수술후 통증관리에 대한 경막외 Ketamine 의 효과

곽상현,정창영,임웅모,이현정 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2

Background : Ketamine hydrochloride, NMDA receptor antagonist is a potent analgesic and anesthetic. Other analgesics, like opioid, have been shown to effectively relieve postoperative pain when infused into epidural space, but effects of ketamine hydrochloride infused into epidrual space for postoperative pain control is still controversial, and therefore the present study was undertaken. Methods : Ninety adult patients (ASA I or II) scheduled for upper abdominal and chest surgery were randomized into ketamine and fentanyl groups. For all patients, informed consent was obtained preoperatively. Anesthesia was induced with thiopental sodium/succinylcholine and maintained with nitrous oxide/oxygen/enflurane. Skeletal muscle relaxation was maintained with vecuronium. Epidural catheterization was done after operation. Ketamine group received epidural bolus of 0.1% bupivacaine 10 ml followed by continuous epidural infusion of 0.1% bupivacaine 100 ml containing ketamine 200 mg. Fentanyl group received epidural bolus of 0.1% bupivacaine 10 ml containing fentanyl 100 ㎍ followed by continuous epidural infusion of 0.1% bupivacaine 100 ml containing fentanyl 600 ㎍. Continuous infusion rate was 2 ml/hr in both groups. Analgesic effects were assessed using VAS (visual analogue score), PHS (Prince Henry score) and PRS (pain relief score). Side effects and number of patients using additional analgesics were evaluated. Results : Analgesic effects were significant in both group after drug administration. But fentanyl group had greater analgesic effects than ketamine group. Fentanyl group experienced side effects such as pruritus (27 cases), nausea and vomiting (9 cases). Ketamine group had side effects such as nausea and vomiting (13 cases). Number of patients using additional analgesics were seven and twenty-four in the fentanyl and ketamine groups, respectively. Conclusions : We conclued continuous epidural infusion of ketamine had fewer analgesics effect at early state of postoperative pain than fentanyl. (Korean J Anesthesiol 1998; 34: 376∼382)

Effects of Contralateral Routing of Signal Hearing Aids on Audiological and Academic Performance in School-Age Children With Unilateral Hearing Loss

곽상현,김대영,배성훈,문인석,김성헌,최재영,정진세 대한이비인후과학회 2021 Clinical and Experimental Otorhinolaryngology Vol.14 No.3

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Audiological and Vestibular Functions in Patients With Lateral Semicircular Canal Dysplasia and Aplasia

곽상현,김민기,김성헌,정진세 대한이비인후과학회 2020 Clinical and Experimental Otorhinolaryngology Vol.13 No.3

Objectives. The aim of the present study was to evaluate audiologic and vestibular functions in patients with lateral semicircular canal (LSCC) dysplasia/aplasia. Methods. We conducted a retrospective study of a patients with LSCC dysplasia and aplasia at tertiary referral center. The subjects included 15 patients with LSCC dysplasia or aplasia, with or without combined inner ear anomalies. Medical history, temporal bone computed tomography scans, pure-tone audiograms, and vestibular function test results were analyzed. Results. LSCC anomaly was identified in 15 patients (20 ears). Nine patients had unilateral LSCC dysplasia only and showed a mean pure-tone average of 45.5±28.7 dB, while three patients (33.3%) among them had normal hearing. Six patients had bilateral LSCC dysplasia/aplasia combined with other inner ear anomalies and profound bilateral hearing loss. Notably, only four out of 15 patients (26.7%) had dizziness symptoms. On caloric test, patients with isolated LSCC dysplasia showed a 51.8%±29.3% level of canal paresis (eight out of nine patients showed anomalies), whereas patients with bilateral LSCC dysplasia/aplasia presented bilateral vestibular loss. One patient with isolated LSCC underwent video-head impulse test; horizontal canal gain decreased to 0.62 (17% asymmetry) and anterior canal gain was 0.45 (52.6% asymmetry), whereas posterior canal gain was normal. Conclusion. Bilateral LSCC dysplasia/aplasia is comorbid with other inner ear anomalies and presents as profound bilateral hearing loss and vestibulopathy. In contrast, isolated unilateral LSCC dysplasia presents as ipsilateral horizontal canal paresis. Hearing function in isolated LSCC dysplasia is usually, but not always, impaired with varying severity.

급성폐손상에 응고 및 섬유소 용해과정의 역할

곽상현 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.2

Acute lung injury (ALI) is a common, life-threatening cause of acute respiratory failure, which is ultimately caused by a variety of local and systemic insults. Alterations in the coagulation and fibrinolysis profiles are present in almost all the patients suffering with ALI. The classic histologic findings in ALI patients include alveolar fibrin formation and microthrombi in the pulmonary vasculature. Decreased circulating levels of protein C and increased concentrations of thrombomodulin are present in patients with septic and nonseptic ALI. The circulating and pulmonary concentrations of plasminogen activator inhibitor-1 (PAI-1) are increased in the setting of ALI, and the degree of elevation in the PAI-1 level directly correlates with mortality. The need for new specific therapies has led a number of investigators to examine the role of altered coagulation and fibrinolysis in the pathogenesis of ALI. This review summarizes the current understanding of coagulation and fibrinolysis in ALI with an emphasis on the pathways that could be potential therapeutic targets, including the tissue factor pathway, the protein C pathway and the modulation of fibrinolysis via plasminogen activator inhibitor-1.

산모의 적출 자궁근 자발운동에 미치는 아편양제제의 영향

곽상현,유경연,정창영,임웅모,김학송 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.6

Background : Effects of fentanyl, sufentanil, meperidine, and morphine on the spontaneous contractility of isolated human pregnant uterine muscle strips were determined. Methods : Uterine specimens were obtained from normal full-term parturients undergoing elective lower-segment cesarean section. Longitudinal muscle strips were made and mounted individually and vertically in tissue chambers to record their isometric tension. After establishment of rhythmic contractions in the buffer solution, opioid concentration-response curves were constructed. The responses to opioids were repeated in the presence of opioid receptor blocker, nitric oxide synthase inhibitor, β- adrenoceptor blocker, or cyclo-oxygenase inhibitor. Results: Fentanyl and meperidine caused concentration-dependent decreases of the uterine contractility, their IC50 (concentration which causes 50% inhibition of the amplitude of spontaneous contractions) being 6.8×10-6 M and 2.2×10-3 M, respectively. On the contrary, sufentanil and morphine w without significant effects on the contractility. Pretreatment with either naloxone, N-nitro-L-arginine methyl ester, atenolol, or indomethacin did not affect the uterine responses to opioids. Conclusions : These results demonstrate that fentanyl and meperidine may have direct inhibitory effects on the contractility of the human uterus. However, the opioid concentrations needed to significantly reduce the uterine contractility were at a supraclinical range. (Korean J Anesthesiol 2000; 39: 775- 779)

전남대학교병원에서의 마취 71901례에 대한 분석-1981년부터 1995년까지-

곽상현,정성수 최신의학사 1997 最新醫學 Vol.40 No.2

다한증의 치료

곽상현 대한마취과학회 2005 Korean Journal of Anesthesiology Vol.48 No.3

습식 산화를 이용한 원형 트렌치 게이트 IGBT에 관한 연구

곽상현,경신수,성만영,Kwak, Sang-Hyeon,Kyoung, Sin-Su,Sung, Man-Young 한국전기전자재료학회 2008 전기전자재료학회논문지 Vol.21 No.11

The conventional IGBT has two problems to make the device taking high performance. The one is high on state voltage drop associated with JFET region, the other is low breakdown voltage associated with concentrating the electric field on the junction of between p base and n drift. This paper is about the structure to effectively improve both the lower on state voltage drop and the higher breakdown voltage than the conventional IGBT. For the fabrication of the circular trench IGBT with the circular trench layer, it is necessary to perform the only one wet oxidation step for the circular trench layer. Analysis on both the on state voltage drop and the breakdown voltage show the improved values compared to the conventional IGBT structure. Because the circular trench layer disperses electric field from the junction of between p base and n drift to circular trench, the breakdown voltage increase. The on state voltage drop decrease due to reduction of JFET region and direction changed of current path which pass through reversed layer channel. The electrical characteristics were studied by MEDICI simulation results.

Current Status of Intensive Care Units Registered as Critical Care Subspecialty Training Hospitals in Korea

곽상현,정철원,이성헌,이현정,고윤석 대한의학회 2014 Journal of Korean medical science Vol.29 No.3

There is a lack of information on critical care in Korea. The aim of this study was todetermine the current status of Korean intensive care units (ICUs), focusing on theorganization, characteristics of admitted patients, and nurse and physician staffing. Critical care specialists in charge of all 105 critical care specialty training hospitalsnationwide completed a questionnaire survey. Among the ICUs, 56.4% were located in ornear the capital city. Only 38 ICUs (17.3%) had intensive care specialists with a 5-day workweek. The average daytime nurse-to-patient ratio was 1:2.7. Elderly people ≥ 65 yr ofage comprised 53% of the adult patients. The most common reasons for admission toadult ICUs were respiratory insufficiency and postoperative management. Nurse andphysician staffing was insufficient for the appropriate critical care in many ICUs. Staffingwas worse in areas outside the capital city. Much effort, including enhancedreimbursement of critical care costs, must be made to improve the quality of critical careat the national level.

초기 경력자의 일터 학습과 조직적응에서 무형식 학습 활동의 조절효과 분석

곽상현 연세대학교 교육연구소 2012 미래교육학연구 Vol.25 No.2

본 연구에서는 초기 경력자의 일터 학습과 조직적응 간의 관계를 규명하고, 일터 학습과 조직적응과의 관계에서 무형식 학습 활동이 갖는 조절효과를 살펴보았다. 연구 결과는 다음과 같다. 첫째, 초기 경력자의 일터 학습은 조직적응의 요인인 직무만족, 조직몰입, 이직의도와 유의한 정의 관계가 있는 것으로 나타났으며, 일터 학습 중 신입직원 입문교육 만족도의 영향이 프리셉터쉽 교육보다 큰 것으로 확인되었다. 둘째, 무형식 학습 활동 정도는 직무만족, 조직몰입, 이직의도와 모두 유의한 정의 관계가 있는 것으로 나타났는데, 직무만족에 미치는 영향이 가장 큰 것으로 확인되었다. 셋째, 초기 경력자의 일터 학습과 조직적응 간의 관계에서 무형식 학습 활동은 일터 학습 중 신입직원 입문교육과 직무만족, 조직몰입, 이직의도 간의 관계를 조절하는 것으로 나타났다. This study aims to investigate the relationship between newcomers' workplace learning and their adaptation to an organization, as well as analyze the moderating effect of informal learning in the relationship between workplace learning and adaptation to an organization. The findings of the data analysis were as follows: First, it was found that newcomers' satisfaction with new employees orientation program and preceptorship program has a meaningful positive relationship with job satisfaction, organizational commitment, and turnover intention - the subordinate variables of organizational adaptation. Newcomers' satisfaction with new employees orientation program turned out to have a larger impact. Second, the study found that informal learning had a significant positive relationship with job satisfaction, organizational commitment, and turnover intentions. Among these, the impact on job satisfaction was the largest. Third, it was found that informal learning activities controlled the satisfaction of newcomers with new employees orientation program, as well as job satisfaction, organizational commitment, and turnover intention.