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인공 심폐기 동안 동맥혈 이산화탄소 분압과 산소공급기 배기가스 이산화탄소 분압간의 관계
진지현 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.3
Background: The neurologic deficit is one of the most serious complications after cardiopulmonary bypass (CPB). This complication has reported to be closely associated with arterial partial pressure of carbon dioxide tension (PaCO2). The traditional way to measure PaCO2 is by intermittent arterial gas analysis during CPB. We tested the relationship between PaCO2 and CPB exhausted partial pressure of carbon dioxide tension (exPCO2) which can be monitored continuously during CPB. Methods: The total 46 patients who underwent cardiac surgery under CPB were studied. Capnography sampling line was connected to CPB exhausted port to monitor exPCO2. We sampled arterial blood from CPB for gas analysis at cooling, stable hypothermia, and rewarming phase and recorded exPCO2 simultaneously at each phase. Results: We found out that exPCO2 was associated with temperature corrected PaCO2 (cPaCO2) at all 3 phases(r = 0.73, 0.70, 0.84, P < 0.05) and with temperature uncorrected PaCO2 (ucPaCO2) at cooling (r = 0.64, P < 0.05) and rewarming phases (r = 0.81, P < 0.05). Conclusions: We concluded that exPCO2 could be used to monitor either ucPaCO2 or cPaCO2 at cooling and rewarming phase and cPaCO2 at hypothermia during CPB.
진지현,이은호,최대기,최인철 대한의학회 2010 Journal of Korean medical science Vol.25 No.7
Airway management during carinal resection should provide adequate ventilation and oxygenation as well as a good surgical field, but without complications such as barotraumas or aspiration. One method of airway management is high frequency jet ventilation (HFJV) of one lung or both lungs. We describe a patient undergoing carinal resection, who was managed with HFJV of one lung, using a de-ballooned bronchial blocker of a Univent tube without cardiopulmonary compromise. HFJV of one lung using a bronchial blocker of a Univent tube is a simple and safe method which does not need additional catheters to perform HFJV and enables the position of the stiffer bronchial blocker more stable in airway when employed during carinal resection.
증례보고 : 경요도 방광종양 절제술을 위한 폐쇄신경 차단 도중에 발생한 예기치 못한 척추바늘의 분리
진지현 ( Ji Hyun Chin ),전인구 ( In Gu Jun ),김영국 ( Young Kug Kim ),강금내 ( Keum Nae Kang ),황규삼 ( Gyu Sam Hwang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Obturator nerve block is occasionally performed during transurethral resection of lateral bladder wall tumors to prevent the violent contraction of the adductor muscle of the thigh. Rare complications including intravascular injection of the local anesthetics and hematoma formation may occur during the obturator nerve block. We report a case of the unintentional breakage of the spinal needle during the obturator nerve block with successful removal of the broken spinal needle by an orthopedic surgeon. (Korean J Anesthesiol 2007; 53: 250~3)
증례보고 : 경요도전립선절제술 중 발생한 무증상의 심한 희석성 저나트륨혈증
진지현 ( Ji Hyun Chin ),황규삼 ( Gyu Sam Hwang ),김영국 ( Young Kug Kim ),상보현 ( Bo Hyun Sang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
The transurethral resection of the prostate (TURP) syndrome is caused by intravascular absorption of an electrolyte-free irrigating fluid during TURP for benign prostatic hypertrophy or prostatic carcinoma. The clinical symptoms and signs include hypertension, bradycardia, respiratory distress, hypotension, nausea, vomiting, confusion, blindness, seizure, coma, hyponatremina, and hypoosmolality. In this case, we incidentally detected very severe dilutional hyponatremia (99 mmol/L) without any symptoms during TURP and immediately took measures to treat TURP syndrome. On the third postoperative day, the hyponatremia had resolved within the normal range. (Korean J Anesthesiol 2007; 53: 815∼8)
증례보고 : 근치적 신적출술과 하대정맥 혈전제거술 시 발생한 치명적인 심장 및 폐색전증
진지현 ( Ji Hyun Chin ),이유미 ( Yu Mi Lee ),김영국 ( Young Kug Kim ),황규삼 ( Gyu Sam Hwang ),황재현 ( Jai Hyun Hwang ),조성강 ( Sung Kang Cho ),한성민 ( Sung Min Han ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Intraoperative pulmonary embolism can result in severe hemodynamic instability, including cardiac arrest. Therefore, immediate diagnosis and proper treatment are required. We report a case of the acute cardiac and pulmonary embolisms during radical nephrectomy and inferior vena cava (IVC) thrombectomy in a patient with renal cell carcinoma with thrombus in the IVC. We diagnosed the cardiac embolism intraoperatively using the transesophageal echocardiogram, and performed emergent cardiac and pulmonary embolectomies immediately. After the surgery, the patient was discharged without any complication. (Korean J Anesthesiol 2007; 52: 600~4)
Cardiovascular collapse due to right heart failure following ethanol sclerotherapy -a case report-
조준영,진지현,박평환,구승우 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.66 No.5
Ethanol sclerotherapy for the treatment of low-flow vascular malformations can cause catastrophic cardiopulmonary complications, including pulmonary embolism and pulmonary hypertension, that can result in right heart failure and fatal arrhythmias, leading to death. We here report a case of abrupt cardiovascular collapse that developed immediately following ethanol sclerotherapy in 31-year-old female patient who had a large arteriovenous malformation in her leg. Anesthesiologists should be aware of the fatal cardiopulmonary complications that are associated with ethanol sclerotherapy and consider the use of invasive hemodynamic monitoring, such as pulmonary artery pressure monitoring, when large doses of ethanol are required.
양홍석,이주현,진지현,고원욱,노영진 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.2
Micro-emboli have been reported to occur commonly during arthroscopic surgery, which is frequently performed as an orthopedic surgical procedure. We here report a patient who experienced unilateral postoperative visual loss after a hip arthroscopy using irrigation fluid in the supine position without any evidence of external compression to either eye throughout the surgical procedure. Retinal fundoscopy suggested that the patient had central retinal artery occlusion, one of the causes of the postoperative visual loss. This case suggests that arthroscopic surgery may pose a substantial risk for paradoxical air embolism, such as central retinal artery occlusion, and suggests the need to prevent the entry of micro-air bubbles during such a type of surgery.
최병문 ( Byung Moon Choi ),진지현 ( Ji Hyun Chin ),김영국 ( Young Kug Kim ),함경돈 ( Kyung Don Hahm ),심지연 ( Ji Yeon Sim ),최인철 ( In Cheol Choi ),황규삼 ( Gyu Sam Hwang ),한성민 ( Sung Min Han ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
An inguinal hernia shows that the protruding viscus exits from the endoabdominal fascial sac through the internal inguinal ring. Because an inguinal hernia is usually associated with incarceration, obstruction and even strangulation, it must be quickly treated whenever observed. Although there are several predisposing factors of the development of inguinal hernia, relatively little is a case report of the inguinal hernia developed by the increased intra-abdominal pressure during general anesthesia. In this case, we report a patient who developed the unexpected recurrence of left inguinal hernia following lumbar spinal surgery in prone position by increasing intra-abdominal pressure. After manual reduction was performed promptly by general surgeon, the patient was discharged without any complication on the eighth postoperative day. (Korean J Anesthesiol 2006; 51: 239~42)
노규정,김태희,김동희,진지현,최병문,이무송 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
Background: The Rhodes index of nausea, vomiting and retching (RINVR) is a patient self-report instrument to assess the objective and subjective factors of nausea and vomiting. The aim of this study is to evaluate the reliability and validity of the RINVR in postoperative nausea and vomiting (PONV). Methods: The RINVR, VAS for nausea and incidence of emetic episodes were administered to 150 patients approximately 30 minutes apart at 6 hours and 24 hours after surgery. The validity was evaluated by Spearman's correlation and internal consistency of reliability was determined using Cronbach's alpha. To determine test-retest reliability, second administration of the RINVR was done 2 hours after the first. The test-retest reliability was evaluated by Spearman's correlation and agreement. Results: Cronbach's alpha of nausea, vomiting, retching and total experience scores of the RINVR ranged from 0.912 to 0.968. Test-retest scores of all items were strongly correlated (Spearman's coefficients: 0.962-1.000, P < 0.0001) and highly agreed (weighted kappa: 0.932-1.000). Coefficients of construct validity for nausea components (vs VAS for nausea) and emetic components (vs incidence of emetic episodes) of the RINVR were 0.860-0.928 and 0.724-0.811, respectively (P < 0.0001). The overall weighted kappa between the incidences of PONV assessed by the RINVR and by patient self-assessment of VAS for nausea and incidence of emetic episodes was 0.917-0.945. The number of patients in “great” total experience category was 1.33% or less. There was no significant difference of VAS for nausea between “severe” and “great” nausea experience categories. Conclusions: The RINVR was a reliable and valid instrument to assess PONV.
손효정,오진영,김욱종,진지현,이은호,최인철 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.2
The double-lumen tube is widely used in various kinds of cardiothoracic surgery as a facilitation for easier procedures. SilbronchoⓇ (Fuji systems, Tokyo, Japan) double-lumen tube, which is made of flexible silicone material, reduces injury to the tracheal and bronchial mucosa during intubation. The bronchial lumen is wire-reinforced to maintain tip angulation and prevent bending or obstruction. However, its increased flexibility resulted in distortion,especially when we encountered resistance to passage. We document an unusual complication case which involved folding of the endobronchial segment of the double-lumen tube after blind intubation in difficult airways. (Anesth Pain Med 2011; 6: 154∼156)