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

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.

임상연구 : 불임 환자에게 시행되는 난자 채취 시 Fentanyl과 Alfentanil을 이용한 정맥 마취의 비교

강용인 ( Yong In Kang ),방은치 ( Eun Chi Bang ),이현숙 ( Hyun Sook Lee ),조경숙 ( Kyung Sook Cho ),김수연 ( Su Yeon Kim ),설정호 ( Jung Ho Sul ),김준영 ( Jun Young Kim ),윤태기 ( Tae Gi Yoon ),석현하 ( Hyun Ha Seok ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5

Background: This study was carried out to compare the effect of intravenous anesthesia with fentanyl or alfentanil on the hemodynamic profile, sedation, recovery and side effect in the patients undergoing oocyte retrieval. Methods: The patients were designed to receive alfentanil (group A, n=70) or fentanyl (group F, n=70) intravenous anesthesia. The patients were given midazolam 0.6 mg/kg and alfentanil 15 μg/kg in group A or fentanyl 1.5 μg/kg in group F. Propofol 0.7 mg/kg was given if patient was awaken during procedure. Hemodynamic changes, propofol used dosage and initial propofol injecting time, Ramsay Sedation Scales, cough reflex on opioid injection, recovery time, duration of apnea and postoperative nausea, vomiting at the recovery room were recorded. Results: Group A had rapid onset, deep sedation, less amount of propofol used, more frequent apnea than group F. There were no significant differences in postoperative nausea, vomiting and recovery time between the two groups. Conclusions: The intravenous anesthesia with fentanyl or alfentanil are suitable for oocyte retreival but apnea happened more frequent in alfentanil group, so the use of alfentanil needs to monitor ventilation and hemodynamic changes carefully. (Korean J Anesthesiol 2008;55:543~8)

임신 중 고혈압 질환의 제왕절개술 마취에 대한 임상적 고찰

김지향 ( Ji Hyang Kim ),이현숙 ( Hyun Sook Lee ),방은치 ( Eun Chi Bang ),전혜선 ( Hye Sun Jeon ),김수연 ( Su Yeon Kim ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.6

목적: 임신 중 고혈압 질환 산모의 제왕절개술 마취의 임상적 고찰을 통해 최적의 마취방법을 정하여 환자의 적절한 관리에 도움이 되고자 한다. 방법: 1999년 1월부터 2003년 12월까지 5년간 본원 산부인과에서 분만한 임신 중 고혈압 질환 산모 중 제왕절개술을 시행받은 환자를 대상으로 의무기록을 토대로 후향적 조사를 시행하였다. 환자를 마취 방법에 따라 전신 마취군과 경막외 마취군으로 분류하여 임상 결과를 통계학적으로 비교분석하였다. 결과: 수술 중 추정 실혈량, 빈혈이나 폐부종 등의 합병 빈도는 경막외 마취군에서 유의하게 낮았다. 그 외 모성 합병증이나 주산기 합병증에는 큰 차이가 없었다. 결론: 임신 중 고혈압 산모의 제왕절개술시 경막외 마취는 마취 방법의 제 1선택으로 무방하다고 생각된다. Objective: The parturient with hypertensive disorders usually has multiple organ alterations, which may affect on the anesthetic care during cesarean delivery. The present study purposed to determine the optimal anesthesia method for the cesarean section of the patients with hypertensive disorders through clinical examination and to support adequate patient management. Methods: We conducted a retrospective survey of medical records of the patients with hypertensive disorders of varying severity delivered by cesarean, between January 1999 and December 2003 at Gangnam CHA Hospital. According to anesthesia method, the patients were divided into the general anesthesia group and the epidural anesthesia group, and the clinical outcomes were compared statistically. Results: Estimated intraoperative blood loss and the frequency of complications such as anemia and pulmonary edema were significantly lower in the epidural anesthesia group. However, there was no major complications with either general or epidural anesthesia Conclusion: Epidural anesthesia is considered allowable as the primary anesthesia method for the caesarean section of the parturient with hypertensive disorders.

산과 경막외마취가 분만에 미치는 영향

이현숙,김수연,김명희,김정환,방은치,강용인,조경숙,김수연 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.12

목적 : 무통분만을 위해 시행한 지속적 경막외제통이 분만에 미치는 영향을 살펴보고자 하였다. 연구방법 : 분만시 통증경감을 원하는 산모를 두군으로 나누어 자궁경부가 3-5cm 개대시 1군 산모 35명은 0.0625% bupivacaine과 0.2㎍/㎖ fentanyl을 혼합하여 지속적 경막외제통을 시행하였고, 2군 산모 43명은 nalbuphine 10mg을 근주하였다. 1군과 2군에서 분만 1기와 2기의 진행시 소요된 시간, 제왕절개술의 빈도, 신생아의 Apgar score 및 체중을 기록하였고 통증 정도는 0-100mm의 시각통증등급에따라 측정하였다. 통계는 모수검정에는 independent t-test, 비모수검정에는 chi-square test를 이용하여 p〈0.05인 경우 통계적 의의를 두었다. 결과 : 1. 1군에서 분만 1기와 2기가 연장되었지만 통계적 차이는 없었다. 2. 신생아의 체중 및 Apgar score는 두 군간에 차이가 없었다. 3. 제왕절개술의 빈도는 1군이 16%(7/35), 2군이 14%(6/43)로 두 군간에 유의한 차이는 없었다. 4. 통증정도는 1군에서 유의하게 낮았다. 결론 : 분만진통시 시행하는 경막외제통은 분만의 진행과정에 지장을 주지 않았고 제왕절개술의 빈도도 높이지 않았다. 경막외제통은 태아나 산모에게 안전하게 시행될 수 있으나 산모선택이나 마취방법, 산과적 수기에 세심한 주의가 필요하다고 사료된다. Background : The effect of epidural analgesia on the progress of labor is controversial. The objective of this study is to determine the effect of analgesia on the outcome of labor, especially cesarean delivery rate in the epidural group and non-epidural group, prospectively. Methods : All the parturients were divided into two groups, group 1(epidural group, n=35) and group 2(non-epidural group, intramuscular nalbuphine, n=43) randomly. Epidural analgesia was maintained with a continuous epidural injection of 0.0625% bupivacaine with 0.2 ㎍/㎖ fentanyl in the group 1 and nalbuphine 10 ㎎ was intramuscular injected in the group 2 when the cervix was dilated to at least 3-5 ㎝. The duration of first and second stage of labor, cesarean delivery rate, Apgar score and body weight of baby were recorded and pain score of parturient was recorded by 0-100 ㎜ visual analog scale. Results : The duration of first and second stage labor were prolonged in the group 1. But there were no significant differences in the duration of first and second stage labor, Apgar score and body weight of baby between the two groups. Cesarean delivery rate was 16%(n= 7/35) in the group 1 and 14%(n= 6/43) in the group 2, so there was no significant difference between the two groups. Pain score was significantly lower in the group 1 than the group 2. Conclusion : Epidural analgesia was not associated with increased cesarean delivery rate and provided safe and effective intrapartum pain control. Maternal-fetal factors and obstetric management, not epidural analgesia, are the most important determinants of the cesarean delivery rate.

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.

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.

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.

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)

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)