고혈압을 동반한 산모의 제왕절개술 마취의 임상적 고찰 (10년간의 후향적 연구)

방은치,이현숙,강용인,조경숙,김수연,김준영 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.4

Background: There are many difficulties in anesthetic management for cesarean section of the patients with hypertension. The anesthetic management of hypertensive disorders in pregnancy has been controversial. Methods: We reviewed the medical records of the patients with hypertensive disorders in pregnancy from Jan., 1998 to Dec., 2007, and made clinical analysis of the anesthesia for cesarean section. Results: Of the total 775 parturients with hypertensive disorders, 638 (82.3%) was delivered by cesarean section. Indications for cesarean section were, in order of frequency, hypertensive disorders in pregnancy (36.9%), multiple pregnancy (13.8%), previous cesarean section (11.6%), etc. Of the total cesarean section, 468 (73.4%) were emergency cases. The majority of preoperative systolic blood pressures were 141−160 mmHg (36.2%) and 161− 180 mmHg (35.2%). The majority of preoperative diastolic blood pressures were 91−100 mmHg (28.6%) and 101−110 mmHg (25.0%). 350 (54.9%) had epidural anesthesia, 195 (30.5%) had general anesthesia, and 93 (14.6%) had spinal anesthesia. Estimated blood loss was significantly lower after regional anesthesia than after general anesthesia. In patients received magnesium sulfate (MgSO4), (40.0% of total) 83.5% had regional anesthesia and 16.5% had general anesthesia. In the cases with MgSO4 1 min Apgar score was lower and neonatal birth weight was smaller than in cases without MgSO4. Conclusions: Anesthesiologist must have much attention on the prevention, treatment and anesthetic management for cesarean section of patients with hypertensive disorders in pregnancy.

무통분만을 위한 경막외 진통에서 Fentanyl의 용량에 따른 0.2% Ropivacaine의 작용발현시간과 작용지속시간

방은치,신지현,이현숙,강용인,조경숙,김수연 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.3

Background:The purpose of this study was to identify the effect of fentanyl dose on the onset and duration of 0.2% ropivacaine. Methods:Sixty-one nulliparous women with singleton vertex pregnancy who requested epidural labor analgesia were enrolled.Patients were administered randomly 0, 50, 100μg of fentanyl with 10 ml of 0.2% ropivacaine (Group F0, F50 and F100, respectively).VAS pain scores were recorded 0, 5, 10, 15 min after epidural injection, after which they were recorded every 15 min.The onset and duration of analgesia were measured.Side effects such as, pruritus, motor blockade, and hypotension were recorded.Satisfaction scores, type of delivery, and neonatal outcomes were recorded. Results:The onset of analgesia was at 8.5 ± 3.4 min in Group F100, compared with 13.7 ± 7.2 min in Group F0 and 13.6 ± 5.3 min in Group F50 (P = 0.009).The duration of analgesia was 122.6 ± 20 min in Group F100, compared with 72.3 ± 21.2 min in Group F0 and 97.8 ± 22.4 min in Group F50 (P = 0.000).There were significant differences in VAS pain scores and satisfaction scores among the three groups. There were no differences in the incidences of maternal side effects and operative delivery or neonatal outcomes. Conclusion:Fentanyl 100μg was the most appropriate dose when combined with 0.2% ropivacaine due to the rapid onset and long duration of epidural labor analgesia.

제왕절개술을 위한 전신마취 유도 후 발생한 아나필락시스 - 증례 보고 -

방은치 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.2

A 35 year old multipara woman was admitted for emergency repeat cesarian section. She had first cesarian section under general anesthesia 3 years ago, and appendectomy under spinal anesthesia 2 years ago. But no uneventful problem developed in two cases of anesthesia. After induction of general anesthesia with propofol and succinylcholine, the patient showed irritability and severe cough, and immediate anaphylactic reaction developed with cardiovascular collapse, bronchospasm, and erythematous skin eruption. We resuscitated the patient with epinephrine and methylprednisolone but cesarian section was performed without delay. Four minutes after the induction of anesthesia female baby was delivered and the patient was recovered without any complication.

만성 미골통 환자에 대한 신경차단

방은치(Eun Chi Bang),윤덕미(Duck Mi Yoon),오흥근(H 대한통증학회 1992 The Korean Journal of Pain Vol.5 No.1

Coccygodynia is severe burning pain around the coccyx and idiopathic coccygodynia refers to the forms of coccygeal pain that are not associated with well defined pathological conditions, such as recent fractures, dislocation, infectious diseases, or tumors of the coccyx. We experienced a case of coccygodynia in which patient had suffered from intermittent se-Were pain around the coccyx for nine years without a well defined cause. So coccygeal nerve block and low caudal blocks were performed with local anesthetics and steroid and the pain was controlled effectively.

증례보고 : 경막외마취 중 발생한 심정지

방은치 ( Eun Chi Bang ),이현숙 ( Hyun Sook Lee ),강용인 ( Yong In Kang ),조경숙 ( Kyoung Sook Cho ),김수연 ( Su Yeon Kim ),김상진 ( Sang Jin Kim ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.2

제왕절개술을 위한 척추마취 시 국소마취제 주입 속도가 저혈압에 미치는 영향

강용인,방은치,신동욱,권대은,김수연,이현숙,조경숙,이수연 이화여자대학교 의과학연구소 2012 EMJ (Ewha medical journal) Vol.35 No.2

Objectives: Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block. Methods: Bupivacaine (0.5%) 9 mg with fentanyl 10 μg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine. Results: Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn’t influence on the onset and level of sensory block and didn’t reduce the incidence of hypotension. But onset of hypotension was delayed. Conclusion: Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.

척추후측만곡을 동반한 만성폐쇄성폐질환 환자에게 Nasal Mask BiPAP을 이용한 호흡보조

고신옥,방은치,전성식,박병학,남용택,이원영 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.6

Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU. (Korean J Anesthesiol 1997; 33: 1207∼1211)

혈역학적으로 불안정한 중환자에서 산소공급과 산소소모 : 생존환자 대 비생존환자, 패혈증환자 대 비패혈증환자의 비교 Comparisons between Survivors vs Nonsurvivors and Septic vs Nonseptic Patients

고신옥,방은치,이세실 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.2

Background: To maintain adequate oxygen delivery and oxygen consumption is essential to care of the critically ill patients. The authors undertook this study to evaluate the patterns of oxygen delivery and oxygen consumption in hemodynamically unstable patients. Methods: Twenty hemodynamically unstable patients were studied, Pulmonary artery catheters were inserted and the hemodynamic variables including oxygen delivery and oxygen consumption were calculated immediately, and 1, 8, 24 hours, respectively after catheterization, and immediately before catheter removal. Patients were divided into survivor and nonsurvivor groups, and the hemodynamic data were compared. The same patients were divided into septic and nonseptic patient groups and same study was done. Results: There were no statistical differences in oxygen delivery and oxygen consumption between the survivors and the nonsurvivors, and the septic and the nonseptic patients. But oxygen delivery and oxygen consumption of the survivors were higher than those of the nonsurvivors. Conclusions: Although we could not find statistical significance, we concluded that supranormal level of oxygen delivery and oxygen consumption could improve the outcome of critically ill patients.

기계환기보조받는 중환자에게 Midazolam 지속적 주입에 의한 진정

고신옥,방은치,남상범 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.5

Background: Midazolam is distinguished from other benzodiazepines by its water solubility, rapid onset, short duration, and lack of accumulation of active metabolites. These pharmacokinetic cbaracteristics support its use by continuous infusion. We evaluated the continuous infusion dose of midazolain for adequate sedation of ventilated patients with hemodynamic and respiratory monitoring. Methods: We started continuous infusion of midazolam at a rate of 0.5∼1.0 ㎍/kg/minute after bolus injection of 3.0 to 5.0 mg and adjusted infusion dose monitoring sedation scale in the 15 patients. Blood pressure, heart rate and central venous pressure were monitored before and 30 minute, 1, 2, 3 and 6 hours after midazolam infusion. Arterial blood gases were measured and peak inspiratory pressure was monitored. We evaluated liver and kidney function before start of infusion and after discontinuation of midazolam infusion. Results: The mean loading dose, infusion rate and total dose of midazolam were 4.1±0.9 mg, 1.2±0.4g/kg/minute and 251.9±84.0 mg. The mean duration of infusion was 59.0±37.0 hours. After infusion, systolic and diastolic blood pressure and heart rate and central venous pressure remained stable when compared with those of the preinfusion state. Arterial blood gas and peak inspiratory pressure remained unchanged. The function of liver and kidney did not deteriorate after infusion. Conclusions: Continuous infusion of midazolam at a rate of 1.2±0.4 ㎍/kg/minute after 4.1±0.9 mg intravenous bolus injection was a safe and effective method for sedation of ventilated patients in intensive care unit without hemodynamic disturbance.

중환자의 사망률 예측 인자로서 APACHE II 점수와 다발성 장기부전 점수(Multiple Organ Failure Score)에 대한 평가

고신옥,방은치,정재원 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.5

Background: The APACHE II scoring system has been regarded as a useful tool in the assessment of the severity of injury and prognosis for acutely ill patients. Recently, there have been many reports that multiple organ failure(MOF) score is the better predictor of the mortality of critically ill patients than any other scoring system. The purpose of this study was to compare APACHE II score and MOF score for mortality prediction in critically ill patients. Methods: 163 critically ill patients were studied. We analyzed the correlation between the mortality rate and the scores that were produced by APACHE II and MOF scoring system within the first 24 hours in the ICU. We analyzed the correlation between each score and the number of days of ICU stay. We also calculated the mortality rate according to the number of organ failure. Results: 1) The APACHE II score and MOF score of the survivors(n=129) were 9 6 and 1 1, respectively and those of nonsurvivors(n=34) were 16 7 and 5 2(mean SD), respectively. 2) The r2 was 0.62 between APACHE II score and mortality rate, and 0.77 between MOF score and mortality rate. 3) The r2 was 0.06 between APACHE II score and ICU stay, 0.01 between MOF score and ICU stay. 4) The mortality rates were 0, 2, 20, 64, 73, 75 and 100 % in 0, 1, 2, 3, 4, 5 and 6 organ failures, respectively. Conclusions: The MOF score was more sensitive predictor of the mortality of critically ill patients than the APACHE II score. (Korean J Anesthesiol 1997; 32: 754∼760)