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- 저자 : 윤창룡 ( Chang Yong Yoon ) (검색결과 3 건)
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증례보고 : 체외순환을 사용하지 않는 관상동맥 우회술에서 심장 전위를 위해 사용된 물주머니와 경식도 심장초음파 영상 개선
여진석 ( Jin Seok Yeo ),김태엽 ( Tae Yop Kim ),윤창룡 ( Chang Yong Yoon ),김준석 ( Jun Seok Kim ),지현근 ( Hyun Keun Chee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2
During off-pump coronary artery bypass graft surgery (OPCAB), vigorous displacement and compression of the heart producing significant hemodynamic change are essential for optimal exposure of graft anastomoses. Intraoperative transesophageal echocardiography (TEE) is useful in determining hemodynamic compromise and prompting medical and mechanical support. However, in addition to the loss of contact between the heart and diaphragm during the displacement, swabs or snears underneath the heart interrupt the TEE signal transmission, resulting in a compromised transgastric (TG) TEE view. Therefore, TEE monitoring during OPCAB is usually limited to the mid-esophageal view. The authors placed a saline bag (a surgical glove filled with saline) underneath the heart to facilitate this anterior displacement of the heart, as well as avoid the signal interruption of the TG echocardiographic window. As a result, the optimal heart position with the minimal changes in LV regional wall motion, LV function and mitral regurgitation were found using the TG and other TEE views. The series of velocity-time integral of aortic valvular flow (VTI-Ao) in TG long axis view, in addition to SvO2, were then monitored as a surrogate marker of the cardiac output during a graft construction of the left circumflex artery. It was concluded that the use of a saline bag may be useful in avoiding compromise of the TG TEE view and determine the hemodynamic change using VTI-Ao during cardiac displacement for OPCAB. (Korean J Anesthesiol 2007; 52: 231~6)
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증례보고 : 개심술 마취에서 동맥압 파형분석을 이용한 심박출량과 중심정맥 산소포화도
김태엽 ( Tae Yop Kim ),권원경 ( Won Kyoung Kwon ),윤창룡 ( Chang Yong Yoon ),김혜경 ( Hae Kyoung Kim ),김준석 ( Jun Seok Kim ),지현근 ( Hyun Keun Chee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1
The determination of arterial pressure wave-derived cardiac output (APCO) and central venous O2 saturation (ScvO2) has been introduced as a less invasive procedure for monitoring cardiac function and oxygen delivery. We have used an APCO sensor (FloTrac(TM)) and a monitor for ScvO2 (Vigileo(TM)) in two cases of cardiac valve surgery, where placement of pulmonary artery catheter (PAC) was not applicable due to unfavorable cardiac structure (case 1) and was contraindicated due to an unstable cardiac conduction disorder and arrhythmia (case 2). In case 1, monitoring of APCO was started from the beginning of anesthesia induction and a ScvO2 monitoring central venous catheter was inserted just after anesthesia induction. APCO, ScvO2 and other hemodyanamic information such as arterial BP, CVP, and data obtained from transesophageal echocardiography (TEE) during the pre-cardiopulmonary bypass (CPB) period were measured. APCO and ScvO2 during the post-CPB period showed a reliable correspondence with continuous cardiac output (CCO) and mixed venous O2 saturation (SvO2) as measured by PAC at the end of CPB. In case 2, APCO and ScvO2 were monitored instead of CCO and SvO2. The values of APCO showed a good correlation to intraoperative COs indirectly calculated by the velocity-time integral of the aortic outflow determined in the TEE examination. We experienced that monitoring APCO and ScvO2 is useful for anesthesia management in cardiac valve surgery and can be an alternative to CCO and SvO2 if the placement of PAC and the thermodilution method are not applicable. (Korean J Anesthesiol 2007; 53: 109~14)
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임상연구 : 부인과 환자에서 낮은 복압(8 mmHg)과 통상적 복압으로 달리 기복 유도된 복강경 수술과 개복수술 중 체온조절 양상 비교
김덕경 ( Duck Kyoung Kim ),이경민 ( Kyoung Min Lee ),이가영 ( Ga Young Lee ),윤창룡 ( Chang Yong Yoon ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: It has been suspected that laparoscopic surgery exacerbates hypothermia to a greater extent than open surgery. Thus, this study was designed to compare the intraoperative thermoregulatory profiles of three different operative techniques: open surgery, low pressure (LP: 8 mmHg) or conventional pressure (CP: 13 mmHg) laparoscopic surgery. Methods: Forty five patients who were scheduled for radical hysterectomy were allocated to three groups, 15 in each group: group O (open surgery), group LP and group CP. Anesthesia was maintained with 2.5% sevoflurane. Intraoperative core temperature and forearm minus fingertip skin temperature gradients were measured at 15-min intervals during the first three hours. Vasoconstriction threshold was defined by the esophageal temperature at which the skin temperature gradient equalled 0°C. Results: All groups were comparable in terms of the characteristics of patients and preoperative body temperatures. Core temperatures and forearm minus fingertip skin temperature gradients were not significantly different among the three groups at all measurements. Thermoregulatory vasoconstrictions were observed in 6 of group O and 6 of laparoscopic surgical patients (4 patients from group LP and 2 patients from group CP). These 12 patients were divided into open (n = 6) and laparoscopic (n = 6) surgery group. There were no significant difference between the groups with regard to the vasoconstriction threshold and threshold time. Conclusions: Laparoscopic procedures with conventional insufflation pressure have similar profiles in terms of intraoperative thermoregulation, when compared to open surgery. Lowering insufflation pressure to 8 mmHg can not reduce the risk of intraoperative hypothermia. (Korean J Anesthesiol 2006; 51: 44~51)
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