Sang Beom Nam

Yonsei University Hospital, Sŏul, Seoul, South Korea

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Publications (10)9.18 Total impact

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    ABSTRACT: Thrombus-in-transit appears to increase the risk of mortality compared to pulmonary embolism alone and can require alteration in therapeutic plan. We present the case of a biatrial thromboembolus caught in transit across a patent foramen ovale diagnosed by intraoperative transesophageal echocardiogram in a 69-year-old female with acute pulmonary embolism and subsequent acute cerebral infarction. We suggest that echocardiography should be performed in a patient with suspected pulmonary thromboembolism to evaluate right heart function and diagnose emboli in transit.
    Korean journal of anesthesiology 02/2015; 68(1):70-3. DOI:10.4097/kjae.2015.68.1.70
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    Korean journal of anesthesiology 04/2013; 64(4):384-5. DOI:10.4097/kjae.2013.64.4.384
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    ABSTRACT: Previous studies have reported a high incidence of acute kidney injury (AKI) after thoracic aortic surgery in heterogeneous patient cohorts, including various aortic diseases and the use of deep hypothermic circulatory arrest. Moderate hypothermia with cerebral perfusion makes deep hypothermia nonessential, but can make end organs susceptible to ischemia during circulatory arrest. We investigated the incidence and risk factors of AKI after thoracic aortic surgery with and without moderate hypothermic circulatory arrest for acute dissection. We reviewed the medical records of 98 patients undergoing graft replacement of the thoracic aorta for acute dissection between 2008 and 2011 at a university hospital. Acute kidney injury was defined by RIFLE criteria, which is based on serum creatinine or glomerular filtration rate. The mean age was 55±15 years. The surgical procedures, 96% of which were emergencies, involved the ascending aorta (67%), aortic arch (41%), descending aorta (41%), and aortic valve (5%). Moderate hypothermic circulatory arrest was performed in 75%. The overall incidence of AKI was 54%, and 11% of 98 patients required renal replacement therapy. Thirty-day mortality increased with AKI severity (p=0.002). Independent risk factors for AKI were long cardiopulmonary bypass duration (>180 minutes; odds ratio, 7.50; p=0.008) and preoperative serum creatinine level (odds ratio, 8.43; p=0.016). Acute kidney injury was common after thoracic aortic surgery for acute dissection with or without moderate hypothermic circulatory arrest and worsened 30-day mortality. Prolonged cardiopulmonary bypass and increased preoperative serum creatinine were independent risk factors for AKI, but moderate hypothermic circulatory arrest was not.
    The Annals of thoracic surgery 06/2012; 94(3):766-71. DOI:10.1016/j.athoracsur.2012.04.057 · 3.65 Impact Factor
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    ABSTRACT: Stress-induced cardiomyopathy (SICM) presenting as an acute myocardial dysfunction is characterized by transient left ventricular wall motion abnormality, which has been known to be associated with excessive catecholamine production caused due to various types of stress. Sympathetic hyperactivity is common during the perioperative period, and reports of SICM occurring during this period have actually increased. We present a case of SICM following negative pressure pulmonary edema due to upper airway obstruction during emergence from anesthesia. Excessive catecholamine release in response to respiratory difficulty could have been the underlying inciting factor.
    Korean journal of anesthesiology 01/2012; 62(1):79-82. DOI:10.4097/kjae.2012.62.1.79
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    ABSTRACT: Suspension laryngoscopy under general anaesthesia with a tracheal tube has been widely used for laryngeal microsurgery, but it has some limitations such as intense cardiovascular stimulation during anaesthesia of short duration, occasionally a poor surgical field, and the possibility of a mass being hampered by the tracheal tube. The aim of this study was to compare the usefulness of the laryngeal mask airway (LMA) Fastrach and fibreoptic bronchoscope with a conventional suspension laryngoscope in laryngeal microsurgery. Forty patients scheduled for laryngeal microsurgery were enrolled in this prospective randomized study consecutively. After general anaesthesia was induced, laryngeal microsurgery was performed with a fibreoptic bronchoscope through the LMA Fastrach or conventional suspension laryngoscope. The best view of the surgical field, evaluated by percentage of glottic opening score, was obtained by the up-down manipulations of the LMA Fastrach or repositioning the suspension laryngoscope. Blood pressure and heart rate changes at the baseline, preinsertion, and postinsertion were recorded. Percentage of glottic opening score of the LMA Fastrach group was 100 and that of the suspension laryngoscope group was 80 (P < 0.05). The LMA Fastrach insertion was performed without remarkable systolic or diastolic blood pressure or heart rate changes, but systolic, diastolic blood pressure or heart rate were increased after intubation in the suspension laryngoscope group. The LMA Fastrach during fibreoptic bronchoscope-guided laryngeal surgery provided a good surgical field and haemodynamic stability without additional risk compared with the conventional suspension laryngoscope.
    European Journal of Anaesthesiology 09/2009; 27(1):20-3. DOI:10.1097/EJA.0b013e3283317dac · 3.01 Impact Factor
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    ABSTRACT: Pheochromocytoma is a rare tumor, but it can cause severe hemodynamic disturbances during anesthesia, and particularly in patients whose pheochromocytoma was not diagnosed preoperatively. We report here on a case of unilateral pulmonary edema during laparoscopic adrenalectomy, and this edema was due to pheochromocytoma that was not diagnosed preoperatively.
    Korean Journal of Anesthesiology 01/2008; 55(4). DOI:10.4097/kjae.2008.55.4.502
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    ABSTRACT: We report a 66-yr-old male patient who developed tricuspid regurgitation secondary to internal cardiac massage. After uneventful off-pump coronary artery bypass surgery, the subject experienced cardiac arrest in the intensive care unit. External cardiac massage was initiated and internal cardiac massage was performed eventually. A transesophageal echocardiography revealed avulsion of the anterior papillary muscle and chordae to the anterior leaflet after successful cardiopulmonary resuscitation. Emergency repair of the papillary muscle was performed under cardiopulmonary bypass.
    Journal of Korean Medical Science 09/2007; 22(4):731-4. DOI:10.3346/jkms.2007.22.4.731 · 1.25 Impact Factor
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    ABSTRACT: The CobraPLA (CPLA) is a relatively new supraglottic airway device that has not been sufficiently investigated. Here, we performed a prospective observational study to evaluate the efficacy of the CPLA during controlled ventilation. In 50 anesthetized and paralyzed patients undergoing elective surgery a CPLA was inserted and inflated to an intracuff pressure of 60 cm H2O. The success rate of insertion upon the first attempt was 82% (41/50), with a mean insertion time of 16.3 +/- 4.5 seconds. The adequacy of ventilation was assessed by observing the end tidal CO2 waveform, movement of the chest wall, peak airway pressure (13.5 cm H2O), and leak fraction (4%). We documented the airway sealing pressure (22.5 cm H2O) and noted that the the site of gas leaks at that pressure were either at the neck (52%), the abdomen (46%), or both (2%). In 44 (88%) patients, the vocal cords were visible in the fiberoptic view through the CPLA. There was no gastric insufflation during the anesthesia. Respiratory and hemodynamic parameters remained stable during CPLA insertion. Postoperative blood staining of CPLA was minimal, occurring in 22% (11/50) of patients. Mild and moderate throat soreness was reported in 44% (22/50) and 4% (2/50) of patients, respectively. Lastly, mild dysphonia was observed in 6% (3/50) of patients and mild dysphagia in 10% (5/50) of patients. Our results indicated that the CPLA is both easy to place and allows adequate ventilation during controlled ventilation.
    Yonsei Medical Journal 01/2007; 47(6):799-804. DOI:10.3349/ymj.2006.47.6.799 · 1.26 Impact Factor
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    ABSTRACT: Various causes of endotracheal tube obstruction during general anesthesia exist. Herein, the case of a 77-year old male patient, with tracheal deviation, who was intubated with an endotracheal tube in the emergency room, without a Murphy eye, is reported. He was transferred to the operating room for the removal of a subdural hematoma. The endotracheal tube suddenly became obstructed during flexion of neck for the craniotomy procedure. The distal bevel of the endotracheal tube, without Murphy eye, was discovered to have come into contact with the tracheal wall, with the airway being obstructed during the fiberoptic bronchoscopy. Shortly after extubation of the obstructed tube, an armored tube, with a Murphy eye, was reintubated, after which the respiration pattern immediately returned to normal.
    Korean Journal of Anesthesiology 01/2007; 52(3). DOI:10.4097/kjae.2007.52.3.339
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    ABSTRACT: The incidence of postoperative hypomagnesemia in patients undergoing spinal surgery has been reported to be 70%. Ionized magnesium is considered to be the biologically active form, but until the early 1990s, only the total magnesium concentration could be measured. Currently, the ionized magnesium concentration as well as total magnesium concentration can be assessed due in part to the development of a selective electrode. The aim of this study was to more fully characterize the changes in the total and ionized magnesium concentrations in patients undergoing elective spinal fusion surgery.
    Korean Journal of Anesthesiology 01/2007; 52(6). DOI:10.4097/kjae.2007.52.6.S37