임상연구 : 제왕절개술을 위한 산모의 전신마취시 마취전 산소화의 평가

이병호 ( Byung Ho Lee ),정미영 ( Mee Young Chung ),채준석 ( Jun Seuk Chea ),김창재 ( Chang Jae Kim ),정동석 ( Dong Suk Chung ),박희상 ( Hee Sang Park ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.44 No.5

36권6호 영문부록 : Fentanyl과 Ketorolac을 사용한 술 후 통증조절 환자에서 지속주입법 첨가에 대한 평가

김대우(Dae Woo Kim),강유진(Yoo Jin Kang),정동석(Dong Suk Chung),인장혁(Jang Hyeok In),이상수(Sang Su Lee),임용걸(Yong Gul Lim) 대한마취과학회 1999 영문부록 Vol.- No.-

서론 : 정맥내 자가통증조절법(PCA; Patient Controlled Analgesia)은 환자가 수술 후 통증을 느낄 때 주입 펌프를 이용하여 환자 스스로 투여되는 진통제의 용량을 조절하는 방법이다. 이러한 주입방법에 대하여 환자가 수면중이거나 예상치 못한 갑작스런 동작 등으로 통증을 유발하는 등의 경우에 대비하여, 이론적으로 약물의 평균 유효 진통농도 유지를 위한 지속적 주입법의 추가가 고려되어 왔다. 그러나 이 방법은 이론적인 면과 달리 약물의 부작용 증가 등의 이유로 그 사용 여부에 대하여 많은 논란이 있었다. 따라서 본 연구에서는 지속적 주입법이 부가되는 지속 주입 자가통증조절 방법과 자가통증조절 단독방법을 비교하여 fentanyl 총 사용량을 줄이고 ketorolac의 진통제 절감효과를 높여서 부작용을 최소화하고 술 후 진통과 환자의 만족을 향상시키고자 한다. 방 법: 미국 마취과 학회 분류상 전신상태 1급 및 2급에 해당되는 제왕절개술 환자 120명에서 잠금시간(lockout time) 6분, 기본 지속 주입 속도 0.5 ml/h, 자가통증조절 일회 주입량 0.5 ml인 Home pump (I-Flow ) PCA 기구를 이용하였다. 1군은 수술 종료 10∼15분전에 fentanyl 2μg/kg의 초회량 후, 환자의 요구에 따른 자가통증조절 일회 주입량은 fentanyl 10μg을 사용하였고, 2군은 1군 방법에 fentanyl 20μg/h의 지속 주입을 첨가하였다. 3군은 fentanyl 2μg/kg과 ketorolac 30 mg의 초회량 후, fentanyl 5μg와 ketorolac 1 mg의 자가통증조절 일회 주입량을 사용하였고, 4군은 3군 방법에 fentanyl 10μg/h와 ketorolac 2 mg/h의 지속주입을 첨가하였다. 각 군에서 visual analogue scale (VAS)에 의한 통증점수, 진정점수(sedation score), 환자의 만족도, fentanyl과 ketorolac의 총 사용량, 부작용의 정도 및 빈도 등에 대하여 비교 검토하였다. 결과: 전체적인 VAS에 의한 통증점수는 3군과 4군이 1군과 2군에 비하여 의의 있게 낮았으며, 2군과 4군에서는 다른 군에 비하여 통증점수상 향상이 없었다. Fentanyl의 총 사용량은 3군이 1군에 비해 64%, 4군이 2군에 비해 43% 감소하였고, 지속 주입의 추가가 없는 1군과 3군은 2군과 4군에 비하여 의의 있게 사용량이 적었다(P<0.05). 술 후 오심은 가장 흔한 부작용이었으며, 3군의 오심 발생빈도는 1군과 2군에 비하여 의의 있게 낮았다(P<0.05). 결론 : 술 후 환자 통증관리에서 자가통증조절 단독방법은 자가통증조절 방법에 부가적인 지속 주입법에 비하여 fentanyl의 사용량이 적었으면서도 통증점수상 별 차이가 없었으며 만족도도 거의 비슷하였다. 술 후 자가통증조절 단독방법의 사용과 ketorolac의 진통제 절감효과는 아편양제제의 사용량을 줄이고 부작용을 최소화할 수 있을 것으로 사료된다. (Korean J Anesthesiol 1999; 36: S 1∼S 8)

IBDV (SH/92)의 인공감염에 의한 닭 면역장기의 병리조직학적 연구

엄성심 ( Sung Shim Eum ),김범석 ( Bum Seok Kim ),임채웅 ( Chae Woong Lim ),임병무 ( Byung Moo Rim ),이호일 ( Ho Il Lee ),정동석 ( Dong Suk Chung ) 한국가축위생학회 1999 韓國家畜衛生學會誌 Vol.22 No.3

Sequential morphologic changes in the lymphoid organs were examined after ocular and cloacal inoculation in 3weekold chicks with a highly virulent strain (SH/92) of infectious bursal disease virus (IBDV). The infected chickens were sacrificed at 6, 12, 24, 48, 72, and 96 hrs post inoculation (P1), and thymus, harderian gland, ceacal tonsil, and spleen were observed. Histologically, the significant lesions were characterized by lymphocyte depletion and the earliest detectable changes were evident at 12 hrs PI. In thymic cortex, lymphoid depletion with apoptosis and prominent "tingible body macrophages" were observed. As the infection advanced, the lesions showed more severe changes. Dying cells were characterized either by capping of nuclear chromatin (apoptosis) or by cytoplasmic swelling (necrosis). In situ staining for apoptosis, some lymphoid cells revealed typical positive reaction, even the stainability was variable depend on every lymphoid organs. These results suggest that IBDV (SH/92) cause severe damage both primary and secondary lymphoid organs, and both T and B lymphocytes. Also the lymphoid depletion of these organs is caused by necrosis and apoptosis induced by IBDV.

제왕절개술시 마취방법에 따른 인지의 빈도

정동석 최신의학사 1994 最新醫學 Vol.37 No.6

경막외마취후 발생한 이하선 종대

정동석 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.6

Salivary gland enlargement in association with anesthesia is an unusual complication first described in 1968. Since then, several additional reports have appeared. This report decribes a case of bilateral enlargement of parotid gland that developed in the recovery room. Anesthesia and surgery contribute to many faetors that predispose to the developement of this disorder. These-include dehydration, the suppression of oral secretions by the restricion of fluids, the use of medication with antisialagogue properties, and inhalation of unhumidified gases. The clinical manifestations, predisposing factors, and treatment are discussed.

설인 신경통 체험 1 예

정동석,정운혁,이도용 대한마취과학회 1983 Korean Journal of Anesthesiology Vol.16 No.1

Glossopharyngeal neuralgia, first discribed by Labat in 1928, is a very rare disease of unknown cause. This neuralgia is associated with a characteristic sharp pain of the posterior pharynx, tonsils and larynx, and especially triggered by swallowing action. It is said that this pain is more severe than that of trigerminal neuralgia and the pain may last several up to 30 minutes and the attack repeats intermittently. Diagnosis of glosspharyngeal neuralgia is made by the symptoms and by the elongation of the right side of the styloid process in this case. The glossopharyngeal nerve block by the deposition of local anesthetic solution is useful in the accurate diagnosis of the douleureux or neuralgia in which this nerve is involved and in providing anesthesia for operative intervention upon the posterior third of the tongue. This is a report of a case of glossopharyngeal neuralgia, which did not respond to Tegretol and other analgesic drugs and treated by glossopharyngeal nerve block with 0.5% bupivacaine l.5-2.0 ml. The block was performed every day for 15 days and the neuralgia disappeared without complication.

원발성 Aldosteronism 의 부신적출술 마취 2예 보고

정인희,김승록,정동석,성춘호,최용우 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.4

Primary aldosteronism is a clinical syndrome manifested by hypertension, hypokalemia and hyporeninemia in which autonomous secretion of aldosterone from the adrenal gland increased. Primary aldosteronism caused by aldosterone-producing adenoma is a surgically treatable conditon. For the first case, operation was performed on a 34 year old woman with this condition, under general anesthesia with N₂O-O₂-Fentanyl. And the other case was 37 year old man. Those patients recovered uneventfully.

심폐 소생술시 발생한 폐수종

박철주,정동석,이도용 대한마취과학회 1982 Korean Journal of Anesthesiology Vol.15 No.4

환자의 체온 변화에 따른 두개강내 체온과 액과 체온 차이

김현숙,정동석,문동언,임경실 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.5

Background : It is believed that the brain temperature is about 1℃ higher than the peripheral temperature. However the result has been mostly obtained in normothermia patients. The objective of this study was to evaluate whether the brain and axillary temperature difference would be increasul or decreased in hypothermic patients. Methods: Sixty-six patients who underwent a craniotomy with implantation of the thermal diffusion flowmetry sensor (SABER 2000; Flowtornics, Phonics, USA) were included in this study. The temperature of the cerebral cortex and axilla were measured simultaneously every 2 hours. The patient groups were divided according to their axillary temperature, hyperthermia (over 38℃: 127 paired clata), normothermia (36-38℃: 1626 paired data) and hypothermia (under 36℃: 285 paired data). A total 2048 paired sample data were collected and analyzed. Results : The temperature difference between the cerebral cortex and the axilla was 0.46±1.04℃ in hyperthermic patients, 0.89±1.65℃ in normotheients and 1.04±0.82℃ in hypothennic patients. The temperature difference has statistical significance in each group (unpaired t-test, P$gt;0.05). Conclusions : Our results demonstrate that the temperature difference in the brain shows a difference according to the patients body temperatute. In normothermia the temperature difference between the brain and the axilla was about 1C. However in a hyperthermic state, the temperature difference decreased and in a hypothermic state, the temperature difference increased. (Korean J Anesthesiol 2000; 39: 613-618)

전신마취시 발생한 경요도적 전립선 절제술 증후군 1 예

전연수,정동석 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.1

A 70-year-old male was performed TURP (Transurethral resection of the prostate) under the diagnosis of benign prostate hyperplasia. Under general anesthesia, two times of TURP and suprapubic prostatectomy were performed for bleeding control during 8 hours. At the end of the operation, hypotension with bradycardia, severe ST elevation, QRS widening, T wave inversion and ventricular tachycardia on EKG appeared. Under the assumption of the diagnosis of hyponatremia, we treated with NaHCO3 and lasix, but cardiac arrest was followed by cardiopulmonary resuscitation. During postoperative five days, patient's cardiopulmonary status was supported by cardiotonic drugs and mechanical ventilation. We report this case to recall TURP syndrome and its management with the review of the relevant literatures.