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두개강내 수막종 수술 시 뇌동맥류의 파열에 의한 쿠싱반사 - 증례 보고 -
손근숙 대한마취통증의학회 2007 Anesthesia and pain medicine Vol.2 No.3
The intracranial meningioma associated with hidden cerebral aneurysm is rare. We experienced a patient with subarachnoid hemorrhage (SAH) due to the rupture of cerebral aneurysm during intracranial meningioma removal, although preoperative 6-vessel angiographic study did not reveal aneurysmal dilatation. During operation, tumor was resected piece by piece, and totally removed, grossly. After removal of tumor, the brain swollen suddenly along with hypertension and bradycardia suspecting Cushing’s reflex was developed. Emergent postoperative CT and CT-angiographic study revealed large amount of SAH and ruptured aneurysmal dilation of A3 segment of anterior cerebral artery. She died from brainstem failure on 4th postoperative day. We report a rare case of anesthesia for coexisting intracranial meningioma and intracranial aneurysm.
손근숙,김재환 대한의사협회 2012 대한의사협회지 Vol.55 No.7
Cancer pain is among the most undesirable side effects and complications for cancer patients. Severe cancer pain acts as physical and psychological stress and makes it difficult for patients to perform daily activities. Uncontrolled cancer pain can be emotionally devastating to patients. However, cancer pain can be controlled with pharmacologic treatment. Traditionally, cancer pain was treated according to the WHO three-step analgesic ladder based on the severity of pain. Recently, it has become to administer weak opioids as well as non-opioid analgesics to patients with mild pain. For moderate pain, weak opioids or strong opioids can be used. Non-opioid analgesics and adjuvant analgesics can be used as an adjuvant to opioids for all severities of cancer pain. Effective cancer pain management depends on the proper selection of a drug, dose, and route and depends on treatment of common side effects associated with the medication. The usage of medication should be individualized to each patient. If necessary, we may use other modalities such as radiotherapy, nerve block, and non-pharmacologic interventions for cancer pain control. The goal of treatment of cancer pain is to obtain complete or partial pain relief with tolerable side effects of the medication, and ultimately, to improve the quality of life of cancer patients.
손근숙,김재환 대한의사협회 2012 대한의사협회지 Vol.55 No.7
T he advent of minimally invasive surgery has provided many benefits to patients including less trauma, less pain, quicker recovery, and shorter hospital stays. A typical example of a minimally invasive surgery technique is laparoscopic surgery. Intraperitoneal insufflation of carbon dioxide is a routine procedure for creating pneumoperitoneum for accurate visualization and operative manipulation during laparoscopic surgery. However, pneumoperitoneum resulted in ventilatory,respiratory, and hemodynamic changes. Along with these changes, the patient position for the operation complicated anesthetic management. An understanding of these pathophysiologic consequences associated with laparoscopic surgery is important in anesthetic management. Robotic surgery was developed to alleviate the disadvantages of laparoscopic surgery. The advantages of computer-assisted robotic surgery include improved operative field visibility with a three dimensional imaging system and improved control of fine movement. However, the huge size of the robot itself unavoidably invades the anesthetic work space and may impair access to the patient. In addition, repositioning of a patient is almost impossible once the robot has been stationed for surgery. With the innovation of scientific technology, new surgical and anesthetic techniques are being developed for patient care. Anesthesiologists need to be aware of this fast changing surgical field and scientific technology and how it affects anesthetic management.
박인경,박정헌,강진구,손근숙,이상준 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.1
A bent lighted stylet has demonstrated effectiveness for intubating patients with difficult airways. We report a case of successful intubation using a lighted stylet that was bent to configure the upper airway passage in a patient with ankylosis of the temporo-man- dibualr joint and a small inter-incisor gap with diffuse submandibular abscesses. We suppose that lighted stylets with different bends can be used in difficult airway cases. The usefulness of a bent lighted stylet to fit the upper airway passage needs further evaluation for additional clinical application.