복부수술을 받는 노인 환자의 경막외 통증 조절 시 0.2%와 0.25% Levobupivacaine의 효과와 안전성 비교

권원경 대한마취통증의학회 2007 Anesthesia and pain medicine Vol.2 No.2

Background: Levobupivacaine appears attractive as epidural analgesia because it is less cardio- and neurotoxic than its racemic mixture. This study evaluated the efficacy and safety of two different concentrations of levobupivacaine infused epidurally as analgesia for elderly patients undergoing abdominal surgery. Methods: This prospective study evaluated the quality of postoperative analgesia, the six graded physical activity score, the time to the first passage of flatus, the time to the first oral intake of clear fluid, and the postoperative hospital stay in patients who received a continuous thoracic epidural infusion of levobupivacaine at two different concentrations over a 48 hour period: Group 0.2% (n = 15) or Group 0.25% (n = 15). The incidence of side effects, such as motor block, hypotension, and bradycardia, was also assessed. Results: There were no differences with regard to the verbal numerical rating scale at rest and cough, the total consumption of rescue analgesia, the incidence of side effects, and the overall satisfaction. The physical activity scores at postoperative 24 and 48 hours were similar in both groups. However, the time to the first passage of flatus and time to the first oral intake of clear fluid was significantly faster in Group 0.25% than in Group 0.2% (P < 0.05). Conclusions: The continuous thoracic epidural infusion of levobupivacaine in elderly patients after abdominal surgery at both 0.2% and 0.25% provides a similar quality of analgesia without any significant motor block. However, increasing the concentration to 0.25% provides a more rapid return of the bowel function but does not shorten the postoperative hospital stay.

Actinotignum schaalii 에 의한 요로감염증 1예

권원경,송동준,허희재,박세훈,기창석,이남용 대한진단검사의학회 2019 Laboratory Medicine Online Vol.9 No.2

Actinotignum schaalii is an emerging uropathogen; however, routine culture protocols and usual phenotypic methods do not allow for easy detection and identification. Herein, we report the first Korean case of urinary tract infection caused by A. schaalii in a 79-year-old patient with prostate cancer. A gram-positive rod bacterium was isolated from the patient's urine after 2 days of culture and identified as A. schaalii using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and DNA target sequencing. Actinotignum schaalii는 신종 요로감염균의 일종이지만, 일반적인 배양법과 표현형 분석법으로는 이를 검출하고 동정하기 어려운 특징이 있다. 저자들은 79세 전립선암 환자에서 발생한 A. schaalii 요로감염증 국내 첫 증례를 보고하고자 한다. 환자의 소변검체에서 배양 이틀 후 그람양성 막대균이 배양되었고, 이는 MALDITOF 질량분석기와 16S rDNA 염기서열분석으로 A. schaalii로 동정되었다.

국내 임상검사실의 반코마이신과 아미노글리코사이드 항생제 약물농도 결과값 비교 평가

권원경,오종원,이수연,박형두 대한진단검사의학회 2020 Laboratory Medicine Online Vol.10 No.4

Background: Therapeutic drug monitoring (TDM) is clinically recommended for vancomycin and aminoglycoside antibiotics owing to their narrow therapeutic range and nephrotoxicity at high concentrations in the blood. This study was conducted to investigate the current status of TDM of vancomycin and aminoglycosides in Korean clinical laboratories. Methods: Ten organizations participated in this survey. Vancomycin, amikacin, gentamicin, and tobramycin were prepared in three samples of five or six different concentrations. Data from each institution were calculated for the mean, standard deviation, within-day, between-day, and within-laboratory precision. The results from each institution were compared in various ways. Results: Six instruments from three manufacturers were used. Samples with the lowest drug concentration were reported as below the lower limit of quantitation in most laboratories. Coefficients of variation for within-laboratory values ranged from 1.1% to 10.9% for vancomycin, 0.8% to 18.2% for amikacin, 1.2% to 7.8% for gentamicin, and 1.3% to 6.1% for tobramycin. Based on the overall results of the participants, only one institution’s vancomycin samples standard deviation index exceeded 3, with all other values below 2. The College of American Pathologist criteria were met by all institutions; however, measurement of vancomycin in one laboratory and of gentamycin in three laboratories failed to meet the Royal College of Pathologists of Australasia acceptance criteria. Conclusions: Although the precision of the antibiotic test in individual institutions was excellent, there was a difference in the measured values between laboratories. Harmonization of antibiotic TDM is needed to reduce inconsistencies in results. 배경: 반코마이신과 아미노글리코사이드 계열 항생제는 좁은 치료범위와 고농도에서의 신독성 부작용 때문에 약물농도 측정(therapeutic drug monitoring)이 추천된다. 이 연구는 주요 국내 임상검사실의 약물농도 측정 현황을 분석하기 위해 수행되었다. 방법: 총 10개 기관이 연구에 참여했다. 반코마이신, 아미카신, 겐타마이신, 토브라마이신에 대해 5-6개의 농도로, 각 농도당 3개씩의 검체를 제조하였다. 각 측정값을 이용하여 전체 기관의 평균, 표준편차를 구하고 개별기관의 정밀도를 평가하였으며, 다양한 방법으로 기관별 결과 차이를 분석하였다. 결과: 세 회사의 여섯 가지 장비가 약물농도 측정에 사용되었다. 대부분의 기관이 최저농도 검체의 값은 최소정량한계 미만으로 보고하였다. 검사실 내 변이계수는 반코마이신에서 1.05-10.89%, 아미카신에서 0.80-18.16%, 겐타마이신에서 1.19-7.80%, 토브라마이신에서 1.27-6.05%였다. 전체 참여기관 결과를 기준으로 할 때 한 기관의 반코마이신 검체에서만 3 SDI를 초과했고 그 외에는 2 SDI 미만이었다. CAP 기준은 모든 기관에서 통과하였지만, 반코마이신에서 한 기관, 겐타마이신에서 세 기관이 RCPA 허용기준을 충족시키지 못했다. 결론: 개별 기관의 항생제 검사의 정밀도는 우수하였음에도 불구하고 기관들끼리 측정값에 차이가 있었다. 결과의 불일치를 줄이기 위해 항생제 약물농도 측정의 일치화가 필요하다.

The First Korean Case of Gorlin–Goltz Syndrome Caused by a PTCH2 Pathogenic Variant Identified via Whole Exome Sequencing

권원경,김형태,윤영철,우혜인,김종원 대한진단검사의학회 2020 Laboratory Medicine Online Vol.10 No.2

Gorlin–Goltz syndrome, also known as basal cell nevus syndrome, is a condition that affects several body parts and increases the risk of developing various cancerous and noncancerous tumors. This syndrome is mostly caused by the pathogenic variants of the PTCH1 and SUFU genes; however, it is rarely diagnosed due to limited prevalence. PTCH2 has rarely been identified as a pathogenic variant in patients with the Gorlin–Goltz syndrome in China and Japan. Here, we report the case of a 30-year-old woman who was diagnosed with the Gorlin–Goltz syndrome—based on multiple calcifications on the body—who carried a frame shift pathogenic variant of the PTCH2 gene (c.1172_1173del) identified via whole exome sequencing. The patient did not present the typical phenotypes of the Gorlin–Goltz syndrome, such as basal cell carcinoma, palmar/plantar pits, macrocephaly, and keratocystic odontogenic tumors. Based on these observations, we suggest that a pathogenic variant of PTCH2 can manifest a milder phenotype of the Gorlin–Goltz syndrome.

노인 수술환자의 전신마취관리

권원경,김태엽 대한의사협회 2017 대한의사협회지 Vol.60 No.5

대동맥궁 단절증 환아의 비심장수술 시 마취관리 —증례보고—

권원경,김덕경,윤태균,김성협,강주은 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.53 No.3

Interrupted aortic arch (IAA) is a rare congenital cardiovascular anomaly in which there is no direct continuity between the aortic arch and the descending aorta. A patent ductus arteriosus (PDA) usually feeds the descending aorta. But, as ductus constricts, IAA is lethal in nearly 100% of the cases, if untreated. The cause of death is a combination of greatly increased left to right shunt with increased pulmonary blood flow, which results in heart failure, pulmonary edema, and sequelae of the reduced perfusion of all structures distal to the interruption. During the noncardiac surgery in such patients, adequate managements with prostaglandin infusion, careful manipulation of the pulmonary-systemic blood flow ratio, inotropic support, and aggressive treatment of acidosis should be provided to ensure optimal outcomes of subsequent surgical reconstruction. We present the anesthetic experience of abdominal surgery in a neonate with a type A IAA combined with PDA and ventricular septal defect.

임상연구 : 과거 마취 경험이 수술 전 환자의 마취 및 마취과 의사에 대한 인식도에 미치는 영향

권원경 ( Won Kyoung Kwon ),성태윤 ( Tae Yun Sung ),허용준 ( Yong Jun Huh ),김경옥 ( Kyoung Ok Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6

Background: The image and status of anesthesiology as a medical specialty in the eyes of the general public has been a problem. This study assessed the patients` thoughts on anesthesiologists and their preoperative concerns and examined the influence of any previous anesthetic experience on their apprehension. Methods: One hundred thirty-nine patients undergoing elective surgical procedures were surveyed with a questionnaire regarding their thoughts on anesthesiologists and their preoperative concerns at preoperative visits. The results were analyzed in terms of a previous experience with anesthesia. Results: Sixty-five patients had previous experience with anesthesia (Group 1), and 74 patients had none (Group 2). Seventy-one percent of patients in Group 1 and 80% in Group 2 reported that a physician-anesthesiologist was in charge of their anesthesia. Regarding the responsibility for the patients` safety during the surgical procedures, 83% of patients in Group 1 and 82% in Group 2 reported that the anesthesiologists were responsible for the patients` well-being. Fifty-seven percent of patients in Group 1 and 58% in Group 2 reported that the anesthesiologists were responsible for their safe recovery from the anesthesia. The most frequent preoperative apprehensions were postoperative pain (57% in Group 1 and 62% in Group 2) and the risk of not waking up from the anesthesia (60% in Group 1 and 57% in Group 2). There were no significant differences between the two groups. Conclusions: Passive learning from previous anesthetic experience does not affect the patients` thoughts on the anesthesiologists and their preoperative concerns. (Korean J Anesthesiol 2007; 52: 621~6)

자가조절 진정을 이용한 기관지 내시경술에서 Midazolam 전투여가 환자 만족도에 미치는 영향

권원경 ( Won Kyoung Kwon ),최은수 ( Eun Su Choi ),김지영 ( Ji Young Kim ),박상리 ( Sang Ri Park ),나효석 ( Hyo Seok Na ),박상헌 ( Sang Hyun Park ),박희평 ( Hee Pyoung Park ),전영태 ( Young Tae Jeon ),황정원 ( Jung Won Hwang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1

Background: Patient-controlled sedation (PCS) with propofol is a safe and effective method of attenuating discomfort during fiberoptic bronchoscopy. The purpose was to evaluate the usefulness of midazolam in addition to PCS for fiberoptic bronchoscopy. Methods: We randomly assigned 155 patients undergoing diagnostic bronchoscopy to two groups. Group M (n=79) received 0.03 mg/kg of midazolam for premedication while group P (n=76) received a loading dose (0.05 ml/kg) of PCS solution composed of 200 mg (20 ml) of propofol and 1 mg (2 ml) of alfentanil. Both groups received the PCS solution 0.2 ml/kg/hr with a bolus of 1 ml and a lockout time of 1 min. Vital signs, pulmonologist satisfaction, patient satisfaction and amnesia were evaluated. Results: After the insertion of the bronchoscope, there was a slight decrease of SpO2 and an increase of blood pressure and heart rate in both groups with no significant differences between the two groups. The group P required more bolus injections (1.6±1.7 in the group M vs 2.5±2.2 in group P; P<0.05). There was no difference in the satisfaction of pulmonologists, but the satisfaction of patients was higher in the group M (P<0.05). More patients in the group P (93%) remembered the procedure than in the group M (70%) (P<0.05). Conclusions: PCS is an effective method for sedating patients undergoing fiberoptic bronchoscopy and midazolam provides more patient satisfaction and amnesia. (Korean J Anesthesiol 2009;56:1~5)

대동맥궁 단절증 환아의 비심장수술 시 마취관리

권원경 ( Won Kyoung Kwon ),김덕경 ( Duk Kyung Kim ),윤태균 ( Tae Gyoon Yoon ),김성협 ( Seong Hyop Kim ),강주은 ( Joo Eun Kang ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.3

Mini-Tab을 이용한 D-Tube 확관 최적 공정 설계

주원경(WonKyung Joo),권용구(YongGu Kwun),배성인(SungIn Bae),송정일(JungIl Song) 대한기계학회 2007 대한기계학회 춘추학술대회 Vol.2007 No.5

The purpose of this study is to find the optimization processing on expanded tube using Taguchi method which was generally used to analyze the effects of various control factors. Mini-Tab is a good for program that is making a selection using Taguchi method. The results of experimental test and analysis are as follows. Optimization processing on a expanded tube is dependent on lubrication condition. The slight eccentricity of expanded tube was obtained a good results on the expanded tube. When expending processing on the expanded tube was performed, the test specimens were almost unaffected by changing pressure loading. The tendencies of test results were related to lubrication condition and eccentricity in expending processing. As a result, a proper lubrication condition and eccentricity in the step of design will improve the optimization processing of expanded tube.