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김범석 ( Bum Suk Kim ),구민석 ( Min Seok Koo ),임필재 ( Pil Jae Lim ),김상호 ( Sang Ho Kim ),이명애 ( Myung Ae Lee ),곽호성 ( Ho Sung Kwak ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
The temporomandibular joint can be dislocated during anesthesia as a result of excessive oral opening and direct laryngoscope handling. Occasionally, yawning can be observed during the induction of anesthesia with propofol. The forceful and voluntary yawning after a propofol injection can lead to a dislocation of the temporomandibular joint. We report a case of an anterior dislocation of the temporomandibular joint upon induction with propofol, which caused difficulties in mask ventilation and endotracheal intubation. Although intubation had been carried out successfully in this case, an unanticipated difficult airway can be confronted at anytime. Therefore, anesthesiologists should be aware of the management of a difficult airway and practice various methods according to a difficult airway algorithm. (Korean J Anesthesiol 2006; 51: 483~5)
복강경하 담낭절제술을 받는 심질환 노인에서 역 Trendelenburg체위가 혈역학에 미치는 영향
김교상 ( Kyo Sang Kim ),이시민 ( Si Min Yi ),전종헌 ( Jong Hun Jun ),정미애 ( Mi Ae Cheong ),구민석 ( Min Seok Koo ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4
Background: We studied the hemodynamic changes induced by pneumoperitoneum and a reversed Trendelenburg in elderly patients with increased cardiac risk (ASA class III; n=30; age 70.8±4.9 years, mean±SD) and compared the results with elderly patients at normal risk (ASA class II; n=30; age 69.2±4.1 years) during laparoscopic cholecystectomy. Methods: The transesophageal Doppler monitor was performed after induction of general anesthesia (pre-incision), after onset of pneumoperitoneum (insufflation), after head-up (20°) and a left lateral tilt (15°) (reversed Trendelenburg) and after deflation and horizontal position (desufflation). Mean arterial pressure (MAP), heart rate, cardiac index (CI) and systemic vascular resistance (SVR) were measured, respectively. Results: Induction of pneumoperitoneum and head-up tilt in patients with cardiac risk resulted significantly in a decrease in CI and an increase in SVR compared with patients with normal risk (P<0.05), and that remained until deflation, but no interval changes in MAP and heart rate. The CI, MAP and heart rate decreased and SVR increased significantly in patients with cardiac risk compared with patients with normal risk before incision (P<0.05). No complications occurred. The results indicate that pneumoperitoneum and a reversed Trendelenburg are associated with significant but relatively benign hemodynamic changes. Conclusions: Anesthesia for laparoscopic cholecystectomy in elderly patients with increased cardiac risk should be performed with an adequate hemodynamic monitoring. (Korean J Anesthesiol 2009;56:398~402)
우동희 ( Dong Hee Woo ),김상호 ( Sang Ho Kim ),장설 ( Sul Jang ),최병문 ( Byung Moon Choi ),구민석 ( Min Seok Koo ),이명애 ( Myung Ae Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3
The incidence of post-dural puncture meningitis is very low. A 44-year-old patient developed a fever (38℃, headache, neck stiffness, nausea, and vomiting after combined spinal epidural (CSE) anesthesia and surgery for closed reduction and internal fixation (CRIF) with intramedullary (IM) nailing, tibia, Rt. With a preliminary diagnosis of bacterial meningitis, empiric broad spectrum antimicrobial treatment was immediately started after cerebrospinal fluid (CSF) sampling. The CSF was clear and revealed a white blood cell count, protein, glucose, and pressure of 146/μl, 225 mg/dl, 48 mg/dl (serum 151 mg/dl), and 26 cmH2O, respectively. The CSF stain and culture were negative. Considering the injection of preventive antibiotics before CSE anesthesia, partially treated bacterial meningitis was suspected. Four weeks later, clinical symptoms had improved before the patient was discharged. (Korean J Anesthesiol 2009; 56: 337~40)
고성경,구민석 大邱大學校附設 基礎科學硏究所 2004 基礎科學硏究 Vol.21 No.1
The purpose of this study is to review the exercise therapy for the low back pain patients. The vertebral column consist of 26 vertebrae. Among the vertebrae, the lumbar vertebrae are heaviest and biggest because of concentration of body weight. L3-L5, S1, between lumbar curvature and Sacrum, are frequent body sites for the low back pain. The risk factors of low back pain are the life-style as like occupation and work, and personal characteristics as like age, sex and history. The exercise for the low back pain patients recommend stretching for the trunk flexibility, abdominal training for muscular strength, and whole body exercise for physical fitness. These exercise should be practice during 3-6 months except for patients with contraindications.