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하지수술시 Fentanyl과 병용한 0.75% 등비중 Ropivacaine을 이용한 척추마취
임일환,이상곤,반종석,민병우 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5
Background: Opioids and local anesthetics administered together intrathecally have a potent synergistic analgesic effect and less hypotention using a minidose of local anesthetic. This study was designed to investigate the safety and efficacy of two doses of intrathecal isobaric ropivacaine/fentanyl in patients undergoing an operation of the lower extremities. Methods: Thirty patients undergoing an elective orthopedic surgical operation of the lower extremities were randomly assigned to two groups for spinal anesthesia. Patients in group Ⅰ (n = 15) received 0.75% ropivacaine 14 mg/fentanyl 20㎍, and patients in group Ⅱ (n = 15) received 0.75% ropivacaine 16 mg/fentanyl 20㎍. After spinal anesthesia, we measured the time to T10, peak dermatomal level, time to peak sensory level, time to maximum motor blockade, duration of complete motor block and duration of complete sensory block using the pin prick test and Bromage motor scale. Also circulatory variables were monitored every 5 min and side effects were measured for 3 day after spinal anesthesia. Results: There were no significant differences between the groups in time to T10, peak dermatomal level, time to peak sensory level, time to maximum motor blockade and duration of complete motor block, but duration of complete sensory block was significantly longer in the 0.75% ropivacaine 16 mg/fentanyl 20㎍ group than the 0.75% ropivacaine 14 mg/fentanyl 20㎍ group. Conclusions: Intrathecal 0.75% ropivacaine 14 mg/fentanyl and 0.75% ropivacaine 16 mg/fentanyl were equally suitable for a lower extremity operation. (Korean J Anerthesiol 2002; 43: 600~605)
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임일환 서강대학교 철학연구소 2016 철학논집 Vol.46 No.-
이 논문은 20세기 후반 죤 맥키에 의해 제기된 ‘논리적 악의 문제’라는 양상(modal) 무신론 논증과 이에 응답하는 플란팅가의 이른바 자유의지 변신론 논 쟁의 철학적 공과를 재점검하는 것을 목표로 한다. 이를 위해 논문은 이 논쟁의 쌍 방은 모두 신의 전지함(omniscience)에 대한 중간적 지식을 가정하고 있으며, 자유 의지와 완벽한 선행지식 간의 양립가능성을 형이상적으로 전제한 논쟁임을 먼저 지 적한다. 논문은 중간적 선행 지식의 가정은 인식론적 악순환이라는 심각한 결함을 갖고 있으며, 후자의 가정은 ‘신의 자유의 문제’라는 또 다른 어려운 문제를 초래 하기 때문에 받아들일 수 없는 가정이라고 논증한다. 따라서 논문은 만일 이런 비 판적 논점들이 옳은 것이라면, 실상 맥키가 과연 ‘새로운’ 형태의 논리적 악의 문 제를 제기했는지조차 불명확하며, 그것이 어떤 정도로 위협적인지조차 분명하지 않 다고 논한다. 결론에서는 논문이 제안하는, 이런 문제적인 가정들을 배제한, 새로운 자유의지 변신론을 모색하는 것이 왜 유신론적 철학 일반에 중요한 통찰과 의의를 갖는 것인지 재점검해보고자 한다.
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임일환 한국미학회 2002 美學 Vol.32 No.-
We all know that the duck-rabbit picture has been widely used in various contemporary philosophical disputes; Sometimes the picture is supposed to show that every observation is somehow 'theory-laden'. At other times, the picture and related perceptual experience was the focus of the so-called "modularity" thesis in the philosophy of mind. In aesthetics, V. Aldrich used the picture and Wittgenstein's notion of "seeing-as" for elaborating his ontology of esthetic objects. And so, naturally I believe, it's been widely assumed that the intriguing perceptual experience, generated by the duck-rabbit, is well understood by all the practitioners in the field and so that there should be no more conceptual riddles to be solved. In this paper, however, I argued that the original philosophical puzzle, raised by Wittgenstein, has been largely forgotten and no one, except R. Chisholm, even bothers to solve it. As I see it, Wittgenstein's puzzle can be reformulated in this way: When one begins to see something A as B, i. e., when what Wittgenstein called "the dawning of an aspect" occurs, there must be something that changes, which would explain a change of aspect involved in the duck-rabbit seeing. Is the change of aspect the result of the changes in the sensational appearances? The answer must be No, for when the dawning of an aspect occurs, the physical diagram itself cannot change from duck-like to rabbit-like and so the given sensational appearance must be one and the same all the time. So we are led to conclude that what changes in the change of aspect is our judgement that is made about that sensation or appearance. Then Is the change of aspect the result of our interpretational changes about mere contentless appearance? Again, the answer seems to be No, for unless the sensational appearances are already somehow duck-like or rabbit-like, they would not arouse our cognitive or interpretational ability to see something as, say, duck; the visual content must be there before our cognitive power shed light on it, so to speak. And so we are caught in a tight circle: given that the diagram cannot change, we must preclude the change in the sensational appearances as an explanation for the aspect change, but the interpretational changes cannot work without the prior changes in the sensational appearances. However there seems to be no third possibility. Following Chisholm, I suggest that one possible solution to this puzzle lies in taking the notion of "attending" or "noticing" seriously. Attending is a kind of mental activity that falls between having a sensation (pure sensation) and making an interpretation (pure thinking). Unlike sensation it is about sensational appearances or more exactly we might say its proper objects are the features of appearance and so it is a form of meta-consciousness. Still there is a sense that it is a form of "sensing" for it might be contentless without sensation and the sensual content gets articulated by this mental process. Then the proposed solution to the puzzle is this: The changes of aspect involve two distinct objects of our attending and so when we begins to see the picture as a rabbit, what changed is the object of our attending i. e., we changed from noticing one feature of our appearance to other distinct feature of that appearance. And in the case of the duck-rabbit, those feature were two distinct spatial wholes consisted of different meaningful parts. It should be noticed that these spatial wholes cannot be identified with the mereological sum of the lines and dots of the physical diagram (for there can be one such mereological sum) and the notion of attending whose proper objects are features or properties of appearance, comes in just for these 'objects'. In conclusion, I draw just one moral from my paper. Unless we are not clear about Wittgenstein's original puzzle about perception, we are not entitled to use the duck-rabbit or the related notion of seeing as for any specific philosophical purpose.
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