중환자실에서의 진통, 진정, 섬망

류호걸 대한내과학회 2018 대한내과학회 추계학술대회 Vol.2018 No.2

Intracranial hemorrhage induced uncontrolled seizure in a deceased donor liver transplant patient -a case report-

류호걸,오승영,이한나,박양효 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.5

Seizure is the second most common neurologic complication after liver transplantation and may be caused by metabolic abnormalities, electrolyte imbalance, infection, and immunosuppressant toxicity. A 61-year-old male patient underwent liver transplantation due to hepatitis B virus-related liver cirrhosis with portal systemic encephalopathy. The immediate postoperative course of the patient was uncomplicated. However, on postoperative day (POD) 6, weakness developed in both lower extremities. No abnormal findings were detected on a brain computed tomography (CT) scan on POD 8, but a generalized tonic clonic seizure developed which was difficult to control even with multiple antiepileptic drugs. A follow-up brain CT scan on POD 15 showed a 2.7 cm sized acute intracranial hemorrhage (ICH) in the left parietal lobe. The patient’s mental status improved after 2 months and he was able to communicate through eye blinking or head shaking. Our case reports an acute ICH that manifested into a refractory seizure in a patient who underwent a liver transplant.

척추굴곡에 따른 옆구리 늑골선이 지나는 요추수준의 변화

류호걸,정철우,이종환,박재현 대한마취과학회 2004 Korean Journal of Anesthesiology Vol.46 No.1

안전한 진정요법 시행을 위한 요건과 대책

류호걸 대한의사협회 2013 대한의사협회지 Vol.56 No.4

The number of sedations performed for diagnostic and therapeutic procedures that do not require general anesthesia is increasing. As most sedations are performed by non-anesthesiologists,safety is has become a critical issue in light of recent adverse outcomes reported in the media. To ensure the safety of patients undergoing sedation for minor procedures, standards regarding patient selection, education, drugs, equipment, facilities, sedation protocols, recovery,and monitoring should be developed and publicized as they have been in the US and European countries. Guidelines developed regarding sedation and analgesia are similar and share their most important goal: patient safety. Any barriers that interfere with achieving this goal should be identified and eliminated. A Korean version of sedation guidelines should be developed. Guidelines that have both the clinical integrity of evidence and consideration of the real world should be developed and enforced.

임상연구 : 머리의 자세가 우측 쇄골하 중심정맥도관의 위치에 미치는 영향

류호걸 ( Ho Geol Ryu ),이상진 ( Sang Jin Lee ),권정은 ( Jung Eun Kwon ),최주연 ( Ju Youn Choi ),윤승주 ( Seung Zhoo Yoon ),전윤석 ( Yun Seok Jeon ),박재현 ( Jae Hyon Bahk ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6

Background: Confirmation of central venous catheter position with chest X-ray is recommended, but frequently omitted in clinical practice. It was suggested that the head posture during right subclavian catheterization affects the incidence of catheter malposition in infants. We evaluated the influence of the head posture on catheter position during right subclavian catheterization in adults. Methods: Two-hundred and seventy four patients scheduled for thoracic or neuro-surgery requiring central venous catheterization were enrolled. Patients were divided into 3 groups depending on the head posture during catheter insertion: the neutral group (n = 109), the turn away group (n = 72), and the turn toward group (n = 93). The catheter position was confirmed with postoperative chest X-ray. Results: Central venous catheterization was failed in 5 patients. There were no differences in the incidence of catheter malposition and the complications among the 3 groups. Conclusions: The head posture during right subclavian catheterization did not affect catheter malposition and immediate complication rates. (Korean J Anesthesiol 2007; 52: 627~9)

라텍스 알레르기 반응이 유발된 산모에서 응급 제왕 절개술을 위한 마취 관리

김진태,류호걸,고홍,이국현 대한마취과학회 2004 Korean Journal of Anesthesiology Vol.46 No.1

Management of Upper Extremity Deep Vein Thrombosis witha Superior Vena Cava Filter -A Case Report-

권우일,류호걸,이한나,유용재 대한중환자의학회 2013 Acute and Critical Care Vol.28 No.1

Upper extremity deep vein thrombosis (UEDVT) is relatively uncommon and superior vena cava (SVC) filter placements are not often encountered due to strict indication. A 33-year old male with underlying protein C/S deficiency and secondary liver cirrhosis was admitted because of hematemesis. The patient was conservatively managed, but underwent elective splenectomy to prevent aggravation of gastric varix. During postoperative care, the patient underwent cholecystectomy for acalculous cholecystitis. During the postoperative course, UEDVT was detected and heparinization was initiated. The patient experienced repeated attacks of severe dyspnea, which was accompanied by chest pain that lasted for 3 to 10 minutes. Repeated episodes of pulmonary thromboembolism were suspected and SVC filter was placed. Warfarin treatment was initiated and the SVC filter was removed about one month later. The case highlights the clinical significance of UEDVT and reports rare case of SVC filter placement. Intensivists should have comprehensive understanding of UEDVT and its management.

Chylopericardial Tamponade in a Patient with Chylothorax after Pulmonary Lobectomy

전진수,류호걸,이한나,유다혜 대한중환자의학회 2013 Acute and Critical Care Vol.28 No.4

Chylopericardium is a very rare, yet potentially fatal, complication following intrathoracic surgery, and can further lead to other life-threatening complications such as cardiac tamponade. A 54-year-old female underwent right upper lobectomy for lung cancer. Chylothorax developed on the 2nd postoperative day, and was managed conservatively with dietary modification. On the 9th postoperative day, the patient suddenly developed hypotension and severe cardiac dysfunction requiring cardiopulmonary resuscitation followed by VA ECMO. Transthoracic echocardiography revealed a large amount of pericardial effusion. Prompt pericardiocentesis was performed and the aspirated fluid showed features of chyle. Thoracic duct ligation with pericardial window operation was performed because the daily amount of chyle drained did not decrease after 3 weeks. Here, we review etiologies and therapeutic options of chylopericardial tamponade following intrathoracic surgery, which should not be underestimated even when the patient seems to demonstrate a good recovery.

신경계 중환자의 영양 집중 치료

정해봉,박수현,류호걸 대한신경집중치료학회 2018 대한신경집중치료학회지 Vol.11 No.2

Nutritional assessment and support are often overlooked in the critically ill due to other urgent priorities. Unlike oxygenation, organ dysfunction, infection, or consciousness, there is no consensus of indicators. Making it difficult to evaluate the effectiveness of an intervention. Nevertheless, appropriate nutritional support in the critically ill has been associated with less morbidity and lower mortality. But, nutritional support has been considered an adjunct, for body weight maintenance and to help patients during the inflammatory phase of illness. Thus, it has been assigned a lower priority, compared to mechanical ventilation or hemodynamic stability. Recent findings have shown that nutritional support may prevent cellular injury due to oxidative stress and help strengthen the immune response. Large-scale randomized trials and clinical guidelines have shown a shift from nutritional support to nutritional therapy, with an emphasis on the importance of protein, minerals, vitamins, and trace elements. Nutrition is also important in neurocritically ill patients. Since there are few studies or recommendations with regard to the neurocritical population, the general recommendations for nutritional support should be applied.

Impact of institutional case volume of solid organ transplantation on patient outcomes and implications for healthcare policy in Korea

Christine Kang,류호걸 대한이식학회 2023 Korean Journal of Transplantation Vol.37 No.1

Solid organ transplantation is distinguished from other high-risk surgical procedures by the fact that it utilizes an extremely limited and precious resource and requires a multidisciplinary team approach. For several decades, institutional experience, as quantified by center volume, has been shown to be strongly associated with patient outcomes and graft survival after solid organ transplantation. The United States has implemented a minimum case volume requirement and performance standards for accreditation as a validated transplantation center. Solid organ transplantation in Europe is also governed by the European Union, which monitors patient outcomes and organ allocation. The number of solid organ transplantation cases in Korea is increasing, with patient outcomes comparable to international standards. However, Korea has outdated regulations regarding hospital facilities, and performance indicators including patient outcomes after transplantation are not monitored. Therefore, centers perform solid organ transplantation with no meaningful oversight. In this review, data regarding the impact of institutional case volume of kidney, liver, lung, and heart transplantation are summarized, followed by a description of current transplantation center regulations in the United States and Europe. The basis for the necessity of adequate transplantation center regulations in Korea is presented.