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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)
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 : 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)
폐렴을 동반한 Seckel 증후군 환아의 마취경험 -증례보고-
김태희 ( Tae Hee Kim ),김영욱 ( Young Uk Kim ),송준걸 ( Jun Gol Song ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Seckel syndrome, also called bird-headed dwarfism, is an extremely rare, inherited, autosomal recessive disorder. The patients with Seckel syndrome are characterized by growth retardation, microcephaly with mental retardation, proportional dwarfism, bird like faces, and beak-like triangular nose. A literature review reveals that they have multiple anesthetic problems such as difficult airway management, difficult venous cannulation and concomitant medical diseases. We describe our experience in anesthetic management of a 21-month-old male patient with Seckel syndrome associated with pneumonia who underwent orchiopexy for bilateral cryptochidism. (Korean J Anesthesiol 2009; 56: 717~9)
임상연구 : 심박수 변이도, 혈압 변이도 및 압반사 민감도를 이용한 간경화 환자의 심혈관 자율신경계 평가
윤미옥 ( Mi Ok Youn ),강수진 ( Su Jin Kang ),전인구 ( In Gu Jun ),신원정 ( Won Jung Shin ),최병문 ( Byung Moon Choi ),도경준 ( Kyung Jun Do ),조선준 ( Sun Joon Cho ),최재혁 ( Jae Hyuk Choi ),송준걸 ( Jun Gol Song ),허인영 ( In You 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
Background: Liver cirrhosis is associated with several hemodynamic abnormalities, including an impairment of autonomic nervous system reflexes, but very few have compared the disease severity with cardiovascular autonomic dysfunction assessed by spectral analysis of blood pressure and electrocardiogram. The aim of this study was to investigate the relationship between Child-Turcotte-Pugh (CTP) score and autonomic indices in patients with liver cirrhosis using the heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS). Methods: Fifty patients scheduled for liver transplantation recipients under general anesthesia were enrolled in the study. Beat-to-beat blood pressure and RR interval were measured for five minutes before anesthesia induction. HRV and BPV were estimated by power spectral analysis of RR interval and systolic blood pressure. BRS was estimated by both the sequence method (Sequence BRS) and high frequency (HF) gain of transfer function analysis (HF BRS). Results: Significant inverse correlations between CTP score and Sequence BRS (r = -0.61), HF BRS (r = -0.59), low frequency (LF) and HF power of HRV (r = -0.57, r = -0.46), LF power of BPV (r = -0.37) were found. However, no significant correlations were observed between CTP score and LF/HF ratio of HRV (r = -0.02) and HF power of BPV (r = 0.27). Conclusions: These results showed that autonomic dysfunction assessed by spectral analysis was associated with increasing severity of liver cirrhosis. Further study will be needed to clarify relationship between our findings and hemodynamic fluctuations during anesthesia for liver transplantation. (Korean J Anesthesiol 2006; 50: 655~62)
박재홍,최윤,이청,신진우,윤창섭,송준걸 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.1
Background: The purpose of this study is to determine if there is any relationship among the distance from the skin to cervical epidural space, patients height, weight, neck circumference and body mass index (BMI). Methods: The data was collected from 219 patients who suffer acute and chronic pain from neck and upper extrmities. Cervical epidural catheterization was perfomed at the C_(6-7), C_7-T_1 intervertebral space. The depth of the epidural space from the skin, age, height, weight and neck circumference were measured by a standard ruler and the BMI was calculated. Results: The distance from the skin to cervical epidural space at C_(6-7), C_7-T_1 in males, and C_(6-7), C_7-T_1 in female were 4.69±0.55 cm, 5.24±0.61 cm, 4.28±0.49 cm, and 4.83±0.54 cm, respectively. Conclusions: The results indicated that body weight, neck circumference and BMI could be a guideline for the location of the cervical epidural space.
박재홍,최윤,이청,신진우,윤창섭,송준걸 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.1
Background: Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The purpose of this study is to analyze the effect of epidural blood patch in spontaneous intracranial hypotension. Methods: The spontaneous intracranial hypotension patients treated with epidural blood patch were analyzed on the symptoms, radiologic images and methods of epidural blood patch retrospectively by the medical records. Results: Patients had postural headache (15 patients) including nausea/vomiting (10 patients), tinnitus (2 patients), neck stiffness (13 patients), vertigo (3 patients) and occular pain (1 patient). Brain CT and MRI showed diffuse enhancement of the pachymeninges (9 patients) and radionuclide cisternography demonstrated direct evidence of leakage (11 patients). With epidural blood patch, the symptoms were promptly relieved in 11 patients. Conclusions: We concluded that epidural blood patch is a good treatment of method in spontaneous intracranial hypotension patients.