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중심정맥압은 혈액량, 정맥tone, 우심장의 기능을 나타내는 지표러서, 중심정맥압을 측정하기 위해서는 상지의 말초혈관, 내외경정맥, 쇄골하정맥 등을 통해서 카테테르 중심정맥내로 삽입하여야 한다. 그러나 카테테르 삽입조각 또는 카테테르 자체에 의해서 감염, 신경 또는 주위조직 손상, 혈종, 혈전성 정맥염, 공기 색전증, 카테테르 색전증, 수흉 등의 각종 합병중이 발생할 수 있다. 따라서 이런 합병증을 예방하기 위한 각종 카테테르 거치 방법이 소개되어 있기는 하나, 아직까지 이러한 합병증을 완전히 없앨 수 있는 방법 및 카테테르 재료는 소개되어 있지 않다. 저자들은 개심슬시 중심정맥압을 관찰하기 위해서 우쇄골하정맥, 우내경정맥을 통해 각각 삽입한 카테테르의 위치이상 3예를 경험하엿는데, 제1예에서는 우내경정맥에 삽입한 카테테르가 우내경정맥내에서 2회 회전한후 우내경정맥동을 향해 카테테르 끝이 제 4 경추 부위에 위치하고 있었으며, 제 2예에서는 우내경정맥에 삽입한 카테테르가 제 3늑간 부위에서 우내경정맥쪽으로 역행하여 제 1흉추부위에 위치하고 있었고, 제 3예에서는 우쇄골하정맥으로 삽입한 카테테르가 우내경정맥으로 삽입되어 카테테르끝이 제 5경추부위에 위치하였다.
Epilepsy surgery is performed in patients with epilepsy of focal origin and seizures which are refractory to medical treatment. Electrophysiologic mapping of the epileptic foci and other cortical areas (e.g., language, memory, sensorimotor) is frequently used to maximize the resection of the epileptogenic lesion while minimizing the neurologic deficits. For language area mapping, general endotracheal anesthesia can not be used because a patient can not vocalize. So awake craniotomy is frequently used. However, during awake craniotomy for language area mapping with local infiltration anesthesia and intravenous sedation and narcotics supplementation analgesia, respiratory arrest or depression and hypoxemia may occur. The airway securement is crucial to the patients. As an alternative to tracheal tubes, laryngeal mask airway can secure the airway and does not interference the vocalization. We could successfully performed the language area mapping in a 17-year-old male patient with laryngeal mask airway under deep intravenous anesthesia with local infiltration anesthesia of the scalp. (Korean J Anesthesiol 1999; 36: 340∼344)
The phenomena of stochastic resonance (SR) have attracted much attention in studies of excitable systems, in particular the nervous systems, under noise. Recently, an alternative SR condition, called bona-fide SR, was proposed in a bistable system, based on the notion of residence time distribution. As the forcing frequency increased, the existence of a resonant frequency was observed. We study SR in a stochastic FitzHugh-Nagumo (FHN) neuron, and we find bona-fide stochastic resonance, the resonance between the forcing frequency and stochastic time scale. The bona-fide stochastic resonance for the FitzHugh-Nagumo neuron is understood through analysis of the phase portraits. The analysis of the phase portraits reveals that it is due to the fact that in the case of the FitzHugh-Nagumo neuron the loop enters the stable state region. An order parameter is introduced to measure the averaged phase synchronization between the sinusoidal input current and the neural responses, which also shows bona-fide stochastic resonance at nearly the same frequency as those observed in inter-spike interval histogram (ISIH) analysis./
Acute hyperkalemia may result from many causes, i.e. excessive load, transcellular shift, decreased renal excretion, and so on, and may be associated with irreversible and fatal cardiac manifestations, muscle weakness, ventilatory and adrenal insufficiency, etc. We experienced a case of acute hyperkalemia probably due to red cell lysis whoch ws evident immediately after the induction of general anesthesia with thiopental sodium and succinylcholine in a 33 year-old female patient with common bile duct obstructive jaundice. In spiote of active management during anesthesia and posoperative period, eventually she died of cardiac arrest. For the successful management of the acute hyperkalemia, the anesthesiologist should be aware of oits etiologies, pathophysiology, diagnosis & treatment.
Recently, various studies have focused on the synchronization phenomenon in the nervous system. In this paper,we focused our attention on the underlying mechanism of synchronization and the robustness of synchronization through a simple unit network of globally coupled excitatory cells. Our network model with various numbers of neurons exhibits synchronized activities that originate from strong lateral excitatory connections. The degree of synchronization is quantified by the measure of the peak height of the power spectrum (PHPS). We find that the synchronization in the firing activities is a robust phenomenon against variations in the noise intensity even though the firing rate is sensitive to such variations. Our study on the robustness of synchronization can be a basis for a study on the role of synchronization in information processing.
The synchronization of rhythms in various frequency ranges over participating cortical areas is one of the important issues in neuroscience. Experimental and modeling studies suggest that rhythms of the beta frequency range have a dynamical structure distinct from that of the gamma rhythms. To elucidate the mechanism of synchronization, the role of the long-range excitatory connection which is incorporated with nite conduction delay time needs to be analyzed. This work attempts such analysis, utilizing the reduced phase oscillator model. It is shown that the long-range gamma rhythm remains unstable, regardless of the presence of the excitatory connection. However, the beta rhythm is stable over a broad range of conduction time delay, which cannot apparently be tolerated by the long-range gamma rhythm. These synchronization features are consistent with experimental observations which imply that gamma rhythms are used for local computations, whereas beta rhythms are used for higher level interactions involving more distant structures.
Arterial cannulation for constant monitoring of arterial pressure and blood gase analyses has become commonplace in the care of the critically ill patients. The radial artery is often regarded as causing a negligible complication risk because of extensive collateral arterial flow in the hand. One of other alternative sites for arterial cannulation is femoral artery. Femoral artery cannulation has a high degree of success in very small, critically ill children. It should be considered an acceptable alternative to small- vessel cannulation when the latter is not technically achievable, or in the unstable patient where rapid establishment of reliable artery access is necessary. Arterial cannulation may cause many complications: arterial catheters can directly injure the vessels, resulting in thrombosis, occlusion, distal embolization or ischemia. Local insertion site complications, such as hematoma, hemorrhage, and infection may occur. Arterial catheter may also be a source of systemic sepsis. We report an unusual case of unintentional release of a catheter fragment into the external iliac artery in a 7-month (7.8 kg) male patient with tetralogy of Fallot, which was inadvertently inserted during right femoral artery cannulation. The catheter fragment was successfully retrieved with the Amplatz Goose Neck microsnare under fluoroscopy without any problems. (Korean J Anesthesiol 1998; 35: 1007∼1011)
A laryngeal mask airway(LMA) was first described by Brain1) in 1983. It has been used worldwide as a preferable airway for outpatient anesthesia as well as an emergency airway to overcome the difficult airway. It can be inserted into the hypopharyngeal area in a blind technique. However, because the tongue is displaced against the posterior pharyngeal wall in a sedated and/or relaxed patients, we occasionally encounter a difficulty in inserting LMA in a blind technique even with a jaw thrust maneuver23), rotational movement4) of LMA. With a forceful insertion against resistance, the LMA tip may damage to the uvula4). So a laryngoscopic aid4,5) may be helpful to facilitate a LMA insertion. However, it is well known that a laryngoscope may demage to the the upper teeth or lip. I devised an introducer to facilitate a LMA placement. The L-shaped introducer is made of the stainless-steel tablespoon which is easily got from a kitchen. It is made by appropriately bending the shaft of the tablespoon, and it has several holes on the distal oval plate of the spoon to drain secretions(Fig. 1). It can ease a LMA insertion by lifting the posteriorly displaced tongue base from the posterior wall and the soft palate(Fig. 2). I compared changes in arterial blood pressure of LMA(Intravent, Pacific Medical, Supplies Pty Lte., Melbourne Australia) insertion with this device to those of the blind insertion technique in 36 female patients (introducer group, n=20; blind technique group, n=16). I observed that there was a significant increase of mean arterial blood pressure 1 minute after LMA placement compared with the immediate placement values in both groups.(P$lt;0.01 by student's t-test). However, there were no statistically significant differences of one-minut mean-arterial blood pressure between the two groups. Thus I concluded that a LMA placement with the introducer had comparable hemodynamic changes to the blind insertion technique. I think the introducer it has several advantages ; easy to get and make, easy to learn how to use, smaller and less heavier than a laryngoscope(easy to handle), no damages to the upper teeth or lip, making more room for LMA insertion in the oral opening than a blind technique. I could easily insert the LMAs with the introducer in five patients who developed the insertion difficulties in a blind technique even with a jaw thrust maneuver2,3) and rotations4) of the LMAs. Thus I recommend the introducer to the readers whenever they encounter difficulty in placing a LMA.