Clinical Research Article : Ultrasound-guided evaluation of the bifurcation of the femoral artery and vein in pediatric patients

Jun Gol Song,Yoon Kyung Lee,Jae Do Lee,Eun Ho Lee,Ji Hyun Park,Mijeung Gwak,Gyu Jeong Noh 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3

Background: The femoral arteries (FA) and femoral veins (FV) are useful access sites for diagnostic and interventional procedures. In adults, the usual puncture sites are 1-3 cm distal from the inguinal crease. In children, however, the optimal puncture site vessels are not known. The aim of our study was to assess the number of branches and bifurcation sites of the femoral vessels in children by using ultrasonography. Methods: Color Doppler ultrasonography was used to determine bifurcation sites of the FA and FV, relative to the inguinal crease, in 48 children (median age, 4 yr; median weight, 18.7 kg) with American Society of Anesthesiologists (ASA) Physical Status (PS) score 1-2 and who were scheduled for general anesthesia. Results: The numbers of FAs and FVs at the inguinal crease were 1.83±0.39 and 1.08±0.29, respectively, in infants, and 1.83±0.58 and 1.0±0.0, respectively, in 10-year-old children. The bifurcation site of the FA in infants and those aged 10 years was 0.78±0.30 cm and 1.47±0.27 cm proximal to the inguinal crease, respectively (P<0.05), whereas the bifurcation site of the FV in these two age groups was -0.96±0.27 cm and -2.29±1.09 cm distal to the inguinal crease, respectively (P<0.05). Conclusions: In children, the FA frequently bifurcates proximal to the inguinal crease, whereas the FV bifurcates distal to the inguinal crease. However, there are anatomical differences among age groups, so care should be taken to avoid complications during femoral vessel cannulation. (Korean J Anesthesiol 2009; 56: 290~4)

The Usage Pattern of Neuromuscular Blocker at Intensive Care Unit

Jun Gol Song,Hwa Sung Jung,Jae Do Lee,Yoon Kyung Lee,Hong Seuk Yang Korean Society of Critical Care Medicine 2006 Acute and Critical Care Vol.21 No.1

BACKGROUND: The neuromuscular blocker is helpful to intubate the patients and reduce the amount of anesthetic agent. It also used at intensive care unit (ICU) to maintain airway patency, to achieve proper ventilatory care, etc. This survey is to determine the neuromuscular blocker usage patterns in ICU settings. METHODS: Three hundred general hospitals with ICU settings were chosen. We designed a 10 itemed questionnaire which has several subquestions with multiple choices and sent it to them. After three months, forty seven hospitals returned the questionnaire and we made careful analysis with it. RESULTS: The most frequent indication of neuromuscular blocker was to facilitate the mechanical ventilation (80.9%). Vecuronium was the most common neuromuscular blocker used (97.9%). Only 6.4% of them used peripheral nerve stimulator and the rest of them (89.4%) used clinical information to determine the degree of neuromuscular blocker. The respondents reported that recovery from muscle relaxation was needed on a periodic basis for regular neurological examinations (59.6%) in ICU settings. All respondents used the sedatives or narcotics with neuromuscular blocker and only 6.4% used reversal agents. CONCLUSIONS: Although the rate of reply was not much (15.7%), we could get the current usage pattern of neuromuscular blocker at ICU. We recommend using short to intermediate acting neuromuscular blocker than long acting agents. Continuous infusion with careful dosage titration by peripheral nerve stimulator would be helpful to achieve rapid recovery. Additional sedatives and narcotics are beneficial to reduce the amount of neuromuscular blocker and to make patients comfortable as well.

임상연구 : Ketamine 마취유도가 압반사의 심박수 조절에 미치는 영향

송준걸 ( Jun Gol Song ),신원정 ( Won Jung Shin ),전인구 ( In Gu Jun ),강수진 ( Su Jin Kang ),최병문 ( Byung Moon Choi ),윤미옥 ( Mi Ok Youn ),김태희 ( Tae Hee Kim ),김영국 ( Young Kug Kim ),허인영 ( In Young Huh ),강성식 ( Seong S 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5

Background: It is reported that ketamine increases central sympathetic activity as well as catecholamine reuptake inhibition. However, little has been known about baroreflex control of heart rate in ketamine anesthetized humans. Thus, the aim of this study was to analyze the effect of ketamine on spontaneous baroreflex sensitivity (BRS) during ketamine induction of anesthesia. Methods: Beat-by-beat arterial blood pressure and electrocardiogram at 5 min before and 10 min after ketamine administration (2 mg/kg) were recorded in twenty healthy living liver transplant donors. Spontaneous BRS was assessed by sequence method and transfer function analysis method. Results: Spontaneous BRS assessed by sequence method, BRSsequence, decreased from 13.7 ± 6.3 to 7.8 ± 4.5 ms/mmHg (P < 0.001). Spontaneous BRS assessed by low frequency transfer function method decreased from 10.9 ± 5.4 to 7.0 ± 4.1 ms/mmHg and by high frequency transfer function method from 14.8 ± 9.2 to 8.7 ± 8.8 ms/mmHg, respectively (P < 0.05). Conclusions: The spontaneous BRS was decreased during ketamine induction of general anesthesia. These results suggest that anesthesia induction with ketamine impairs baroreflex control of heart rate, which may provoke hemodynamic instability. (Korean J Anesthesiol 2006; 51: 528~34)

증례보고 : 중뇌동맥 경색증 환자의 마취유도 직후 경식도 심초음파에 의해 진단된 좌심방 혈전 -증례보고-

송준걸 ( Jun Gol Song ),황규삼 ( Gyu Sam Hwang ),김영국 ( Young Kug Kim ),성승혜 ( Seung Hye Sung ),최인철 ( In Cheol Choi ),황재현 ( Jai Hyun Hwang ),조성강 ( Sung Kang Cho ),한성민 ( Sung Min Han ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6

Stroke is one of the most common causes of death; in particular, cardiac source of embolism may be responsible for 15-20% of ischemic strokes. Here we report a case of left atrial thrombus diagnosed by transesophageal echocardiography (TEE) immediately after induction of general anesthesia in a patient with infarction of the middle cerebral artery. In this case, an emergent craniectomy was cancelled and medical treatment was performed. This case report shows that TEE taken in the operating room may play an important role in the change of treatment plan in a patient displaying acute mental change. (Korean J Anesthesiol 2007; 52: 702~6)

증례보고 : 경요도전립선절제술 중 발생한 방광천공에 의한 경요도절제후증후군

송준걸 ( Jun Gol Song ),김영국 ( Young Kug Kim ),김영욱 ( Young Uk Kim ),서형석 ( Hyung Seok Seo ),강금내 ( Kum Nae Kang ),황규삼 ( Gyu Sam Hwang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2

A transurethral resection of the prostate (TURP) is often performed to treat benign prostatic hypertrophy or prostatic carcinoma. Transurethral resection syndrome (TURS) is a rare but serious complication of TURP that has two different causes: (1) intravascular absorption of the irrigation fluid through the open prostatic venous sinus (TURP syndrome); and (2) intraperitoneal extravasation of the irrigation fluid through perforation of the bladder. In general, a laparotomy, repair of injury, or conservative approach such as bladder drainage, percutaneous drainage of the abdomen combined with medical treatment are performed to manage TURS attributed to the latter mechanism. We report a patient with TURS, who showed a gradual onset of hyponatremia after bladder perforation and intraperitoneal extravasation of the irrigation fluid, and was treated successfully using a conservative approach. (Korean J Anesthesiol 2007; 53: 254~8)

증례보고 : Budd-Chiari Syndrome 환자의 간이식 수술 중 예상 밖의 대량출혈

송하나 ( Ha Na Song ),정성문 ( Sung Moon Jeong ),서영주 ( Young Joo Seo ),김희영 ( Hee Yeong Kim ),전혜영 ( Hye Young Jeon ),최재문 ( Jae Moon Choi ),송준걸 ( Jun Gol Song ),함경돈 ( Kyung Don Hahm ),황규삼 ( Gyu Sam Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6

Budd-Chiari syndrome (BCS) is a heterogenous group of disorders characterized by obstruction of hepatic venous outflow. Severe liver cirrhosis and limited cardiac reserve in patients with BCS makes them less tolerant to liver transplantation. We experienced two cases of massive bleeding during living donor liver transplantation in patients with BCS. Blood products and fluids were rapidly infused with a rapid infusion system, final infusion volume in these two patients were 177 L and 193 L, and the use of Cell Savers allowed for the patient`s blood products to be saved. The patients were managed successfully and recovered uneventfully with advanced monitoring, including monitoring of their jugular venous oxygen saturation and continuous cardiac output. Therefore, rapid infusion systems and Cell Savers, along with advanced monitoring, are necessary in the event of massive bleeding during liver transplantation. (Korean J Anesthesiol 2007; 53: 796∼802)

수소호기검사와 소장통과 신티그라피의 구강 , 맹장 통과시간 비교

송치욱,문정섭,현진해,최재걸 대한소화기학회 1998 대한소화기학회지 Vol.30 No.5

Background/Aims: Patients with gastrointestinal symptoms, and motility disorclers are considered a main part of disease entities. Various motility tests have been used but the motility of the small bowel is hard to evaluate directly. Measurement of oro-cecal transit time u:;ing the hydrogen breath test has been used for the evaluation of small bowel motility, but critericn to indicate cecal arrival was different arnong many studies. We aimed to identify the criterion of cecal amval in hydrogen breath test compared with radionuclide scintigraphy. Methods: Subjects were 30 volunteers with no gastrointestinal symptom and no past history of diarrhea, enema, or antibiotic intake for three weeks before the study. We performed hydrogen breath tests and enteric radionuclide scintigraphy simultaneously every fifteen minutes for six hours after the intake of the test meal composed of an egg sandwich with 1mCi 99mTc sulfur colloid:md lactulose. We compared the results of oro-cecal transit time by scintigraphy with the hydro,;en breath test, in which cecal arrival was defined by various criteria of H2 concentration incri:ment above basal level(eg. 3, 5, 10 ppm and double of baseline). Results: Oro-cecal transit time by scintigraphy was 87.5±20.1 minutes in healthy volunteers and their positive rate of breath hyd-ogen was 80% in criterion of 10ppm, 66.6% in criterion of 20pprn. Oro-cecal transit time by the hydrogen breath test in which each criterion was defined by 3, 5, 10 ppm and double increase above baseline was 91.8±24.6, 106.9±32.2, 117.9±37.7 and 92.4±30.2 minutes respectively. Relationship of oro-cecal transit time by scintigraphy and hydrogen breath test was greatest in criterion of 3ppm increase above basal level in the hydrogen breath test. Conclusions: Oro-cecal transit time by the hydrogen breath test was convenient and was also a non-invasive method to evaluate small bowel motility and the most accurate criterion to show cecal arrival was 3ppm increase above baseline compared with the results of radionuclide scintigraphy.

차 품종별 녹차 제다방법에 따른 첫물차의 향기성분

김영걸(Young-Gol Kim),이정대(Jung-Dae Lee),최성희(Sung-Hee Choi),송관정(Kwan Jeong Song) 한국차학회 2010 한국차학회지 Vol.16 No.2

This study was carried out to examine the aroma characteristics of green tea combined with different tea cultivars and manufacturing methods. We analyzed the aroma components of steamed and pan-fired green tea processed with five tea cultivars: Saemidori, Yutakamidori, Yabukita, Hushun, and Okumidori. There were differences in the aroma components and composition of green tea between the different cultivars. Saemidori contained much higher phenyl acetaldehyde and linalool oxide II (cis-furanoid) content, while Yutakamidori showed the highest pentanal, hexanal, 2-hexenal, benzaldehyde, linalool, α-terpineol, indole, cis-3-hexenyl hexanoate, and cis-jasmone content among the tea cultivars. Yabukita contained the highest content of linalool oxide IV. However, Okumidori and Hushun did not have markedly higher aroma components compared to other cultivars. The manufacturing process of green tea, such as steaming or pan-firing, also affected the aroma components and composition. Pan-fired Saemidori and Yutakamidori tea contained higher geraniol content than that of steamed tea, which was the reverse of that observed for Yabukita. Okumidori and Hushun did not have different geraniol contents with different manufacturing processes. Pan-fired tea showed higher linalool, linalool oxide I (trans-furanoid), linalool oxide II (cis-furanoid), and linalool oxide IV content than that of steamed tea for most cultivars except Okumidori. These results indicate that Saemidori was proper for pan-firing, Yabukita and Okumidori for steaming, and Yutakamidori for both making processes.

Effects of Levosulpiride in Patients with Functional Dyspepsia Accompanied by Delayed Gastric Emptying

(Chi Wook Song),(Hoon Jae Chun),(Chang Duck Kim),(Ho Sang Ryu),(Jin Hai Hyun),(Jae Gol Choe) 대한내과학회 1998 The Korean Journal of Internal Medicine Vol.13 No.1

N/A Objectives:Levosulpiride is the levo-enantiomer of sulpiride, a well-known anti- emetic, antidyspeptic and antipsychotic drug. This study was undertaken to investigate the effects of levosulpiride on dyspeptic symptoms and gastric motor function in a group of patients with functional dyspepsia showing delayed gastric emptying. Method:Forty two eligible patients were entered into a 3 week, double-blind randomized comparison of 25mg of levosulpiride or placebot.i.d.. Symptom assess- ment and gastric scintigraphy following the intake of scrambled egg sandwich, were performed in each patient before and after treatment. Results:The improvement of symptom score in levosulpiride group was higher than the placebo group(p<0.05). We assessed global efficacy, which was excellent in 1(6%), good 11(65%), fair 4(24%), nil 1(6%) of those receiving levosulpiride, and fair 9(60%), nil 5(33%), poor 1(6%) of those receiving placebo. Levosulpiride tended to be more effective than placebo in relieving the dyspeptic symptoms especially in the subgroups of dysmotility-like(p<0.05) and nonspecific(p<0.05) as compared to other subgroups(p=0.16). The reduction of gastric emptying time after levosulpiride treatment was more marked than Placebo group(p<0.05). We found a significant correlation between changes of symptom score and gastric emptying time(r=0.47, p=0.01). No serious adverse effects were reported after administration of either levosulpiride or placebo. Only two patients reported mild somnolence during levosul- piride administration. Conclusions:Levosulpiride is effective and well tolerated in patients with func- tional dyspepsia accompanied by delayed gastric emptying. Its efficacy may be related to its action on the gastric motor function by improving the delayed gastric emptying.

차 품종별 각공 방법에 따른 녹차의 화학성분 및 품질특성

김영걸(Young-Gol Kim),이정대(Jung-Dae Lee),김희숙(Hee-Suk Kim),송관정(Kwan Jeong Song) 한국차학회 2010 한국차학회지 Vol.16 No.1

This study was performed to determine the effects of two distinct green tea manufacturing methods, steaming and pan-fìring, on the chemical composition and specifìc character of each tea cultivar. We examined steamed and pan-fired tea made from the following fìve cultivars: Saemidori, Yutakamidori, Yabukita, Hushun, and Okumidori. The results showed that manufacturing method did not influence the chemical composition oftea leaves However, there was a difference in tea color depending on the manufacturing method. ln every cultivar, the color of green tea became brighter and deeper when manufactured by steaming. Further, the color of green tea was affected by the cultivar itself. Lastly, a sens아y test confirmed that Yabukita was best prepared by steaming, whereas Yutakamidori and Saemidori were best suited for pan-firing. However, manufacturing method had little effect on quality for Okumidori and Hushun based on their sensory test scores.