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임상연구 : 관상동맥우회술 시 흉부 경막외 Lidocaine 주입이 이식된 관상혈관의 혈류량에 미치는 영향
심지연 ( Ji Yeon Sim ),임연주 ( Yeon Ju Leem ),김동욱 ( Don Guk Kim ),고원욱 ( Won Wook Ko ),최인철 ( In Cheol Choi ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Background: Thoracic epidural anesthesia (TEA) is increasingly used to reduce stress response, pain and pulmonary complication of patients under coronary artery bypass graft (CABG). However, effects of TEA on blood flow of grafted coronary artery are scarcely noticed. Imbalance between blood flow of grafted coronary artery and myocardial oxygen demand can bring about perioperative myocardial ischemia. Thus we evaluated the effect of TEA on blood flow of coronary grafts. Methods: Twenty seven patients with triple-vessel coronary artery disease under CABG were recruited. Left internal mammary artery, radial artery, and great saphenous vein were anastomosed to left anterior descending artery, obtuse marginalis, and posterior descending artery, respectively. Before surgery, an epidural catheter was inserted. Total intravenous anesthesia was undertaken using fentanyl, midazolam and vecuronium. After grafts anastomosis, blood flow of grafted coronary artery was measured using transit-time flowmeter (TTFM) before weaning from CPB. And then, mixture of 2% lidocaine 10 ml, fentanyl 50μg and bicarbonate 1 mEq was injected via epidural catheter. Under the constant pump flow, the blood flow of grafted coronary artery before, 10 and 20 minutes after drug administration were measured using TTFM. Results: The blood flow of coronary artery grafts was similar in three time interval, irrespective of grafted artery. There are no significant differences in changes in coronary blood flow associated with epidural lidocaine injection among 3 types of grafted artery. Conclusions: The present study shows that there are no significant effects of TEA on blood flow of newly grafted coronary artery after CABG. (Korean J Anesthesiol 2007; 52: 42~8)
설태경 ( Tai Kyung Seol ),심지연 ( Ji Yeon Sim ),박희연 ( Hee Yeon Park ),안원식 ( Won Sik Ahn ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
We report a case of awakening during general anesthesia due to a vaporizer malfunction. The sevoflurane vaporizer had a hole through which approximately 20% of fresh gas escaped. The gas in the common gas outlet contained only 60% of the sevoflurane stated on the vaporizer setting. Moreover, the gas monitor module was out of order, and the heart rate and blood pressure were stable. As a result, we were unaware of the low sevoflurane concentration. The leakage through the hole could not be detected with the commonly used low-pressure system leak checking method. The implication of this case is that unexpected awakening can occur in patients with stable vital signs with an inhalation anesthesia. Therefore, more attention is needed to detect the level of patient awareness. (Korean J Anesthesiol 2007; 578~81)
임상연구 : 국내 마취과학 임상연구의 임상윤리위원회 심의여부와 동의서의 실태조사
고원욱 ( Won Uk Koh ),심지연 ( Ji Yeon Sim ),안원식 ( Won Sik Ahn ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: All medical research requires approval of the institutional review board (IRB) and informed consent from the research participants in advance. But there are reports of low rates of IRB approval in major anesthesia journals. The purpose of the study is to investigate IRB approval and informed consent rates of Korean anesthetic field researches and provide suggestion. Methods: We reviewed 11 years data from Korean journal of anesthesiology and obtained the number and percentage of IRB approved papers, informed consents and verbal consents. Results: The total number and percentage of IRB approved papers has increased to 60% and so as cases with informed consents over the past 11 years. But the ratio is still under 25%. The ratio of informed consent against verbal consent is also increasing. Conclusions: The number of IRB approved and informed consented papers have increased. But the proportion is still not satisfying or low. Changes in understandings of the clinical researchers with education of research ethics and systemic establishment are needed. (Korean J Anesthesiol 2007; 53: 753~8)
최병문 ( Byung Moon Choi ),진지현 ( Ji Hyun Chin ),김영국 ( Young Kug Kim ),함경돈 ( Kyung Don Hahm ),심지연 ( Ji Yeon Sim ),최인철 ( In Cheol Choi ),황규삼 ( Gyu Sam Hwang ),한성민 ( Sung Min Han ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
An inguinal hernia shows that the protruding viscus exits from the endoabdominal fascial sac through the internal inguinal ring. Because an inguinal hernia is usually associated with incarceration, obstruction and even strangulation, it must be quickly treated whenever observed. Although there are several predisposing factors of the development of inguinal hernia, relatively little is a case report of the inguinal hernia developed by the increased intra-abdominal pressure during general anesthesia. In this case, we report a patient who developed the unexpected recurrence of left inguinal hernia following lumbar spinal surgery in prone position by increasing intra-abdominal pressure. After manual reduction was performed promptly by general surgeon, the patient was discharged without any complication on the eighth postoperative day. (Korean J Anesthesiol 2006; 51: 239~42)
증례보고 : 승모판 성형술 중 BIS 및 대뇌산소포화도에서 이상 소견을 보인 환자에서 수술 후 발생한 가역적인 시각 장애
김혜진 ( Hye Jin Kim ),이윤경 ( Yoon Kyung Lee ),함경돈 ( Kyung Don Hahm ),심지연 ( Ji Yeon Sim ),최인철 ( In Cheol Choi ),( Long Zhe Piao ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Cerebral complication after cardiac surgery with cardiopulmonary bypass varies widely focal neurologic deficit, stupor, coma, dementia, memory deficit, or seizures. The incidence of visual loss from ischemic optic neuropathy is from 0.06% to 0.113%. Visual loss is a rare but devastating complication of cardiac surgery. This report describes a patient who had reversible visual loss in postoperative period. She had undergone the decrease of bispectral index, cerebral oxygen saturation and the increase of suppression ratio during mitral valvuloplasty. (Korean J Anesthesiol 2006; 51: 490~4)
Wook Jong Kim,Jin-Young Oh,Hyo Jung Son,심지연,Dae Kee Choi,Eun Ho Lee,Ji Yeon Sim,최인철 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.5
Little is known about the prophylactic use of recombinant factor VIIa (rFVIIa) in patients undergoing surgery for a bleeding aorta employing cardiopulmonary bypass. We report the successful use of rFVIIa in a patient undergoing hypothermic circulatory arrest and prolonged cardiopulmonary bypass for repair of a DeBakey type III aortic dissection.