Acute and Critical Care

Seung Hoon Baek

6 Articles

Foreign Body Removal at Right Main Bronchus in A Neonate: Hyun Su Ri, Sang Wook Shin, Seung Hoon Baek, Hyae Jin Kim, Sun Jae Lee, Seong Wan Baik; Korean J Crit Care Med. 2013;28(3):201-203.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.201

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Abstract PDF: Foreign body in the airway could be a life-threatening risk, especially for young pediatric patients. A 6-day old male patient with foreign body, which was located deep in the right main bronchus was being admitted. Although we tried three times to remove it with rigid bronchoscopic forceps under the general anesthesia, we failed. Before switching to surgical treatment, we changed the Trendelenburg position and tapped his back several times in order to alter the foreign body toward the forcep. Finally we were able to catch and extract the foreign body successfully. We suggest that back percussion with the Trendelenburg position is a useful solution to remove a foreign body within a deep airway.

Hypertensive Crisis during Removal of Retroperitoneal Mass in a Patient with Undiagnosed Paraganglioma - A Case Report -: Hee Young Kim, Joo Yun Kim, Hae Kyu Kim, Seung Hoon Baek; Korean J Crit Care Med. 2013;28(1):64-66.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.64

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Abstract PDF: Paragangliomas have been reported on multiple locations. A diagnosis of a catecholamine-secreting tumor was considered only after induction of anesthesia, when BP (blood pressure) increased. A 61-year-old male patient was referred for removal of a retroperitoneal mass suspected hemangiopericytoma. He was on medications for hypertension. There was a surge of ABP (arterial blood pressure) to 186/117 mmHg when the tumor was manipulated at the beginning of the surgery, and this was treated by bolus of diltiazem. After resection of the tumor, ABP dropped to 57/36 mmHg. In order to improve the patient's hemodynamic parameters, crystalloid fluid was given, and ephedrine was administered intravenously. Persistent hypotension was treated with titrated vasopressors (epinephrine and norepinephrine). When paraganglioma is suspected due to a sudden hypertensive crisis during surgery, the surgeon must decide whether to proceed with the surgical procedure or to stop and restart the surgery after proper management of the crisis.

Detection of Pulmonary Artery Catheter Knotting by Transesophageal Echocardiography: A Case Report: Eun Soo Kim, Seung Hoon Baek, Kyu Youn Jung, Jae En Kim; Korean J Crit Care Med. 2011;26(2):98-100.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.98

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Abstract PDF

Placement of a pulmonary artery catheter is associated with various complications, including catheter knotting. Fluoroscopy can be used to visualize and confirm catheter knotting. Transesophageal echocardiography is readily available to detect knot formation in the operating room or intensive care unit. We present a case in which pulmonary artery catheter knotting was detected by transesophageal echocardiography. This method may be useful in the operating room or in the intensive care unit to identify the presence and location of catheter knotting.

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Knotting of Pulmonary Artery Catheter During Tricuspid Valve Surgery - A Case Report -
Kyung Chen Lee, Wol Seon Jung, Yong Beom Kim, Ji Yeon Lee
Korean Journal of Critical Care Medicine.2012; 27(1): 45. CrossRef

The Effects of Intrathecal Ketamine and NBQX on Neurologic Injury and Spinal Cord Glutamate Receptor mRNA Expression in Transient Spinal Ischemia in the Rat: Seung Hoon Baek, Jung Min Hong, Kyoo Sub Chung; Korean J Crit Care Med. 2005;20(1):24-31.

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Abstract PDF: BACKGROUND
Spinal cord injury occurring as the result of surgical repair of thoracic and thoracoabdominal aortic disease remains a devastating complication. Excitatory amino acids have been known to cause neurologic injury after neuronal ischemia. The purpose of this study was to elucidate the effects of intrathecal ketamine or NBQX on neurologic outcome and NMDA receptor gene expression in transient spinal ischemia. METHODS: Sprague-Dawley rats were anesthetized with enflurane, divided by 4 groups: Control (C group), Intrathecal ketamine 0.1 mg (K-1 group), Intrathecal ketamine 0.2 mg (K-2 group), and intrathecal NBQX 1 nM (N group). Spinal ischemia was produced by both induced hypotension and thoracic aortic cross clamping. After spinal ischemia, neurologic scores were assessed after 1, 2, 3 hours. After 3 hours rats were euthenized and spinal cords were removed for the assay of NMDAR and mGlu1 mRNA. RESULTS: The neurol ogic scores of K-2 and N groups were significantly lower than C group and K-1 group. There were no significant difference between K-1 group and C group. The NMDAR and mGlu1 gene expression was increase in C and K-1 group compared to sham operation. In K-2 and N groups, the gene expressions were significantly lesser than C group.
CONCLUSIONS
The NMDAR and mGlu1 gene expressions were increased in transient spinal ischemia. Intrathecal ketamine and NBQX were effective in preventing neurologic injury after transient spinal ischemia. The NMDA antagonistic action of ketamine might involve to prevent neurologic injury.

The Effect of Sevoflurane and Propofol on Expression of Inducible Nitric Oxide Synthase in Endotoxemic Rats: Cheul Hong Kim, Joo Hyeuk Park, Seung Hoon Baek, Seong Wan Baik; Korean J Crit Care Med. 2004;19(2):106-114.

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Abstract PDF: BACKGROUND
It is a well-known phenomenon that alveolar and peritoneal macrophages exposed to bacterial lipopolysaccharide (LPS) induce a large output of nitric oxide (NO) and an inducible nitric oxide synthase (iNOS) mRNA expression. The purpose of this study is actually how much NO production and iNOS mRAN expression are effected by anesthetics (sevoflurane and propofol) on endotoxemic rats.
METHODS
To examine the production of NO in peritoneal macrophages, NO concentration were measured from the rats following 2 hours exposure to LPS and 2 hours administration of sevoflurane and propofol, respectively. Culture supernatants were collected 24 hours after exposure to LPS and anesthetics and assayed by ELISA (Enzyme Linked Immunosorbent Assay) for production of NO. The iNOS mRNA expression was measured using PCR (Polymerase Chain Reaction) techniques and autoradiography. RESULTS: In the control group, the NO concentration was measured at 2 hours after infusion of LPS to rats, and showed 12 4micrometer. After insufflations of anesthetics to experimental animals, NO concentration increased in the sevoflurane and propofol groups, 37 13 (p<0.05) and 29 12micrometer (p<0.05) respectively. The size and brightness of the iNOS mRAN bands were distinct in sevoflurane and propofol in order.
CONCLUSIONS
There were no different in regard of NO production and hemodynamic changes but iNOS mRNA expression between sevoflurane and propofol group in endotoxemic rats. The mechanism is not clear, but it is related to the strong stimulating effects on the respiratory tract of inhalation anesthetics.

Effects of Sevoflurane and Ischemic Preconditioning on Neurologic Injury and Bcl-2 Family Protein mRNA Expression after Transient Spinal Ischemia in the Rats: Soon Hwan Kang, Eun Soo Kim, Seung Hoon Baek, Jae Young Kwon; Korean J Crit Care Med. 2004;19(1):20-31.

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Abstract PDF: BACKGROUND
Spinal cord injury occurring as the result of surgical repair of thoracic and thoracoabdominal aortic disease remains a devastating complication. Anesthetic and ischemic preconditioning have been known to prevent ischemic injury. The purpose of this study was to elucidate the effects of sevoflurane and ischemic preconditioning (IPC) on neurologic outcome, DNA fragmentation and Bcl-2 protein gene expression in transient spinal ischemia. METHODS: Rats were anesthetized with enflurane or sevoflurane, divided by 5 groups: Sevoflurane group and enflurane group (13 minutes of ischemia), Control group, Rapid group, Delayed group (15 minutes of ischemia). Spinal ischemia was produced by both induced hypotension and thoracic aortic cross clamping. Neurologic scores were assessed at the time of recovery and 1, 2, 3, 24 hours after transient spinal ischemia. After 24 hours, rats were euthenized and spinal cords were removed for the assay of DNA fragmentation. Other groups of rats received 5 minutes of ischemia, and after 1, 6, 24, 48 and 72 hours, spinal cords were removed for the assay of Bcl-2 family protein mRNA and DNA fragmentation. RESULTS: The neurologic injury and DNA fragmentation of sevoflurane group were significantly lesser than enflurane group. 5 minutes of IPC caused increase in Bcl-xl protein mRNA transcription at 48 and 72 hours reperfusion. There were no significant changes in neurologic injury, Bcl-2 family mRNA transcription and DNA fragmentation between control group, rapid group, and delayed group. CONCLUSIONS: Sevoflurane was effective in preventing neurologic injury after 13 minutes of transient spinal ischemia. However, rapid and delayed ischemic preconditioning did not potentiated neuroprotective action of sevoflurane during 15 minutes of spinal ischemia.

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