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증례보고 : 경막외마취 후 발생한 심한 저혈압을 동반한 당뇨병성 케톤산혈증
노운석 ( Woon Seok Roh ),이도석 ( Do Seok Lee ),이준석 ( Jun Seog Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Morbidity and mortality are higher in diabetics undergoing surgery, which most often reflect various cardiovascular complications. Ketoacidosis is the most serious acute metabolic complications of diabetes perioperatively. Ketoacidosis has adverse effects such as decreased myocardial contractility and peripheral vascular tone, dehydration and electrolyte imbalances. We encountered a case of a 47 year-old man who presented with ketoacidosis and severe hypotension 15 minutes after being administered epidural anesthesia for femoro-popliteal arterial bypass surgery. This case highlights the need for anesthesiologists to consider the possibility that ketoacidosis can mimic severe hypotension due to epidural anesthesia or cardiogenic shock. (Korean J Anesthesiol 2006; 51: 391~4)
증례보고 : 말기 신부전증 환자의 동정맥루 수술에서 액와 상완 신경총 차단후 Lidocaine 정주로 촉발된 고칼륨성 심정지
송석영 ( Seok Young Song ),신흥동 ( Heung Dong Shin ),서귀주 ( Kwi Chu Seo ),정진용 ( Jin Yong Chung ),노운석 ( Woon Seok Roh ),김봉일 ( Bong Il Kim ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.6
Axillary brachial plexus blockade (BPB) is commonly used as an anesthetic method for patients undergoing the creation of an arteriovenous fistula (AVF) during end-stage renal disease (ESRD). Several studies have shown that the combination of intravenous lidocaine and hyperkalemia in ESRD can produce severe conduction disturbance and asystole. Here, we report a case of cardiac arrest in a 41 year old male patient who manifested severe cardiac conduction disturbance during creation of an AVF. Sixty-five minutes after BPB, the intravenous therapeutic doses of lidocaine administered to treat frequent premature ventricular contractions aggravated his heart rhythm and produced a sine wave and ventricular fibrillation. It was assumed that ventricular fibrillation was induced by a combination of local anesthetics administered during BPB and systemic hyperkalemia as a result of the ESRD [ED highlight-please ensure my changes do not alter your intended meaning]. The patient was completely resuscitated 45 minutes after the cardiopulmonary resuscitation and correction of the hyperkalemia. (Korean J Anesthesiol 2008; 55: 756~60)
증례보고 : 사각근간 상박 신경총 차단하 견관절경 수술 시 좌위에서 발생한 무수축성 심정지
박찬홍 ( Chan Hong Park ),권홍태 ( Hong Tae Kwon ),노운석 ( Woon Seok Roh ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
An interscalene block for shoulder surgery provides excellent surgical conditions and is well received by patients. However, a combination of the sitting position, regional anesthesia, an awake patient, and a surgical procedure can result in another side effect, vasovagal episodes, which may lead to cardiac arrest in extreme cases. We experienced a case of 32-year-old male patient with a severe vasovagal episode that led to asystolic cardiac arrest 15 minutes after the changing to the sitting position under an interscalene block for shoulder arthroscopic surgery. (Korean J Anesthesiol 2006; 51: 383~6)