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임상연구 : Desflurane 흡입 마취가 Sevoflurane과 달리 수술 후 장관 기능의 회복을 지연시키는가?
김덕경 ( Duk Kyung Kim ),김혜경 ( Hae Kyoung Kim ),우남식 ( Nam Sik Woo ),김태엽 ( Tae Yop Kim ),권원경 ( Won Kyoung Kwon ),김양렬 ( Yang Lyoul Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
Background: Sympathetic nervous hyperactivity presents in response to surgical stress has been implicated as an important component of postoperative ileus. Because desflurane induces sympathetic activation, the effects of desflurane and sevoflurane on the recovery of bowel function were compared. Methods: Forty patients undergoing a laparoscopic appendectomy were randomly assigned to receive either sevoflurane (Group S, n = 20) or desflurane (Group D, n = 20). The anesthetic, operative, and postoperative pain managements were standardized. The CRP (C-reactive protein), total leukocyte count, and ratio of the neutrophil to leukocyte counts were measured preoperatively and 12 hours postoperatively. The mean arterial blood pressure (MABP), heart rate, and end-tidal anesthetic concentration were measured at 10-min intervals during the surgery. The degree of postoperative pain, 11-graded surgical difficulty score, time to the first passage of flatus and first oral intake of clear fluid, as well as the postoperative hospital stay were also evaluated. Results: Finally, 16 and 17 subjects in Groups S and D were included the analyses. There were no significant differences in the MABP, heart rate, and end-tidal anesthetic concentration between the two groups. The clinical and laboratory parameters related to the severities of inflammation and surgical trauma were similar in both groups. There were no significant differences in the times to the first passage of flatus and first oral intake of clear fluid and the postoperative hospital stay between the two groups. Conclusions: Although desflurane induces sympathetic activation, unlike sevoflurane, it does not delay the return of bowel function following a laparoscopic appendectomy. (Korean J Anesthesiol 2007; 52: 630~6)
일회용 주사기를 이용한 기관내튜브의 새로운 기낭 팽창법의 유용성
허진 ( Jin Huh ),윤태균 ( Tae Gyoon Yoon ),권원경 ( Won Kyoung Kwon ),주영 ( Young Joo ),김덕경 ( Duk Kyung Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
Background: Risk for injuries resulting from overinflated or underinflated endotracheal tube cuff warrants adequate cuff inflation technique. Thus, this study was designed to measure the actual intracuff pressures obtained by new estimation techniques. Methods: 95 adult surgical patients requiring tracheal intubation were randomized to two groups with respect to the endotracheal tube model: Portex(R) (n=55) and Euromedical(R) (n=40). After induction of anesthesia, the cuff was inflated using new estimation techniques with two different syringes: PR10 or PR20 (passive release technique using a 10-ml or 20-ml syringe, respectively). Subsequently, an aneroid manometer was used to measure the actual intracuff pressures. These inflation techniques were repeated two times. A direct cuff measurement range of 25 to 40 cmH2O was used as a reference for optimal intracuff pressure. Size 7.0 mm internal diameter (ID) tubes were used for women and size 7.5 mm ID for men. Results: 88 eligible patients were studied: Portex group (n=50) and Euromedical group (n=38). With respect to the rate of optimal cuff inflation, PR10 was significantly higher than PR20 in both groups (56% vs. 10% in Portex group; 63.2% vs. 0% in Euromedical group, respectively) (P<0.05). Conclusions: When direct intracuff measurement is not available, a new method, named "passive release technique" using a 10-ml syringe, is a useful alternative cuff inflation method. (Korean J Anesthesiol 2009;56:513~8)
외래 및 퇴원환아 부모의 전화상담요구와 간호중재에 대한 조사연구
강화자,한경자,최명애,박승현,김영미,권원경,김선구,안혜영,허미영,Kang Hwa Ja,Han Kyung Ja,Choe Myoung Ae,Park Seung Hyun,Kim Young Mi,Kwon Won Kyoung,Kim Sun Gu,Ahn Hye Young,Heo Mi Young 한국아동간호학회 1996 Child Health Nursing Research Vol.2 No.1
The purpose of this study was to investigate the current status of the need of telephone call and to identify the status of nursing intervention through telephone. Head nurses of the pediatric nursing unit and a nurse of pediatric outpatient clinic wrote down the telephone record of calls by parents of children discharged from hospital from 7 am to 3 pm during the period of March to June, 1995. Content of 120 telephone calls but for 26 calls with incomplete record among 146 calls were analyzed into frequency of general characteristics, needs and nursing intervention. The needs of telephone call were identified and classified into 11 areas and analyzed into frequency of detailed content by 11 areas. Nursing intervention was identified and classified into 10 categories, and analyzed into frequency of detailed content by 10 categories. The findings of this study were as follows ; The need of telephone call was identified with nutritional state, medication, vital signs, language retardation, personal hygiene, vaccination, administration procedure, physical symptoms, follow up care management and others. The most frequent needs were physical symptoms and vaccination. A kind of food among nutrition dose of drugs among medication, fever among vital signs, cough among physical symptoms, and content of vaccination among vaccination was the most frequent needs. Nursing intervention through telephone was identified with instruction, knowledge offer, information offer, judgement, solicitation, referral and instruction, referral, connection, reassurance, reservation, and regulation. Instruction, knowledge offer and information offer was the most frequent nursing intervention by telephone call. Instruction was about a visit to hospital, a visit to nearby clinic, instruction about symptoms,, instruction about nursing care procedure, retelephoning and vaccination. Knowledge offer was about vaccination, knowledge related to medication, and dental care. Information offer and judgement was about vaccination and medication. Referral and instruction delivery was about instruction delivery following consultation to doctor, visit to emergency room and a visit to hospital following consultation to doctor. These results suggest that telephone call intervention program should be established as a field of extended pediatric nursing role in health care delivery system for the children.
증례보고 : Loeys-Dietz Syndrome 환아에서 대동맥판막 역류증 수술의 마취 관리
김성협 ( Seong Hyop Kim ),백승우 ( Seung Woo Baek ),권원경 ( Won Kyoung Kwon ),김덕경 ( Duk Kyung Kim ),윤태균 ( Tae Gyoon Yoon ),임정애 ( Jeong Ae Lim ),우남식 ( Nam Sik Woo ),김태엽 ( Tae Yop Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
Loeys-Dietz Syndrome (LDS) is a recently described autosomal dominant aortic aneurysm syndrome with widespread systemic involvement. It is characterized by the triad of 1) arterial tortuosity and aneurysms, 2) hypertelorism, and 3) bifid uvula or cleft palate. A 12-year-old boy with LDS was scheduled to undergo correction of aortic valve regurgitation due to aortic annuloectasia. We report our clinical experiences of a case of LDS patient with brief review of related literatures and relevant anesthetic problems. (Korean J Anesthesiol 2009;57:371∼5)