity. A central venous catheterization via the internal jugular vein was attempted in a 43-year-old female who presented for intracranial aneurysmal clipping under general anesthesia. Inadvertent arterial puncture was recognized as pulsatile arterial blood flow through the needle. The needle was removed and local compression was applied to the puncture site. The catheter was inserted via the right femoral vein. After surgery, the patient recovered from anesthesia without any complications. On postoperative day 5, thrill and bruit on the right side of the neck were noted on physical examination. Angiography confirmed vertebro-vertebral AVF, which was successfully obliterated with a stent 3 months later. (Korean J Anesthesiol 2007; 53: 806∼9)
증례보고 : 다발성 골절 환자에서 족관절 개방골절 외부고정술 후 진단된 뇌지방 색전증 -증례보고-
김병건 ( Byung Gun Kim ),송장호 ( Jang Ho Song ),양춘우 ( Chun Woo Yang ),차영덕 ( Young Deog Cha ),이춘수 ( Choon Soo Lee ),한정욱 ( Jung Uk Han ),임현경 ( Hyun Kyoung Lim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
Even though cerebral fat embolism develops rarely after long bone fracture, it may be very important complication because it can be fatal and the early detection is not easy. Neurologic symptoms include confusion, restlessness, disorientation, seizure, and stroke with focal deficits. High intensive T2 signal MRI of the brain is most sensitive for diagnosis of cerebral fat embolism. We report a case of cerebral fat embolism diagnosed after external fixation of ankle open fracture in a 46 year old woman patient with multiple fracture. (Korean J Anesthesiol 2006; 50: 731~5)
성상신경절 차단이 혈장 ACTH 및 Cortisol 치에 미치는 영향
채영근(Young Geun Choi),송장호(Jang Ho Song),임현경(Hyun Kyung Lim),한정욱(Jung Wook Han),이성근(Seong Keun Lee),차영덕(Young Deog Cha),신재규(Jae Kue Shin),류중하(Jung Ha Ryu) 대한통증학회 2002 The Korean Journal of Pain Vol.15 No.1
N/A Background: Stellate ganglion block (SGB) is a sympathetic nerve block method which has been used most frequently in pain clinics due to its wide range of indications. This study was conducted to determine the endocrinologic response to repeated SGBs. Methods: Thirteen healthy volunteers were studied. SGB was performed one hunderd times with 6 ml of 1% mepivacaine. Venous blood was drawn to measure plasma adrenocorticotrophic hormone (ACTH) and cortisol consentration before and after SGB for twenty, forty, sixty, eighty and one hundred times. The blood was drawn at 8:00 a.m. and 4:00 p.m. every sampling day. Results: The plasma concentration of eortisol at 8:00 a.m. was significantly higher after SGB one hundred times than prior to SGB. The plsma concentration at 4:00 p.m. was significantly higher after SGB forty times than prior to SGB. The ACTH concentration was significantly times at 4:00 p.m. Conclusions: After SGB, the plasma concentration of cortisol tended to increase while the ACTH levels tended to decrease. However, the effects of endocrinologic response to SGB were unclear since all values were within the normal limit.
흰쥐의 술 후 통증모델에서 척수강내로 투여된 Gabapentin과 Non-NMDA 수용체 길항제인 CNQX의 항통각과민 효과
박혜진 ( Hae Jin Park ),송장호 ( Jang Ho Song ),송진만 ( Jin Man Song ),이홍식 ( Hong Sik Lee ),이춘수 ( Choon Soo Lee ),정춘근 ( Choon Kun Chung ),차영덕 ( Young Deog Cha ),김부성 ( Boo Seong Kim ),유중하 ( Joong Ha Ryu ) 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.2
증례보고 : 전신마취 유도 중 발생한 Vecuronium에 의한 아나필락시스
신헬렌키 ( Helen Ki Shinn ),임현경 ( Hyun Kyoung Lim ),송장호 ( Jang Ho Song ),한정욱 ( Jeong Uk Han ),고두현 ( Du Hyun Ko ),정인준 ( In Jun Jung ),정종권 ( Jong Kwon Jung ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5
Anaphylaxis is one of major causes of morbidity and mortality during anesthesia. Muscle relaxants are the most common cause of anaphylaxis during anesthesia. A 54-year-old woman was scheduled for thyroidectomy. She had no history of allergy and had never previously undergone general anesthesia, Lidocaine, propofol and vecuronium were injected sequentially to induce general anesthesia. Two minutes after the vecuronium injection, severe hypotension, tachycardia and bronchospasm developed, and delayed skin rashes appeared. The patient recovered without any significant complications after immediate proper intensive care. The operation was delayed and a skin test was performed on the 7th day after discharge. She revealed a positive skin test for vecuronium. The anesthesia was re-induced without muscle relaxant and maintained with propofol and remifentanil infusion. Surgery was completed uneventfully, and the patient recovered without any adverse reaction. (Korean J Anesthesiol 2008;55:613~7)