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조윤이,Ji Hyun Yoo,Hyun Joo Kim,길혜금 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.3
Background: Epidurally administered dexamethasone may reduce the incidence and severity of postoperative pain. We investigated whether postoperative pain could be alleviated by preoperative or postoperative epidural dexamethasone administration in patients undergoing major abdominal surgery. Methods: Ninety patients (age 30-77 with American Society of Anesthesiologists physical status I and II) undergoing radical subtotal gastrectomy were randomly allocated to three groups using computer generated randomization. In all groups, 10 ml of 0.25% ropivacaine was injected epidurally before the start and at the end of the operation. In Group I, a bolus ropivacaine epidural without dexamethasone was administered. In Group II, dexamethasone (5 mg) was added to the ropivacaine bolus epidural before the start of operation. In Group III, the same amount of dexamethasone was given with the ropivacaine epidural at the end of operation. Effort and resting VAS, the use of rescue analgesics and any complications noted during the procedure were evaluated. Results: VAS and requirements of rescue analgesics were significantly lower in Groups II and III when compared to Group I. There were no difference in the incidence of nausea and vomiting between groups, but an itching sensation was frequent in Group III. Conclusions: The administration of 5 mg of dexamethasone epidurallly, before or after operation, could reduce the pain and analgesic requirement after radical subtotal gastrectomy.
조윤이,김용범,양미란,장영진 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.3
Although the incidence of extrapyramidal reactions associated with metoclopramide has been reported to be approximately 0.2%, such reactions are rare in the anesthetic field. Several anesthetic adjuvants, including ondansetron and pregabalin, have also been associated with extrapyramidal side effect. Here, the authors report the case of a 47-year-old patient, previously administered pregabalin and ondansetron, who developed extrapyramidal side effects after a single injection of metoclopramide (10 mg) in a post-anesthesia care unit.
조윤이,장영진,정월선,남승균 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.1
The patients with diabetes mellitus (DM) have abnormal cerebral auto-regulation and preexisting DM is one of the major factors related to adverse postoperative neurological deficits. New onset hemiparesis is a rare and devastating event in a patient awakening from general anesthersia. We report a case of transient hemiparesis after general anesthesia in a patient underwent laparoscopic cholecystectomy with uncontrolled DM.
Sedation Strategies for Procedures Outside the Operating Room
조윤이,곽현정 연세대학교의과대학 2019 Yonsei medical journal Vol.60 No.6
With the rapid development of diagnostic and therapeutic procedures performed outside the operating room (OR), the need forappropriate sedation care has emerged in importance to ensure the safety and comfort of patients and clinicians. The preparationand administration of sedatives and sedation care outside the OR require careful attention, proper monitoring systems, and clinicallyuseful sedation guidelines. This literature review addresses proper monitoring and selection of sedatives for diagnostic andinterventional procedures outside the OR. As the depth of sedation increases, respiratory depression and cardiovascular suppressionbecome serious, necessitating careful surveillance using appropriate monitoring equipment.
Hypercapnic Respiratory Failure Immediate After Bariatric Surgery
조윤이,정월선,박희연,장영진 대한비만학회 2012 The Korean journal of obesity Vol.21 No.3
흉부나 상복부 수술과 이에 동반한 전신마취는 일시적인 가스교환의 이상과 부적절한 호흡역학을 동반한 폐기능 장애가수반될 수 있으며 이는 비만한 환자에서 더 심각하게 나타날수 있다. 비만 저환기 증후군을 가진 37세 여환이 복강경 하위소매절제술을 시행받았다. 환자는 복강경 수술을 위한 복강내 이산화탄소 주입 후 교정되지 않는 심각한 호흡성 산증이있었고, 술 후 각성 후 고이산화탄소 혈증을 동반한 호흡 부전을 경험하였다. 이에 저자들은 비만환자들의 수술 및 마취 중나타나는 생리적 변화에 대한 중요성을 인식하고 가능한 합병증에 대하여 참고문헌과 함께 기술하였다.
조윤이,이경천,김홍순,배현경,장영진 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.6
Antiphospholipid syndrome (APS) is defined as an autoimmune disorder characterized by recurrent thrombosis or obstetrical morbidity. A 29-year-old woman who was diagnosed with APS underwent emergency cesarean delivery at 23 weeks’ gestation. She had a seizure attack and her laboratory findings were: AST/ALT 1459/1108 IU/L, LDH 1424 IU/L, 30% hematocrit, a platelet count of 43 × 103/ml and urine protein (4+). We describe the anesthetic experience of catastrophic HELLP syndrome with antiphospholipid syndrome and we review the relevant literature.
간절제술 시 발생한 치명적 순환 허탈을 동반한 정맥혈 공기 색전증 -증례 보고-
조윤이,장영진,박종민,김홍순 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.4
Venous air embolism (VAE) is a potentially fatal complication in patients with chronic liver disease during liver surgery, although VAE is unlikely to occur during laparotomy in a supine position. We report a case presenting unexpected cardiovascular collapse due to venous air embolism in a patient with liver cirrhosis during hepatic resection.
Profound Hypotension after an Intradermal Injection of Indigo Carmine for Sentinel Node Mapping
조윤이,이미금,이경천,윤순영 한국유방암학회 2013 Journal of breast cancer Vol.16 No.1
Intradermal injections of indigo carmine for sentinel node mapping are considered safe and no report of an adverse reaction has been published. The authors described two cases of profound hypotension in women that underwent breast-conserving surgery after an intradermal injection of indigo carmine into the periareolar area for sentinel node mapping.
조윤이,박춘곤,이지연,권선구,곽현정 대한마취통증의학회 2019 Korean Journal of Anesthesiology Vol.72 No.6
Background: Postoperative desaturation in older individuals is rarely addressed in the literature. The objective of this retrospective study was to investigate whether a preoperative spirometric test and arterial blood gas analysis (ABGA) might predict postoperative desaturation after spinal anesthesia in extreme older patients. Methods: The medical records of 399 patients (age ≥ 80 yrs) who were administered spinal anesthesia for a femur neck fracture surgery were retrospectively reviewed. Early postoperative desaturation was defined as a reduction of oxygen saturation (SpO2) below 90% within 3 days of surgery, despite O2 supply via a nasal prong. Binary logistic regression analysis was used to identify predictors of early postoperative desaturation. Results: The incidence of postoperative desaturation was 12.5%. Major morbidity rate was significantly higher in the desaturation group (n = 50) than that in the non-desaturation group (n = 349) (14% vs. 3.2%, P = 0.001) with more frequent postoperative stays in the intensive care unit (22% vs. 12%, P = 0.004). In a binary logistic regression analysis, preoperative ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2 ratio) (OR, 0.972; 95% CI 0.952–0.993; P = 0.010) and history of cardiovascular disease (OR, 2.127; 95% CI 1.004–4.507; P = 0.049) predicted postoperative desaturation. Conclusions: Preoperative PaO2/FiO2 ratio, but not preoperative spirometry, was predictive of the postoperative desaturation in older patients after being administered spinal anesthesia for femur fracture surgery. Based on our results, preoperative ABGA may be helpful in predicting early postoperative desaturation in these patients.