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증례보고 : 내경정맥 카테터 제거 후 발생한 뇌 공기색전증
유수봉 ( Soo Bong Yu ),류시정 ( Sie Jeong Ryu ),윤상호 ( Sang Ho Yoon ),강효석 ( Hyo Suk Kang ),김두식 ( Doo Sik Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Air embolism can occur during central venous catheter removal. We encountered a patient diagnosed with cerebral air embolism associated with the removal of an internal jugular venous catheter. The patient was 65 years old and was admitted to the intensive care unit due to pneumonia. He had a catheter placed in the right internal jugular vein. Five days thereafter, the catheter was removed in semi-Fowler`s position using the Valsalva maneuver. Immediately after the catheter removal, the patient became pale, felt dyspneic, lost consciousness and exhibited seizure activity. A neurological examination, revealed left upper arm (grade I) and lower leg paralysis (grade II) as well as left facial palsy. A brain computed tomogram showed that, air was trapped in the cavernous sinus. In diffusion weighted magnetic resonance imaging, signal changes were reported in the right frontal cortex, indicating acute cerebral infarction. Hyperbaric oxygen therapy and ventilatory support with synchronized intermittent mandatory ventilation mode was applied. Twenty days thereafter, consciousness and motor functions were recovered completely except for mild weakness of the upper arm (grade IV). (Korean J Anesthesiol 2009;57:673∼7)
신경병증성 통증과정의 NMDA 수용체 활성과 칼슘통로 α2δ1 Subunit의 영향
유수봉,임영수,김두식,Yu, Soo Bong,Lim, Young Soo,Kim, Doo Sik 대한통증학회 2009 The Korean Journal of Pain Vol.22 No.3
Background: Several studies have indicated that a nerve injury enhances the expression of the voltage-gated calcium channel ${\alpha}2{\delta}1$ subunit (Cav ${\alpha}2{\delta}1$) in sensory neurons and the dorsal spinal cord. This study examined whether NMDA receptor activation is essential for Cav ${\alpha}2{\delta}1$-mediated tactile allodynia in Cav ${\alpha}2{\delta}1$ overexpressing transgenic mice and L5/6 spinal nerve ligated rats (SNL). These two models show similar Cav ${\alpha}2{\delta}1$ upregulation and behavioral hypersensitivity, without and with the presence of other injury factors, respectively. Methods: The transgenic (TG) mice were generated as described elsewhere (Feng et al., 2000). The left L5/6 spinal nerves in the Harlan Sprague Dawley rats were ligated tightly (SNL) to induce neuropathic pain, as described by Kim et al. (1992). Memantine 2 mg/kg (10 ul) was injected directly into the L5/6 spinal region followed by $10{\mu}l$ saline. Tactile allodynia was tested for any mechanical hypersensitivity. Results: The tactile allodynia in the SNL rats could be reversed by an intrathecal injection of memantine 2 mg/kg at 1.5 hours. The tactile allodynia in the Cav ${\alpha}2{\delta}1$ over-expressing TG mice could be reversed by an intrathecal injection of memantine 2 mg/kg at 1.5, 2.0 and 2.5 hours. Conclusions: The behavioral hypersensitivity was similar in the TG mice and nerve injury pain model, supporting the hypothesis that elevated Cav ${\alpha}2{\delta}1$ mediates similar pathways that underlie the pain states in both models. The selective activation of spinal NMDA receptors plays a key role in mediating the pain states in both the nerve-injury rats and TG mice.
Remifentanil과 Lidocaine이 고혈압 환자에서 기관내삽관 시 심혈관계 반응에 미치는 효과
강효석 ( Hyo Suk Kang ),유수봉 ( Soo Bong Yu ),김두식 ( Doo Sik Kim ),류시정 ( Sie Jeong Ryu ),장태호 ( Tae Ho Chang ),김세환 ( Se Hwan Kim ),김경한 ( Kyung Han Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
Background: Hypertensive patients are more prone to exhibit an exaggerated hemodynamic responses to laryngoscopy and tracheal intubation. We compared the effects of remifentanil and lidocaine on the cardiovascular responses during intubation in hypertensive patients. Methods: Fifty adult hypertensive patients (>140/90 mmHg) were divided into 2 groups (remifentanil group; 1.0 μg/kg, n=25, lidocaine group; 1.5 mg/kg, n=25). After 3 minutes`oxygenation, anesthesia was induced using 0.2 mg glycopyrrolate, 1.5 mg/kg propofol, and 1 of experimental drugs (30 seconds) bolus administration. Tracheal intubation was facilitated 90 seconds after administration of rocuronium; anesthesia was maintained with 2% sevoflurane and air in oxygen. Arterial blood pressure and heart rate were measured at the following times: resting state (baseline), after oxygenation; before intubation; just after intubation; and at 1, 3, and 5 minutes after intubation. Results: There was significant attenuation of mean systolic and diastolic arterial blood pressures, after intubation of the remifentanil group compared to the lidocaine group at just after intubation and at 1 minute after intubation (P<.05). The difference in heart rate was not significant between both groups. Conclusions: Bolus administration of remifentanil was found to be superior to lidocaine in the attenuation of the blood pressure during intubation in hypertensive patients. (Korean J Anesthesiol 2009; 57: 20~5)
유수봉 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4
We report a case of intractable spontaneous intracranial hypotension complicated with acute subdural hematoma. A 44 year-old woman presented with severe orthostatic headache, nausea and vomiting for 1 month. Her symptom didn't improve after bed rest, hydration, caffeine and steroid neither after 3 repetitive thoracic epidural blood patch therapy. Moreover, her mentality deteriorated acutely. Brain CT revealed bilateral acute subdural hemorrhage and she took an emergency burr hole drainage operation.
유수봉 고신대학교의과대학 2008 고신대학교 의과대학 학술지 Vol.23 No.4
The tracheal bronchus means an abnormal bronchus originating directly from the trachea proximal to the carinal bifurcation and ventilating the right upper lobe in many cases. It has clinical significance for anesthesiologists because it occasionally makes troubles with managing patients' airway during surgery. In this case, we were faced to unanticipated problem while trying one lung ventilation with a left sided double lumen endotracheal tube. After the tracheal bronchus was diagnosed with bronchoscopy, one lung isolation was successfully done with Univent tube and the surgery was performed uneventfully.
유수봉,최형규,류시정 고신대학교의과대학 2006 고신대학교 의과대학 학술지 Vol.21 No.2
The number of obese women increases recently. Obesity itself has many physiologic problems such as decreased functional residual capacity and increased oxygen demand which result in hypoxemia easily, and increase of gastric acidity and volume which can results in aspiration pneumonia. Pregnancy induces similar physiologic changes, also. Rapid sequence induction and tracheal intubation are very important especially in morbidly obese parturient for general anesthesia. It is important to predict the possibility of difficult intubation during preoperative period. We experienced a morbidly obese parturient (height: 173 cm, weight: 155 kg, BMI: 51.8) who received cesarean section under general anesthesia without difficult intubation and any complications. Although obesity is not confirmed as a risk factor predicting difficult intubation, we should prepare against failed intubation in advance in obese patient.