Transient right hemidiaphragmatic paralysis following subclavian venous catheterization: possible implications of anatomical variation of the phrenic nerve -a case report-

양춘우,Jin Sung Bae,Tae In Park,Jong Cheol Lee,Jeong Eun Sohn,Ryunga Kang,Kye Ho Lee 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.6

Phrenic nerve paralysis is an unusual complication associated with central venous catheterization. Various mechanisms have been proposed. We present a case of transient right hemidiaphragmatic paralysis after subclavian venous catheterization. We hypothesize that anatomical variation of the phrenic nerve was responsible for this complication.

The effect of ketorolac and dexamethasone on the incidence of sore throat in women after thyroidectomy: a prospective double-blinded randomized trial

양춘우,정성미,배유경,박상진 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.1

Background: We evaluated the effect of two drugs with anti-inflammatory action, dexamethasone and ketorolac, on reduction of postoperative sore throat (POST) after general anesthesia with endotracheal intubation in patients undergoing thyroidectomy. Methods: One hundred and ninety-two female patients scheduled to undergo general anesthesia with endotracheal intubation for thyroidectomy were enrolled in this prospective study. Participants were randomly allocated to receive intravenous medication; placebo (Group C, n = 45), ketorolac 30 mg immediately before intubation (Group Kpre, n = 47), ketorolac 30 mg at the end of surgery (Group Kpost, n = 45) and dexamethasone 10 mg (Group D, n = 43). The incidence and severity of POST and hoarseness were evaluated at 1, 6 and 24 hours after surgery. Results: Incidences and severities of POST at rest and during swallowing in first 6 hours after extubation were comparable among 4 groups. At 24 hours postextubation, the incidence (P = 0.002, 95% CI of proportion differences; 0.05–0.39) and severity (P = 0.008) of POST during swallowing were significantly lower in group D than in group C. Kpre and Kpost groups did not show a greater reduction in POST than group C, despite lower rescue analgesic requirement at 1 hour after extubation in group Kpre (P = 0.006; 95% CI of proportion differences; 0.07–0.38). No intergroup differences were observed in incidences of hoarseness or adverse events. Conclusions: Intravenous administration of dexamethasone 10 mg, but not ketorolac, before induction of anesthesia reduces the incidence and severity of POST during swallowing at 24 hours after thyroidectomy.

Effects of increasing the dose of ropivacaine on vertical infraclavicular block using neurostimulation

양춘우,강포순,이규창,권희욱,이명종,김혜영,최은경,임현경,김철웅 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.1

Background: Use of an infraclavicular block is appropriate for surgery of the upper limb. However, it does not consistently block the entire brachial plexus. The aim of this study was to investigate whether increasing the dose of ropivacaine could enhance the success rate, onset time, and efficacy of the sensory and motor block during the use of a vertical infraclavicular block using neurostimulation in upper limb surgery. Methods: Two hundreds and ten patients were prospectively randomized into three groups: Group 1 (30 ml of 0.5%ropivacaine; n = 70), Group 2 (40 ml of 0.5% ropivacaine; n = 70), and Group 3 (40 ml of 0.75% ropivacaine; n = 70). Patients in each group received a vertical infraclavicular block using neurostimulation and obtained a distal motor response of the ulnar or median nerve. Recorded outcome measures included block success rate, onset time, sensory and motor blocks, and adverse events. Results: No differences were found in the block success rate among the three groups (92.8%, 97.1%, and 94.2% for Groups 1, 2, and, 3, respectively; P = 0.346). There were no significant differences in onset time (P = 0.225) among groups, nor was there enhancement in the sensory block, but the motor block was enhanced. Local anesthetic toxicity was observed in five female patients from group 3 (P = 0.006). Conclusions: Although the efficacy of the motor block was significantly improved, success rate, onset time, and efficacy of sensory block were not enhanced significantly among groups despite differences in volume and volume/concentration of the local anesthetic. Background: Use of an infraclavicular block is appropriate for surgery of the upper limb. However, it does not consistently block the entire brachial plexus. The aim of this study was to investigate whether increasing the dose of ropivacaine could enhance the success rate, onset time, and efficacy of the sensory and motor block during the use of a vertical infraclavicular block using neurostimulation in upper limb surgery. Methods: Two hundreds and ten patients were prospectively randomized into three groups: Group 1 (30 ml of 0.5%ropivacaine; n = 70), Group 2 (40 ml of 0.5% ropivacaine; n = 70), and Group 3 (40 ml of 0.75% ropivacaine; n = 70). Patients in each group received a vertical infraclavicular block using neurostimulation and obtained a distal motor response of the ulnar or median nerve. Recorded outcome measures included block success rate, onset time, sensory and motor blocks, and adverse events. Results: No differences were found in the block success rate among the three groups (92.8%, 97.1%, and 94.2% for Groups 1, 2, and, 3, respectively; P = 0.346). There were no significant differences in onset time (P = 0.225) among groups, nor was there enhancement in the sensory block, but the motor block was enhanced. Local anesthetic toxicity was observed in five female patients from group 3 (P = 0.006). Conclusions: Although the efficacy of the motor block was significantly improved, success rate, onset time, and efficacy of sensory block were not enhanced significantly among groups despite differences in volume and volume/concentration of the local anesthetic.

Ultrasound-guided supraclavicular brachial plexus block in pediatric patients -A report of four cases-

양춘우,조춘규,권희욱,노재영,허윤무,안성민 대한마취통증의학회 2010 Korean Journal of Anesthesiology Vol.59 No.-

Supraclavicular brachial plexus blocks are not common in pediatric patients due to the risk of pneumothorax. Ultrasonography is an important tool for identifying nerves during regional anesthesia. Directly visualizing the target nerves and monitoring the distribution of the local anesthetic are potentially significant. In addition, ultrasound monitoring helps avoid complications, such as inadvertent intravascular injection or pneumothorax. This paper reports four cases of pediatric patients who received ultrasound-guided supraclavicular brachial plexus block for upper limb surgery.

임상연구 : 제왕절개술을 위한 경막외 마취 시 0.5% Levobupivacaine과 0.5% Ropivacaine 비교

양춘우 ( Chun Woo Yang ),정성미 ( Sung Mee Jung ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),류승훈 ( Seung Hun Ryu ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3

Background: Ropivacaine and levobupivacaine, both single S-enantiomers, show less toxicity on the central nervous and cardiovascular system than racemic bupivacaine. Earlier studies have shown that levobupivacaine and bupivacaine are almost equipotent while ropivaciane was 60% less potent than bupivacaine. The aim of this prospective, double blinded study was to compare the clinical efficacy and safety of epidural anesthesia produced by 0.5% levobupivacaine and 0.5% ropivacaine for a cesarean section. Methods: Sixty-two parturients undergoing an elective cesarean section were randomized to receive either epidural levobupivacaine 0.5% 20 ml (n = 31) or epidural ropivacaine 0.5% 20 ml (n = 31). Surgery was commenced when the sensory block had reached the dermatome level, T6. The onset, duration, quality of the sensory and motor block and abdominal muscle relaxation were evaluated. The blood pressure and heart rate of the mother and neonatal outcome, as assessed by the Apgar score and umbilical pH, were also recorded. Results: There was no difference in the onset time, the segmental spread of sensory block and analgesic supplement between the two groups. However, levobupivacaine produced a longer duration of sensory block than ropivacaine (levobupivacaine 224.1 ± 66.6 min, ropivacaine 176.5 ± 32.8 min, P < 0.05). The onset time (except Bromage scale 2), intensity and duration of the motor block and muscle relaxation were similar in both groups. There was no difference in the maternal and neonatal outcomes between the two groups. Conclusions: 0.5% levobupivacaine and 0.5% ropivacaine produced equivalent efficacy and safety in epidural anesthesia for a cesarean section, but levobupivacaine resulted in a longer duration of sensory block. (Korean J Anesthesiol 2007; 52: 284~90)

임상연구 : 부인과 수술환자에서 Sufentanil과 병용한 0.1% Levobupivacaine 또는 0.1% Ropivacaine의 술 후 경막외 진통 비교

양춘우 ( Chun Woo Yang ),박정민 ( Jeong Min Park ),임영수 ( Young Su Lim ),조춘규 ( Choon Kyu Cho ),김경식 ( Kyong Sik Kim ),김응균 ( Eung Kyun Kim ),정성미 ( Sung Mee Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6

Background: Ropivacaine and levobupivacaine are recently introduced amide local anesthetics that are structurally similar to bupivacaine. In this study, we compared the quality of postoperative analgesia and the side effects of 0.1% ropivacaine/sufentanil and 0.1% levobupivacaine/sufentanil. Methods: Sixty patients scheduled for gynecologic surgery under general anesthesia were randomized to receive either 0.1% ropivacaine with sufentanil (ropivacaine group) or 0.1% levobupivacaine with sufentanil (levobupivacaine group) for postoperative epidural analgesia using a patient-controlled analgesia pump at a rate of 5 ml/h during the 48 hour period following surgery. Visual analogue scale (VAS) scores at rest and on coughing, sitting and movement, the degree of ambulation, additional analgesic requirements and side effects were assessed. Results: In the levobupivacaine group, VAS scores at rest and on coughing, sitting and movement were lower than in the ropivacaine group (P < 0.05). In the ropivacaine group more patients were able to walk unaided (P < 0.05). There were no differences in local anesthetic consumption, additional analgesic requirements and side effects between the groups. Conclusions: Both 0.1% ropivacaine with sufentanil and 0.1% levobupivacaine with sufentanil provided effective postoperative epidural analgesia, but ropivacaine produced lesser motor block. (Korean J Anesthesiol 2007; 53: 746~52)

A comparison of palonosetron and dexamethasone for postoperative nausea and vomiting in orthopedic patients receiving patient-controlled epidural analgesia

김병건,양춘우,김현주,임현경,오소라,이병욱 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.5

Background: Postoperative nausea and vomiting (PONV) is one of the major concerns after anesthesia and surgery, and it may be more frequent in orthopedic patients receiving patient-controlled epidural analgesia (PCEA). The purpose of this study was to compare the effect of palonosetron and dexamethasone on the prevention of PONV in patients undergoing total joint arthroplasty and receiving PCEA. Methods: Patients scheduled for total hip or knee arthroplasty under spinal anesthesia/PCEA were randomly allocated to receive either intravenous palonosetron (0.075 mg, n = 50) or dexamethasone (5 mg, n = 50). Treatments were administered intravenously to the patients 30 min before the beginning of surgery. The total incidence of PONV and incidence in each time period, severity of nausea, need for rescue anti-emetics, pain score, and adverse effects during the first 48 h postoperatively were evaluated. Results: The total incidence of PONV was lower in the palonosetron group compared with the dexamethasone group (18.4% vs. 36.7%, P = 0.042), but there were no statistically significant differences in incidence between the groups at all time points. No significant intergroup differences were observed in the severity of nausea, use of rescue anti-emetics, pain score, and adverse effects. Conclusions: Although there were no significant differences in the incidence of PONV between the treatment groups at all time points, intravenous palonosetron reduced the total incidence of PONV in orthopedic patients receiving PCEA compared with dexamethasone.

A Study on E-commerce Recommender Systems Based on LSI and Fuzzy Model

권영직,양춘우,권동훈 대구대학교 정보통신연구소 2009 情報通信硏究 Vol.6 No.1

This paper combines two analytical techniques to create a model that not only narrows product choices but also producesa prioritized product list of recommendations tailored to a specific customer. Specifically, the paper proposes to create a recommender system based on applications of Latent Semantic Indexing (LSI) and Fuzzy Synthetic Judgment (FSJ). The application ofthese two analytic models will serve a two-fold purpose. Latent Semantic Indexing will enable the model to account for incomplete rating information in the collaborative rating matrix so that the completed rating matrix can then be decomposed using the Singular Value Decomposition (SVD) method. Fuzzy Synthetic Judgment will then provide a prioritized list to the customer of recommended selections. In order to provide a clearer understanding of the proposed recommender process, the authors will demonstrate the requisite calculations through an application. In addition to clarifying the process, the example will serve to help validate the proposed model.

노인에서의 다른 3가지 방법의 척추 경막외 병용마취 및 척수마취 방법의 비교 연구

임영수,양춘우,권희욱 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.2

Background: Combined spinal epidural anesthesia (CSE) combines the rapid onset and intensity of a subarachnoid blockade with the flexibility of an epidural catheter, thereby allowing the intraoperative extension of anesthesia and postoperative epidural analgesia. This study investigated the effects of hyperbaric bupivacaine during CSE for lower limb orthopedic surgery in geriatric patients. Methods: Group 1 received a subarachnoid injection of 8 mg of bupivacaine and an epidural catheter. Group 2 received a subarachnoid injection of 5 mg of bupivacaine and fentanyl, 10μg and an epidural top-up with 3 ml saline. Group 3 received a subarachnoid injection of 5 mg of bupivacaine and fentanyl 10μg with an epidural top-up of 6 ml saline. Group 4 received a subarachnoid injection of 6 mg of bupivacaine and an epidural top-up with 6 ml saline. The maximal level of the sensory blockade, the time of onset to the maximal sensory blockade, the two segment regression time, the time for sensory regression to the tenth thoracic dermatome (T10) and the motor recovery to modified Bromage Scale 0 were compared. After recording the baseline systolic blood pressure and heart rate, the systolic blood pressure and heart rate were recorded at 5 min intervals. Results: There were significant differences in the two-segment regression times, the times to motor recovery between the groups. However, the intraoperative blood pressure and heart rate were similar. Conclusions: In terms of the peri-operative side effects and recovery from the blocks, CSE was better for lower limb orthopedic surgery in geriatric patients than spinal anesthesia. (Korean J Anesthesiol 2006; 50: 152~7)

한국과 독일의 중등학교 수학교과서 비교 연구 : 중학교 대수 영역을 중심으로 Focused on the Area of Algebra

노정학,양춘우,정환옥 한국수학교육학회 2003 수학교육 Vol.42 No.3

In this paper we compared and analyzed the Korean and German mathematics textbooks for the middle school students. For the research we investigated only the area of algebra, which is consisted of the three sections-section of numbers and arithmetic operations, section of letters and expressions, and section of rules and functions. We expect that this paper would contribute on the development of the whole area in our nation's mathematical educations, including the organization and exploitation of the curriculums for the middle school students.