전신 마취후 윤상피열연골의 아탈구를 동반한 반회후두신경 마비

이성호,송필오,김인규,이헌석,신명근 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5

Arytenoid subluxation or recurrent laryngeal nerve paralysis may result from injury to the larynx following endotracheal intubation or blunt laryngeal trauma. Early diagnosis is important for appropriate treatment and better prognosis. A 62-years-old man was admitted for cholecystectomy. He was intubated without any difficulty and nasogastric tube was inserted with the help of laryngoscope and Magill forcep before surgery. He had a weak voice and hoarseness after atraumatic extubation and those symptoms did not improve even 2 days after. Indirect laryngoscopy, videolaryngotelescopy, electromyography(EMG) and computed tomographic findings revealed anterior, inferior subluxation of left cricoarytenoid cartilage associated with left thyroarytenoid muscle denervation and resultant unilateral vocal cord palsy. Conservative treatment for 40 days after the operation and follow-up examination was done. The voice quality was improved and indirect laryngoscopy examination showed that right vocal cord crossed midline in a attempt to meet its paralyzed counterpart on phonation. (Korean J Anesthesiol 1998; 35: 1018∼1022)

제왕절개술시 마취유도제로 Propofol, Propofol-Ketamine과 Ketamine사용시 산모와 태아에 미치는 영향에 대한 비교

김홍범,신명근,송필오,김인규,이성호 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.4

Background : Propofol and ketamine had been used for anesthesia induction and for total intravenous anesthesia. The nature of any hypnotic interactions occurring between propofol and ketamine are unknown. A comparison of maternal and neonatal effects among propofol-ketamine combination, ketamine and propofol were studied when used for anesthesia induction in Cesarean section. Methods : Forty five patients in ASA class I or II scheduled for Cesarean section randomly assigned to either propofol 2 mg/kg(n=15), ketamine 1 mg/kg(n=15) or propofol 1 mg/kg - ketamine 0.5 mg/kg combination group(n=15) as an induction agent. Maternal systolic and diastolic blood pressure, heart rate, Apgar score and umbilical blood gas analysis were measured. Results : Before intubation, systolic and diastolic pressure were decreased in propofol group but increased in ketamine and propofol-ketamine combination group. Heart rate were increased in all three groups. But there were no significant differences among three groups(p<0.05). fter intubation, there were significant increase in systolic, diastolic pressure and heart rate in three groups but no significant differences among three groups(p<0.05). And there was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. Conclusions : Propofol-ketamine combination was found to be similar to propofol or ketamine only in the effects on the mother and neonate. But propofol-ketamine gained more stable hemodynamic change than propofol or ketamine before intubation. Therefore propofol-ketamine appears to be a suitable alternatives to propofol or ketamine as an induction agent for anesthesia in Cesarean section.(Korean J Anesthesiol 1997; 33: 653∼659)

마취 유도시 필요한 Propofol 정주량에 대한 고찰

김홍범,신명근,송필오,김인규,박찬홈,이성호 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2

Background : Propofol is a short-acting intravenous sedative-hynotic agent that can be used for induction and maintenance of general anesthesia. This study was perfomed to evaluate adequate dose requirements of propofol by injection during anesthesia induction, and to evaluate the induction technique by assessing induction dose, induction time, success rate of induction and hemodynamic effects. Methods : Ninety healthy adult patients(ASA class I or II), scheduled for elective surgery under general anesthesia, were randomly assigned to receive propofol 1 mg/kg(group I), 2 mg/kg(group II), and 3 mg/kg(group III) respectively as an induction agent. Mean arterial pressure(MAP) and heart rate(HR) were measured before the administration of propofol and just after successful induction. We determined the speed of injection as lasting 40 seconds. Results : Success rate of induction in group I(30%) was lower than group II(100%) and III(100%). The induction time in group I(81s) was longer than group II(51s) and III(47s). The MAP were statistically significant difference among three groups(p$lt;0.05 compared with before induction). In group III, the MAP was more decreased than group I and II and HR was more increased than group I and II. Conclusions: We concluded that propofol in group II(2 mg/kg) is more desireable dose than group I(1 mg/kg) and group III(3 mg/kg) for induction of general anesthesia. (Korean J Anesthesiol 1997; 32: 226∼230)

마취중 우측 쇄골하 및 내경 정맥압과 중심 정맥압과의 비교

김인현,김인규,신명근,송필오,손소인 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.6

The internal jugular and subclavian veins are considered as satisfactory intravenous routes for rapid blood and fluid replacement. To determine whether these venous pressures can be used as reliable guides for central venous pressure monitoring, simultaneous measurements of the Rt. internal jugular venous pressure and central venous pressure (CVP), or Rt. subclavian venous pressure and CVP using long 14 gauge catheter were made in 20 patients undergoing cardiac anesthesia. The results were as follows: 1. Each mean value of the Rt. internal jugular venous pressure and CVP was 10.64±5.43 cm H₂O and 10.05±5.55cm H₂O (Mean±SD) respectively in first 10 patients. Pressure difference was 0.59±0.39cm H₂O (p$lt;0.005). 2. Each mean value of the Rt. subclavian venous pressure and VP was 7.77±3.37 cm H₂0 and 7.05±3.49cm H₂O (Mean±SD) respectively in second 10 patients. Pressure difference was 0.73±0.59cm H₂O (p$lt;0.005). 3. There were significant correlations between Rt. internal jugular venous pressure and CVP .005) as well as between Rt. subclavian venous pressure and CVP (r=0.98, p$lt;0.005). The results suggest that Rt. internal jugular or subclavian vein catheterized with short intravenous catheter during Anesthesia can be used as effective and reliable guides for CVP monitoring because pressure differences with CVP were small and consistant.

제왕절개술후 통증치료를 위한 경막외강 Buprenorphine 과 Morphine 의 비교연구

김승환,신명근,박찬흠,송필오,김인규,이성호 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.4

Buprenorphine is a semisynthetic, highly lipophilic opioid derived from thebaine and it is 30 to 40 times more potent than morphine. This study was performed to compare the clinical effects of epidural buprenorphine on postoperative pain control with those of epidural morphine in 150 cesarean deliveries. They were physical status 1 or 2 by ASA classification and randomly divided into three groups. They were administered morphine 3 mg in group I, buprenorphine 0.15 mg in group II and buprenorphine 0.3 mg in group III as first dose mixed with 0.25% bupivacaine 10 ml respectively through indwelling epidural catheter at the time of ligation of umbilical cord. Second and third doses were administered with 8 hours intervals, morphine 3 mg with N/S 10 ml was injected in group I and buprenorphine 0.15 mg with N/S 10 ml was injected in group II and III respectively. Their analgesic effects were evaluated by VAS and severity of side effects was also evaluated. The Results were as follows; 1) VAS was significantly increased in group II compared to group I and III(p$lt;0.05). There was no significant difference between group I and III. 2) Pruritus was lesser in group II and III than group I(p$lt;0.05). 3) There was no significant difference in nausea and vomiting. 4) None of patients had respiratory depression. The authors' findings indicate that epidural administration of buprenorphine of suitable dose may be useful in the treatment of postoperative pain.

페암 환자에서 통증 치료중 발생한 하지 마비

김홍범(Hong Beum Kim),송필오(Pil Oh Song) 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

Continuous epidural analgesia has been used widely for chronic pain control, especially in cancer patients. As one of the complications, paraplegia developed during continuous epi- dural analgesia may be caused by epidural abscess, epidural hematoma, neural damage, chronic adhesive arachnoiditis, anterior spinal artery syndrome, delayed migration of extradural catheter into subdural space or subarachnoid space and preexisting disease. A 55-years-old male with lung cancer was implanted with continuous thoracic epidural catheter for pain control. Twenty days after catheterization, moderate back pain, weakness of lower extremity and urinary difficulty were developed. We suspected epidural abscess at first and made differential diagnosis with MRI which showed metastatic cancer at T2-4 spine. And compressed spinal cord was the main cause of the lower extremity paralysis.

산모의 요추부 경막외강 깊이에 대한 고찰

박찬흠(Chan Heum Park),송필오(Pil Oh Song),신명근( 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1

N/A Background: Epidural anesthesia is now accepted as a popular technique for pain relief and anesthesia. However, accidental dural puncture may occur during placement of the epidural needle. This study was undertaken to evaluate difference of the epidural depth between parturients and non-parturients. Method: Eighty non-parturients receiving epidural anesthesia were assigned to group I, and eighty parturients whose body weight had not yet increased over 15 kg from pregnancy were assigned to group II. With patients in lateral decubitus position, 18 guage Tuohy needle was punctured by approaching at L interspace. Epidural space was identified using loss-of-resistance to air technique. Result: Epidural depth was 4.18 cm and 4.25 cm in group I and group II respectively. There was no significant statistical difference in body mass index(BMI) and ponderal index(PI) (p < 0.05), nor in epidural depth between the two groups. Conclusion: Epidural. needle need not be placed deeper in parturients than in nonparturients