Relationship between N-terminal pro-B-type natriuretic peptide and renal function: the effects on predicting early outcome after off-pump coronary artery bypass surgery

조윤이,곽영란,Jonghoon Lee,최용선 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.1

Background: Plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) provide useful prognostic predictors in patients after cardiac surgery. However, predictive accuracy of NT-proBNP levels has varied significantly according to renal dysfunction. The purpose of this study was to assess whether preoperative NT-proBNP levels could be used as predictors of early postoperative outcomes on the basis of renal function in patients undergoing off-pump coronary artery bypass surgery (OPCAB). Methods: In 219 patients undergoing elective OPCAB, NT-proBNP and an estimated glomerular filtration rate (eGFR)were assessed preoperatively. All patients were divided into 3 groups according to tertiles of eGFR: the first (eGFR ≥90 ml/min/1.73 m^2), the second (90 ml/min/1.73 m^2 > eGFR ≥ 72 ml/min/1.73 m^2) and the third tertile group (eGFR < 72 ml/min/1.73 m^2). End point was the composite of early postoperative complications defined as myocardial infarction, new onset atrial fibrillation, ventricular dysfunction, prolonged mechanical ventilator care (> 48 hr),prolonged ICU stay (≥ 3 days), and in hospital mortality. Results: There was no difference in early postoperative complications among groups. A preoperative NT-proBNP level of 228 pg/ml and 302 pg/ml (sensitivity 70%, specificity 67%, P < 0.001 and sensitivity 73%, specificity 63%, P = 0.001, respectively) were optimal cut-off values predicting complicated early postoperative course in second and third tertile group, respectively. Conclusions: Preoperative NT-proBNP levels seem to be predictive of early postoperative complications in patients with eGFR < 90 ml/min/1.73 m^2 undergoing OPCAB

Total intravenous anesthesia for Kartagener’s syndrome -A case report-

조윤이,정월선,김홍순,Sang-Ho Byen,이경천 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.4

Kartagener’s syndrome (KGS) is an autosomal recessive disorder which possible to link the occurrence of abnormal ciliary movement and abnormal position of the body organs. Considering the fact that airway ciliary function plays an important role in the primary pulmonary defense mechanism, prevent the ciliodepressant actions are also important for anesthetic management. We described successful anesthetic management of a 44-year-old male scheduled for endoscopic sinus surgery who had a history of frequent epistaxis,anosmia and situs inversus totalis. Anesthesia was induced and maintained with propofol and remifentanil using a target controlled infusion device.

Extrapyramidal side effects after metoclopramide administration in a post-anesthesia care unit -A case report-

조윤이,김용범,양미란,장영진 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.3

Although the incidence of extrapyramidal reactions associated with metoclopramide has been reported to be approximately 0.2%, such reactions are rare in the anesthetic field. Several anesthetic adjuvants, including ondansetron and pregabalin, have also been associated with extrapyramidal side effect. Here, the authors report the case of a 47-year-old patient, previously administered pregabalin and ondansetron, who developed extrapyramidal side effects after a single injection of metoclopramide (10 mg) in a post-anesthesia care unit.

Transient hemiparesis following laparoscopic cholecystectomy in a patient with uncontrolled diabetes mellitus -A case report-

조윤이,장영진,정월선,남승균 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.1

The patients with diabetes mellitus (DM) have abnormal cerebral auto-regulation and preexisting DM is one of the major factors related to adverse postoperative neurological deficits. New onset hemiparesis is a rare and devastating event in a patient awakening from general anesthersia. We report a case of transient hemiparesis after general anesthesia in a patient underwent laparoscopic cholecystectomy with uncontrolled DM.

The effect of warmed inspired gases on body temperature during arthroscopic shoulder surgery under general anesthesia

조윤이,김홍순,곽현정,장영진,윤순영 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.1

Background: Perioperative hypothermia can develop easily during shoulder arthroscopy, because cold irrigation can directly influence core body temperature. The authors investigated whether active warming and humidification of inspired gases reduces falls in core body temperature and allows redistribution of body heat in patients undergoing arthroscopic shoulder surgery under general anesthesia. Methods: Patients scheduled for arthroscopic shoulder surgery were randomly assigned to receive either room temperature inspired gases using a conventional respiratory circuit (the control group, n = 20) or inspired gases humidified and heated using a humidified and electrically heated circuit (HHC) (the heated group, n = 20). Results: Core temperatures were significantly lower in both groups from 30 min after anesthesia induction, but were significantly higher in the heated group than in the control group from 75 to 120 min after anesthesia induction. Conclusions: In this study the use of a humidified and electrically heated circuit did not prevent core temperature falling during arthroscopic shoulder surgery, but it was found to decrease reductions in core temperature from 75 min after anesthesia induction.

The effect of epidural administration of dexamethasone on postoperative pain: a randomized controlled study in radical subtotal gastrectomy

조윤이,Ji Hyun Yoo,Hyun Joo Kim,길혜금 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.3

Background: Epidurally administered dexamethasone may reduce the incidence and severity of postoperative pain. We investigated whether postoperative pain could be alleviated by preoperative or postoperative epidural dexamethasone administration in patients undergoing major abdominal surgery. Methods: Ninety patients (age 30-77 with American Society of Anesthesiologists physical status I and II) undergoing radical subtotal gastrectomy were randomly allocated to three groups using computer generated randomization. In all groups, 10 ml of 0.25% ropivacaine was injected epidurally before the start and at the end of the operation. In Group I, a bolus ropivacaine epidural without dexamethasone was administered. In Group II, dexamethasone (5 mg) was added to the ropivacaine bolus epidural before the start of operation. In Group III, the same amount of dexamethasone was given with the ropivacaine epidural at the end of operation. Effort and resting VAS, the use of rescue analgesics and any complications noted during the procedure were evaluated. Results: VAS and requirements of rescue analgesics were significantly lower in Groups II and III when compared to Group I. There were no difference in the incidence of nausea and vomiting between groups, but an itching sensation was frequent in Group III. Conclusions: The administration of 5 mg of dexamethasone epidurallly, before or after operation, could reduce the pain and analgesic requirement after radical subtotal gastrectomy.

유도형 리니어 모터

조윤현(曺允鉉),손영대(孫永大) 대한전기학회 1999 전기의 세계 Vol.48 No.2

Comparison of the success rate of inguinal approach with classical pubic approach for obturator nerve block in patients undergoing TURB

조윤이,Eunkyeong Choi,길혜금 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.2

Background: During transurethral resection of bladder tumors (TURB) under spinal anesthesia, electrical resection of the lateral wall mass may cause violent adductor contraction and possible inadvertent bladder perforation. Therefore, obturator nerve block (ONB) is mandatory after spinal anesthesia to avoid adductor muscle contraction. We compared the success rate and efficacy of an inguinal approach, to a pubic approach for ONB. Methods: One hundred and two patients who required ONB undergoing TURB with spinal anesthesia were included in this study. After spinal anesthesia, ONB was performed with an inguinal approach (Group I, n = 51) or pubic approach (Group P, n = 51) using a nerve stimulator. In the pubic approach, a needle was inserted at a point 1.5 cm lateral and 1.5 cm inferior to the pubic tubercle. For the inguinal approach, a needle was inserted at the midpoint of the femoral artery and the inner margin of the adductor longus muscle 0.5 cm below the inguinal crease. If the adductor contracture had not occurred by the 3rd attempt, it was defined as a failed block. Puncture frequency,success rate, anatomical characteristics, and the presence of adductor muscle contraction during operation were evaluated. Results: The success rate of ONB was higher in group I compared to group P (96.1% vs. 84.0%, P = 0.046) and the frequency of needle attempts was lower in group I than in group P (1.8 ± 0.9 vs. 1.3 ± 0.6, P = 0.01). Conclusions: The inguinal approach for ONB appears to be technically easier and offers certain anatomical advantages when compared to the pubic approach.

Hypercapnic Respiratory Failure Immediate After Bariatric Surgery

조윤이,정월선,박희연,장영진 대한비만학회 2012 The Korean journal of obesity Vol.21 No.3

흉부나 상복부 수술과 이에 동반한 전신마취는 일시적인 가스교환의 이상과 부적절한 호흡역학을 동반한 폐기능 장애가수반될 수 있으며 이는 비만한 환자에서 더 심각하게 나타날수 있다. 비만 저환기 증후군을 가진 37세 여환이 복강경 하위소매절제술을 시행받았다. 환자는 복강경 수술을 위한 복강내 이산화탄소 주입 후 교정되지 않는 심각한 호흡성 산증이있었고, 술 후 각성 후 고이산화탄소 혈증을 동반한 호흡 부전을 경험하였다. 이에 저자들은 비만환자들의 수술 및 마취 중나타나는 생리적 변화에 대한 중요성을 인식하고 가능한 합병증에 대하여 참고문헌과 함께 기술하였다.

제왕절개술 후 실혈성 쇽 환자에서 발생한 스트레스성 심근증 -증례 보고-

조윤이,권자영,장윤성,최용선 대한중환자의학회 2011 Acute and Critical Care Vol.26 No.1

Stress-induced cardiomyopathy is a recently described acute and transient cardiomyopathy with typical left ventricular apical ballooning mimicking the clinical scenario of an acute myocardial infarction. Cesarean delivery causes intense emotional and physical stresses, which may precipitate stress-induced cardiomyopathy. We report a case presenting stress-induced cardiomyopathy occurring during ICU care in the early postpartum period following cesarean delivery.