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초음파 유도하 목갈비근 옆접근법(Parascalene technique)에 의한 팔신경얼기차단하에 시행한 견관절경 수술: 8례 -증례보고-
신영덕 ( Young Duck Shin ),이근석 ( Keun Seok Lee ),김은석 ( Eun Seok Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3
Performing a brachial plexus block is very useful for shoulder arthroscopic surgery. Several techniques for blocking the brachial plexus have been described with the purpose of improving the efficacy and minimizing the risk. The parascalene approach was introduced in 1979. This block approaches at the lateral border of the anterior scalene muscle and superior to the clavicle. At this level, the incidences of phrenic nerve paralysis and spinal or epidural anesthesia should be minimized. Previous studies have reported on ultrasound-assisted brachial plexus blocks, but few studies have applied this imaging technology to the parascalene region. We report here on 8 cases of parascalene brachial plexus block with using ultrasound guidance to show the clinical usefulness of this technology for conducting arthroscopic shoulder surgery. Ultrasound technology is valuable to anesthesiologists to localize nerves and the needle placement during the parascalene approach to block the brachial plexus for conducting arthroscopic shoulder surgery. (Korean J Anesthesiol 2009; 56: 341∼4)
신영덕 ( Young Duck Shin ) 대한췌장담도학회 2014 대한췌담도학회지 Vol.19 No.2
I think endoscopic retrograde cholangiopancreatography (ERCP) is a very highly advanced upper endoscopic procedure, and is an uncomfortable procedure that requires adequate sedation for its successful conduction. But, The optimum method for sedation for endoscopic procedures is not known. Propofol has a faster recovery time than traditional sedative agents, but may be associated with increased complication rates. Dexmedetomidine is a highly selective α2 adrenoceptor agonist that has many advantages over other sedatives. In addition to producing sedative, analgesic, and anxiolytic effects, it provides respiratory stability. When patients are treated with appropriate analgesics, sedation with dexmedetomidine for ERCP would be safe and associated with better outcomes than sedation with other sedatives.
민경득(Kyung-Deuk Min),신영덕(Young-Duck Shin),전용욱(Yong-Wook Jeon),이태수(Tae-Soo Lee),김영철(Young-Chol Kim) 대한전기학회 2013 전기학회논문지 Vol.62 No.10
Esophageal stethoscope is used for monitoring the heart sounds and breath sounds of patients during surgery under a general anesthesia. Recently, an electronic esophageal stethoscope (EES)[1] has been developed for the purpose of real-time monitoring these information visually. This system uses only a microphone as the sound sensor. A drawback of the EES system is that it may be difficult to distinguish the first sound (S₁) and the second sound (S₂) of heart, because their periods are irregular depending on patients. In this paper, we propose an improved EES system in which the infrasound is measured by adding a pressure sensor as well as a sound sensor. We investigate some correlations between the infrasound and characteristics of the heart sound. The proposed system has been tested on 15 patients. The results show that the new system is capable of detecting the first sound more reliably and easily determining the heart rate and breathing period.
Propofol-Remifentanil 마취유도 시 McCoy와 Macintosh 후두경 하 기관내삽관이 혈압 및 심박수에 미치는 영향
신현정 ( Hyun Jung Shin ),신영덕 ( Young Duck Shin ),김상태 ( Sang Tae Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4
Background: This study was designed to compare the hemodynamic changes in response to direct laryngoscopy with using the McCoy or Macintosh blade. Methods: Seventy seven patients were randomly allocated into two groups. The induction of anesthesia was done with target controlled infusion of propofol (5 μg/ml) and remifentanil (3 ng/ml) and vecuronium 0.1 mg/kg was also given. The vocal cords were visualized with either the McCoy or the Macintosh laryngoscope blade, and then tracheal intubation was performed. The heart rate and blood pressure were measured just before induction, at intubation and at 1, 3 and 5 minutes after intubation. Results: There were no significant differences in the blood pressure and heart rate responses to tracheal intubation with using the McCoy or Macintosh blade. But, in the Macintosh groups, the blood pressure at 1 and 3 minutes and the heart rate at 1 minute after intubation were increased significantly compared with the preintubation values. Also, in the McCoy groups, the blood pressure and heart rate at 1 minute after intubation were significantly higher than the preintubation values. Conclusions: The McCoy and the Macintosh blade show similar changes in heart rate and blood pressure after tracheal intubation. (Korean J Anesthesiol 2009;56:387~91)
증례보고 : 비중격비성형술 후 발생한 일시적 혀 밑신경 마비
주지원 ( Ji Won Ju ),신영덕 ( Young Duck Shin ),민병상 ( Byoung Sang Min ),한석희 ( Seok Hee Han ),정태원 ( Tae Won Jung ),박상용 ( Sang Yong Park ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Hypoglossal nerve palsy is a rare complication after general anesthesia with orotracheal intubation. It can present with symptoms of tongue deviation, dysarthria and swallowing difficulties. We report 33-year-old female who was scheduled to undergo surgery for a nasal bone fracture under general anesthesia, using orotracheal intubation. After surgery, she complained right side tongue deviation and, dysarthria, and was diagnosed with right hypoglossal nerve palsy. The cause of the hypoglossal nerve palsy was assumed to be a complication of the orotracheal intubation. Fortunately, the patient fully recovered 2 weeks after surgery. (Korean J Anesthesiol 2007; 52: 617~9)
노인 환자에서 Propofol로 마취유도 시 기관내삽관에 따른 심혈관계변화를 최소화하기 위한 Remifentanil의 적정 효과처 농도는?
탁양주 ( Yang Ju Tak ),신현정 ( Hyun Jung Shin ),김은석 ( Eun Seok Kim ),구본욱 ( Bon Wook Koo ),신영덕 ( Young Duck Shin ),김상태 ( Sang Tae Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4
Background: The addition of remifentanil during propofol TCI (target controlled infusion) attenuates the hemodynamic changes induced by endotracheal intubation. This study examined the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation in elderly patients. Methods: Fifty ASA 1 or 2 elderly patients scheduled for elective surgery under general anesthesia were assigned randomly to one of two groups according to the effect-site concentration of remifentanil. Each group was administered 4 μg/ml of propofol TCI with 1 ng/ml (group R1) or 3 ng/ml (group R3) of remifentanil. The heart rate (HR), systolic (SAP), mean (MAP) and diastolic arterial pressure (DAP) were measured at pre-induction, before and after endotracheal intubation. Results: After intubation, the HR, SAP, MAP and DAP increased significantly in the two groups compared with the pre-intubation values. However, the HR, SAP, MAP and DAP for group R3 were lower than group R1 for 5 min after intubation. Conclusions: In elderly patients administered 4 μg/ml of propofol TCI, we suggest that the optimal effect-site concentration of remifentanil to minimize the cardiovascular changes to endotracheal intubation is 3 ng/ml rather than 1 ng/ml. (Korean J Anesthesiol 2009;56:392~7)
증례보고 : 설갑상선으로 인하여 유발된 예기치 못한 어려운 기관내 삽관
민병상 ( Byoung Sang Min ),주지원 ( Ji Won Ju ),한석희 ( Seok Hee Han ),신영덕 ( Young Duck Shin ),정태원 ( Tae Won Jung ),김윤환 ( Yoon Hwan Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
Lingual thyroid is a rare clinical entity that is due to the failure of the thyroid gland to descend early in the course of embryogenesis. It may be present with symptoms of dysphagia and upper airway obstruction. We report here on the case of a 63-year-old female who was scheduled for an operation for lumbar disc herniation and she could not be intubated. The cause of the airway obstruction was an ectopic thyroid at the base of the tongue, which made visualization of the glottis impossible. Several attempts at endotracheal intubation were unsuccessful. Fortunately, the patient was mask ventilated. We awakened the patient and consulted an otolaryngologist, and she was diagnosed with lingual thyroid. After a week, she was operated on using spinal anesthesia. (Korean J Anesthesiol 2006; 51: 236~8)
민병상 ( Byoung Sang Min ),정태원 ( Tae Won Jung ),한석희 ( Seok Hee Han ),신영덕 ( Young Duck Shin ),박상용 ( Sang Yong Park ),주지원 ( Ji Won Ju ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3
We experienced a case of acute cerebral infarction during spinal anesthesia. The patient was a seventy years old male with diagnosis of right femur periprosthetic fracture scheduled for a open reduction & internal fixation under spinal anesthesia. Intraoperatively, he developed a mental confusion and his blood pressure decreased from 115/70 mmHg to 80/45 mmHg. After operation, he appeared to have left hemiparesis and left facial palsy. Angiogram revealed thrombus in superior division of the right middle cerebral artery. He expired 3 months after the surgery despite supportive measures. (Korean J Anesthesiol 2007; 52: 346~9)
견관절경 수술 후 초기 통증에 대한 사각근간 차단 마취술의 유용성
김용민(Yong-Min Kim),박경진(Kyoung-Jin Park),김동수(Dong-Soo Kim),최의성(Eui-Sung Choi),손현철(Hyun-Chul Shon),조병기(Byung-Ki Cho),신영덕(Young-Duck Shin),배승환(Seung-Hwan Bae) 대한정형외과학회 2011 대한정형외과학회지 Vol.46 No.4
목적: 견관절의 관절경 수술은 그동안 전신 마취하에 주로 실시되었는데, 수술 후 초기 통증이 매우 심할 뿐 아니라 잘 조절되지 않았다. 이에 본 연구에서는 견관절경 수술에 있어 상완신경총 사각근간 차단술 마취를 전신 마취와 비교하여 상완신경총 사각근간 차단술의 술 후 초기 통증 조절의 유용성에 대해 알아보고자 하였다. 대상 및 방법: 2008년 9월부터 2009년 3월까지 회전근개 파열로 견관절경 수술을 시행받은 환자 가운데 40예를 대상으로 전향적, 무작위 검사를 실시하였다. 상완신경총 사각근간 차단 마취하에 수술한 20예, 전신 마취하에 수술한 20예로 나누었으며 두 군의 수술 전과 수술 후 3일간의 통증 정도를 visual analogue scale (VAS)을 이용하여 측정하였다. 그리고 입원 중 자가진통조절기(patient controlled analgesia, PCA)의 사용 시간과 추가적인 진통제 사용량을 조사하였다. 그밖에 두 군 간의 자세적인 차이와 자세에 따른 합병증을 조사하였다. 그리고 유의성을 알기 위해 이원 반복 측정 분산 분석으로 통계학적 분석을 하였다. 결과: 두 군간의 수술 전 VAS score는 유의한 차이를 보이지 않았으며 상완 신경총 사각근간 차단 마취군의 경우 수술 직후부터 수술 후 48시간까지 VAS score가 전신 마취군과 비교하여 유의하게 적었다. 입원 중 PCA의 사용기간은 사각근간 차단 마취군에서 유의하게 길었음을 확인할 수 있었고 추가적인 진통제 사용은 사각근간 차단 마취군에서 유의하게 적었다. 결론: 상완 신경총 사각근간 차단 마취후 시행한 견관절경 수술은 수술 후 48시긴 간의 통증이 유의하게 적어 환자의 초기 재활치료를 수월하게 시행할 수 있었고 추가적인 진통제 사용 또한 적어 진통제로 인한 부작용을 최소화 할 수 있었다. 따라서 상완 신경총 사각근간 차단마취는 견관절경 수술에 있어 수술 초기 통증을 효과적으로 감소시킬 수 있는 좋은 마취법이라 생각된다. Purpose: After shoulder arthroscopy via general anesthesia, most patients complain of severe pain during the early post operative period. In this study, the efficacy of pain control during the early post operative period with interscalene block anesthesia for shoulder arthroscopy was investigated and compared with general anesthesia. Materials and Methods: A prospective randomized controlled study was conducted on 40 patients who underwent shoulder arthroscopy between September 2008 and March 2009. The patients were grouped according to the method of anesthesia. The visual analogue scale (VAS) at the preoperative and early postoperative periods was checked and compared. In addition, the duration of patient controlled analgesia (PCA) usage and additional pain killer injections were examined. Results: There was no significant difference between the two groups for the VAS score before surgery, but the interscalene block group showed a significantly lower VAS score. The duration of PCA usage was also significantly longer for the interscalene block group, which implies less pain The number of additional pain killer injections was significantly less in the interscalene block group. Conclusion: The patients who underwent shoulder arthroscopy with interscalene block had significantly less pain during the immediately post operative period for up to 48 hours. So patients could conduct initial rehabilitation and experience minimized side effects caused by analgesics due to the decreased use of pain killer. Therefore, interscalene block is considered a good method of anesthesia for the immediate postoperative pain control after shoulder arthroscopy.