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증례보고 : 체외순환을 사용하지 않는 관상동맥 우회술에서 심장 전위를 위해 사용된 물주머니와 경식도 심장초음파 영상 개선
여진석 ( Jin Seok Yeo ),김태엽 ( Tae Yop Kim ),윤창룡 ( Chang Yong Yoon ),김준석 ( Jun Seok Kim ),지현근 ( Hyun Keun Chee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2
During off-pump coronary artery bypass graft surgery (OPCAB), vigorous displacement and compression of the heart producing significant hemodynamic change are essential for optimal exposure of graft anastomoses. Intraoperative transesophageal echocardiography (TEE) is useful in determining hemodynamic compromise and prompting medical and mechanical support. However, in addition to the loss of contact between the heart and diaphragm during the displacement, swabs or snears underneath the heart interrupt the TEE signal transmission, resulting in a compromised transgastric (TG) TEE view. Therefore, TEE monitoring during OPCAB is usually limited to the mid-esophageal view. The authors placed a saline bag (a surgical glove filled with saline) underneath the heart to facilitate this anterior displacement of the heart, as well as avoid the signal interruption of the TG echocardiographic window. As a result, the optimal heart position with the minimal changes in LV regional wall motion, LV function and mitral regurgitation were found using the TG and other TEE views. The series of velocity-time integral of aortic valvular flow (VTI-Ao) in TG long axis view, in addition to SvO2, were then monitored as a surrogate marker of the cardiac output during a graft construction of the left circumflex artery. It was concluded that the use of a saline bag may be useful in avoiding compromise of the TG TEE view and determine the hemodynamic change using VTI-Ao during cardiac displacement for OPCAB. (Korean J Anesthesiol 2007; 52: 231~6)
증례보고 : 중증 신생아호흡곤란증후군을 동반한 미숙아의 동맥관 개존증 폐쇄술의 마취 관리
조재훈 ( Jae Hun Cho ),여진석 ( Jin Seok Yeo ),권원경 ( Won Kyoung Kwon ),김덕경 ( Duck Kyoung Kim ),김혜경 ( Hae Kyoung Kim ),이경민 ( Kyoung Min Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Premature infants with respiratory distress syndrome may have clinically significant shunting through a patent ductus arteriosus (PDA). Left-to-right shunting through the PDA may lead to left ventricular volume overload and pulmonary edema. We present a case of perioperative management for severe respiratory distress syndrome in a premature infant who underwent surgical closure of PDA. Under general anesthesia, the infant was successfully managed by inhaled nitric oxide, high frequency oscillation ventilation with intermittent mandatory ventilation despite intermittent hypoxia. The operation was performed safely in the neonatal intensive care unit. (Korean J Anesthesiol 2006; 51: 495~8)
증례보고 : 편측 성대마비가 동반된 극소저출생체중 미숙아의 서혜부 탈장 수술 시 척추마취 경험
김덕경 ( Duck Kyoung Kim ),여진석 ( Jin Seok Yeo ),오충식 ( Chung Sik Oh ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
In premature infants, the incidence of inguinal hernia has been reported to be 14-30%. It is generally accepted that inguinal hernia should be repaired as soon as possible, as the incidence of incarceration is higher in infant than in children. However, the risk of life-threatening apnea after surgery is significant in this age group. Spinal anesthesia in premature infants offer a safe alternative to general anesthesia, especially if intubation should be avoid because of coexisting disease. We present a case of successful spinal anesthesia for inguinal herniorraphy in a premature female infant at a postconceptual age 44 + 6 weeks weighing 2,620 g with coexisting unilateral vocal cord paralysis to illustrate technical details and feasibility of this technique even in very low birth weight (birth weight < 1,500 g) infants. (Korean J Anesthesiol 2006; 51: 252~6)
임상연구 : 전신마취를 받는 환자에서 발생하는 압박 욕창의 발생률과 위험인자의 조사
황희윤 ( Hee Youn Hwang ),신용섭 ( Yong Sup Shin ),조현성 ( Hyun Sung Cho ),여진석 ( Jin Seok Yeo ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1
Background: The occurrences of pressure sores have an extensive impact on patients and the medical team. Pressure sores decrease quality of life and productivity, as well as increase the overall cost of treatment. The purpose of this study was to identify the risk factors associated with pressure ulcers among surgical patients. Methods: Data were collected from 588 patients who underwent general anesthesia. The data included age, gender, weight, height, body mass index, ASA status, surgical position, anesthesia time, pre-and postoperative hemoglobin concentration, serum albumin, NYHA class, co-morbidity, steroid use, body temperature, use of warming water mattress and preoperative hospital admission day. The patient`s skin was inspected closely before surgery and again within 24 hours after surgery and the locations and severity of skin breakdowns were assessed. Results: Twenty-five patients (4.3%) developed pressure sores during surgery. The hemoglobin concentration change between the preoperative and postoperative period (≥2 g/dl), position during surgery, length of stay before operation (≥4 days), anesthesia time (≥5 hours) and decrease in body temperature (≥0.5℃) were significantly related to the development of pressure sores (P < 0.05). Conclusions: Five risk factors for pressure ulcers were confirmed. The anesthesiologist can decrease hemoglobin and modify body temperature; therefore, attention should be given to these risk factors during the operation. (Korean J Anesthesiol 2007; 53: 79~84)
만성 허혈 후 통증모델에서 발생한 건측의 이질통과 척수의 중추감작
곽경화 ( Kyung Hwa Kwak ),정경영 ( Kyung Young Jung ),최지영 ( Jy Young Choi ),류태하 ( Tae Ha Ryu ),여진석 ( Jin Seok Yeo ),박성식 ( Sung Sik Park ),임동건 ( Dong Gun Lim ),김시오 ( Si Oh Kim ),백운이 ( Woon Yi Baek ),홍정길 ( Ju 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4
Background: Mirror-image allodynia is a mysterious phenomenon that occurs in association with many clinical pain syndromes including complex regional pain syndromes (CRPS). Underlying mechanisms for the development of such pain are still a matter of investigation. Several studies suggest that activation of the N-methyl-D-aspartate (NMDA) receptor is essential for central sensitization as a base for persistent pain. The aim is to assess whether alteration of NMDA receptor expression correlates with the contralateral allodynia in the chronic post-ischemia pain (CPIP) model rats representing CRPS-Type I. Methods: Application of a tight-fitting tourniquet for a period of 3 hours before reperfusion produced CPIP in male Sprague-Dawley rats. The mechanical paw withdrawal thresholds to von Frey stimuli (using a dynamic plantar aesthesiometer) were measured as pain indicators in ipsilateral and contralateral hindpaws. Phosphorylation of the NMDA receptor 1 subunit (pNR1), assessed with Western blot, was measured in the contralateral L4-6 spinal cord. Results: Ipsilateral and contralateral mechanical allodynia is present at 4 hours after reperfusion, peaked at 3 days, and continued for 7 days after reperfusion. The relative density of pNR1 of CPIP rats significantly decreased in the contralateral L4-6 spinal cord compared to baseline value (P<0.05). There was significant correlation between paw withdrawal threshold and the relative density of pNR1 (ipsilateral; R2=0.75, P<0.01, contralateral; R2=0.60, P<0.01). Conclusions: These data suggest that pNR1 is correlated to the contralateral mechanical allodynia in CPIP rats. (Korean J Anesthesiol 2009;56:419~24)
실험연구 : 잡견에서 Bupivacaine의 주입에 의한 심장 독성 발생 시 시행한 심폐소생술에서 인슐린 부가 효과의 연구
함태수 ( Tae Soo Hahm ),신병섭 ( Byung Seop Shin ),김정수 ( Chung Su Kim ),이상민 ( Sang Min Lee ),여진석 ( Jin Seok Yeo ),황희윤 ( Hee Youn Hwang ),이국현 ( Kook Hyun Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: Because of the difficulty of resuscitation caused by bupivacaine-induced cardiotoxicity, the choice of resuscitation medication is still unclear. We investigated whether insulin can improve outcomes of resuscitation by epinephrine from bupivacaine-induced cardiovascular collapse. Methods: Twenty-four mongrel dogs were randomly allocated to one of the two groups: an EPI group (n = 12), and an EPI + RI group (n = 12). Sixty minutes after induction of general anesthesia, baseline measurement of hemodynamic parameters and arterial blood gas tension was performed. Bupivacaine infusion was started at a rate of 0.5 mg/kg/min and kept until mean arterial blood pressure fell below 40 mmHg and heart rate 40 beats per minute. At this point, bupivacaine infusion was stopped and resuscitation was started, with epinephrine in EPI group and epinephrine combined with regular insulin in EPI + RI group. Results: Bupivacaine infusion caused significant decreases in mean arterial blood pressure, heart rate, cardiac output, and systemic vascular resistance and increases in mean pulmonary blood pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, and central venous pressure. The recovery rate of EPI + RI group (8/12) was higher than that of EPI group (2/12). Conclusions: Combined administration of epinephrine and regular insulin improves outcomes of resuscitation of bupivacaine-induced cardiovascular collapse. Therefore, we believe that prompt administration of insulin should be strongly considered in case of bupivacaine-induced cardiotoxicity. (Korean J Anesthesiol 2006; 50: 579~84)
임상연구 : 두부 하강, 외회전 자세에서의 내경정맥과 경동맥의 관찰
정익수 ( Ik Soo Chung ),권민아 ( Min A Kwon ),황희윤 ( Hee Youn Hwang ),박정헌 ( Jeong Heon Park ),여진석 ( Jin Seok Yeo ),김정수 ( Chung Su Kim ),함태수 ( Tae Soo Hahm ),이상민 ( Sang Min Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: This study evaluated the position and relationship between the right internal jugular vein (IJV) and the surrounding external landmarks using ultrasonography. Methods: Fifty-four patients undergoing central vein access for cardiac surgery were enrolled in this study. The IJV, carotid artery (CA) and sternocleidomastoid muscle (SCM) at the cricoid cartilage level in 15˚ trendelenburg position with 30˚ head rotation were examined using a two dimensional ultrasound transducer of a TEE machine. Images of the vessels and the demographic data of the patients were recorded and analysed. Results: At the level of the cricoid cartilage, the position of the right IJV was medial to middle of the clavicular head of the SCM muscle in 26 cases (48.2%), lateral in 11 cases (20.4%) and just above the middle of clavicular head of the SCM muscle in 17 cases (31.5%). In 43 patients (79.6%), the IJV overlapped the CA anterolaterlly < 5 mm, and these cases were regarded as normal. Ten patients (18.5%) had a medially positioned IJV overlapping the CA more than 5 mm and the IJV was positioned lateral to CA in 1 (2%) patient. The mean ratio of the overlapped diameter and the diameter of the CA was 33.6% and the overlapping ratios were greater than 50% in 10 patients (31.4%). The mean skin-to-vein distance at the angle of 30˚ was 1.82 cm. Conclusions: In 18.5% of patients positioned in the 15˚ Trendelenburg position, with their head turned to the left 30˚, the IJV overlapped the CA medially more than 5 mm, which increased the risk of a carotid puncture using the blind technique. (Korean J Anesthesiol 2006; 51: 11~6)