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잘못 장착된 기화기로 인한 전신마취 중 각성 -증례보고-
김경헌 ( Kyoung Hun Kim ),조상윤 ( Sang Yun Cho ),김규남 ( Kyu Nam Kim ),심재항 ( Jae Hang Shim ),전우재 ( Woo Jae Jeon ),염종훈 ( Jong Hoon Yeom ),신우종 ( Woo Jong Shin ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Awareness with recall after general anesthesia is a relatively infrequent occurrence and this awareness is often associated with significant adverse psychological sequelae, including posttraumatic stress disorder. The occurrence of awareness is often the consequence of the light anesthetic techniques with using minor anesthetic agents. Because the locking lever of the Penlon Sigma Delta Anesthetic vaporizer (sevoflurane) was at the unlock position, disconnection happened between the anesthetic machine and the vaporizer (the Selectatec(R) vaporizing system). In our two cases, the inhalation agents were not supplied and awareness with recall was identified after surgery. We recommend to check the concentration of the inhalation agents by monitoring the concentration of using endtidal inhalation agents and to measure the hypnotic level of anesthesia via the bispectral index (BIS) and the auditory evoked potential (AEP). (Korean J Anesthesiol 2009; 56: 693~7)
김경헌(Kyoung Hun Kim),강주용(Ju Yong Kang),이명철(Myung Chul Lee),최익준(Ik Joon Choi) 대한두경부종양학회 2017 대한두경부 종양학회지 Vol.33 No.2
Verrucous carcinoma was first described by Ackerman who reported a case of verrucous carcinoma of the oral cavity. While it is primarily occurred in oral cavity, larynx is the second most affected site, accounting for nearly 35% of cases. It is a rare variant of well-differentiated squamous cell carcinoma and comprises 1% to 4% of all laryngeal carcinomas. It is characterized by locally invasive, slow growth and the surface shows papillary fronds with prominent hyperkeratosis. Because of the benign appearance and difficulty of the tissue diagnosis, it is often undiagnosed or misdiagnosed. The primary treatment modality is surgery and the extent of surgical resection may be guided by T stage. We experienced a case of verrucous carcinoma of larynx in a patient with hoarseness lasted for about 2 years and had difficult to diagnosis and treatment. Therefore we report this case with a brief review of literature.
김경헌(Kyoung Hun Kim),김남영(Nam Young Kim),이국행(Guk Haeng Lee),최익준(Ik Joon Choi) 대한두경부종양학회 2017 대한두경부 종양학회지 Vol.33 No.1
A non-recurrent laryngeal nerve on the left side is a rare anomaly which is reported in 0.04% and it is associated with abnormal developments of the aortic arch during embryogenesis. Although the possibility is extremely low, it is important to consider the possible existence of a non-recurrent laryngeal nerve to prevent a nerve injury during thyroidectomy. We experienced a 42 year-old male with left thyroid papillary cancer who had right side aortic arch and aberrant left subclavian artery. Even though we found that this patient had a recurrent laryngeal nerve, we present this case of the right aortic arch with an aberrant left subclavian artery variation with a brief review of literature.
임상연구 : Sevoflurane 마취 시 아산화질소가 Bispectral Index에 미치는 영향
김경헌 ( Kyoung Hun Kim ),최윤정 ( Yun Jeong Choi ),심재항 ( Jae Hang Shim ),전우재 ( Woo Jae Jeon ),조상윤 ( Sang Yoon Cho ),신우종 ( Woo Jong Shin ),염종훈 ( Jong Hoon Yeom ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: Nitrous oxide is generally avoided in order to prevent either hypoxia or graft dislodgment during tympanoplasty. The aim of this study was to investigate the effect of nitrous oxide on the bispectral index during sevoflurane anesthesia at the anesthetic dose. Methods: The bispectral index was continually measured during nitrous oxide-oxygen-sevoflurane anesthesia, discontinuation of nitrous oxide and the reintroduction of nitrous oxide. Results: The bispectral index of nitrous oxide-oxygen-sevoflurane anesthesia increased after discontinuing the nitrous oxide and decreased after its reintroduction. Conclusions: Nitrous oxide decreased the bispectral index of nitrous oxide-oxygen-sevoflurane anesthesia compared with oxygen-sevoflurane anesthesia at the anesthetic dose. (Korean J Anesthesiol 2006; 50: 511~4)
김남영(Nam Young Kim),김경헌(Kyoung Hun Kim),박성호(Sung Ho Park),이국행(Guk Haeng Lee),이병철(Byeong Cheol Lee),이명철(Myung-Chul Lee),최익준(Ik Joon Choi) 대한두경부종양학회 2015 대한두경부 종양학회지 Vol.31 No.2
Background and Objectives: This study aimed to analyze the features of patients with papillary thyroid carcinoma (PTC) recurred as distant metastases (DM). Materials and Method: We retrospectively reviewed and analyzed clinical records of 63 patients who were treated for PTC recurred as DM between 2000 and 2006. Univariate and multivariate analyses of various clinical factors were performed. Results: Male patients were 12, and female patients were 51. The 5- and 10-year survival rates for PTC recurred as DM were 85% and 73%, respectively. Size of tumor, multi-plicity of tumor, lateral neck node metastasis, and RAI ablation therapy with other treatments such as surgery were associated with survival rate (p < 0.005) in univariate analysis. The lateral neck node metastasis[p =0.039, hazard ratio=2.2(95% CI. 1.18~3.24)] and multiple organ DM[p =0.041, hazard ratio=2.18(95% CI. 1.03~2.89)] were related to the survival in multivariate analysis. Conclusion: PTC recurred as DM is uncommon (2.2%). The size of tumor, the multiplicity of tumor, lateral neck node metastasis and RAI ablation therapy with other treatments for DM were revealed as associated factors for the survival. Evaluation of DM should be considered in patients with PTC during long-term follow-up.
김영선 ( Young Sun Kim ),신우종 ( Woo Jong Shin ),신중천 ( Joong Cheon Shin ),심재항 ( Jae Hang Shim ),전우재 ( Woo Jae Jeon ),조상윤 ( Sang Yoon Cho ),염종훈 ( Jong Hoon Yeom ),김경헌 ( Kyoung Hun Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: High monitors are patients who require information on anesthesia and surgery and generally carry out active searches. These patients will benefit from more information related to surgery preoperatively whereas low monitors will benefit from less detailed information. This study examined whether or not patients` desire for information related to anesthesia and surgery differ according to their coping style classified by the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Methods: 465 patients were asked to fill out the questionnaires in APAIS, State-Trait anxiety inventory (STAI) and also to mark their perception on a 10 cm line in a visual analog scale (VAS). The APAIS with the other subjective measurements of anxiety were evaluated according to their gender, ASA class, past history of surgery and degree of education. Thirteen questionnaires were evaluated according to their coping styles. Results: High monitors wanted to know all 13 questions compared with low monitors, whereas low monitors preferred not to know (P<0.05). The APAIS has a significant relationship with the VAS and STAI (P<0.05). Women, patients with no prior history of surgery, and patients with ASA 2 were significantly more anxious than men, patients with a prior experience of surgery and ASA 1 patients, respectively (P<0.05). The VAS and APAIS were in good agreement in defining patients as anxious and there were significant correlations between the two instruments (P<0.05). Conclusions: The APAIS can be used as an efficient tool for identifying patients who are particularly anxious or require information. (Korean J Anesthesiol 2007; 53: 153~8)