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증례보고 : 전신 마취 중 발생한 심박수 의존성 좌각차단
임경실 ( Kyung Sil Im ),정현주 ( Hyun Ju Jung ),이재명 ( Jae Myeong Lee ),박훈 ( Kuhn Park ),김종분 ( Jong Bun Kim ),심진철 ( Jin Cheol Sim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3
Rate-dependent left bundle branch block during general anesthesia is rare, but its occurrence makes the electrocardiographic diagnosis of acute myocardial ischemia or infarction difficult. It can also be confused with slow rate ventricular tachycardia. Herein, a case of rate-dependent left bundle branch block, in a patient with no previous history of ischemic heart disease, is reported. The administration of esmolol resulted in a decrease in the heart rate, with reversion to normal sinus rhythm. (Korean J Anesthesiol 2007; 52: 350~4)
증례보고 : 대퇴골 간부 골절 고정술 후 발생한 반대 측 좌골 신경 손상 -증례보고-
임경실 ( Kyung Sil Im ),권용순 ( Yong Soon Kwon ),정현주 ( Hyun Ju Jung ),김종분 ( Jong Bun Kim ),이재명 ( Jae Myeong Lee ),이민혜 ( Min Hye Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
A sciatic nerve injury as a complication of the position appears to be rare. There are several reports on sciatic nerve injuries that occurred as complications of the lithotomy position. We present two cases of an opposite sciatic nerve injury after the fixation of a femur shaft fracture. Two patients complained of hyperesthesia of the right foot and a foot drop after surgery. Nerve conduction and electromyographic studies were performed, which revealed a sciatic nerve injury. The patients were treated with physiotherapy and an ankle-foot orthotic. In the case 1, patient had completely recovered ten months after surgery. However, in case 2, the patient still had residual hyperesthesia and weakness two months after surgery when he was lost to follow-up. The mechanism of nerve injury in these patients was a stretching of the nerve. Tension was placed on the nerve as a result of the external rotation of the thigh with the hip and knee joints flexed. (Korean J Anesthesiol 2007; 52: 707~11)
임상연구 : 견관절경 수술 후 관절강 내 및 정맥 내 자가 통증조절의 효과 비교
임경실 ( Kyung Sil Im ),권용순 ( Yong Soon Kwon ),정현주 ( Hyun Ju Jung ),이재명 ( Jae Myeong Lee ),김종분 ( Jong Bun Kim ),박훈 ( Kuhn Park ),심진철 ( Jin Cheol Sim ),권오수 ( Oh Soo Kwon ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1
Background: The purpose of this study was to compare the postoperative analgesic effects and side effects of an intra-articular PCA infusion of bupivacaine and morphine using an intravenous PCA infusion of morphine following arthroscopic shoulder surgery. Methods: Seventy-one patients, undergoing arthroscopic shoulder surgery under general anesthesia, were randomly assigned to one of two groups. In group 1 (n = 32), morphine and ondansetron, 8 and 4 mg, respectively, were intravenously injected following surgery, with the subsequent infusion of normal saline 100 ml, including morphine and ondansetron, 32 and 12 mg, respectively, through an intra-venous PCA catheter. In group 2 (n = 39), 0.25% bupivacaine, 40 ml, including an intra-articular injection of morphine, 3 mg, followed by an infusion of 0.25% bupivacaine, 100 ml, including morphine, 5 mg, were administered through an intra-articular PCA catheter. In groups 1 and 2, the PCA infusion rate was 2 ml/h, with a bolus dose of 0.5 ml, with a lock out time of 8 min. The VAS for pain at rest, and the range of motion (ROM) exercise and side effects were assessed 0.5, 1, 2, 4, 12, 18 and 24 h postoperatively. Results: The patients in group 2 had significantly lower VAS for pain for the ROM than those in group 1 30 min postoperatively. However, the VAS for pain at rest was significantly lower in group 1 than 2 after 18 and 24 h, but the VAS for pain for the ROM was significantly lower in group 1 than 2 24 h postoperatively. There was no significant difference in the side effects between the two groups, with the exception of dizziness, which was more severe in group 2 at 1, 2 and 4 h postoperatively. Conclusions: An intra-articular PCA infusion of bupivacaine and morphine is no more effective than an intra-venous PCA infusion of morphine and ondansetron with respect to postoperative analgesia and side effects. (Korean J Anesthesiol 2007; 53: 72~8)
증례보고 : 기도 협착 환자에서 체외순환 보조를 이용한 마취 경험 -증례보고-
이재명 ( Jae Myeong Lee ),임경실 ( Kyung Sil Im ),노희천 ( Hee Chern No ),정현주 ( Hyun Ju Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
In tracheal stenosis, airway management is most challenging for anesthesiologists. A small sized endotracheal tube, laryngeal mask airway, with high frequency jet ventilation can be used, but may result in ineffective oxygenation and ventilation. In such cases, extracorporeal life support, ECLS, can be helpful. Herein, a case of tracheal stenosis in an adult assisted with the ECLS is reported. (Korean J Anesthesiol 2007; 52: 719~23)
증례보고 : 과용량의 Risperidone 투여로 발생한 신경이완성 악성 증후군
김종분 ( Jong Bun Kim ),임경실 ( Kyung Sil Im ),이재명 ( Jae Myeong Lee ),정현주 ( Hyun Ju Jung ),김대영 ( Dae Young Kim ),홍상현 ( Sang Hyun Hong ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
Neuroleptic malignant syndrome (NMS) is a rare, but potentially fatal idiosyncratic reaction to neuroleptics characterized by muscle rigidity, fever, altered consciousness, autonomic instability, leukocytosis and elevated creatinine phosphokinase level suggesting muscle injury. The incidence of NMS is estimated to be between 0.07 and 2.2% among patients receiving neuroleptics, with a motality of 11%. Although the pathophysiology of NMS is not completely understood, reduced dopaminergic activity secondary to antipsychotic induced dopamine receptor blockage is considered to be the best explanation to date. We experienced NMS in a 22-year-old male with antipsychotic drug intoxication who underwent primary closure of dual, self-inflicted wrist laceration. We recognized as NMS about 30 minutes after induction of general anesthesia. All anesthetics were stopped, and supportive care was performed with management of hyperthermia and fluid. Also, Dantrolene sodium and bromocriptine were administered. The patient recovered without any complication. (Korean J Anesthesiol 2006; 51: 261~6)
증례보고 : 액와 상완신경총 차단 후 발생한 지속적 상완신경총 손상 -증례보고-
정현주 ( Hyun Ju Jung ),임경실 ( Kyung Sil Im ),홍상현 ( Sang Hyun Hong ),김대영 ( Dae Young Kim ),김종분 ( Jong Bun Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
A 26-year-old male patient presented for stump revision of an amputated right 3rd finger and neurorrhaphy for a lacerated right 2nd finger. An axillary brachial plexus block was performed using the transarterial technique. Postoperatively, the patient demonstrated signs and symptoms of brachial plexus injury. He exhibited paresthesia in the distribution of the ulnar nerve and motor weaknesses the wrist, elbow, and shoulder. On the 18th postoperative day, nerve conduction and electromyographic studies were performed, which revealed possible right radial neuropathy and axillary neuropathy, or right brachial plexopathy with posterior cord involvement. After seven months of medical and physical treatment, the pain subsided but slight paresthesia and muscle weaknesses still remained. We describe a case of postoperative neuropathy, which is believed to be caused by a direct nerve injury after an axillary brachial plexus block with persistent signs and symptoms over a considerable period. (Korean J Anesthesiol 2006; 50: 718~22)
증례보고 : 심장수술 중 발생한 여과기/열 습도 교환기 폐쇄
이재명 ( Jae Myeong Lee ),정현주 ( Hyun Ju Jung ),이정윤 ( Jeong Yun Rhee ),임경실 ( Kyung Sil Im ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
An acute obstruction of the breathing circuit during surgery can be a devastating situation. A 45-year old man who diagnosed with infective endocarditis and aortic valve regurgitation underwent emergency cardiac surgery. However, an obstruction of the breathing circuit occurred when the cardiopulmonary bypass was weaned. Fortunately, the ventilation normalized after removing the airway filter/heat and moisture exchanger (HME). We report this case of a HME obstruction of the breathing circuit with a review of the relevant literature. (Korean J Anesthesiol 2007; 52: 582~5)
정현주 ( Hyun Ju Jung ),강성학 ( Sung Hak Kang ),임경실 ( Kyung Sil Im ),이재명 ( Jae Myeong Lee ),김대영 ( Dae Young Kim ),홍상현 ( Sang Hyun Hong ),김종분 ( Jong Bun Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
One of the most fearful rare complication of ureteroscopic lithotripsy is sepsis. Since sepsis after endourological maneuvers usually occur immediately after procedure, it is important to pay attention to symptoms representing sepsis such as pyrexia, tachycardia, tachypnea, and oliguria. In addition to clinical symptoms, laboratory tests including white blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and urine and blood cultivating can help to diagnosis of sepsis. We present a case of shock after ureteroscopic lithotripsy, which was suspected with septic shock strongly. (Korean J Anesthesiol 2006; 51: 508~11)