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증례보고 : 위암환자의 위전절제술 중 발생한 심장의 무맥박 전기 활동
송재격 ( Jae Gyok Song ),엄우식 ( Woo Sik Eom ),정해정 ( Hae Jeong Jeong ),조대순 ( Dae Soon Cho ),신혜영 ( Hye Young Shin ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Pulseless electrical activity refers to a heterogeneous group of cardiac rhythm disorders, all characterized by pulselessness in the presence of some type of electrical activity other than ventricular tachycardia or ventricular fibrillation. We experienced a case of sudden pulseless electrical activity and cardiac arrest during hetastarch infusion in general anesthesia in an adult who had total gastrectomy. We report this experience with a brief review of literature. (Korean J Anesthesiol 2007; 52: 246~9)
증례보고 : 발견되지 않은 갈색세포종이 동반된 갑상선수질암 환자의 정맥마취 유도시 발생한 빈맥과 저혈압
송인애 ( In Ae Song ),정해정 ( Hae Jung Jung ),조대순 ( Dae Soon Cho ),윤정연 ( Jung Yeon Yun ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.2
A 35 year old woman with hypercalcitoninemia was scheduled for an operation to treat her medullary thyroid cancer (MTC). TIVA with propofol and remifentanil was planned, and about 3 minutes after the infusion of anesthetics, her heart rate was suddenly elevated to 180/min and the systolic blood pressure was lowered to nearly 50 mmHg. The blood pressure returned to normal after the injection of phenylephrine 100 μg and a rapid infusion of 700 ml crystalloid solution. After the operation, bilateral pheochromocytoma and a RET proto-oncogene mutation related with multiple endocrine neoplasia 2A (MEN-2A) were found. Patients with MTC can present with peripheral vasodilation and relative hypovolemia that are related with hypercalcitoninemia. Patients with MEN-2A can be anesthetized for a MTC operation without the appropriate preparation for their pheochromocytoma. Therefore, we suggest that patients with MTC and hypercalcitoninemia should be cautiously anesthetized with TIVA. They also should be screened for pheochromocytoma and the RET proto-oncogene mutation to prevent deleterious hemodynamic events during anesthesia. (Korean J Anesthesiol 2009;57:254∼8)
한국 성인의 나이와 성별에 따른 pseudocholinesterase 의 활성도
조대순,인장혁 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.5
Serum pseudocholinesterase activities, using butyrylthiocholine as substrate, measured in 639 employees of Korea Cancer Center Hospital in 1993. Overall mean value of pseudocholinesterase was 9.38±2.10 U/ml, 10.6±2.10 U/ml in male, and 8.58±1.67 U/ml in female, respectively. Male in the first five decades of life had higher pseudocholinesterase activity than female, and after the age of 50 tbere was no intersexual difference. These findings suggest that adults before the age of 50, male has higher pseudocholinesterase activity than female.
체온 변화에 따른 근육이완제의 작용시간 변화에 대한 연구
조대순,허해량,안기천 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.6
This project is based on the hypothesis that induced hyperthermia may prevent or treat the prolonged muscular relaxation caused by intraoperative hypothermia or by unknown origin. In some researches, one of the causes of postoperative respiratory depression is residual curarization which is usually resulted from hypothermia. But, there is no articles about the twiteh response in hyperthermia. The 10 mongrel dog with no muscular, renal or hepatic disease were classfied into 3 groups according to the type of muscle relaxants, atracurium group, pancuronium group and norcuron group. In each case, induced hyperthermia was applied on one side and normothermia was maintained on the other side. Muscular twitch response from the TOF stimulation was recorded. This experiment was repeated with tourniquet application in order to avoid the effect of systemic circulation. The muscular twitch response appeared faster in hyperthermia group than in normothermia group regardless of the type of muscle ralaxants. Now, therefore, we can utilize the results by inducing hyperthermia to treat and prevent the postoperative hypoxia caused by intraoperative hypothermia as well as excessive use or inade- quate reverse of muscle relaxants.
술전 혈장 교환을 이용한 중증 근무력증 환자의 마취 관리
조대순,허해량 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.1
Myasthenia gravis is believed to be an autoimmune disease involving morphologic and electrophysiologic disturbances of motor end plates brought about by circulating antibodies against acetylcholine receptors. Its treatment includes the use of steroids, anticholinesterase, immunosuppression and plasmapheresis. Plasmapheresis, in particular, is used either as a stand-alone temporary measure for its often dramatic, though short-lived, effect, or as an adjunctive treatment. Plasmapheresis is considered to be essential not only in preventing and treating myasthenic crisis but in preoperative management of myasthenia gravis, usually before thymectomy. the authors here report a case of myasthenia gravis that underwent preoperative plasmapheresis followed by the use of atracurium for muscle relaxation during anesthesia for thymectomy.
개에서 Sevoflurane 마취중에 Diltiazem 투여가 심혈관계 및 산소화에 미치는 영향
곽일용,조대순 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.5
Diltiazem was administered by two different dosages with 200 μg/kg 1V+10 μg/kg/min infusion, 400 μg/kg 1V+20 μg/kg/min infusion, in order to assess the interaction between sevoflurane and diltiazem on the cardiovascular function and oxygenation in dogs during inhalation of 1.0 MAC of sevoflurane. Significant decrease in heart rates, mean arterial pressure, pulmonary vascular resistance, systemic vascular resistance, coronary perfusion pressure were observed. Subsequently rate pressure product, as a parameter of myocardial oxygen consumption, decreased with no significant changes of oxygen extraction ration in 1.0 MAC of sevoflurane anesthesia with the above dosages of diltiazem in dogs. The author concludes that concomittent use of diltiazem in clinical doses induced tolerable hemodynamic depression and no untoward effects on oxygenation during maintenance of anesthesia with 1 MAC of sevoflurane. These combination would be safe for anesthetic cares in patient with ischemic heart diseases and coronary arte diseases in which adequate oxygen supply in the heart is essentially necessary.