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증례보고 : 승모판 부전 환자에서 간정맥으로 이탈된 폐동맥 카테터
전덕희 ( Duk Hee Chun ),정금희 ( Kum Hee Chung ),이종연 ( Jong Yun Lee ),송지은 ( Ji Eun Song ),김준영 ( Jun Young Kim ),이정향 ( Jung Hyang Lee ),박정현 ( Chung Hyun Park ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
A 47-year-old woman was scheduled for mitral valvoplasty. Before induction of anesthesia, a pulmonary artery catheter (PAC) was placed via right internal jugular vein. Central venous pressure or right atrial pressure was traced until about 60 cm of PAC insertion and right ventricular pressure curve appeared without arrhythmias. We withdrew and advanced the catheter several times, but pressure tracing showed the same pattern. And we could not obtain the pulmonary artery pressure. We decided to leave the PAC in the right ventricle. No ventricular arrhythmia was detected. Postoperative chest x-ray revealed that PAC traveled through inferior vena cava and looped in the hepatic vein with the tip of the catheter in the right ventricle. Under fluoroscopic guidance, PAC was inserted to the pulmonary artery. No sign of hepatic vein obstruction was detected. (Korean J Anesthesiol 2009;57:633∼6)
증례보고 : Eisenmenger씨 증후군 환자의 응급 개두술을 위한 마취 관리
정금희 ( Kum Hee Chung ),김승호 ( Seung Ho Kim ),전덕희 ( Duk Hee Chun ),이종연 ( Jong Yun Lee ),박성철 ( Seong Cheol Park ),박정현 ( Chung Hyun Park ),김민구 ( Min Goo Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Eisenmenger`s syndrome describes the elevation of pulmonary arterial (PA) pressure to the systemic level caused by an increased pulmonary vascular resistance with reversed or bi-directional shunt through an intracardiac or aortopulmonary communication. We report a case of an emergent craniotomy for cerebellar abscess in a 21-year-old male patient with Eisenmenger syndrome secondary to Large VSD. A PA catheter was inserted via right femoral vein, but could not be advanced pass the pulmonic valve. After futile attempts to place the catheter tip in the right ventricle. Anesthesia was induced with etomidate, rocuronium, midazolam and fentanyl and maintained with only high dose fentanyl. Milinone and norepinephrine were infused continuously to decrease right to left shunt. He was transferred to the intensive care unit under intubated state and treated with antibiotics for a few days due to intermittent high fever. The operation ended without major complications and the patient was discharged 42 days later. (Korean J Anesthesiol 2009;57:666∼9)
경요도 절제술을 시행받는 환자에서 초음파기를 이용한 폐쇄신경 차단 - 서혜부 주름부위 접근법
길현주 ( Hyun Jue Gill ),전덕희 ( Duk Hee Chun ),백인찬 ( In Chan Baek ),장준흠 ( Jun Heum Jang ),신동욱 ( Dong Wook Shin ),강화자 ( Wha Ja Kang ) 경희대학교 경희의료원 2014 慶熙醫學 Vol.29 No.1
연구배경: 경요도절제술을 시행받을 환자 중에서 초음파기와 신경 자극기를 이용하여 폐쇄신경 차단 을 시행하는 것이 환자에게 안전하고 효과적인지 알 아보고자 한다. 방법: 척추 마취하 경요도절제술을 시행 받는 26 명의 환자들에게 초음파기와 신경 자극기를 사용하 여 폐쇄신경 차단을 시행하였다. 초음파로 해부학적 구조를 확인하고 근수축 확인 후 1% lidocaine 10 ml 를 폐쇄신경의 anterior와 posterior branch에 각각 투 여하였다. 초음파기를 이용하여 해부학적 위치감별 에 걸리는 시간, 전체 신경차단에 걸리는 시간, 바늘 깊이, 수술 중 근수축의 정도, 실패율, 합병증등을 평가하였다. 결과: 초음파기를 이용하여 fascial plane을 감별하 는 데 걸리는 시간은 21±14.9초, 폐쇄신경의 anterior branch와 posterior branch를 확인하는 데 걸리는 시간 은 각각 39.6±27.4와 24.3±11.7초였으며 전체 신경차 단에 걸리는 시간은 174±65.1초, 바늘 깊이는 anterior branch가 4.8±0.8 cm, posterior branch가 6.2±1.1 cm였 다. 실패율은 anterior branch가 2/26 (7.7%), posterior branch가 7/26 (26.9%)이었다. Grade 1의 근수축은 22/26 (84.7%)에서 나타났으며 폐쇄신경술의 성공률 은 23/26 (88.5%)이었다. 결론: 서혜부 위치에서 초음파로 신경의 위치를 확인하는 방법은 쉬우나 초음파와 신경 자극기를 사 용한 폐쇄신경 차단술의 성공률은 큰 차이가 없었다.
Budd-Chiari syndrome 산모의 제왕절개술을 위한 마취 -증례보고-
송지은 ( Ji Eun Song ),양현정 ( Hyeon Jeong Yang ),박성철 ( Seong Cheol Park ),전덕희 ( Duk Hee Chun ),정금희 ( Kum Hee Chung ),이종연 ( Jong Yeon Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6
Budd-Chiari syndrome (BCS) represents a spectrum of disease states resulting in hepatic venous outflow occlusion. Prothrombotic disorders, such as protein S deficiency may cause thrombosis of the portal and hepatic veins. We report the management of a 30-year-old BCS primigravida with protein S deficiency and destroyed lung by the pulmonary tuberculosis scheduled for Cesarean section. Moreover, patient`s lungs were destroyed by the pulmonary tuberculosis. Spinal anesthesia was selected for the anesthetic management. The patient recovered without any complication and discharged from hospital on the fifth postoperative day. (Korean J Anesthesiol 2009; 57: 793∼5)