전신마취 후 뇌경색으로 인한 양측 피질성 시력손실

안기량,최종국,김천숙,강규식,김지은,유시현,권진형 대한마취통증의학회 2004 Korean Journal of Anesthesiology Vol.47 No.1

Cortical blindness is characterized by visual sensation loss with retention of pupillary reaction to light, and a normal fundoscopic examination. The suggested causes are emboli, profound hypotension, anemia, and infarction of watershed areas in the parietal or occipital lobe. We experienced a case of cortical blindness with severely reduced visual acuity after penile cancer surgery under general anesthesia. In the acute stage, visual acuity was slightly improved, but over the course of several months, no further improvement in visual acuity occurred. In this case there was no severe hypotension or anemia during the operation. Two days after the operation, electroencephalography (EEG) was performed during the period of blindness and the recording obtained was abnormal, with no alpha rhythm. Biparieto-occipital lucency was found by magnetic resonance imaging (MRI). Therefore parieto-occipital infarction due to seizure, embolus, or thrombosis could be considered a possible etiology. We concluded that cortical blindness can unexpectedly develop perioperatively and postoperatively, and that close monitoring of the patient and adequate management are essential. (Korean J Anesthesiol 2004; 47: 122~125)

대퇴골 골절 환자에서 전신마취 시 발생한 숨겨진 뇌동맥류 파열 : 증례보고 A case report

안기량,유인상,강규식 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Spontaneous intracranial hemorrhage (ICH) occurs rarely during general anesthesia. It can occur in patients with intracranial aneurysm, hypertension, vascular malfomation, malignancy and blood dyscrasia. We experienced a case of death from massive intracerebral hemorrhage during the genernal anesthesia. she did not show any abnormal neurological sign, physical examination and coagulation abnormality on arrival in the operation room. Anesthesia was induced with thiopental and succinylcholine and maintained with 50% N2O and 2.0-3.0 vol% enflurane in oxygen. After operation, the patient showed delayed recovery from anesthesia and both pupils were dilated without light reflex. Immediate computerized tomogram (CT) of brain revealed hemorrhage in the right basal ganglia, frontotemporoparietal lobe and entire ventricles. An emergency craniectomy was peformed to remove the hematoma. Therefore high intracranial blood pressure relating to general anesthesia could be considered the possible etiology. We concluded that ICH can unexpectedly develop during perioperative and after postoperative, and that close monitoring of the patient and adequate management are essential.

소아오목가슴 수술 후 Fentanyl을 사용한 정맥통증자가조절법

안기량,정지원,권진형,정성학,유시현,이정석,강규식 대한마취통증의학회 2005 Korean Journal of Anesthesiology Vol.49 No.5

Background: Nuss procedure used in pectus excavatum repair is preferred, because of its excellent effect from the cosmetic point of view and improved pulmonary function, but it cause severe pain due to thoracic expansion after the operation. This study was designed to evaluate effective fentanyl dose using an intravenous patient-controlled analgesia (IV-PCA) pump for pain control following pectus excavatum repair in pediatric patients. Methods: Sixty patients undergoing elective thoracic surgery were randomly assigned to received fentanyl 0.5μg/kg/hr (Group I, n = 20), 0.7μg/kg/hr (Group II, n = 20), and 1.0μg/kg/hr (Group III, n = 20) via an IV-PCA pump (basal, 1 ml/h; bolus, 0.5 ml; lock out interval, 30 min) after operation. A blind observer evaluated each patient using the Children’s Hospital of Eastern Ontario pain scale (CHEOPS) and the faces scale (FS). Incidences of side effects and pain control satisfaction were assessed at postoperative 48 hrs. Results: There were no significant differences in CHEOPS or FS score between the groups the postoperative 48 hrs period. CHEOPS and FS scores at 4 and 8 hrs in groups II and III were significantly lower than in group I (P < 0.05), but all groups showed lower CHEOPS and FS scores during the first postoperative 48 hrs. Satisfaction of pain control assessment by mothers was significantly higher in groups II and III than in group I (P < 0.05). CHEOPS and FS scores were highly correlated with each other (P < 0.001). Conclusions: We conclude that infusion of fentanyl at 0.5μg/kg/hr using an IV-PCA pump is effective for pain control of 5 years of age or older after Nuss procedure.

전신마취 후 점액으로 인한 기관내관 폐쇄 : 증례보고 A case report

안기량,엄희상,김지은 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Nasotracheal intubation is commonly and safely used in the anesthetic management of patients undergoing oral cavity surgery. But endotracheal tube obstruction causes serious complications, including pneumothorax, pulmonary edema, brain injury and death. We experienced a case of endotracheal tube obstruction due to mucous crust after general anesthesia. A 5-year-old woman with cleft palate was intubated with a 4.5 mm amored tube for general anesthesia. During the surgery, vital signs were within normal limits. In the intensive care unit, she exhibited sign of complete airway obstruction. We exchanged the tube with another tube after failure of suction. The airway obstruction was due to a dried mucous crust attached to the bevel of the endotracheal tube. We should keep in mind the presence of an amored endotracheal tube cannot be regarded as a guarantee of a patent airway.

Nuss 방법에 의한 소아 오목가슴 수술 후 정맥 통증자가조절법을 사용한 Fentanyl 과 Fentanyl-Ketorolac의 진통효과 비교

안기량,서은정,김천숙,강규식,유시현,정진헌,정지원 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.2

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쇄골상위식 쇄골하정맥 도관삽입술 후 발생한 혈종격 (증례보고)

안기량 순천향대학교 1989 논문집 Vol.12 No.1

Percutaneous insertion of 16 gauge angiocatheter has been essential for case of the massive fluid or blood adminstration, parenteral hyperalimentation, and CVP monitoring. However, their placement is an invasive procedure, and then, this procedure rarely cause potential complication. Hence, accurate knowledge of their procedure relation is essential for catheterization. We have experience a case of hemomediastinum as a complication of subclavian vein catheterization. We report the case with review of the literature of central venous catheterization and its possible complication.

원발성 Aldosteronism-좌측부신 적출술의 마취 2예 보고

안기량 순천향대학교 1988 논문집 Vol.11 No.1

Primary aldosteronism, one of the surgically correctable causes of hypertension, is a syndrome due to excessive secretion of aldosterone from the adrenal cortex, and most cases are secondaty due to small solitary adenoma. In 1955, shortly after the discovery of aldosterone, Conn described the condition in which the adrenal gland produces an excess of aldosterone in dependent of nomal physiological control mechanism. The condition is called primary aldosteronism or Conn's syndrome and it is a well established, though rare, clinical entity. The author reported an anesthetic experience of left adrenalectomy for two cases with primary aldosteronism. The patients tolerated N₂O-O₂-halothane-pancuronium or d-tubocurarine anesthesia very well. During anesthesia, violent change in blood pressure was not observed.

기관내 십관후 발새한 후두육아종에 대한 임상적 연구

안기량,한찬수,김일호 순천향의학연구소 1995 Journal of Soonchunhyang Medical Science Vol.1 No.1

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CT를 이용한 복강신경총차단(2예보고)

안기량 순천향대학교 1993 논문집 Vol.16 No.4

Celiac plexus block is one of teh most useful technique employed by anesthesiologist in teh control of pain syndrome. It is specifically effective for treatment of intractable pain from the carcinoma of the pancreas or other upper abdominal visceral tumor, but technique is not ease and complication are variable. We performed celiac plexus block used by CT scanner in order to correctly inject neurolytic agents into or near celac plexus. The effect will be described.

근무력증 환자에 대한 흉선절제술시 마취관리

안기량 순천향대학교 1993 논문집 Vol.16 No.4

Myasthenia Gravis is now considered as one of autoimmune disease entites and characteristics by progressive muscle weakness upon exertion and high sensitivity to the motor end-plate. It's relatively common in young women. The author anesthelized 10 cases of myasthenia gravis for thymectomy and obtained following results. 1) Premedication was glycopyrrolate 0.004㎎/㎏ and ativan 0.08㎎/㎏ IM. Anesthetic induction of 3 cases was by thiopental 2-6㎎/㎏ with the inhalation of halothane 1-2% (or) enflurane 2-4% and 7 cases was bythiopental 2-6㎎/㎏ with inhalation agent and N-M bloker. 2) Mean duration from the end of operation to extubation was 6.3±2.0 hrs. All patients did not require reintubation. 3) Complication were occured 1 case of slight pulmonaryedema, and 1 case of cardiac congestion. 4) Abstinence of muscle relaxants, adequate respiratory care and the protection from cholinergic crisis wer the most important factors for successful management.