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서은정 ( Eun Jung Seo ),안기량 ( Ki Ryang Ahn ),김천숙 ( Chun Sook Kim ),강규식 ( Kyu Sik Kang ),유시현 ( Sie Hyun You ),정진헌 ( Jin Hun Chung ),정지원 ( Ji Weon Chung ),이승진 ( Seung Jin Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Nuss procedure offers excellent outcome effect in the cosmetic point of view, but the complications such as cardiac perforation, pericardial effusion, constrictive pericarditis, hemothorax, pneumothorax and bar displacement sometimes occur. We experienced a 13-year-old-male, who showed the profound hypotension with bradycardia due to the cardiac perforation and the lung laceration during the pericardiectomy and the removal of pectus bar. Emergent partial cardiopulmonary bypass was initiated and then, ruptured right atrium and lung laceration were repaired without the remarkable complications. In anesthetic management of the pectus excavatum. This case reveals that special attention should be paid to those with cardiac perforation and lung laceration. (Korean J Anesthesiol 2007; 53: 539∼43)
정진헌 ( Jin Hun Chung ),안기량 ( Ki Ryang Ahn ),전혜정 ( Hye Jung Chun ),김천숙 ( Chun Sook Kim ),강규식 ( Kyu Sik Kang ),유시현 ( Sie Hyeon Yoo ),정지원 ( Ji Won Chung ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4
Corticosteroid preparations have anti-inflammatory and immunosuppressive properties and are used widely for the treatment of allergic disorders and asthma. Steroids themselves, however, can induce hypersensitivity reactions. In this study, we report the case of a 66-year-old man with chronic obstructive pulmonary disease who exhibited an allergic reaction (rash, bronchospasm, bradycardia, severe hypotension and cardiac arrest) immediately after the intravenous injection of methylprednisolone sodium succinate. Despite cardiopulmonary resuscitation, sinus rhythm was not restored. The anesthesiologist should be aware that allergic reactions to corticosteroids can occur. (Korean J Anesthesiol 2009;57:499∼502)
정진헌 ( Jin Hun Chung ),안기량 ( Ki Ryang Ahn ),신온섭 ( On Sub Shin ),김천숙 ( Chun Sook Kim ),강규식 ( Kyu Sik Kang ),유시현 ( Sie Hyeon Yoo ),정지원 ( Ji Won Chung ),구자욱 ( Ja Ug Koo ),이정석 ( Jeong Seok Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Background: Information concerning the cardiopulmonary effects of pneumoperitoneum in children is lacking. Methods: Twenty eight patients were assigned to receive diagnostic laparoscopy (n=12) or laparoscopic surgery (n=16). Before insufflation of CO2, tidal volume was set at 10 ml/kg and respiratory rate was adjusted to achieve an end-tidal CO2 (P(ET)CO2) of 30-35 mmHg. Abdominal pressure was maintained at 10-15 mmHg by a CO2 insufflator. We measured the changes of systolic arterial pressure (SAP), heart rate (HR), P(ET)CO2 and peak airway pressure (PAP) at 5 min before (control value) and after CO2 insufflation and 5 min after CO2 deflation. Results: SAP and PAP were increased significantly after pnemoperitoneum compared with the control both in diagnostic laparoscopy and laparoscopic surgery (P<0.05). P(ET)CO2 was increased significantly after pneumoperitoneum and after CO2 deflation in laparoscopic surgery compared with the control and also with diagnostic laparoscopy (P<0.05). Driving pressure (the difference between peak airway pressure and abdominal pressure) was increased significantly after pneumoperitoneum in laparoscopic surgery compared with diagnostic laparoscopy (P<0.05). Conclusions: SAP, PAP and P(ET)CO2 increases during diagnostic laparoscopy and laparoscopic surgery, but this effect appears to be of smaller magnitude in diagnostic laparoscopy compared to laparoscopic surgery. We found that these changes had no clinically deleterious effects in healthy children. (Korean J Anesthesiol 2009;56:31~5)
정진헌 ( Jin Hun Chung ),송상우 ( Sang Woo Song ),안기량 ( Ki Ryang Ahn ),김천숙 ( Chun Sook Kim ),강규식 ( Kyu Sik Kang ),유시현 ( Sie Hyeon Yoo ),정지원 ( Ji Won Chung ),구자욱 ( Ja Ug Koo ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
H type of congenital tracheoesophageal fistula (TEF) is rare, occurring approximately once in 100,000 births. The presentation of this anomaly in adults is indeed uncommon. We report a case of a 47-year-old male with congenital TEF dectected during epidural hematoma removal under general anesthesia. Intermittent disappearance of normal capnography, bubbling sound at substernal area, and air leakage at oral cavity observed during manually assisted ventilation, especially during inspiration. We observed a H-type of TEF and tracheal intubation via esophagus in chest CT after operation. (Korean J Anesthesiol 2009; 56: 698~702)
강규식 ( Kyu Sik Kang ),김창원 ( Chang Won Kim ),안기량 ( Ki Ryang Ahn ),김천숙 ( Chun Sook Kim ),유시현 ( Sie Hyeon Yoo ),정진헌 ( Jin Hun Chung ),정지원 ( Ji Won Chung ),김상호 ( Sang Ho Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Background: Breast reconstruction following mastectomy has become increasingly popular in recent years. The purpose of this study was to compare the efficacy of cervical epidural patient-controlled analgesia (CEA) and intravenous patient-controlled analgesia (IV-PCA) for controlling the postoperative pain and the side effects after mastectomy with immediate Latissimus dorsi (LD) flap breast reconstruction. Methods: Sixty patients who were to undergo mastectomy with immediate LD flap breast reconstruction were randomly assigned to receive CEA [Group CEA, (n=30), 0.15% ropivacaine+fentanyl 4 μg/ml] or IV-PCA [Group IV-PCA (n=30) fentanyl 20 μg/kg+ketorolac 3 mg/kg] for postoperative pain control via a PCA pump (basal rate: 2 ml/h, bolus: 2 ml, lock out interval: 15 min) after their operation. Before general anesthesia, an epidural catheter was inserted at the cervical (C) 7-thoracic (T)1 level in the patients of the CEA group. The resting visual analogue scale (VAS) for pain, the systolic blood pressure, the heart rate and the side effects were recorded for 48 hours after operation. Results: The VAS at rest was significantly lower in the CEA group than that in the IV-PCA group at 16 hours after surgery. The CEA group required less additional analgesics as compared with the group IV-PCA. There were no significant differences in the systolic blood pressure, the heart rate and the incidence of side effects between the two groups. Conclusions: We conclude that cervical epidural analgesia, as compared with intravenous patient-controlled analgesia, provides effective pain control and it shows a similar incidence of side effects after mastectomy with immediate LD flap breast reconstruction. (Korean J Anesthesiol 2009; 56: 669~74)
유시현 ( Sie Hyeon Yoo ),서환주 ( Hwan Joo Seo ),김천숙 ( Chun Sook Kim ),안기량 ( Ki Ryang Ahn ),강규식 ( Kyu Sik Kang ),정진헌 ( Jin Hun Jung ),천경아 ( Kyung Ah Chun ),김종분 ( Jong Bun Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: Thoracic paravertebral blockade (TPVB) can be effective in many clinical settings. However, many clinicians are reluctant to use this technique due to its adverse effects such as pneumothorax. The aim of this study was estimate the appropriate depth and width for safe needle positioning. Methods: The depth from skin to the paravertebral space (PVS) and the width from the spinous process (SP) to the PVS and the lateral tip of the transverse process (LTTP) were measured in all available sections from 84 patients examined by chest computed tomography (CT). The correlation between age, gender, body mass index (BMI) and each measured value was analyzed. Results: All 828 sections from the 84 patients aged between 19 and 65 years old were evaluated. The minimum and maximum values of the mean depth from the skin to PVS were 40.3-52.4 mm in men and 41.2-55.9 mm in women. The minimum and maximum values of the mean width from the SP to LTTP were 29.2-34.6 mm in men and 23.7-31.0 mm in women. At every thoracic level, the depth to PVS was similar in both genders but the width from the SP to the NEP in men was significantly higher than in women. Weight significantly influenced the width from the SP to LTTP in men but height and BMI did not. Also weight and BMI significantly influenced the depth from skin to PVS in almost all of the thoracic region at both sex, but height did not influence the depth from skin to PVS in both sex. Conclusions: We report clinically useful estimates that may be used to help avoid side effects such as pneumothorax and achieve a successful thoracic paravertebral blockade. (Korean J Anesthesiol 2007; 53: 188~93)
Stroke is defined as a focal neurological deficit lasting more than 24 hours. The complication related to the central nervous system after general anesthesia is unusual and difficult to discover the exact causes. We experienced a case of an unexpected cerebral infarction after lung decortication and clousure of bronchopleural fistula (BPF). His medical problem included diabetus mellitus, pulmonary tuberculosis, and history of several episode of focal neurological deficit. Anesthesia was induced with thiopental and succinylcholine and maintained with 50% N_(2)0 and 2.0-3.0 vol% enflurane in oxygen. After approximately 10 h in intensive care unit, he was still very lethargic. Immediate brain magnetic resonance angiography(MRA) revealed acute cerebral infarction in left middle cerebral artery (MCA) and anterior cerebral artery(ACA) territory due to left internal carotid artery (ICA) obstruction. An emergency decompressive craniectomy was performed. Therefore cerebral thrombosis, hypotension could be considered the possible etiology. We concluded that cerebral infarction can unexpectedly develop during perioperative and after postoperative and that close monitoring of patient and adequate management are essential.