혈역학적으로 불안정한 환자의 마취관리

권무일 대한마취과학회 1986 Korean Journal of Anesthesiology Vol.19 No.3

응급수술을 위한 마취

권무일 한국의학사 1987 診斷과治療 Vol.7 No.4

최근 2년간 발생한 마취관련 의료분쟁들에 대한 분석

권무일 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.1

Background : 42 anesthesia-related medico-legal cases, consulted to the Korean Society of Anesthesiologists(KSA) in a recent 2 year period(1994, 11∼1996, 10) were analysed. Method : Results of the analysis were classified into 11 items. Results : Cases sources were 26 cases from civil court, 2 cases from criminal court, 8 cases from police stations and 6 cases from health centers, and involved surgical departments were obstetric & gynecology (17 cases), general surgery(7), orthopedic surgery(6), and others(12). Operation classification were Cesarean section(14 cases), reduction and fixations(5), gastrectomy(4) and others(19), and anesthesia methods were general anesthesia(36 cases), regional anesthesia(3), and local anesthesia(3). Involved hospitals were university hospitals(15), general hospitals(16) and private clinics(11), and involved anesthesiologists(anesthetists) were certified anesthesiologists(34), nurse anesthetists(3), and others(5). Patient's ages were classified into 0∼20 years old(4), 20∼40 ys old(23), 40∼60 years old(13) and over 60 years old(2), and patient's sex ratio was 16(male) to 26(female). Outcome of victims were deaths(26 cases), severe brain damages(10) and nerve injuries(6), and autopsy findings were hypoxic brain edema(4 cases), coronary artery diseases(3), and other findings(4). Causes of medico-legal problems were hypoxemia by ventilatory failure (12), pre-existing diseases(4), embolisms followed by operation(2), malignant hyperthermia(1), and uncertain cases(21). Conclusion : The most common cause of medico-legal problems was hypoxemia by ventilatory failure. (Korean J Anesthesiol 1997; 33: 154∼161)

유형별로 본 마취관련 의료사고와 예방책

권무일 대한마취과학회 2004 Korean Journal of Anesthesiology Vol.46 No.1

마취과 영역에서의 혈관확장제 요법

권무일 한국의학사 1986 診斷과治療 Vol.6 No.11

전신마취 하 일측폐환기를 통한 내시경적 흉부 교감신경분지차단술 중 발생한 심정지

권무일,정상우,박성욱 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.4

Primary hyperhidrosis has been associated with an increased activity of the sympathetic nervous system. Conventional nonsurgical therapies are inconvenient and only temporarily effective. Endoscopic thoracic sympathicotomy (ETS) is a minimal invasive procedure of thoracic sympathetic block and has been used successfully and safely in the treatment of primary palmar and axillary hyperhidrosis. Sympathicotomy results in an initial sympathovagal imbalance with a parasympathetic predominance, which is restored in a long-term basis. ETS is commonly performed to treat hyperhidrosis but there are some rare complications including cardiac arrest. In our hospital, we experienced 2 cases of patients who suffered from sudden cardiac arrest during right ETS, which was performed soon after left ETS. We're going to report these cases and consider about possible causes.

마취중 과한기가 동맥혈과 뇌척수액의 산-염기 변화에 미치는 영향

권무일,신광일,류창한,김민구 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.1

The use of controlled gyperventilation during neurosurgical procedures prevents the deleterious effects of hypercarbia on the cerbral blood flow and intracranial pressure. Hyperventilation with hypocarbia produces cerbral vasoconstriction, reduced cercbbral blood flow and a reduction in brain size in the majority of patients with increased intracranial pressure. But, since excessive cerebral vasoconstriction might induce cerebral ischemia, there has been much discussion concernin the optimal level of hypocarbia. Several studies have shown biochemical evidence of a change in cerebral glucose utilization to anaerobic metabolism during hupocarbia. In our investigation, the effect of huperventilation of 10 neurosurgical patients was evaluated by blood gas analysis and the estimation of lactate and pyruvate in arterial blood and the cerebrospinal fluid. The results were as follows: 1) PaCO_2 decreased from a prearesthetic value of 38±2.2 mmHg to 22±2.1 mmHg 1 hour postinduction and 24±2.2 mmHg at 2 hours due to hyperventilation. pH was 7.58±0.047 1 haur postionduction and 7.56±0.018 at 2 hours. PaO_2 was 251±33.0 mmHg 1 hour postinduction 1 hour and 215±20.9 mmHg at 2 hours under a 50% inspired oxygen concentration(FiO2=0.5). 2) The arterial blood lactate value increased statistically significantly from a preanesthetic value of 9.3±15 mmg% to 11.8±1.47 mg% 1 hour postinduction(p<0.01) to 12.5±1.53 mg% at 2 hours(p<0.005). However all vales were wirthin the normal range(4.7±15.1 mg%), and the lacte/pyruvate rato did not change. 3) In the cerebrospinal fluid, pH was 7.45±0.057, PCO_2 was 34±3.5 mmHg and PO_2 was 91±6.7 mmHg following hyperventilation for 1 hour. The lactate value of the cerebrospinsifluid was 19.2±3.14mg%(normal range: 11.0∼27.0mg%) and the lactate/pyruvate ratio was 14.5±2.39. 4) No evidence of an excessive increase in CSF lactate was seen in any case. The above findings suggest that maintenance of an adequate oxygen concentration and a carbon dioxide value over 20 mmHg would prevent cerebral ischemia following hypocarbia due to hyperventilation.

외래환자를 위한 마취관리

권무일 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.5

Sodium Nitroprusside(SNP)에 의한 유도저혈압이 폐흉일동맥혈 산소분압차 및 폐션트율에 미치는 영향

권무일,정윤국 대한마취과학회 1985 Korean Journal of Anesthesiology Vol.18 No.4

The effect of induced hypotension with sodium nitroprusside(SNP) on alveolar-arterial oxygen tension difference and pulmonary shunting in 10 surgical patients whith normal pulmonary function was studied under general anesthesia. Heart rate, mean arterial pressure, central venous pressure, blood gases and hemoglobin were measured before, during and after SNP infusion. Using the above data, alveolar-arterial oxygen tension difference and pulmonary shunting were calculated. The results were as follows. 1) Mean arterial pressure decreased significantly from 98±9.1 mmHg before SNP infusion to 61±3.0 mmHg during SNP infusion(p<0.001), and increased to 96±6.7 mmHg again after SNP infusion. 2) Heart rate increased significantly from 78±10.5 beats/min. to 101±11.9 beats/min. (p<0.001), and decreased to 84±11.5 beats/min. again. 3) Srterial oxygen tension decreased from 489±32.5 mmHg to 480±25.0 mmHg, but was not statistically significant.(p>0.05). 4) Alveolar-arterial oxygen tension difference increased from 188±29.0 mmHg to 196±25.0 mmHg, but was not statistically significant(p>0.05). 5) Pulmonary shunting increased from 9.0±1.83% to 9.2±1.50%, but was not statistically significant.(p>0.05) The above findings suggest that pulmonary shunting in patients with normal lung function will not affected during induced hypotension with SNP.

제주표류인 이방익의 노정에 관한 지리고증

권무일 제주학회 2019 濟州島硏究 Vol.52 No.-

The purpose of this essay is to study historical evidence on Lee Bang-ik’s long journey across China for nine months after he was cast away on the coast of China. This historical research is mainly based on close examination of the literature such as Pyohaerok and Pyohaega written by Lee Bang-ik, and Seobangeeiksa by Park Jee-Won, and also conducted by exploring the historic sites mentioned in the literature. Lee Bang-ik (1757~1801) who was in government service visited Bukchon-li in Jeju Island on September 1796 in order to move the grave of his mother at Udo Island. On the way back, he and his group encountered a storm and was adrift. After sixteen days of drift, they finally arrived at Penghu Island on the coast of Taiwan, and was interrogated by the government official. But Lee gallantly told them about his position in Chosun as a public official, and as a result was treated as such. After that, his group were transferred to Xiamen in China and were praised by Chinese people for participating in Zhuzi auditorium. They were so warmly welcomed by local people wherever they go, and some Chinese people liked their clothes. They also walked across Xianxialing, the border between Fujian and Zhejian, and also visited scenic spots. And also they stop by famous temples in Hanzhou and Sujou. Lee reported what he had experienced to the King Jeongjo, who was very impressed by all this. But Park Jee Won thought that Lee’s testimony was not correct in many respects, and tried to confirm Lee’s testimony, on the basis of some Chinese literature. Pyohaega and Pyohaerok) are the essays Lee wrote about his experiences in China. The latter contains more detailed and substantial information than the former. But still there are many parts that are hard to understand for many reasons. Our research team followed Lee Bang-Ik’s journey, and supplemented our research data through correspondence with some Chinese scholars and their works. Eventually, I found out that Lee Bang-Ik’s essays are closer to the truth than Park Jee-Won’s essay. 본 논문은 9개월간의 표류에서 돌아온 이방익이 쓴 「표해록」과 「표해가」 그리고 「박지원」의 「서이방익사」를 근간으로 하여 그가 중국에 표착하여 거친 노정을, 필자 등이 답사하여 고증함에 의미가 있다. 충장위장(정3품) 이방익(1757-1801)은 1796년 9월 휴가를 얻어 고향 제주 북촌리를 찾았는데 우도에 묻힌 모친 묘의 완장을 위해서였다. 그는 일행 7명과 더불어 우도에 다녀오다가 폭풍을 만나 표류하게 되었다. 그들은 16일간 표류한 끝에 대만해협의 팽호도에 닿았고 대만에 이송되어 심문을 받았다. 이방익은 당당하게 자신의 관직을 털어놓았고 상응한 대우를 이끌어냈다. 그는 중국의 하문으로 이송되었는데 주자서원에 참예함으로써 중국인들의 칭송을 받았다. 이방익 일행은 가는 곳마다에서 주민들의 환영을 받았는데 특히 그들이 입은 옷을 보고 반가워하는 사람들을 만난 경우도 있다. 이방익 등은 복건성‧절강성의 경계인 선하령을 넘었고 가는 길에 유명한 명승지를 편답했고 항주와 소주에서는 유명한 사찰을 찾기도 하였다. 이방익은 자신이 다닌 노정과 경험담을 정조에게 보고했는데 이는 정조에게 신선한 충격이었다. 박지원은 이방익이 말한 것이 두서가 없고 틀린 것이 많다고 전제하고 중국문헌을 검토하여 이방익이 언급한 장소를 일일이 고증하려 했다. 한편 이방익은 자신의 경험담을 썼는데 「표해가」와 「표해록」이다. 전자는 운문적 필체라 상세기록이 적지만 후자는 기행문이라 기록이 보다 풍성하다. 그러나 지명을 기록하지 않았거나 기록이 꼼꼼하지 않고 오기하는 등 이해하기 어려운 부분이 많았다. 필자 등은 중국 탐방단을 조직하여 이방익이 걸어간 길을 걸었고 현지 학자들과의 대화 및 향토사학자들의 저서를 통하여 내용을 보충했다. 필자는 문헌을 참조하여 쓴 박지원의 글보다 이방익의 글이 진실에 가까운 점을 발견했다.