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임병건,정유진,임영진,김용철,박경운,이동규,이미경,최상식 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.6
Background: Serotonin-also known as 5-hydroxytryptamine or 5-HT-can induce nausea and vomiting (NV) by peripheralmechanisms via the activation of 5-HT3 receptors. In this study, we observed perioperative NV, including intraoperativeNV, and changes in serum 5-HT concentrations. We evaluated the relationship between perioperative NV and serum5-HT levels in patients undergoing cesarean section under epidural anesthesia, and carried out a pilot study to determineif further studies on a larger scale were justified. Methods: Twenty-eight patients who were scheduled for cesarean section under epidural anesthesia were included in thestudy. Patients were assigned to 2 groups according to the occurrence of NV after induction, i.e., an NV-positive or anNV-negative group. Serum 5-HT concentrations were measured before induction, at the time that NV occurred (in thecase of the NV-positive group) or 5 min after the umbilical cord clamping (in the case of the NV-negative group) duringsurgery, and at 2 h postoperatively. Results: NV occurred in 10 of the 28 patients. No significant differences in serum 5-HT concentrations were found withinor between the two groups. Conclusions: This study suggests that there is no correlation between serum 5-HT concentration and the occurrence ofperioperative NV in patients undergoing cesarean section under epidural anesthesia, and the findings do not seem tosupport further investigations regarding a possible relationship between serum 5-HT concentration and perioperativeNV.
황색인대 골화증으로 인해 발생한 흉추부 신경근병증 환자의 보존적 치료 -증례보고-
임병건,이미경,김남엽,정선섭,이동규,최상식 대한통증학회 2009 The Korean Journal of Pain Vol.22 No.3
Ossification of the yellow ligament (OYL) is a pathologic condition that causes spinal stenosis, which is a form of ectopic ossification. OYL causes compressive myelopathy and radiculopathy. Although the pathogenesis of OYL is still unclear, diffuse mechanical stresses and degenerative changes caused by extreme ranges of motion may be related to the development of OYL in young sportsmen. Here we report an interesting case of thoracic radiculopathy due to OYL in a 35-year-old male amateur judo player who was successfully treated with continuous thoracic patient controlled epidural analgesia and epidural adhesiolysis.
Anesthetic management of geriatric patients
임병건,이일옥 대한마취통증의학회 2020 Korean Journal of Anesthesiology Vol.73 No.1
The number of elderly patients who frequently access health care services is increasing worldwide. While anesthesiologists are developing the expertise to care for these elderly patients, areas of concern remain. We conducted a comprehensive search of major international databases (PubMed, Embase, and Cochrane) and a Korean database (KoreaMed) to review preoperative considerations, intraoperative management, and postoperative problems when anesthetizing elderly patients. Preoperative preparation of elderly patients included functional assessment to identify preexisting cognitive impairment or cardiopulmonary reserve, depression, frailty, nutrition, polypharmacy, and anticoagulation issues. Intraoperative management included anesthetic mode and pharmacology, monitoring, intravenous fluid or transfusion management, lung-protective ventilation, and prevention of hypothermia. Postoperative checklists included perioperative analgesia, postoperative delirium and cognitive dysfunction, and other complications. A higher level of perioperative care was required for older surgical patients, as multiple chronic diseases often makes them prone to developing postoperative complications, including functional decline and loss of independence. Although the guiding evidence remains poor so far, elderly patients have to be provided optimal perioperative care through close interdisciplinary, interprofessional, and cross-sectional collaboration to minimize unwanted postoperative outcomes. Furthermore, along with adequate anesthetic care, well-planned postoperative care should begin immediately after surgery and extend until discharge.
임병건 대한마취통증의학회 2019 Anesthesia and pain medicine Vol.14 No.4
Nociception monitoring devices using changes in autonomic nervous system activity have been developed in numerous ways. Although there have been few studies conducted on children, compared to the relatively higher number of studies on adults, most of the nociception monitors in children, as in adults, appear to be more useful than the standard clinical practice that uses hemodynamic parameters in the evaluation and treatment of intraoperative nociception (pain) during general anesthesia. Particularly, when monitoring the surgical pleth index (SPI) in anesthetized children, the application of a new target range of SPI values (≤ 40) to the SPI monitoring criteria seems to be necessary for providing a more proper intraoperative analgesia. The analgesia nociception index (ANI) shows promising results in anesthetized adults, and recently, positive results along with cardiorespiratory coherence have been reported in pediatric patients. Newborn infant parasympathetic evaluation (NIPE) could be useful for providing adequate analgesia in newborns, infants, and children under 2 years of age in anesthetized or awake states. In cases of skin conductance and pupillometry, further studies are needed. Understanding the pros, cons, and limitations of these nociception monitoring tools will provide more effective and safe intraoperative analgesia to pediatric patients undergoing general anesthesia, and it may also help to plan and conduct promising research on the use of perioperative nociception monitoring in pediatric patients in the future.
전신마취 중 투여한 rocuronium과 cisatracurium에 의한 연속된 아나필락시스 -증례 보고-
이충훈,임병건,조성인,이소현,문숙희,이일옥 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.4
We experienced anaphylaxis during general anesthesia twice in the same patient. After the first incidence of anaphylaxis at the induction of anesthesia, we speculated that the allergen was rocuronium. Thus, we administered sugammadex as well as a vasopressor to treat the anaphylaxis and the vital signs gradually recovered to nearly normal. Thereafter, we could not avoid the administration of another muscle relaxant, cisatracurium, since the patient moved uncontrollably after the surgery was restarted. A second anaphylactic event then occurred. We speculated that the second allergen was cisatracurium and stopped using it. The results of the investigation after the surgery showed that the allergens were indeed rocuronium and cisatracurium. When we encounter anaphylaxis during general anesthesia, it is necessary to suspect all administered medicines as the cause, with the potential of two or more causes, especially with muscle relaxants.
이재진,임병건,이미경,공명훈,Kyongjong Kim,이재연 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.3
Patients with cervical spine instability and limited range of motion are challenge to anesthesiologists. It is important to consider alternatetive methods for securing the airway while maintaining neutral position and minimizing neck motion, because these patients are at increased risk for tracheal intubation failure and neurologic injury during airway management or position change. We experienced two cases that patients had cervical spine instability and severe limited range of motion due to the fusion of the entire cervical spine. One patient was a 6-year-old girl weighing 12.7 kg and had Klippel-Feil syndrome with Arnold-Chiari malformation, the other was a 24-year-old female weighing 31 kg and had juvenile rheumatoid arthritis. We successfully performed the intubation by using the fiberoptic intubation though a laryngeal mask airway in these two cases.