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증례보고 : 진단받지 않은 후두개 낭종으로 인한 어려운 기관 내 삽관
이정혁 ( Jeoung Hyuk Lee ),최준권 ( Jun Gwon Choi ),윤동일 ( Dong Il Yoon ),이영민 ( Young Min Lee ),인준용 ( Jun Yong In ),정승현 ( Seung Hyun Chung ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
An epiglottic cyst is a common form of laryngeal cysts which are rare causes of upper airway obstruction. A congenital laryngeal cyst always causes neonatal respiratory distress, but an acquired cyst shows very wide spectrum of symptoms such as no specific complaints, dysphagia, respiratory difficulty, or even death according to its size, location, or age. From anesthesiologists` point of view, an asymptomatic undiagnosed laryngeal cyst is a major concern. Unexpectedly, it can cause difficult airway such as ‘cannot intubate` or `cannot intubate and cannot ventilate` situation during anesthesia. Recently we discovered an undiagnosed epiglottic cyst obscuring laryngeal inlet, leading to difficult intubation during general anesthesia for decompression and fusion of lumbar vertebrae. Fortunately, mask ventilation was possible, and after failed attempts of direct laryngoscopy, we could perform oral fiberoptic bronchoscope-aided intubation. He was discharged 10 days later with no harmful events. (Korean J Anesthesiol 2009;56:567~70)
임상연구 : 광봉을 이용한 기관내 삽관 시 혈역학적인 변화를 최소화하기 위한 Remifentanil의 정적 효과처 농도는?
이정혁 ( Jeoung Hyuk Lee ),전우재 ( Woo Jae Jeon ),심재항 ( Jae Hang Shim ),조상윤 ( Sang Yoon Cho ),염종훈 ( Jong Hoon Yeom ),신우종 ( Woo Jong Shin ),김경헌 ( Kyoung Hun Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3
Background: In the previous studies, remifentanil reduces the hemodynamic change induced by endotracheal intubation. We studied the optimal effect site concentration of remifentanil for endotracheal intubation using light wand. Methods: Sixty ASA 1 or 2 patients scheduled for elective surgery under general anesthesia were classified in three groups according to the TCI (target controlled infusion) dose of remifentanil. Each group was administered 4μg/ml of propofol TCI, rocuronium, with 2 ng/ml (group 1), 4 ng/ml (group 2), 6 ng/ml (group 3) of remifentanil TCI. Blood pressure, heart rate and bispectral index score were measured before induction, 3 minutes after remifentanil and propofol TCI, after endotracheal intubation using light wand, and 3 minutes after endotracheal intubation. Statistical analysis was done for comparison of time and dose dependant change among the groups. Results: After endotrachal intubation, blood pressure and heart rate were significantly increased in group 1, and decreased in group 2 and 3. 3 minute after endotracheal intubation, heart rate significantly decreased in group 3, but there were no changes in group 2. Conclusions: The spontaneous BRS was decreased during ketamine induction of general anesthesia. These results suggest that anesthesia induction with ketamine impairs baroreflex control of heart rate, which may provoke hemodynamic instability. (Korean J Anesthesiol 2007; 52: 278~83)
Desflurane 폐포내농도 상승에 따른 뇌산소포화도 반응에 미치는 Remifentanil의 효과와 뇌혈관의 이산화탄소 반응성
이정혁 ( Jeoung Hyuk Lee ),이윤석 ( Youn Suk Lee ),인준용 ( Jun Yong In ),정승현 ( Seung Hyun Chung ),신홍일 ( Hong Il Shin ),이경진 ( Kyoung Jin Lee ),김경옥 ( Kyoung Ok Kim ),조헌 ( Hun Cho ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
Background: It is known that sympathetic stimulation and increase in cerebral blood flow velocity can be induced by desflurane. Cerebral oxygen balance could be disturbed during desflurane induction. Aim of this study was to elucidate that cerebral oxygen imbalance induced by desflurane mask induction can be reduced by combination of remifentanil and hypocapnia. Methods: Twenty ASA 1-2 subjects were allocated randomly into 5 groups divided by concentration of remifentanil (0.0, 0.5, 1.0, 1.5, and 2.0 ng/ml). After confirmation of attaining proposed concentration of remifentanil, propofol and vecuronium were administered and mechanical ventilation was done with 8% desflurane with facial mask. Subsequently, changes in regional cerebral oxygen saturation (△rSO2), arterial blood pressure, heart rate, cardiac index, estimated alveolar concentration of desflurane (P(DESF)), and end-tidal concentration of carbon dioxide (PET(CO2)) were recorded for the following 10 minutes. According to concentration of desflurane and remifentanil, △rSO2 and hemodynamic factors were checked. Results: During desflurane induction, changes in cerebral oximetry reached up to+10% (6 [first quartile], 13 [third quartile]). Arterial blood pressure, heart rate, and cardiac index were changed within clinical ranges. The △rSO2 showed S-shaped increasing pattern according to increasing P(DESF). Hypocapnia and concentration of remifentanil reduced the maximum △rSO2 (P=0.0046, P=0.0060). Hypocapnia also shifted the curve to left (P=0.0001). Conclusions: During 8% desflurane induction, regional cerebral oxygen saturation (rSO2) increases maximum +25%. Hypocapnia and use of remifentanil can reduce the increase in regional cerebral oxygen saturation. (Korean J Anesthesiol 2009;56:543~51)
윤탁,김용식,이남영,김세현,최준권,이정혁,정인원,Youn, Tak,Kim, Yong Sik,Lee, Nam Young,Kim, Se Hyun,Choi, Jun Gwon,Lee, Jeoung Hyuk,Chung, In Won 대한생물정신의학회 2017 생물정신의학 Vol.24 No.3
Electroconvulsive therapy (ECT) has been recognized effective as primary or secondary treatments for major psychiatric disorders including depression and schizophrenia, as well as psychiatric emergency such as suicide, food refusal and catatonia, and so on. Medicines used in anesthetic induction for ECT, cause various reactions in autonomous, hemodynamic, and neuromuscular systems. The anesthetics also affect the duration, threshold, and intensity of seizures evoked with electric stimuli, and thus modify the seizure quality in ECT. Individual characteristics of age, sex, weight, comorbid physical disorders, and medications should also be considered for optimal clinical response after ECT. When preparing for anesthesia, adequate anesthetic agents and muscle relaxants, and rapid recovery should be carefully considered. We conducted a case-series study to address practical issues that are frequently encountered during ECT anesthesia with reviews of updated journals in order to provide practical helps to clinicians who are preparing ECT for their patients.
환자들은 수술 후 오심 및 구토 예방에 어느 정도 지불할 용의가 있는가?
정승현 ( Seung Hyun Chung ),김경옥 ( Kyoung Ok Kim ),이정혁 ( Jeoung Hyuk Lee ),이경진 ( Kyoung Jin Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.2
Background: Postoperative nausea and vomiting (PONV) remains a common complication of anesthesia. We tried to assess the amount patients were willing to pay for a hypothetical antiemetic that would completely prevent PONV. Methods: Trained residents interviewed 86 patients, who were scheduled to undergo general anesthesia, and questionnaires were completed. Results: Patients were willing to pay a median of 30,000 won for an antiemetic that would completely prevent PONV. The amounts patients were willing to pay correlated with age, previous history of PONV, and patient income. Conclusions: Patients assigned a value for avoidance of PONV. It is suggested that more efforts to prevent PONV would be helpful for the increase in patient satisfaction. (Korean J Anesthesiol 2009;57:151∼4)
김경옥 ( Kyoung Ok Kim ),신홍일 ( Hong Il Shin ),이정혁 ( Jeoung Hyuk Lee ),이윤석 ( Youn Suk Lee ),최준권 ( Jun Gwon Choi ),윤동일 ( Dong Il Yoon ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
Hysteroscopic surgery has become a routine gynecologic procedure. The advantages are associated with more accurate removal of lesion, its short operating time, rapid post-operative recovery and low morbidity. However, there are potentially serious complications which can be occured during and following hysteroscopic surgery. The complications are uterine perforation, fluid overload and electrolyte disturbance due to intravasation and absorption of uterine distention media, hemorrhage and, rarely, gas or air embolism. We experienced pulmonary edema during hysteroscopic surgery in three consecutive patients. Therefore, we report these cases of fluid overload with uterine distention media resulting acute pulmonary edema during hysteroscopic surgery. (Korean J Anesthesiol 2009; 57: 117~22)