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Intraoperative management of critical arrhythmia
김성협,권창희 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.2
The incidence of intraoperative arrhythmia is extremely high, and some arrhythmias require clinical attention. Therefore, it is essential for the anesthesiologist to evaluate risk factors for arrhythmia and understand their etiology, electrophysiology, diagnosis, and treatment. Anesthetic agents reportedly affect normal cardiac electrical activity. In the normal cardiac cycle, the sinoatrial node initiates cardiac electrical activity through intrinsic autonomous pacemaker activity. Sequential atrial and ventricular contractions result in an effective cardiac pumping mechanism. Arrhythmia occurs due to various causes, and the cardiac pumping mechanism may be affected. A severe case may result in hemodynamic instability. In this situation, the anesthesiologist should eliminate the possible causes of arrhythmia and manage the condition, creating hemodynamic stability under proper electrocardiographic monitoring.
김성협,김지영,정승민,성태윤,임정애,우남식 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.2
Acute fatty liver of pregnancy is a rare but usually fatal complication of the third trimester.We report the case of a 28-year-old primigravida at 37 weeks of gestation with an acute fatty liver. Continuous fetal heart rate monitoring demonstrated frequent late fetal heart decelerations and the lack of beat-to-beat variability during the induction of vaginal delivery.We decided to perform an emergency cesarean section under a combined general-epidural anesthesia with bispectral index.No complications occurred during or after surgery except for a delayed recovery from the muscle relaxant.The patient made an uneventful recovery and discharged at eight days after cesarean section.
Remimazolam – current knowledge on a new intravenous benzodiazepine anesthetic agent
김성협,Fechner Jörg 대한마취통증의학회 2022 Korean Journal of Anesthesiology Vol.75 No.4
Intravenous anesthetic agents such as midazolam, propofol, and ketamine are routinely used to provide anesthesia and sedation. They have been shown to effectively induce and maintain amnesia, sedation, and hypnosis in various patient groups and clinical settings. However, all anesthetic agents have the potential to cause unwanted side effects such as hemodynamic instability, respiratory depression, or slow recovery due to prolonged post-procedural sedation. Remimazolam, a recently approved benzodiazepine for general anesthesia and procedural sedation in Korea, has been successfully used for these purposes. To date, inconclusive knowledge has been obtained regarding the use of remimazolam in different patient populations and under various surgical conditions. With respect to the specific pharmacokinetic and pharmacodynamic characteristics of remimazolam, the use of remimazolam is expected to increase providing safe general anesthesia and sedation. This review aims to provide an overview of the basic and clinical pharmacology of remimazolam and to compare it with midazolam and propofol.
수용성 조영제의 피하주사시의 조직손상에 관한 실험적 연구
김성협 대한영상의학회 1989 대한영상의학회지 Vol.25 No.2
The water soluble contrast media cause tissue necrosis infrequentely by extravasation during intravenous injection in various radiological examinations. However it has not been well documented that what kind and what concentration of contrast media can cause tissue necrosis. And also the mechanism of tissue necrosis by extravasated contrast media has not been well known. The purpose of this experimental study was to evaluate the frequency and severity of tissue damage following subcutaneous injection of various water soluble contrast media to investi-gate the characteristics of the contrast media acting on the tissue damage and to provide the basic data for the clinical application, Meglumine ioxithalamate sodium and meglumine ioxithalamate iopromide iopamidol iox-aglate meglumine diatrizoate and sodium diatrizoate of various iodine content and osmolality were injected into subcutaneous tissue of the dorsum of 970 feet of 485 rats. The tissue reaction of injection sites were grossly examined with period from 1 day to 8 weeks after the injection, Representative gross changes were correlated with histologic findings. The results were as follows; 1. The basic tissue damage by extravasated contrast media was acute and chronic inflammatory reaction of the soft tissue with subsequent progress into the henmorrhagic and necrotizing lesion, 2. Larger volume of contrast media cause more severe tissue damage. 3. Contrast media of higher osmolality caused more severe tissue damage. 4. AT same osmolality contrast media of higher iodine content caused more severe tissue damage.5. Ionic contrast media of meglumine salt caused more severe tissue damage than those of sodium salt. 6. There was no significant difference of tissue damage between ionic and non-ionic contrast media under the same or similar osmolality and iodine content. 7. The younger rats showed more severe tissue damage by contrast media of high osmolality. It is therefore recommended to use the contrast media of lower osmolality and lower iodine content regardless of ionic or non-ionic and to use the contrast media containing sodium salt rather than meglumine salt in case of high risk of extravasation in clinical practice.
김성협,Jae-Sung Ryu,김태엽,Tae-Gyoon Yoon,Woon-Seok Kang,Ji Eun Song 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.2
Intracardiac thrombus during cardiopulmonary bypass (CPB) with full heparinization is very rare but fatal. A 60-year-old woman was scheduled for aortic and mitral valve repairs with a maze procedure for mixed aortic and mitral valvular heart disease with atrial fibrillation. Preoperative transthoracic echocardiography and cardiac computed tomography showed moderate aortic regurgitation and moderate mitral stenosis with regurgitation. There was no intracardiac thrombus. Aortic and mitral valve repairs with the maze procedure were successfully performed without unexpected events. During CPB weaning, a mobile hyper-echogenic mass in the left atrium was detected on transesophageal echocardiography. After cardiac arrest, it was surgically removed. On completion of the operation,weaning from CPB was accomplished uneventfully. The patient fully recovered and was discharged from the intensive care unit on her third postoperative day.
제왕 절개술시 음악이 산모의 혈역학적 변화와 혈중 Cortisol 에 미치는 영향 및 인지와 상기에 미치는 영향
김성협,임정애,강포순,우남식,김혜경 건국대학교 의과학연구소 2003 건국의과학학술지 Vol.13 No.-
Light plane of general anesthesia for cesarean section is usually applied to the mother for the fetal safety. The mother have increased awareness and recall due to stress under light anesthesia. Music is widely used to help patient relax, diverting their attention from unpleasant and stressful situation. It eliminates noise of operating room. Our aim of study was to find the effect of music on maternal cardiovascular response, stress response, intraoperative awareness and recall. Forty patients undergoing cesarean section with general anesthesia were allocated randomly to either control group (n=20) (group 1) or music group (n=20) (group 2). Patients of group 2 listened to music by head phone during an operation. The blood pressure, heart rate, intraoperative awareness using isolated forearm technique OFT), postoperative recall, plasma cortisol level and patient's satisfaction were assessed. Systolic blood pressure and heart rate were decreased significantly in the group 2 than group 1 at 1 minute before intubation and 5 minute after extubation (P<0.05). The incidence of followed commands were 9(45%), 13(65%) in group 1 and 8(40%), 12(60%) in group 2 at 1 minute after intubation and 2 minute after extubation. The incidence of "made reaching movement" were 15(75%), 13(65%), 4(20%) in group 1 and 13(65%), 10(50%), 1 (5%) in group 2 at 1 minute, 2 minute and 3 minute after intubation. Postoperative recall such as auditory perception and dream were 6(30%), 200%) in group 1 and 200%), 4(20%) in group 2. The plasma cortisol level was significantly elevated in the group 1 than group 2 at 30 minute after intubation and 10 minute after arrival at the recovery room (P<0.05). Patients showed good satisfaction with music in group 2. It was found that the playing music to the mother during a cesarean section under general anesthesia decreased anxiety and stress response. This technique may help patients to protect from unwanted and perhaps distorted information by blocking noise in the operating room.