Incidental Contralateral Retrograde Internal Jugular Venous Catheterization via a Right External Jugular Venous Route −A case report−

서일숙,김범수 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.54 No.3

We report of the occurrence of an incidental retrograde left internal jugular venous (IJV) catheterization during a right external jugular vein (EJV) approach.After induction of anesthesia, central venous catheterization was performed through the right EJV using the standard technique.There was no expected cardiac arrhythmia during guide wire insertion, and there was no atrial waveform on the CVP tracing.Therefore, we took a chest X-ray for confirmation of catheter placement, which revealed the tip was placed in the left IJV.We withdrew the catheter about 6−7 cm to prevent possible impairment of cerebral venous drainage by a retrograde-positioned catheter in the IJV.We think that the dilation of the left IJV due to Trendelenburg position, positive pressure ventilation, and the upward direction of the J-wire tip contributed to the contralateral retrograde IJV catheterization.We recommend that a chest X-ray always be taken if correct catheter tip placement is not confirmed during CVP catheterization.

소아 사시 수술시 테논낭하 국소마취제 주사 및 수술 전 불안감이 sevoflurane 마취 후 회복기 각성흥분에 미치는 영향

서일숙,임승기,김명미 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.51 No.4

Background: Inhalation anesthesia with sevoflurane is widely used for pediatric patients. However, emergence agitation after sevoflurane anesthesia has been reported. This study examined whether or not a lidocaine injection into subtenons space and/or preoperative anxiety affects emergence agitation after pediatric strabismus surgery with sevoflurane anesthesia. Methods: Two hundred children receiving sevoflurane anesthesia for strabismus surgery were randomly assigned into four groups. Before induction, the anesthesiologist explained the general anesthesia and its possible complications to the children in groups 2 and 4, while it did not in groups 1 and 3. The anxiety score was then evaluated. Anesthesia was induced with 4-6 mg/kg thiopental sodium and 0.8 mg/kg rocuronium, and was maintained with O2-N2O-sevoflurane. Before the end of surgery, a surgeon injected the subtenons space with 2% lidocaine 1 ml in groups 3 and 4, while there was no injection in groups 1 and 2. The degree of emergence agitation was assessed at the postanesthetic care unit using a five point scoring scale. Results: The preoperative anxiety score was similar in the preoperative explanation (Gp 2, 4) and non preoperative explanation groups (Gp 1, 3). The incidence of emergence agitation was significantly higher in patients with a higher preoperative anxiety score (P < 0.05). The incidence of emergence agitation was 17% in the subtenons lidocaine injection group, which was significantly lower than in the control group (36%) (P < 0.05). Conclusions: A lidocaine injection into the subtenons space reduces emergence agitation after sevoflurane anesthesia in pediatric strabismus surgery. (Korean J Anesthesiol 2006; 51: 430~5)

소아 외래마취의 특성

서일숙 영남대학교 기초/임상의학연구소 2001 Journal of Yeungnam Medical Science Vol.18 No.2

In recent years, health care cost containment concerns have resulted in an increase in outpatient (or same-day) surgery. Many procedures previously performed on an inpatient surgery basis have been shifted to outpatient settings. Anesthesia for outpatient surgery is exactly the same as inpatient anesthesia, except that the primary concern is the selection of patients who can be discharged safely on the day of surgery. The anesthesiologist should have a sound rational basis for choice of pharmacologic agents that are geared to expeditious patient discharge from the hospital. Cost concerns aside, outpatient surgery has many additional advantages in the pediatric setting. It minimizes the length of time the child is hospitalized, decreases separation anxiety, promotes parental involvement in the child's postoperative care in the more congenial environment of home, and decreases risk of nosocomial infection and iatrogenic illness.

영아 전신마취에서 조절호흡 시 적합한 호흡수의 결정

서일숙,임승기,이성민 대한마취통증의학회 2004 Korean Journal of Anesthesiology Vol.46 No.2

Background: We experienced unintentional hyperventilation during mechanical ventilation in infants under general anesthesia. It is very difficult to decide upon respiratory rate or tidal volume for adequate ventilation without respiratory gas monitoring. During pulmonary ventilation using a Mapleson D circuit, the utilization of high fresh gas flow dilutes the expired gas and causes an underestimation of end-tidal CO2. We undertook to find a proper respiratory rate (RR) with a fixed tidal volume during controlled ventilation in infant general anesthesia. Methods: We studied 50 infants weighing below 10 kg during general anesthesia. An uncuffed endotracheal tube was selected 3.5 or 4.0 mm (inner diameter). After intubation with midazolam, thiopental sodium and vecuronium, controlled ventilation was applied: total fresh gas flow 3 L/minute, peak inspiratory pressure 15-20 cmH2O, and RR 19 or 20/minute. Arterial blood gas analysis was done 20 minutes later. We calculated the RR for a PaCO2 of 36 mmHg according to the equation: RR (applied) = estimated RR × estimated PaCO2/ideal PaCO2. In addition, linear regression was performed to analyze the relation between age and RR. Results: The estimated regression equation for RR using Pearson's correlation coefficient was as follows: RR = 22.835 - 0.415 × age (months). Conclusions: The equation (RR = 22.835 - 0.415 × age [months]) could be used as an index for safe ventilatory management without severe hyper- or hypo-carbia in infants during general anesthesia. (Korean J Anesthesiol 2004; 46: 186~190)

소아 전신마취에서 조절호흡시 적합한 호흡수의 결정

서일숙,이용환,김세연 대한마취통증의학회 2002 Korean Journal of Anesthesiology Vol.43 No.4

=Proper Respiratory Rate during Mechanical Ventilationin Pediatric General AnesthesiaIl Sok Seo, M.D., Yong Hwan Lee, Sae Yeon Kim, M.D.

만성 폐쇄성 폐질환자에서 척추마취후 발생한 경련발작 1례

서일숙 영남대학교 의과대학 1988 Yeungnam University Journal of Medicine Vol.5 No.2

만성폐쇄성 폐질환을 동반한 노인환자에서 척추마취하에서 치골상부 전립선 절제술을 시행하는 도중 척추마취와는 무관한 것으로 사료되는 원인불명의 경련 발작 및 혈압강하가 초래된 환자가 발생하였기에 그 원인을 규명하고 문헌적 고찰과 함께 보고하는 바이다. In the geriatric patient with COPD, incidence of postoperative pulmonary complication is higher than young patient. Therefore, some anesthesiologists preferred spinal anesthesia to general anesthesia for surgery of the perineum, lower extremities, and pelvic extraperitoneal organs. But, during spinal anesthesia, the same careful observation is required as during general anesthesia. We experienced a case of the convulsive seizure at about 1 hour after spinal anesthesia for open prostatectomy in a 76-year-old male patient wit COPD. It was suspected that his convulsive seizure be resulted from hypercapnea combined with hypoxia following upper airway obstruction. This patient was treated successfully by ultrashort acting barbiturate and controlled ventilation.

상복부 술후 진통을 위한 요부 경막외 Narcotics의 투여효과

구본업,서일숙 영남대학교 의과대학 1985 Yeungnam University Journal of Medicine Vol.2 No.1

상복부 수술후 진통을 위하여 경막외 narcotics주입시 임상에서 경막외강 천자가 가장 많이 시술되고 있는 부위인 요부 경막외강에 morphine과 demerol을 각각 주입하여 진통효과를 관찰하였다. 전신 마취하에서 상복부 수술을 받은 환자 20명을 대상으로 하여서 morphine 1㎎을 주입한 10명의 Ⅰ군, demerol 10㎎을 주입한 10명의 Ⅱ군에서의 진통 효과를 관찰하였던 바 다음과 같은 결론을 얻었다. 1. Morphine을 주입한 Ⅰ군에서는 평균 진통 시간이 29.4시간이었다. 2. Demerol을 주입한 Ⅱ군에서는 평균 진통 시간이 4.0시간이었다. 3. Morphine을 주입한 Ⅰ군이 Demerol을 주입한 Ⅱ군보다 진통 시간이 훨씬 길었으며 통계학적으로 유의하였다. (P<0.05) 이상의 결과로 보아 상복부 수술후 진통 목적으로 마약제를 경막외강에 투여시 시술이 안전한 요부 경막외강내로 투여하여도 우수한 진통효과를 얻을 수 있으며 마약제로는 morphine의 투여가 demerol의 투여보다 더욱 진통 효과가 우수한 것으로 사료된다. To assess the effect of post-operative pain control of upper abdominal surgery through lumbar epidural narcotic injection, the 3rd or 4th lumbar epidural puncture was done, and were injected 1㎎. of morphine (GroupⅠ) or 10㎎. of demerol (GroupⅡ) mixed with 10㎖ of normal saline into the epidural space, after operation of the cholecystectomy in 10patients and antrectomy and vagotomy, subtotal or total gastrectomy in 10patients. Time interval of the post-operative analgesic effect between morphine and demerol groups were compared. The results of this study were as follows: 1. In the groupⅠ, average analgesic duration was 29.4 hours. 2. In the groupⅡ, average analgesic duration was 4.0 hours. It is concluded that post-operative pain control of upper abdominal surgery through the lumbar epidural narcotic injection was effective, and morphine injection was more effective than demerol.

Enflurane 마취시 혈압 및 맥박의 변화상에 대한 통계학적 관찰

박대팔,서일숙 영남대학교 의과대학 1986 Yeungnam University Journal of Medicine Vol.3 No.1

저자는 enflurane을 사용한 200예의 전신마위시술하에서 혈압 및 맥박의 변화상을 이론식을 도입하여 時系列型으로 표현하여 실현된 型의 類別과 분포상태를 분석하였던바 다음과 같은 결과를 얻었다. 1. 삽관시 혈압 및 맥박이 상승한다. 2. 삽관시 혈압 및 맥박이 상승하였다가 하강하여 20분 이내에 대체로 안정상태로 되었다. 3. 구조상으로 상승하강동치이행 (ADEE)형이 73-74%로 가장 많았고 다음은 상승동치이행(AEEE)형이 40∼44%였다 Observationn of changing pattern of blood pressure and pulse rate of enflurane anesthesia for 200 cases operations, performed during the past 4 years(1983-1986) in Yeungnam University Hospital have been evaluated clinically. In order to observe the influence of enflurane upon the blood pressure and pulse rate during general anesthesia, the authors prepared a formula, expressing changing of blood pressure and pulse rate by time series and analyzed the type and distribution pattern in the experiment. The results Obtained were as follows: 1. Blood pressure and pulse rate were increased at the time of intubation. 2. Generally, blood pressure and pulse rate were increased at the time of intubation and then stabilized withing 20 minutes. 3. Most common patterns were identified. ADEE type was 73∼74%. Which is not common type and AEEE type was about 40%.

경비 기관내삽관 시 발생된 편측 기관지 폐쇄의 처치

서일숙 ( Seo Il Sook ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Nasotracheal intubation is commonly used in patients undergoing maxillofacial surgery. The tracheal tube is passed through the nasal cavity after induction of anesthesia, followed by direct laryngoscopy to insert the tube into the trachea under direct vision by using Magill forceps. Various complications resulting from nasal passage of the tube, such as epistaxis, turbinectomy or retropharyngeal dissection, have been reported. The most common complication of nasotracheal intubation is epistaxis and several recommendations have been made to reduce its incidence. In spite of efforts such as local application of vasoconstrictive drugs, thermosoftening of the tube, and use of a nasopharyngeal airway as a pathfinder, epistaxis cannot be prevented entirely. 1) This case report describes an 18-year-old female patient with difficult nasal intubation due to narrow nasal passageway. The patient was admitted for mandible angle splitting ostectomy and angle resection for cosmetic purpose. Epistaxis had occurred due to repeated nasotracheal intubation attempts, and blood had been aspirated. After intubation, the patient was desaturated (SpO2<92%) with asymmetric inflation of the chest wall during controlled ventilation. We took frequent suction and tube lavage with saline, thereafter changed patient`s position to right lateral decubitus, and chest percussion was done with a face mask and the palm of the hand. About 20 minutes after aspiration, the SpO2 was restored to 98%, and the operation proceeded, which finished uneventfully. On the next day, the chest x-ray revealed segmental atelectatic change in the right lung field, and nasal packing was done because of recurrent epistaxis. The patient was discharged on the 4th postoperative day without complications.

소아마취시 금식과 수액투여가 혈당농도에 미치는 영향

서일숙,송선옥,박대팔 영남대학교 의과대학 1984 Yeungnam University Journal of Medicine Vol.1 No.1

선택수술이 계획된 4세이하, 체중 18kg이하 소아환자 38명을 대상으로 하여 수술전 병실에서 측정된 혈당치를 대조치료하고, 8시간 정도의 금식후 수술실로 오기 1시간 전부터 비포도당액인 Hartmann’s solution을 공급한 Ⅰ 군과 포도당이 함유된 Hartmann’s dextrose solution을 공급한 Ⅱ이군으로 나누어 각각 혈당치를 측정하고 또 수술 1시간후의 혈당치를 측정하여 혈당치변화를 관찰하였던 바 다음과 같은 결론을 얻었다. 1) Ⅰ군에서는 대조치 95.4±13.3mg%에 비해 8시간 금식후의 혈당치는 85.6±12.2mg%로 감소했으며, 수술후 1시간에 있어서의 혈당치는 119.2±33.0mg%로 대조치에 비해 유의한 증가를 보였다. 2) Ⅱ군의 경우에는 대조치 94.6±28.5mg%에 비해 8시간 금식후의 혈당치는 99.8±21.8mg%로 약간 증가되었고, 수술후 1시간의 혈당치는 122.3±27.3mg%로 유의한증가를 보였다. 이상의 결과로 보아 신아에서 약 8시간정도의 금식으로는 저혈당이 초래되지 않으며, 또한 수술중에 혈당이 증가되므로 소아수술시 수술중 혈당유지를 위한 포도당액의 투여는 필요치 않는 것으로 사료된다. This study included 38 children patients of less than 4 years old and 18kg body weight. After 8 hours of starvation, the children were divided into 2 groups: GroupⅠ received Hartmann’s solution and Group Ⅱ received Hartmann‘s dextrose solution. In both groups, the rates of infusion were 10ml/kg/hr before and during operation and blood samples were collected just before and 1 hr after induction of anesthesia, respectively. The results were as follows; 1) In the Group Ⅰ, blood glucose concentraton just before induction was decreased than control values that was checked at ward, and 1 hr values after induction was significantly increased than control values. 2) In the GroupⅡ, blood glucose concentration was increased just before and 1 hr after induction than control values significantly respectively. 3) In the blood glucose concentration 1 hr after induction, difference between Group Ⅰ and Group Ⅱ was not significant. 4) In children, duration of starvation about 8 hrs did not significant influence on blood glucose concentration although dextrose was not administered.