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증례보고 : 경요도전립선절제술 중 발생한 무증상의 심한 희석성 저나트륨혈증
진지현 ( Ji Hyun Chin ),황규삼 ( Gyu Sam Hwang ),김영국 ( Young Kug Kim ),상보현 ( Bo Hyun Sang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
The transurethral resection of the prostate (TURP) syndrome is caused by intravascular absorption of an electrolyte-free irrigating fluid during TURP for benign prostatic hypertrophy or prostatic carcinoma. The clinical symptoms and signs include hypertension, bradycardia, respiratory distress, hypotension, nausea, vomiting, confusion, blindness, seizure, coma, hyponatremina, and hypoosmolality. In this case, we incidentally detected very severe dilutional hyponatremia (99 mmol/L) without any symptoms during TURP and immediately took measures to treat TURP syndrome. On the third postoperative day, the hyponatremia had resolved within the normal range. (Korean J Anesthesiol 2007; 53: 815∼8)
증례보고 : 비심장 수술 중 발생한 관상동맥 스텐트 혈전
김현혜 ( Hyun Hea Kim ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
We report a 62-year-old man who expired due to intraoperative stent thrombosis. He presented for radical cystectomy because of a bladder cancer. Before a surgery, coronary stent intervention was performed at left anterior descending (LAD) artery. And then he received dual antiplatelet medication for three weeks. Four weeks later, he had an operation for bladder cancer. During the surgery, arrhythmias were developed. After the surgery, the patient suffered from a ST segment elevation myocardial infarction, which was caused by total occlusion of the stent. Additional stent implantation was performed but immediately after the procedure, uncontrolled ventricular arrhythmias developed. It seems that patients with stents may be at heightened risk of stent occlusion during and after surgery. They should be required safe waiting period, titrated anticoagulatory therapy and exact monitoring of myocardial ischemia during the entire perioperative period. (Korean J Anesthesiol 2006; 51: 760~3)
증례보고 : 근치적 신적출술과 하대정맥 혈전제거술 시 발생한 치명적인 심장 및 폐색전증
진지현 ( Ji Hyun Chin ),이유미 ( Yu Mi Lee ),김영국 ( Young Kug Kim ),황규삼 ( Gyu Sam Hwang ),황재현 ( Jai Hyun Hwang ),조성강 ( Sung Kang Cho ),한성민 ( Sung Min Han ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Intraoperative pulmonary embolism can result in severe hemodynamic instability, including cardiac arrest. Therefore, immediate diagnosis and proper treatment are required. We report a case of the acute cardiac and pulmonary embolisms during radical nephrectomy and inferior vena cava (IVC) thrombectomy in a patient with renal cell carcinoma with thrombus in the IVC. We diagnosed the cardiac embolism intraoperatively using the transesophageal echocardiogram, and performed emergent cardiac and pulmonary embolectomies immediately. After the surgery, the patient was discharged without any complication. (Korean J Anesthesiol 2007; 52: 600~4)
증례보고 : 경요도 방광종양 절제술을 위한 폐쇄신경 차단 도중에 발생한 예기치 못한 척추바늘의 분리
진지현 ( Ji Hyun Chin ),전인구 ( In Gu Jun ),김영국 ( Young Kug Kim ),강금내 ( Keum Nae Kang ),황규삼 ( Gyu Sam Hwang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Obturator nerve block is occasionally performed during transurethral resection of lateral bladder wall tumors to prevent the violent contraction of the adductor muscle of the thigh. Rare complications including intravascular injection of the local anesthetics and hematoma formation may occur during the obturator nerve block. We report a case of the unintentional breakage of the spinal needle during the obturator nerve block with successful removal of the broken spinal needle by an orthopedic surgeon. (Korean J Anesthesiol 2007; 53: 250~3)
증례보고 : 중뇌동맥 경색증 환자의 마취유도 직후 경식도 심초음파에 의해 진단된 좌심방 혈전 -증례보고-
송준걸 ( Jun Gol Song ),황규삼 ( Gyu Sam Hwang ),김영국 ( Young Kug Kim ),성승혜 ( Seung Hye Sung ),최인철 ( In Cheol Choi ),황재현 ( Jai Hyun Hwang ),조성강 ( Sung Kang Cho ),한성민 ( Sung Min Han ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
Stroke is one of the most common causes of death; in particular, cardiac source of embolism may be responsible for 15-20% of ischemic strokes. Here we report a case of left atrial thrombus diagnosed by transesophageal echocardiography (TEE) immediately after induction of general anesthesia in a patient with infarction of the middle cerebral artery. In this case, an emergent craniectomy was cancelled and medical treatment was performed. This case report shows that TEE taken in the operating room may play an important role in the change of treatment plan in a patient displaying acute mental change. (Korean J Anesthesiol 2007; 52: 702~6)
증례보고 : Lesch-Nyhan 증후군 환자의 경피적 신쇄석술을 위한 전신마취 경험
전인구 ( In Gu Jun ),진지현 ( Ji Hyun Chin ),김영국 ( Young Kug Kim ),김영욱 ( Young Uk Kim ),조성강 ( Sung Kang Cho ),황규삼 ( Gyu Sam Hwang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Lesch-Nyhan syndrome (LNS) is a rare, X-linked recessive inherited disorder caused by a deficiency of the enzyme hypoxanthine-guanine-phophoribosyltransferase, leading to excessive purine production and elevation of uric acid. Clinical manifestations include mental retardation, spasticity, choreathetosis, compulsive self-mutilation, renal calculi followed by obstructive nephropathy, and arthritis. Patient with LNS may have increased risk of aspiration pneumonia, acute renal failure and unexpected sudden death. We accomplished successful general anesthesia in a case of LNS requiring percutaneous nephrolithotomy due to renal calculi. (Korean J Anesthesiol 2007; 53: 520~3)
실험연구 : 두 신경병증 통증 쥐 모델에서 척수강 내 투여 Cholinesterase Inhibitors와 NMDA Antagonists의 항이질통 효과 비교
강금내 ( Keum Nae Kang ),조선준 ( Sun Jun Cho ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: Cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) antagonists reduce the mechanical allodynia in neuropathic pain models. In this study our aim was to compare the antiallodynic effects between intrathecal cholinesterase inhibitors and NMDA antagonists on two well-characterized neuropathic pain rat models. Methods: Male Sprague Dawley rats were anesthetized and either had the left L5 and L6 spinal nerves ligated (SNL group) or Freund complete adjuvant (FCA) administrated to the sciatic nerve (FCA group) in order to cause neuropathic pain. A catheter was implanted into the intrathecal space for drug administration. After obtaining baseline values, edrophonium (3-100μg), neostigmine (0.3-10μg), AP-5 (0.3-3μg) and MK-801 (1-30μg) were administered intrathecally to each group. The allodynic left hind paw withdrawal thresholds to von Frey hairs were assessed and converted to % MPE. Antiallodynic effects on the two groups were compared by analyzing dose-response curves and ED 50 values. Motor weakness was also checked. Results: Intrathecal edrophonium, neostigmine, AP-5 and MK-801 had a dose-dependent antiallodynic effect on the two neuropathic pain models. Comparing the antiallodynic effect dose response curves, intrathecal cholinesterase inhibitors had lower ED 50 with steep slopes in the SNL model, whereas intrathecal NMDA antagonists had lower ED 50 in the FCA model, but there were no statistically significant differences between the two models. Conclusions: Intrathecal cholinesterase inhibitors and NMDA antagonists have relatively better antiallodynic effects on the SNL and FCA neuropathic pain rat models, respectively. (Korean J Anesthesiol 2007; 53: 767∼73)
실험연구 : Lidocaine 또는 MK-801의 척수강내 투여시 두가지 신경병증 통증 모델에서 항이질통 효과 비교
조선준 ( Sun Joon Cho ),강금내 ( Keum Nae Kang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Background: Neuropathic pain can be induced by nerve injury or inflammation. An N-methyl-D-Aspartate (NMDA) antagonist (MK-801), and a sodium channel blocker (lidocaine) have been found to reduce mechanical allodynia. This study was conducted to determine whether intrathecal lidocaine or MK-801 had an antiallodynic effect on established mechanical allodynia in two well-characterized neuropathic pain rat models. Methods: Male Sprague Dawley rats (n = 107) were anesthetized, and the left L5 and L6 spinal nerves were ligated (SNL group) or Freund complete adjuvant (FCA) was administrated to the same spinal nerves (FCA group) in order to cause neuropathic pain. A catheter was then implanted into the lumbar intrathecal space. After obtaining the baseline scores, time-effect curves of each drug were established for the antiallodynic effects of lidocaine (30μg, 100μg and 300μg) and MK-801 (1μg, 3μg, 10μg and 30μg). The allodynic thresholds for the left hind paw withdrawal to von Frey hairs were assessed and converted to %MPE, and the ED50 value was then calculated using the %MPE. The antiallodynic effects of the two groups were then compared by analyzing the dose-response curves and the ED50 values. Results: Both intrathecal lidocaine and MK-801 resulted in a dose dependent antiallodynic effect. ED50 values and the analysis of dose response curves showed that intrathecal lidocaine provided more effective antiallodynia in the SNL group, whereas intrathecal MK-801 resulted in a greater antiallodynic effect in the FCA group. Conclusions: In the SNL group, lidocaine had a better effect in reducing allodynic pain, whereas in the FCA group, MK-801 showed a greater antiallodynic effect. (Korean J Anesthesiol 2007; 53: 497~503)