강화된 환경중심 의사소통중재가 지적장애아동의 의사소통기능 산출형태에 미치는 영향

송희선,이영철 한국특수교육학회 2016 한국특수교육학회 학술대회 Vol.2016 No.-

대퇴골 골절 수술 후 발생한 폐색전증

송희선,이상귀,송정자,고성훈,유춘원 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.4

Pulmonary embolism is a common and lethal, which accounts for substantial morbidity and mortality. Clinical manifestations of pulmonary embolism are nonspecific during general anesthesia. A 60 years old female received elective operation for left femur fracture under general anesthesia. At the end of operation, she suddenly became hypotensive and developed cyanosis. Immediate cardiopulmonary resuscitation(CPR) was performed without definitive diagnosis. Pulmonary embolism was suspected by clinical signs and echocardiography. So, patient was transferred to intensive care unit and with intensive care and aggressive treatment, patient's vital signs and ventilatory status were progressively improved. However, the endotracheal tube was accidentally extubated by the patient at the second postopetative day, and then cardiac arrest was developed and the patient expired. The primary goal of therapy for pulmonary embolization is to prevent reembolization. In the pulmonary thromboembolization, early diagnosis and intensive care improve outcome.

기관튜브의 종류가 굴곡성 후두경을 이용한 경구 기관내삽관의 용이도에 미치는 영향

송희선,이상귀,이준례,김윤희 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2

Background : The spiral-wound tracheal tubes have the different flexibility, materials, and shape of bevel according to the manufacturers. Theses different tube characteristics may affect the ease of orotracheal intubation. So this study was designed to investigate the ease of fiberoptic orotracheal intubation with two different types of spiral-wound tracheal tube. Methods : Seventy-one adult female patients who undergo fiberoptic intubation were randomly divided into two groups. Fiberoptic orotracheal intubation with silicone made spiral-wound tracheal tubes(M group) or silicone-rubber made spiral-wound tracheal tubes(R group) was performed. In the first attempt, the tracheal tube was advanced into the trachea over the pediatric fiberoptic laryngoscope which was orotracheally placed with the bevel of the tracheal tube oriented anteriorly at 12 o'clock direction. If the insertion was hindered the tracheal tube was withdrawn about 4∼5cm backward and rotated 60o to the left(10 o'clock direction) and readvanced If the second attempt was unsuccessful the tracheal tube was rotated 60o to the right(2 o'clock direction) and readvanced. If the third attempt was unsuccessful it was considered that the fiberoptic intubation was failed. Results : Success rate of the first attempt was 23.7%(9/38) in group M and 72.7%(24/33)in group R(P$lt;0.05). Failure rate was 23.7%(9/38) in group M and 3.0%(1/33) in group R(P$lt;0.05). Conclusions : It should be considered that the ease of fiberoptic intubation is different according to different types of spiral-wound tracheal tube in the attempt of fiberoptic orotracheal intubation. (Korean J Anesthesiol 1997; 32: 214∼218)

家兎에 있어서의 Atropine의 中樞性心搏減少에 關하여

宋熙善 전북대학교 의과학연구소 1980 全北醫大論文集 Vol.4 No.1

The author observed changes in heart rate and blood pressure following injection of atropine and scopolamine into the lateral ventricle or cisterna magna of rabbits under urethane anesthesia. The results were as followings : 1. Intraventricular atropine(30, 100, 300ug) slightly decreased the heart rate, while the same amounts of scopolamine did not. 2. Atropine (30, 100, 300ug) administered into cisterna magna produced marked decrease in heart rate, while the same amounts of scopolamine produced slight decrease. 3. The decrease in heart rate by intracisternal atropine was less prominent in the vagoto-mized or methylatropinized rabbits. 4. After intracisternal injection of regitine intracisternal norepinephrine did not produce decrease in heart rate, while intracisternal atropine produced slight decrease. 5. After simultaneous administrations of intracisternal regitine and intravenous me-thyla tropine, intracisternal atropine did not progduce the decrease in heart rate. 6. The stimulation of the vagal center and central adrenorecepters may be responsible for the bradycardia by central atropine. It is suggested that the bradycardia by atropine in man is not related to that in the present experiments.

제반 마취제가 심혈관계와 정신신경증상에 미치는 영향

송희선 의과학연구소 1987 全北醫大論文集 Vol.11 No.3

To investigate the ideal anesthetic agent during general endotracheal anesthesia in humans, the author devided 107 randomly sampled patients into four goups-halothane(26 patients), enflurane(22 patients), thalamonal(21 patients), ard ketamine anesthesia group(38 patients), - and observed the hemodynamic(systolic, diastolic blood pressure, heart rate), electrocardiographic and postoperative psychomimetic damages. The postanesthetic recovery score, time of awakening, the degree of oral salivation and a requirement for muscle relaxant were also observed. Ketamine may be recommended as the best anesthetic of choice in patients with poor cardiovascular condition because of the stimulating effect on the cardiovascular system and a good analgesic effect. But the disadvantages of an increase in oral salivation, increased requirement of muscle relaxant shoud be namaged with proper means. A long anesthetic recovery time and postoperative psychomimetic reaction may also limit the routine use of ketamine. Thalamonal may also be used in patients with unstable cardiovaseular status because the drug has minimal cardiovascular depressant effect and provides excellent postoperative analgesia.

Epinephrine 과 Clonidine 에 의한 T-Cain 척수마취의 연장 효과

송희선,한영진,이상귀,최현규,신감진 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.3

Vasoconstrictors such as epinephrine or phenylephrine have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an areceptor agonist, has been proved to have analgesic effect and to prolong epidural and spinal anesthesia. We used 0.3mg of epinephrine, 75 μg and 150 μg of clonidine in spinal anesthesia with 12 mg of T-Cain respectively and compared hemodynamic and analgesic effects of each drug. Heart rate and blood pressure were checked before, during and after anesthesia. Sensory level was checked by pin-prick method and motor blockade was measured by Bromages scale. The results were as follows. 1) Heart rate changed little in the epinephrine group and decreased significantly in all other groups. 2) Systolic blood pressure decreased significantly in all groups except the epinephrine group. Both 75 μg and 150 μg of clonidine caused a significant fall in diastolic pressure. 3) The onset time for sensory and motor blockade varied little among all gro 4) Sensory blockade was significantly higher in the 150 μg of clonidine group than the control group. Time to achieve the maximum level of sensory blockade was significantly faster in control group than 150 μg of clonidine group. 5) The duration of sensory and motor blockade was significantly prolonged in epinephrine and clonidine group than control group. The results indicate that clonidine, when used as an adjunct to T-Cain spinal anesthesia, is as effective as epinephrine in prolongation of motor and sensory blockade.

수술중 Bupivacaine 으로 늑간신경차단후 갑자기 발생한 저혈압

송희선,이상귀,송정자,구자홍 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.5

Postoperative pain may be associated with shallow breathing, inability to cough, and reduction in spirometric values which lead to restrictive pattern of ventilation with hypoxemia and/or hypercarbia. Therefore, postoperative pain should be managed with appropriate methods. The authors have usually performed intraoperative intercostal nerve block with 0.25% bupivacaine hydrochloride to alleviate postoperative thoracotomy pain. A 21 years old male patient developed sudden hypotension and severe bradycardia 1 minute following the intraoperative 4th, 5th, 6th intercostal nerve block with a total of 10 ml of 0.25% bupivacaine hydrochloride, who was treated by ephedrine with success. The authors discuss the possible causes of sudden hypotension and severe bradycardia in detail.

전신 마취시 아산화질소 투여 중단후 중이 내압의 변동

송희선,이상귀,윤용주,홍기환,최현규,신감진,권삼현 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.6

N₂O can diffuse in and/or out the middle ear cavities and it may alter the middle ear pres-sure. This study was performed to investigate the effect of N₂O discontinuation on the changes in middle ear pressure during general endotracheal anesthesia. We measured middle ear pres-sures and end-tidal NO concentrations at preanesthesia, immediately after N₂O discontinuation and then at every five minutes for 60 minutes under either halothane or enflurane an- esthesia in two groups(group 1=50% administration of N₂O in O₂; group 2=60% administration of N₂O in O₂). The middle ear pressures after N₂O discontinuation decreased slowly but they did not returned to the preanesthetic value in both groups. The end-tidal N₂O concentrations decreased rapidly until five minutes and then they decresed slowly to the zero leve1 until 30 minutes after N₂O discontinuation in both groups. The expected time of the middle ear pres-sure of preanesthesia value was 89.4 minutes in group 1 and 80.9 minutes in group 2 respectively. The middle ear pressure do not return to the level of preanesthesia at 60 minutes after N₂O discontinuation while the end-tidal N₂O concentration decrease to the zero level via 30 minutes after its discontinuation. Thus it is recommended that N₂O administration should be discontinued at least 30 minutes before an application of tympanic membrane patch on the ear drum and N₂O is carefully administered in patients with middle ear and/or upper airway disesses.

후두마스크 삽입 및 기관내삽관이 안압에 미치는 영향

송희선,이상귀,김재양 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7

Many studies have been performed in order to evaluate intraocular pressure changes during induction and maintenance of anesthesia in ocular surgery. Use of the laryngeal mask airway permits the maintenance of a clear airway without laryngoscopy. To evaluate the effect of laryngeal mask airway placement with/withaut laryngoscopy on intraocular pressure, sixty patients were randomly allocated to one of three groups; a tracheal intubation group with laryngoscopy (TI, n=20); a laryngeal mask airway placement group with laryngoscopy (LMA-L, n=20); a laryngeal mask airway placement group with blind technique (LMA, n=20). The authors compared the intraocular pressure and hemodynamic responses to the laryngeal mask airway insertion with (LMA-L group) and without (LMA group) laryngoscope to those of tracheal intubation (TI group) in 60 patients during a standardized anesthetic pratice. Baseline measurements of intrao- cular pressure, heart rate, and arterial blood pressures were recorded and repeated at one minute after insertion of the airway device in each group. Insertion of the laryngeal mask airway required significantly more time (LMA-L group, 15.5 sec; LMA group, 14.3 sec) in comparison with that for the tracheal intubation (9.1 sec). The laryngeal mask airway placement did not increase intraocular pressure, or arterial blood pressures except for heart rate above baseline values. However, tracheal intubation was associated with significant increases of intraocular pressure, heart rate, and arterial blood pressure at one minute compared to the baseline values. The mean intraocular pressures at one minute after airway instrumentation in TI group were significantly different from those of LMA or LMA-L group. The authors suggest that a laryngeal mask airway may be a good alternative to tracheal intubation in intraocular surgery if a laryngeal mask airway is not contraindicated.

마취제의 신기능 및 호르몬에 관하여

송희선 의과학연구소 1991 全北醫大論文集 Vol.15 No.3

Since Pringle and colleagues demonstrated oliguria during ether anesthesia in 1905, much interest has been generated in the effects of anesthesia on the renal function. Some broad areas related to renal function are reviewed in this artcle ; a brief discussion of renal physiology and the changes of renal function associated with anesthesia using various anesthetic agents and anesthetic methods.