말기신부전 환자의 구강외과 수술 마취관리 -증례보고-

박창주,박종철,강영호,명훈,이종호,김명진,김현정,염광원,Park, Chang-Joo,Park, Jong-Chul,Kang, Young-Ho,Myoung, Hoon,Lee, Jong-Ho,Kim, Myung-Jin,Kim, Hyun-Jeong,Yum, Kwang-Won 대한치과마취과학회 2003 Journal of Dental Anesthesia and Pain Medicine Vol.3 No.2

Patients in end-stage renal disease (ESRD) and chronic renal failure present a number of challenges to the anesthesiologist. They may be chronically iii and debilitated and have the potential for multiorgan dysfunction. A 65-year-old male patient with ESRD was scheduled for oral cancer surgery under general anesthesia. He was in regular hemodialysis three times a week and secondary hypertension with left ventricular hypertrophy was accompanied. He also had chronic metabolic acidosis and hyperkalemia. The day after hemodialysis, general anesthesia was carried out. Uneventful anesthetic induction using thiopental and vecuronium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 9 hours. During the anesthesia, he did not have any problem but persistently increasing serum potassium level. After anesthetic emergence, he was transferred to intensive care unit for mechanical ventilation. So we report this successful case of anesthetic management in a patient with ESRD for oral cancer surgery, which massive bleeding and long anesthetic time were inevitable in, from the preoperative preparation to anesthetic emergence.

혈우병 환아에서의 구강외과 수술 마취관리 -증례 보고-

박창주,이종호,염광원,김현정,Park, Chang-Joo,Lee, Jong-Ho,Yum, Kwang-Won,Kim, Hyun-Jeong 대한치과마취과학회 2002 Journal of Dental Anesthesia and Pain Medicine Vol.2 No.1

Hemophilia A is the most common congenital bleeding disorder, which is sex-linked disease, caused by a deficiency of clotting factor VIII. We experienced a case of alveolorrhaphy using iliac bone graft under general anesthesia for the correction of bilateral cleft alveolus in 10-year-old boy with hemophilia A. Factor VIII activity in this patient was 0.7%, on the severely deficient level, and aPTT was 100 seconds. Just before operation, he received 1,750 units of factor VIII intravenously for loading dose. After we confirmed his factor VIII activity improved to 95% and aPTT to 38.4 seconds, operation was begun. No more transfusion was needed during the operation. In his postoperative care, he received 50 units/kg a 12 hours for 3 days and 30 units/kg a 12 days for 2 days. His factor VIII activity was maintained at 57-139% during his hospitalization. He was discharged without any anesthetic complication. So we report this successful case of anesthetic management for the oral surgery in a child with hemophilia A.

Dental Treatment for Handicapped Patients in Day Care Units: 2 Years' Experience at Seoul National University Dental Hospital

박창주,염광원,김현정,Park, Chang-Joo,Yum, Kwang-Won,Kim, Hyun-Jeong The Korean Dental Society of Anesthsiology 2002 Journal of Dental Anesthesia and Pain Medicine Vol.2 No.1

연구배경: 장애인의 치과치료는 일반인의 치과치료와는 달리 많은 문제점들을 가지고 있다. 이러한 장애인 환자의 치과치료를 위하여 서울대학교 치과병원에서는 치과마취과를 중심으로 임상 각과가 협진하여 외래마취 기반 하에 1999년부터 장애인 진료실을 운영하고 있다. 이번 연구에서는 서울대학교 치과병원 장애인 진료실의 치료방법을 소개하고 그 동안 치료받은 장애인 환자들의 자료를 바탕으로 마취과적인 특징을 분석하였다. 방법: 2001년 1월부터 2002년 5월까지 치료받은 총 54명의 장애인 환자들의 치료기록지와 마취, 그리고 회복실 기록지를 검토하였다. 환자의 성별, 나이, 전신질환, 수술 전 시행된 검사, 치료에 참여한 협진과, 마취 유도제와 유지제, 총 마취시간과 회복실 체류시간, 그리고 회복실에서 관찰된 합병증을 조사하였다. 결과: 총 54명의 환자들을 대상으로 58건 치과치료가 시행되었다. 한 건의 의식진정 법을 제외하고는 모두 전신마취 하에서 치과치료가 시행되었다. 마취유도제는 thiopental sodium, 근이완제는 vecuronium과 succinylcholine가 가장 많이 사용되었으며 마취 유지를 위해서는 enflurane과 isoflurane의 흡입마취제를 이용하거나 TCI를 이용한 propofol 지속정주를 이용하였다. 총 마취지속시간은 $160.2{\pm}55.5$분이었으며 회복실에서의 체류시간은 $132.8{\pm}50.1$분, 그리고 완전한 회복을 확인하기 위해 병동에 단기 입원시킨 소아환자에서는 $58.7{\pm}16.8$분이었다. 회복실에서 심각한 합병증은 발생하지 않았다. 지속적인 감시를 위하여 4명의 환자가 입원을 권유받았으나 특별한 합병증 없이 다음 날 퇴원하였다. 결론: 서울대학교 치과병원 장애인 진료실은 외래마취에 대한 기존의 연구들보다 긴 마취시간과 회복실 체류시간을 보였다. 그러나 별다른 합병증 없이 일회 방문으로 장애인 환자들에게 필요한 치과치료를 모두 제공할 수 있었다.

치과 환자에서의 $Perfusor^{\circledR}$ fm 자가통증조절기를 이용한 Propofol 자가진정조절법

박창주,염광원,김현정,Park, Chang-Joo,Yum, Kwang-Won,Kim, Hyun-Jeong 대한치과마취과학회 2002 Journal of Dental Anesthesia and Pain Medicine Vol.2 No.2

Background: Patient-controlled sedation (PCS) has been blown for a safe and effective sedative method on the same pharmacological concepts of patient-controlled analgesia. Many different kinds of infusion devices have been used but they often have too long nominal infusion rate and lockout time. $Perfuser^{\circledR}$ fm (B. Braun, Germany) is a new PCA device with 999.9 ml/hr nominal infusion rate and minimum 1 min lockout time. In this study, the feasibility of propofol PCS using $Perfuser^{\circledR}$ fm was examined in order to provide a safe satisfactory sedation for dental patients. Methods: Eleven healthy patients presenting for oral surgery were studied. Propofol PCS was performed using $Perfuser^{\circledR}$ fm, which was set to deliver a bolus dose of 5 mg with 999.9 ml/hr nominal infusion rate and 1 min lockout time. Propofol loading dose was randomly assigned to a bolus dose ${\times}$ 0, 2, and 3 (initial bolus). Patients were told to press the bolus button as often as they needed to relieve discomfort. Results: Total infused dose of propofol was mean 1.8 mg/kg/hr and D (Delivery)/A (Attempt) ratio was mean 72.8%. All patients was awake and there were no clinically significant intraoperative side effects during the sedation. Almost all patients were very satisfied with this type of PCS. Conclusion: Propofol PCS using $Perfuser^{\circledR}$ fm infusion pump provided good conscious sedation for dental procedures.

Enflurane으로 인하여 발생한 마취 중 급성과민증

박창주,서광석,김현정,최진영,염광원,Park, Chang-Joo,Seo, Kwang-Suk,Kim, Hyun-Jeong,Choi, Jin-Young,Yum, Kwang-Won 대한치과마취과학회 2004 Journal of Dental Anesthesia and Pain Medicine Vol.4 No.1

Anaphylactic reactions to anesthetic drugs could potentially produce life-threatening immune-mediated crisis. Most published reports are associated with neuromuscular blockers and anaphylactic reactions to inhalation anesthetics are rare. A 25-year-old male patient with no significant medical history and no previous abnormal drug reaction was scheduled for orthognathic surgery under general anesthesia. After uneventful anesthetic induction and nasotracheal intubation, generalized urticaria and erythema were detected during the maintenance period with $O_2-N_2O$-enflurane. No severe changes of vital signs and no ventilation problem were accompanied. The operation was cancelled and the cutaneous lesions were faded away during the recovery with 100% $O_2$. The skin-prick and intradermal tests showed that he was hypersensitive to all halogenated inhalation anesthetics including enflurane and not to intravenous anesthetics and neuromuscular blockers. The re-operation was safely carried out under intravenous anesthesia with propofol-fentanyl-vecuronium. We report this case of intraoperative anaphylactic reaction to enflurane with literature review.

간이식 예정인 간부전 환아의 치과치료 시 마취관리 -증례 보고-

박창주,장기택,염광원,김현정,Park, Chang-Joo,Jang, Ki-Taeg,Yum, Kwang-Won,Kim, Hyun-Jeong 대한치과마취과학회 2002 Journal of Dental Anesthesia and Pain Medicine Vol.2 No.2

Special anesthetic considerations were required for children with acute or chronic liver disease. We experienced a case of dental treatment to control infection under general anesthesia in the 2-year-old girl with liver failure. She was also scheduled for liver tansplantation. Her preanesthetic results of liver function test, electrolytes, and coagulation panel were unstable and out of normal ranges. Uneventful anesthetic induction using isoflurane and atracurium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 2 hours. Oozing from multiple extraction sites was sustained, so the transfusion of platelet concentration 1 units, fresh frozen plasma 1 unit, and packed red blood cell 1 unit was done. She was recovered without complication but was transferred to pediatric intensive care unit for wound care with her endotracheal tube kept. She was transferred to a ward without noticeable complications next day. So we report this successful case of anesthetic management for dental treatment in a child with liver failure.

3상 불평형 부하를 고려한 TCR 제어기법에 관한 연구

박창주(Chang-Joo Park),박기원(Ki-Won Park),최창호(Chang-Ho Choi) 대한전기학회 2001 대한전기학회 학술대회 논문집 Vol.2001 No.7

Early loading의 난제 stability dip, 어떻게 극복할 것인가?

박창주(Chang-Joo Park) 대한치과의사협회 2013 대한치과의사협회지 Vol.51 No.4

Nowadays, it seems like that the concept of the early loading protocol has been intruded between the concept of the immediate loading supported by advanced clinicians and the concept of the conventional loading supported by the prudent clinicians. In particular, the stability dip, which is found to occur usually at 4~6 weeks after dental implant placement because the decrease of the primary mechanical stability is not compensated by the increase of the secondary biologic stability, is frequently pointed out as one of the major causes of early loading failure. In this article, based on our recent clinical investigation about the crestal bone preservation effect of the early loaded NanoTite™ Tapered Certain Prevail (Biomet 3i, USA), the concept of the early loading is revisited. In addition, various methods to overcome the stability dip are reviewed as the oral and maxillofacial surgeon’s view point.

d-q이론을 이용한 계통 연계형 단상 인버터 제어기 설계기법

박창주(Chang-Joo Park),김창현(Chang-Hyun Kim),김명철(Myung-Chul Kim),최재영(Jae-Young Choi) 대한전기학회 2003 대한전기학회 학술대회 논문집 Vol.2003 No.7

간동맥 화학색전술시 조영제 희석 비율에 따른 Cone-beam CT Hepatic Arteriography 영상 비교평가

박창주(Chang Joo Park),안승원(Seung Won An),김상현(Sang Hyeon Kim),김영주(Young Joo Kim),이혁준(Hyuk Joon Lee),대창민(Chang Min Dae) 대한인터벤션영상기술학회 2021 대한인터벤션영상기술학회지 Vol.24 No.1

목적 : DynaCT와 XperCT 같이 혈관 조영 C-arm 장비의 기술적 발전으로 고해상도의 CBCT영상을 얻게 되었다. 최근 TACE 시술 계획을 세우는 데 있어 필수적인 CBCT-HA 영상에서 조영제 희석 비율의 변화가 영상에 어떠한 영향을 미치는지 알아보고 최적의 조영제 희석 비율을 찾고자 한다. 대상 및 방법 : 본원의 연구 심의 위원회의 후향적연구로 승인 받았으며, 연구 대상은CBCT-HA검사 시 조영제 희석 비율 (40%, 60%, 80%, 100%로)을 달리 시행한 환자 34명을 대상으로 하였다. 실험 방법 1) 정량적 평가를 위해 5지점을 선정(Catheter tip, proximal-RHA, distal-RHA, proximal-LHA, distal-LHA)하여 HU변동률을 측정하였다. 실험 방법 2) 정성적 평가를 위해 총 4가지 항목에 대한 영상 평가로 각 항목은 3지점 (distal-RHA, distal-LHA, HCC feeding artery)의 조영 정도와 cone-beam artifact 발생 정도이며 4명의 평가자가 10점 척도로 육안적 평가를 하였다. 결과 : 1) 정량적 평가에서 조영제 희석 비율 전체의 HU평균 변동률은 proximal-distal RHA 79.5%, proximal-distal LHA 81%로 감소하였으며, RHA와 LHA의 변동률 차이는 조영제 희석 비율이 40% 일때 5% 이상으로 통계적으로 유의하였고, 나머지에서는 차이가 없었다. 2) 정성적 평가 결과, 조영제 희석 비율 각 각의 영상 평가 평균점수는 7.7, 8.58, 8.64, 8.75점으로 희석 비율 40% 일 때 가장 낮은 평가를 받았다. 그중 3 지점의 조영 정도 평가는 distal-RHA, distal-LHA은 희석 비율 100%일때, HCC feeding artery는 희석 비율 60%일 때 각각 8.8, 8.77, 8.95점으로 가장 우수하였으며, cone-beam artifact 평가에서는 희석 비율 100%일 때 7.8점으로 가장 많이 발생하였다. 결론 : 조영제 희석비율을 60%로 감소 시켜 CBCT-HA 영상을 촬영한다면 필수적인 영상정보를 모두 포함하며 cone-beam artifact를 줄여 영상의 질이 향상하고, 환자에게 주입하는 조영제의 양 또한 감소시킬 것으로 사료된다. 때, HCC feeding artery는 희석 비율 60%일 때 각각 8.8, 8.77, 8.95점으로 가장 우수하였으며, cone-beam artifact 평가에서는 희석 비율 100%일 때 7.8점으로 가장 많이 발생하였다. PURPOSE : High-resolution CBCT images have been obtained through technological advances in angiographic Carm equipment such as Dyna CT and Xper CT. Using CBCT-HA images; a recent and essential technique used for the planning of TACE procedures, we expect to find out how the change in contrast dilution ratio affects the image and find the optimal contrast dilution ratio. METHODS : It was approved as a retrospective study by the research deliberation committee of our institute, and the subjects of this study were 34 patients who underwent the contrast agent concentration of 40%, 60%, 80%, and 100% during the CBCT-HA test. As for the experimental method, 1) 5 points were selected for quantitative evaluation (Catheter tip, proximal-RHA, distal-RHA, proximal-LHA, distal-LHA) and the HU reduction rate was measured. 2) Qualitative evaluation criteria were image analysis and evaluation by four evaluators on a 10-point scale for a total of four items: the degree of contrast at three points (distal-RHA, distal-LHA, HCC feeding artery) and the degree of cone-beam artifacts. RESULT : 1)1) The average reduction rate of the contrast medium HU was 79.5% at the proximal-distal RHA and 81% at the proximal-distal LHA. The difference between the right and left reduction rates at 40% was more than 5% and there was no difference at 60%, 80%, and 100%. 2) As for the qualitative evaluation results, the average score of 40%, 60%, 80%, and 100% was 7.7, 8.58, 8.64, 8.75 points respectively, and at 40% the case received the lowest rating. The highest rating of the three points was [Distal-RHA (8.8 points at 100%) and Distal-LHA (8.77 points at 100%) and HCC feeding artery (8.85 points at 60%)]. The average cone-beam artifact score was 6.6, 6.8, 7.5, 7.8 at 40%, 60%, 80%, and 100% respectively, resulting the highest result at 100%. CONCLUSIONS : If a CBCT-HA image is taken with a contrast agent dilution ratio of 60%, all the necessary image data is obtained and better images can be produced by reducing cone-beam artifacts, while reducing the amount of contrast media being injected into a patient.