Lorazepam-Ketamine-Alcuronium 에 의한 기관내 마취의 임상적 연구

길혜금,오흥근,윤덕미 대한마취과학회 1980 Korean Journal of Anesthesiology Vol.13 No.3

The effect of various drugs on the incidence and severity of hypertension, tachycardia and emergence phenomena associated with ketamine anesthesia were investigated in many studies. Lorazepam is a psychotropic agent of the benzodiazepine class. similar in action to, but more potent than, diazepam. This study was carried out to investigate the efficiency of the ketamine I.V. drip technique under endotracheal intubation with a combination of nitrous oxide, oxygen, muscle relaxant and controlled ventilation. The only contraindications to the use of this technique were hypertension, a history of cerebrovascular disease or psychotic upset. Eighteen patients, ranging in age from 20 to 60 years, were premedicated with I.M. atropine sulfate and oral lorazepam (2mg/kg) administration. Anesthesia was induced with 1.5~2,0mg/kg ketamine and 0.03~0.04mg/kg alcuronium, before intubation. Anesthesia was maintained by dripping 0. l% ketamine in 5% dextrose in water, with N₂O and 0₂, The average dosage of ketamine was l. 68g/kg for induction and 0.011mg/kg/min for maintenance during operations with a duration of from 55 to 275 minutes. Alcuronium is a non-depolarizing muscle relaxant and a derivative of C-toxiferine l. It has a little ganglionic blocking effect. The increase of blood pressure after endotracheal intubation was not significant. The incidence of complications of anesthesia was increased blood pressure 16. 7% (20mmHg above preop. value), tachycardia 38. 9% , dreams 5. 6 % and hallucination 5. 6%. Also oral premedication with lorazepam provided significant anterograde amnesia in all patients. It may be concluded that a combination of oral premedication by lorazepam and ketamine I.V. drip anesthesia with N₂,O, O₂ and alcuronium, followed by endotracheal intubation, can be used relatively satisfactorily in explo-laparatory operations in which muscle relaxation is needed.

수술실에서 심전도 감시기와 마취기의 생존기간

길혜금,김원옥,김광희,이우정 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.2

We have done survival analysis of the EKG monitor(from March, 1976 to February, 1993) and anesthetic machine(from February, 1915 to February, 1993) retrospectively in operating room at Severance hospital. Thirty eight EKG monitors and twenty eight anesthetic machines were included. Also EKG monitors were divided into two groups(one group was made in foreign country and another was made in Korea) and its survival function were compared. All statistics were treated with Product-limited estimate of survival function(Kaplan and Meier, 1958) with BMDP 1L. Mean survival time(±S.E) of all EKG monitor was 113.61(±5.70) months and the EKG made in foreign country was 106.65(±8.22) months and made in Korea was 113.35(±8.97) months. But there was no statistical differences between two groups. And mean survival time of anesthetic machine was shown to be 189.45(±6.09) months. It is advisable to replace aging machine before malfunction and failure to protect patients from mishaps stem from equipment failure. We concludt life cycle of equipment for proper time to replace the equipment is not underestimated to reduce the accident by aging machine failure.

MERA-F 호흡회로의 임상적 응용

길혜금,엄대자,최령,우남식 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.3

The MERA-F breathing circuit is a light in weight, disposable, multi-purpose breathing system corsisting of double coaxial tubes ; inner tube for inspiration and outer corrugate tube for expiration. This circuit is especially effective on head and neck operations that may lead to accidental disconnection or extubation. And the circuit provides effective carbon dioxide elimination with only conventional total fresh gas flow(70 ml/kg/minute) and appropriate maintenance of heat and humidity of the airway mucosa.

소아의 사시교정술시 Propofol-Fentanyl 과 Propofol-Ketorolac 마취가 수술후 오심 및 구토발생에 미치는 영향

길혜금,김원옥,김명은,이종복,홍정연 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.5

Background : Strabismus surgery is associated with a high incidence of postoperative nausea and vomiting. Propofol is an anesthetic which has an antiemetic effect. A randomized study was done to compare the efficacy of propofol-fentanyl and propofol-ketorolac anesthesia for strabismus surgery in children. Methods : Eighty-five children, ASA physical status I or II, for strabismus surgery, were studied. Patients were randomly assigned to one of two groups by picking the envelop. Preanesthetic medication was not given. Fentanyl group received fentanyl 1.5 g/kg i.v. and ketorolac group received ketorolac 1 mg/kg, 2 minutes before induction. Atropine was given after that. Anesthesia was induced with propofol 2.4 mg/kg and vecuronium 1 mg/kg and intubation was performed. Anesthesia was maintained with a three-stage infusion technique of propofol(12 mg/kg/hr for 1st 10 minutes, 9 mg/kg/hr for 2nd 10 minutes and 6 mg/kg/hr was followed) with oxygen and nitrous oxide. Ketorolac was injected intramuscularly for preemptive analgesia immediate after induction. The incidence of nausea and vomiting was evaluated for postoperative 48 hours. And also, intraoperative oculocardiac reflex was monitored to compare the difference between two groups. Results : During postoperative 48 hours, fentanyl group and ketorolac group had a similar low incidence of nausea and vomiting(4.2% and 7.0%). There is no significant difference of intraoperative oculocardiac reflex between two groups(45.2% and 30.2%) Conclusions: Propofol administered to induce and maintain anesthesia with a three-stage infusion technique is equally effective in preventing postoperative nausea and vomiting in propofol-fentanyl and propofol-ketorolac anesthesia for strabismus surgery in children. (Korean J Anesthesiol 1998; 34: 984∼990)

마취과 영역에서 윤리활동 : 인테넷을 통한 기초조사

길혜금,김원옥,남순호,박홍로 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.3

Background : In recent years, an unprecedented expansion of high-tech medical knowledge has forced anesthesiologists to confront a moral climate never experienced before, thereby escalating the need to refer to ethical resources for the appropriate responses. This study was prepared to identify the issues and to determine the extent of activities in making proper ethical decisions regarding anesthesia around the world. Methods: Eighteen questions were asked via electronic mail to anestheisa-associated doctors recognized by the Internet between April and June 1998. Information about issues, guidelines/standards/policy, consulting system/committee, education and training were requested. Results : One hundred and twenty-two practitioners completed the questionnaire. Informed consent (38,31.1%) was the most frequently raised issue, followed by medical economics (13.1%) and DNR (11.5%). The most serious broad issue was medical economics (13.1%), but specific or unique issues were not prominent. Among respondents, 73.8% had no guideline/standards/policy in their department, 56.6% felt the need to have one, 38.5% had one in the hospital and 51.6% indicated they needed one in their hospital. Most departments had no consulting system (61.5%) or committee (79.5%), while 48.4% had no consulting system and 63.9% had no committee in the hospital. A few (28, 23.1%#) had a program/curriculum, and lectures were the most common format. The most common duration of ethical education was more than 3 hours and the main obstacle was time constraints. Informed consent (41.8%) was indi- cated as the most important issue to be taught. Conclusions : A limited number favored systemic support and the educational benefit of lectures on ethics. Most respondents were willing to have such a lecture program in the department. Establishing a systemic structure for ethics was recommended by most respondents and restricted resources should be distributed for this purpose according to the survey results. (Korean J Anesthesiol 2000; 38: 497 ~ 502)

소아의 사시교정술 시 안구심반사와 술후 오심 구토에 대한 Propofol-Nitrous Oxide 와 Propofol-진정맥마취의 비교

길혜금,김원옥,김연진,이우경 대한정맥마취학회 2000 정맥마취 Vol.4 No.1

서론: 수술중의 안구심반사와 술후 오심 구토는 소아의 사시수술에 잇어 흔한 증상이다. Propofol은 우수한 항오심효과가 있지만 안구심반사의 발생을 증가시킨다고 알려져 있다. 본 연구의 목적은 소아사시수술에 잇어서 propofol과 아산화질소를 병용하는 경우와 병용하지 않는 경우 수술중 안구심반사와 술후 오심구토의발생률간에 차이가 있는지를 관찰하는데 있다. 방법: 1세에서 14세 사이로 사시교정술을 받는 소아들을 무작위로 아산화질수 60%를 주는 군과 압축대기를 주는 두 군으로 분류하여 마취전투약 없이 fentanyl 2 ㎍/㎏과 propofol 2.2 ㎎/㎏으로 마취유도하고 atracurium 0.4 ㎎/㎏ 투여후 기관내 삽관하였으며 atropine 0.015 ㎎/㎏을 정주하였다. 마취는 propofol을 3단계 정주법으로 유지하였으며 술중 기초 맥박의 20% 이상이 갑자기 감소하는 경우를 안구심반사로 정의하여 관찰하였고 술후 24시간동안의 오심과 구토를 관찰하였다. 결과: 224명중 아산화질소군은 111예중 41예(36.9%)에서, 대기군은 113예중 66예(58.4%)에서 안구심반사가 나타나 유의한 차이를 보였으며 술후 오심 구토는 14예(12.6%), 12예(10.6%)로 차이가 없었다. 안구심반사는 외직근(39.5%)보다는 내직근교정(62.5%)시 빈발하였으며 안구심반사와 오심 구토간 유의한 상관관계는 없었다. 결론: 소아의 사시교정술에서 propofol사용시 전정맥마취보다는 아산화질소를 투여하는 균형마취가 술중 안구심반사의 발생빈도를 줄이면서 술후 향오심효과에 효과적인 것으로 생각된다. Background: Intraoperative oculocardiac reflex (OCR) and postoperative nausea and vomiting (PONV) are common problems of pediatric strabismus surgery. Propofol is thought to increase the incidence of OCR in spite of profound antiemetic effect. The goal of this study was to assess, in pediatric strabismus surgery, the incidence of OCR and PONV in a propofol with and without nitrous oxide (N_2O) anesthesia. Methods: Children (1 - 14 yr.'s) undergoing strabismus surgery as in patients were randomly allocated to two anesthetic techniques: propofol with 60% N_2O and propofol with air instead of N_2O. All children received ⅳ fentanyl 2 ㎍/㎏, atropine 0.015 ㎎/㎏ and 1% lidocaine 1.5 ~ 2 ml before propofol 2.5 ㎎/㎏ injection. Anesthesia was maintained with three stage infusion method of propofol with and without N_2O by groups after intubation with atracurium 0.4 ㎎/㎏. A significant OCR was defined as an acute decrease in heart rate of 20% or greater associated with traction os an ocular muscle. Results: Data on 224 children were analyzed. An intraoperative OCR was elicited in 41 (36.9%) of the 111 children in the N_2O group and in 66 (58.4%) of the 113 children in Air group, while 14 (12.6%) and 12 (10.6%) developed PONV in the N_2O group and the Air group in the subsequent 24 h period. The OCR was more frequent during medial rectus muscle correction (62.5%) than in lateral rectus muscle correction (39.5%). There was no significant correlation between OCR and PONV. Conclusions: We conclude that propofol with N_2O anesthesia was effective in reducing the incidence of intraoperative OCR with a similarly excellent postoperative antiemetic effect in pediatric strabismus surgery compared to propofol without N_2O anesthesia.

성대미세수술을 위한 고빈도 제트환기동안의 기관내 이산화탄소분압 측정

길혜금,김원옥,이성진,한승연 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.3

Background : The monitoring of end-tidal CO2 tension (PETCO2) during high frequency jet ventilation (HFJV) has been unsatisfactory because of a small tidal volume and slow response time of CO2 analyser, although several authors have reported strategies of successful PETCO2 measurement during HFJV. The aim of this study was to assess the validity of tracheal CO2 tension (PtCO2) as a PaCO2 during HFJV. Methods : We studied 24 patients undergoing laryngomicrosurgery during HFJV (rates: 100/min; I:E= 0.2; driving pressure: 0.25∼0.35 MPa) through a 12 Fr. polyethylene injector placed 6∼7 cm below the vocal cord. A gas sampling line was placed longitudinally against the injector and they were wrapped with aluminum foil. Continuous capnography was recorded during 20 minutes of HFJV. Every 5 minutes of HFJV, PtCO2 was obtained from the plateau value of CO2 wave after the stopping of JV and arterial blood gas analysis was done at 20 minutes of HFJV comparing PaCO2 to PtCO2. A Pearson's product moment correlationd regression analysis between PtCO2 and PaCO2 and the agreement between the two methods using Bland-Altman method were assessed. Results : A regression analysis (R2=0.928) and a Pearson's product moment correlation (r=0.965, P<0.001) indicated a strong correlation of PtCO2 and PaCO2 during HFJV. The difference against a mean scatter diagram showed a relative good agreement between the two method (mean difference: 1.58 (SD 2.22) mmHg; limit of agreement: 2.86 and -6.02). Conclusions : PtCO2 obtained from a plateau of CO2 wave on capnography after interruption of HFJV can accurately reflect PaCO2 during HFJV in relative. (Korean J Anesthesiol 1999; 36: 392∼396)

소아의 외래수술을 위한 Propofol 마취시 후두마스크 사용의 임상경험

길혜금,김원옥,김승호 대한정맥마취학회 2000 정맥마취 Vol.4 No.2

서론: 후두마스크(laryngeal mask airway; LMA)는 비교적 용이하게 거치할 수 있고 삽관이나 제거 시 기관내튜브나 다른 인공기도에 비해 혈역학적 변화가 적으며 기침이나 후두경련, 인후통등의 발생률이 낮아 간단한 수술이나 외래수술을 위한 전신마취 시 유용하게 사용될수 있다. 저자들은 소아의 외래수술에서 LMS를 이용한 propofol 마취 시 삽관시도회수, 삽관에 소요된 시간, 기침이나 후두경련등의 합병증 발생, 커프에 주입한 공기량의 변화 및 술후 인후통 빈도와 음식물 섭취시간등을 관찰하여 LMA사용의 유용성을 살펴보았다. 방법: 2세에서 13세사이의 30명의소아를 대상으로 하여 마취전투약 없이 fentanyl 2 ㎍/㎖과 목표농도 조절주입의 propofol로 마취를 유도한 후 LMA를 삽관하고 20 ㎝H_2O의 압력으로 용수환기할 때 약간 새는 소리가 나는 정도로 커프를 공기로 팽창시켰다. 마취는 propofol과 67%의 N_2O로 유지하였으며 수술이 종료된 후 커프의 공기를 제거하여 양을 관찰하고 마스크화니로 각성시켰다. LMA삽관 및 제거 시 기침이나 후두경련 등을 관찰하고 술후 인후통과 구역 혹은 구토 유무, 음식물 섭취까지 걸린 시간을 관찰하였다. 결과: 평균연령 및 체중은 5.7 ± 2.5세, 20.5 ± 7.4 ㎏이었고 마취시간은 81.5 ± 30.8분이었다. 30예중 28예(93.3%)에서 첫시도에서 거치에 성공하였으며 소요시간은 11.7 ±12.8초였다. LMA제거시 1예에서 기침을 , 2예에서 경한 후두경련이 있었으며 커프내 가스증가량은 1.6 ± 1.2 ㎖이엇다. 1예에서만 경한 인후통을 호소하였으며 마취종료 56.6 ± 23.9분 후 음식물을 처음 섭취하였다. 결론: 소아의 외래수술을 위한 propofol 마취 시 LMA는 별다른 합병증 없이 용이하게 사용될 수 있으며 음식물 섭취를 더 빨리 할 수 있어 재원시간을 단축시킨다. Background: Advantages of LMA included increased ease and speed of placement by non-expert, improved hemodynamic stability during insertion and removal, lower incidence of coughing and sore throat, and reduced anesthetic requirements for airway tolerance. This study was designed to determine the ease and speed of LMA insertion, the incidence of perioperative complications, and time to first oral intake after recovery from anesthesia in children. In addition, cuff volume changes following anesthetic duration was evaluated. Methods: The study sample consisted of 30 pediatric patients (2 to 13 yr of age) who presented for elective ambulatory surgery. Anesthesia was induced and maintained with fentanyl and target controlled infusion of propofol. LMA cuff volume changes and perioperative complications, such as cough, laryngospasm, sore throat, and hoarseness, were evaluated. In addition, time to oral intake after recovery from anesthesia was recorded. Results: Successful insertion rates on the first attempt showed 93.3% and mean insertion time was 11.7 ± 12.8 seconds. Coughing (1/30) and mild laryngeal spasm (2/30) were occurred following removal of LMA. Mean time to first oral intake after recovery was 56.6 ± 23.9 minutes. Cuff volume was increased 1.6 ± 1.2 ml following anesthetic duration of 81.5 ± 30.9 minutes. Conclusions: The LMA triggers less perioperative complications in children. Moreover, the time to first oral intake can be shorten with LMA under general anesthesia with propofol and it can be a contributing factor of rapid discharge from hospital.

Sevoflurane의 폐활량 흡입마취유도 중 조절환기와 자발호흡에서 나타나는 임상적 특징의 비교

길혜금,이용경,구본녀,박준희,김원옥,전덕희 대한마취과학회 2005 Korean Journal of Anesthesiology Vol.48 No.3

남북한 마취과학 관련용어의 비교

길혜금,김원옥,강정완,김광희 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.1

Background: Terminology is a good index of reflections in conceptional imaginations, trends and technological advances in the field of their own. The goal of this study was to compare the similarity and difference of terms in anesthesiology to evaluate the communicability between South and North Korea. These results may be particularly helpful during the next step of making glossary, academic communication and the searching of social unity at the time of reunion. Methods: Several books and indexes written in South and North Korea and data from seminars were obtained. Multiple terms were then drawn from these data. These terms were used to make a comparison between South and North side. Results: Both side does not use a Chinese character in their books and indexes, even though many terms stem from a Chinese character. North side had more terms of native language than South side. There were some different terms because of each others rules of grammar. Several terms were confusedly used in both side. In some of combined terms, words were reversed in their orders. Conclusions: We conclude that terminology using in South and North Korea in the field of anesthesiology is not so far way and both side can be capable of communication without any difficulty. But both have many areas to be filled with terms of native language to have identity.