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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 : 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 : 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)
증례보고 : Lesch-Nyhan 증후군 환자의 경피적 신쇄석술을 위한 전신마취 경험
전인구 ( In Gu Jun ),진지현 ( Ji Hyun Chin ),김영국 ( Young Kug Kim ),김영욱 ( Young Uk Kim ),조성강 ( Sung Kang Cho ),황규삼 ( Gyu Sam Hwang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Lesch-Nyhan syndrome (LNS) is a rare, X-linked recessive inherited disorder caused by a deficiency of the enzyme hypoxanthine-guanine-phophoribosyltransferase, leading to excessive purine production and elevation of uric acid. Clinical manifestations include mental retardation, spasticity, choreathetosis, compulsive self-mutilation, renal calculi followed by obstructive nephropathy, and arthritis. Patient with LNS may have increased risk of aspiration pneumonia, acute renal failure and unexpected sudden death. We accomplished successful general anesthesia in a case of LNS requiring percutaneous nephrolithotomy due to renal calculi. (Korean J Anesthesiol 2007; 53: 520~3)
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)
임상연구 : 액와 대퇴 동맥 우회술을 위한 척추마취 시행 시 환자의 자세가 혈압과 심박수에 미치는 영향
박수경 ( Soo Kyoung Park ),김영국 ( Young Kug Kim ),정성량 ( Sung Lyang Chung ),진지현 ( Ji Hyun Chin ),이청 ( Chung Lee ),이유미 ( Yu Mi Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
Background: Hypotension is one of the most common complications from the spinal anesthesia frequently used for surgery on the lower abdomen or extremities. It might be important in prognostic improvements to maintain cardiovascular homeostasis in elderly or patients with cardiovascular diseases. This study evaluated the effect of the patients` position on the preservation of cardiovascular stability when elderly patients suffering from hypertension undergo surgery for an axillo-femoral arterial bypass. Methods: 24 patients with hypertension undergoing an elective axillo-femoral bypass surgery were examined. The patients were randomly allocated into two groups (Lateral 20 min group: patients with lateral position for 20 min after spinal anesthesia; Supine group: patients with the supine position immediately after spinal anesthesia). The observers recorded the hemodynamic variables, as well as the loss of sensation on both sides. Results: Considering the changes in the arterial blood pressure and heart rate from the baseline values, patients in the supine group showed a greater decrease in arterial blood pressure and heart rate (P < 0.05). In the lateral 20 min group, there was a lower block level of cold sensation that reflected the sympathetic blockade at the non-operated site (P < 0.05). Conclusions: The lateral decubitus position for 20 min after spinal anesthesia can contribute to the maintenance of cardiovascular stability during unilateral axillo-femoral bypass surgery in elderly patients with hypertension. (Korean J Anesthesiol 2006; 51: 675~9)
증례보고 : 경식도 심초음파로 흉부 하행대동맥에서 발견된 심방중격 폐쇄장치 (Amplatzer septal occluder)
최대기 ( Dae Kee Choi ),윤선경 ( Sun Kyung Yoon ),진지현 ( Ji Hyun Chin ),하승일 ( Seung Il Ha ),이은호 ( Eun Ho Lee ),최인철 ( In Choel Choi ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4
Percutaneous device closure of atrial septal defect (ASD) has proven to be safe and effective, and become a widely accepted option to the surgical repair. However, the embolization of Amplatzer septal occluder (ASO) occurs in about 0.55% to 3.5% of cases, regardless of ASD size, device size, or the physician`s expertise. We report a case of embolization of an ASO into the thoracic descending aorta, successfully removed through a surgical approach. (Korean J Anesthesiol 2009;56:453~6)
임상연구 : 수술 후 환자에서 기계식 통증자가조절기의 안전성 및 유효성에 관한 임상연구
정용보 ( Yong Bo Jeong ),이무송 ( Moo Song Lee ),최병문 ( Byung Moon Choi ),진지현 ( Ji Hyun Chin ),노규정 ( Gyu Jeong Noh ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2
Background: The disposable patient-controlled analgesia (PCA) devices are convenient for portability and management. An ideal PCA can be developed as an electronic device with various functions of safety and control. Recently, Accumate 1000(R). was developed as an electronic pump in Korea, and has passed the relevant laboratory criteria of safety and efficacy. We conducted a clinical study on the safety and efficacy when the device is applied to patients. Methods: Fentanyl 1,500μg, ketorolac 180 mg, and ondansetron 8 mg were used for PCA. Continuous infusion rate, bolus dose, and lockout time were set at 1 ml/h, 1 ml, and 15 min, respectively. Fifty patients were monitored for 48 h. The safety of Accumate 1000(R). was evaluated by backflow and siphonage, auto-clamp function, and lockout time intraoperatively. The efficacy was evaluated by the accuracy of bolus and total infused dose, and the satisfaction rates of patients and users. Results: Backflow and siphonage did not occur, and the auto-clamp function was excellent. There was no bolus infusion during lockout time, and the bolus dose was infused accurately after lockout time. For the accuracy of the total infused dose, the mean and median value of performance error between the infused and target doses were -0.55%, and -0.29%, respectively. Noise, button sense, and convenience of cable were rated as satisfactory by 90%, 78%, and 84%, of patients respectively. Conclusions: The safety and efficacy of Accumate 1000(R) were established by clinical trial. We can provide patients with the more precise and optimal analgesia. The history of drug infusion can be used as research data. (Korean J Anesthesiol 2007; 52: 161~5)