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허진산,김건희,이상민 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.2
The efficacy of electroconvulsive therapy (ECT) in depression is dependent on the duration of seizure. Over a course of ECT, progressive reduction in the duration of the induced seizure is common. Caffeine pretreatment is reported to prolong seizure activity in patients experiencing inadequate seizure activity although maximal electrical stimulus for ECT is applied. The side effects of caffeine are anxiety, psychomotor agitation, prolonged seizures, enhanced hemodynamic changes and arrythmias. Caffeine is generally well tolerated by most patients, but it should be used with caution for those medically fragile patients, i.e., with preexisting cardiac disease. We describe here a case of anesthesia for ECT with caffeine augmentation. A 61-year-old man was diagnosed of major depression. Caffeine pretreatment with ECT was scheduled after antidepressants and 3 ECTs failed. Hypertension and tachyarrythmia were treated with esmolol. (Korean J Anesthesiol 2006; 50: 236~9)
요추부 추간판 탈출증세와 유사한 골반내 악성종양 증례 보고
박정헌,김태형,심우석,허진산,권민아 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.2
A pelvic bone tumor may produce symptoms such as a herniated intervertebral lumbar disc if it invades the sacrum and sacro-iliac joint. Diagnosis is not always easy, and misdiagnosis due to nerve root compression of the pelvic bone tumor may occur. Herein, the case of a 61-year-old patient, whose diagnosis was more difficult than for a herniated intervertebral lumbar disc due to a lack of symptoms usually associated with malignancy, is described. Unfortunately, the patient underwent an operation for the suspected herniated discs. In such cases, the correct diagnosis often can not be made on the first attempt. In conclusion, it must be remembered that patients who do not respond to the usual forms of treatment in a reasonable period of time should be re-examined both clinically and radiographically.
간이식 수술 환자에서 간성 수흉(Hepatic Hydrothorax) 배액 후 발생한 재팽창성 폐부종
김갑수,양미경,김학진,허진산 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.1
A hepatic hydrothorax is a pleural effusion that develops in patients with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. It is a complication of end-stage liver disease, and a liver transplant is the treatment of choice. In our case, a reexpansion pulmonary edema occurred after evacuating 4,250 ml of ascites and aspirating 3,600 ml of the pleural effusion within 15 minutes aimed at visually improving the surgical field in a 46-year-old male patient receiving a liver transplant. 1 hour 30 minutes after aspirating the pleural effusion, the level of oxygen saturation decreased from 100% to 95%, and serosanguinous fluid spilled over from the endotracheal tube. We inserted a double lumen endotracheal tube to both separate and protect the unaffected left lung, and applied CPAP 10 cmH2O at the affected right lung. The reexpansion pulmonary edema was successfully treated using this supportive management. (Korean J Anesthesiol 2006; 50: 103~7)