노인환자에서 시행된 부위마취의 분석

원유흥,김 웅 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

부위마취 방법은 노인환자에서 심부 정맥혈전증과 술후 섬망을 줄일수 있는등 잇점을 갖는 마취방법이다. 이 연구는 동국대학교병원에서 1991년 10월부터 1996년 7월까지 마취를 받은 노인환자중에서 495명의 부위마취환자를 후향적으로 분석하였다. 전체 마취례수는 13,932건이었으며 이 중 노인환자의 비율은 8.0%였다. 노인환자의 부위 마취는 전체환자의 3.6%를 차지하였다. 연령상 가장 많았던 군은 65~74세 군으로 전체의 63.1%를 차지하였고 부위마취 방법으로는 척추 마취가 83.6%의 환자에서 시행되었다. 과별분포는 정형외과 환자가 전체의 52.9%를 차지하였고, 노인환자에서 가장 흔히 동반된 질환은 고혈압으로 41.1%를 차지하였다. 합병증으로는 저혈압(66.3%)과 서맥(22.9%)을 관찰할 수 있었으며 부위마취제의 중독증상을 나타낸 경우는 찾아볼 수 없었다. 노인환자에서 부위마취는 비교적 안전하고 잇점이 많은 방법으로 향후 술자와 환자에게 만족을 줄 수 있는 다양한 부위마취방법의 개발이 필요하다고 사료된다. The regional anesthetic method give many advantages to geriatric patients. which reduce the deep vein thromboembolism and postoperative delirium. This study based on geriatric patients receiving anesthesia in DongGuk university hospital since Oct. 1991 to July 1996. We analyzed retrospectively 495 geriatric patients received regional anesthesia. Total anesthetic case was 13,932 and the proportion of geriatric patient was 8.0%. The 3.6% of patient received regional anesthesia. The frequent aged group in our hospital was 65-74yr group, 63.1%. The most frequent used anesthetic method was spinal anesthesia (83.6% of patients).Orthopedic surgery placed 52.9% of the geriatric regional anesthetic patient. The most concurrent disease was hypertension(41.1%) and complications were hypotension(66.3%). bradycardia(22.9%). No severe regional anesthetic toxicity was seen. The regional anesthesia on geriatric patients was revealed relatively good and safe method and need further evaluation for aged patient. For provide good operative condition and fine result of patient, various regional anesthetic technique is required recently.

경주병원 소아 예정수술환자의 취소원인 분석

원유흥 東國大學校 1999 東國論叢 Vol.38 No.-

Background; The cancellation of elective surgery give much economic loss and mental stress to the patient and their parent. The effective management of surgical room are also disturbed. So we examined the causes of cancellation of the elective pediatric surgery in Kyongju hospital. Method; We received the request of next day suegery schedule at 4 o'clock (p.m) and the day of surgery, we counted the case of cancellation and examined the causes during 1 year in Kyongju hospital. Result; The total number of scheduled pediatric surgery were 496 case. and the case of cancellation were 41 case (8.27%). the most frequent cause was upper respiratory infection (24 case, 58.54%). The second leading cause was fever with unknown origin (7case, 17.07%). Conclusion; The relationship between the surgeon and anesthesiologist are important. The upper respiratory infection was most common cause of cancellation. the definition and diagnosis of upper respiratory infection must be discussed both surgern and anesthesiologist. The pediatric day case surgery unit may be considered carefully.

Lidocaine-epinephrine 용액을 이용한 상박 신경총 차단환자에서 예방적 esmol 투여로 인한 혈역학적 변화의 고찰

원유흥 東國大學校 2000 東國論叢 Vol.39 No.-

Epinephrine is added to local anesthetic solution for prolongation of local anesthetic block and absorption. Systemically absorbed epinephrine may cause hypertension and tarchycardai. The goal of this study was to asess the effect of esmolol attenuated the response of absorbed epinephrine during axillary brachial plexus block. 20 patients scheduled for operation below the shoulder joint were studied. All patients were over 45 hear old. The E-group (n=10) received intravenous esmolol (0.3 mg/kg) followed by 0.03 mg/kg/min for 60 min after bracheal plexus anesthesia. The C-group (n=10) was control received no systemic medication after anesthesia. Non-invasive blood pressure and heart rates were asessed 15min. 30min. and 60min. after completion of bracheal plexus block. Both C-group and E-group were similar demographically. C-group patients had more increase in blood pressure and heart rate compared to E-group. There was no serious complication. The results are summarized in the table 1. and 2. Application of prophylactic use of esmolol to decrease the response of absorbed epinephrine to the high risk and old patients in bracheal plexus block has much beneficial effects during the surgical procedure.

A Study of Walt Whitman : 시대적 배경과 作品을 중심으로

원유흥 圓光大學校 師範大學 學生會 1974 師大 學術 硏究 Vol.1 No.-

제왕절개술후 Butorphanol과 Fentanyl의 통증 자가조절의 비교

김웅,원유흥 東國大學校醫學硏究所 1997 東國醫學 Vol.4 No.-

계획된 제왕절개술을 받은 30명의 환자를 대상으로 술후 24시간 동안의 butorphanol(n=15) 또는 fentanyl(n=15)에 의한 통증 자가조절장치를 이용한 통증광리로 통증점수(VAS), 환자의 만족도, 부작용 등을 조사하여 다음과 같은 결과를 얻었다. 1) VAS는 butorphanol군과 fentanyl군에서 PCA시작전 각각 8.2±0.6, 8.3±0.5, 1시간 후 4.1±0.5, 4.1±0.9로 감소하엿고 그 뒤 24시간 동안 4 이하를 유지하여 두 군간 유의한 차이는 없었다. 2) 환자의 만족도는 butorphanol군 80%, fentanyl군 86%로 나타났다. 3) 부작용으로는 butorphanol군에서 오심 2례, 졸음증 3례, fentanyl군에서 오심 3례, 구토 1례, 소양증 2례, 졸음증 1례가 발생하여 양군간 의미있는 차이는 없었다. 이상의 결과에서 butorphanol이 fentanyl과 비슷한 정도의 제통효과 및 우수한 환자 만족도를 보이면서, 부작용의 빈도는 더 적은바 술후 통증 자가조절장치를 이용한 통증조절에 유용한 약물이라 생각된다. Compared to fentanyl, butorphanol, an agonist-antagonist has similar analgesic effect and less side effects. The authors studied the efficacy and incidence of side effects of intravenous patient-controlled analgesia(IV-PCA) using butorphanol with Baxter infusor for postoperative pain control after Cesarean section and compared these to fentanyl. Thirty healthy women who underwent Cesarean section were randomly assigned into two groups, butorphanol and fentanyl group. When awakened in the recovery room after general anesthesia, butorphanol(n=15) patients received 20 mcg/kg, 1.5 mcg/kg as loading does and 0.2 mg/kg, 15 mcg/kg respectively as maintenance does in total volume of 40 ㎖. The infusion rate was 0.5㎖/hr and the module has 15 minutes lockout interval. The analgesic effect and the percentage of patient satisfaction was similar in both groups. The incidence of side effects was less in butorphanol group except somnolence. Butorphanol has less incidence of side effects and comparable level of analgesia when compared to fentanyl. We concluded that butorphanol could be alternative to fentanyl for IV-PCA after Cesarean section.

術前 不安은 propofol 誘導用量에 影響을 주는가?

元裕興 동국대학교 경주대학 2000 東國論集 Vol.19 No.-

The purpose of this study was to assess the relationship between preoperative anxiety level of patients and dose of propofol for induction. Thirty man patients with propofol based anesthetic regimen were enrolled in this study. Anxiety and rate pressure product were assessed immediately enter the operating room (=VAS 1, RPP 1). After permitting rest for 5 min, re-assessed the VAS and RPP (=VAS 2, RPP 2). Then provided propofol based anesthesia and assessed dose of propofol for induction by the time at loss of eyelid reflex. The results were that patients with high score production of VAS 1-VAS 2 or RPP 1-RPP2 required less propofol for induction (r=-0.482, r=-0.534 respectively). The results means that patients with high flexibility of mental, neuroendocrine and cardiovascular system requires less propofol for induction, and this results require further survey.

폐질환 환자에서 지속적 늑막강내 차단 3례

원유흥,김웅 東國大學校醫學硏究所 1997 東國醫學 Vol.4 No.-

흉부나 상복부 수술환자에서 흉부 경막외강에 아편양 제재와 국소 마취제를 투여하여 술후 통증을 제거하는 방법은 기술적으로 어렵고, 투여 약제로 인한 저혈압이나 심각한 호흡억제, 구토, 오심, 소양증 등을 초래 할 수 있는 단점이 있다. Reiestad에 의해 소개된 늑막강내 차단법은 비교적 간편하고 일측 늑막강내로 국소마취제를 주입하므로 별다른 후유증 없이 진통 효과를 나타내는 방법이나 폐 병변이 있을 경우 이에 대한 자세한 연구가 부족하여 그 진통효과나 약제의 운명이 명확히 규명되지 않은 상태이다. 이에 저자들은 폐기능 저하 또는 폐질환 환자에게 늑막강내 차단술을 시행하고 저농도의 bupivacaine 20㎖을 투여하여 저혈압이나 중독반응, 폐기능의 악화 없이 약 4∼6시간에 걸쳐 VAS score(visual analogue scale, 이하 VAS)가 2∼3으로 유지되는 결과를 관찰하였으며 추가 주입으로 술후 48시간 동안 효과적인 통증 조절이 가능함을 확인하였다. 추후 폐의 병변을 갖는 환자에서 늑막강내 차단의 효과와 사용약제의 분포, 배설 등에 관한 연구가 더 필요하리라 생각된다. The recent method of eliminating the post-operative pain after upper abdominal or thoracic surgery with administration of local anesthetics or opioids into the thoracic epidural space has some disadvantages, such as nausea, vomiting, pruritus, hypotension and respiratory depression. Interpleural analgesia, first introduced by Reiestad is known to be relatively simple to perform and has little complication. But the local anesthetics adminstered into the interpleural space may produce some adverse effects due to relatively large volume and rapid uptake of local anesthetics, and because of the relatively sparse studies about pharmacodynamic and pharmacokinetic course in the diseased lung, there are controversies for the use of interpleural block in the case of respiratory compromise. We experienced good analgesia after interpleural administration of bupivacaine 20ml with epinephrine (1:200,000) in patients with reswpiratory disease or decreased pulmonary function and maintained the VAS(visual analogue scale) 2-3 for 4 to 6 hours without hypotension, local anesthetic toxicity and deteriorating lung function. After repeated administration of same mixture of bupivacaine and epinephrine, the patients maintained relatively good analgesia for 48 hours. For the safe use of interpleural block in patients with respiratory problems, the pharmacodynamic and pharmacokinetic studies after administration of local anesthetics into the interpleural space would be needed in detail.

심부전이 동반된 갑상선기능항진증의 전신마취 1례

김태환,원유흥,김웅,권영무 동국대학교 경주대학 1996 東國論集 Vol.15 No.-

갑상선기능항진증 환자는 선택수술시 마취전에 장기적으로 항갑상선 약물과 베타-수용체 차단제를 사용하여 정상갑상선기능으로 만들어, 적어도 맥박수가 분당 85회이하로 되었을 때 마취를 하여야한다. 정상갑상선기능으로 만들지 않은 환자를 수술을 하였을 때, 수술중이나 후에 갑상선 호르몬이 과량으로 분비하여 합병증을 유발할 수 있다. 그러나 응급수술시에는 수술을 하지 않았을 때의 생명의 위험도와 마취와 수술을 하였을 때의 위험도를 비교하여 결정하여야 한다. 저자들은 심부전을 동반한 조절되지 않은 갑상선기능항진증을 가진 38세의 여자환자를 응급으로 전신 마취하여 성공적으로 난관난소적출술을 시행한 경우를 보고하는 바이다. Elective surgery should never be considered until hyperthyroid patients have been rendered euthyroid and controlled by antithyroid drugs and beta-adrenergic blockades, as evidenced by resting bean rates less than 85 beets/min. Patients who cannot be rendered euthyroid before surgery may develop adverse responses related to excessive release of thyroid honnones during the perioperative period. But in the emergency case, it must be considered the severity between life and risk We described the case of the 38-year-old woman with uncontrolled hyperthyroidism accompanying the congestive heart failure, who was successfully carried out a salpingoophorectomy under general anesthesia.

액와 상박신경총 차단시 Lidocaine-fentanyl 혼합 투여에 따른 선행진통효과

김웅,원유흥,김태환 東國大學校醫學硏究所 1997 東國醫學 Vol.4 No.-

급성통증에 대한 기전의 이해와 치료방법의 발달은 술후 통증관리에 있어서 많은 진전을 가져왔다. 술후 통증관리에 한 방법으로 조직손상에 기인한 통증의 뇌척수후각 과민반응을 미리 차단하므로서 숭후 통증을 경감시킬 수 있다는 선행진통에 대한 보고들이 있다. 이것은 국소마취제로 국소차단을 하여 구심성경로를 차단하거나 아편양 제재나 NMDA수용제 길항제를 이용해 중심성감작을 억제하는 방법으로 시행되고 있다. 아편양 제재는 최근에 중추성 효과와 더불어 말초적 진통기전에 대해서도 관심이 늘고 있다. 저자들은 조직 손상으로 이미 통증이 있는 환자군과 조직 손상이 없는 무통환자군에서 국소마취제와 아편양 제재를 혼합 사용하여 말초신경을 차단하고 그 마취효과 및 진통효과를 관찰하였다. 양군에서 진통 효과 발현 시간이나 감각, 운동 차단 지속 시간 등은 유의한 결과를 관찰할 수 없었으나 추후 더 많은 예에서 아편양 제재의 국소적 투여에 의한 선행 진통 효과와 또한 선재하는 통증이 아편양 제재의 국소적 작용에 미치는 영향에 대한 많은 연구가 필요할 것으로 사료된다. The greater improvement is noted in controlling acute postoperative pain by the knowledge of mechanism of acute pain. The another method in controlling postoperative pain, pre-operative nociceptive block with local anesthetics or opioids (i.e, pre-emptive analgesia) may reduce the postoperative pain. But the pre-existing pain will counteracts the this concepts of pre-emptive analgesia. The opioids have central and peripheral effects. The peripheral action of opioids been studied widely. We evaluated pre-emptive analgesic effect of axillary brachial plexus block with local anesthetics and opioids to the two group, the group with painless patients or the group suffering with acute pain. In both group, there was no significant difference in analgesic time, onset time, sensory and motor blocking and recovery time. the effect of preemptive analgesia, effect of peripheral action of fentanyl were not seen. The study to evaluate the effect of the peripheral opioids and local anesthetics in pre-emptive analgesia will be needed further.

제왕절개술을 위한 경막외 마취시 국소마취제의 용량과 Ephedrine 사용에 대한 임상적 고찰

김태환,정혜령,원유흥 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.5

Background : Hypotension occurs frequently after epidural anesthesia. Intravenous fluid or vasopressors are among treatment methods to many suggested causes. This study was undertaken retrospectively to determine if the age, weight and height of parturients are related to the local anesthetic dosage in epidural anesthesia for the cesarean section, and if the dosage of local anesthetic influence the change of blood pressure and the requirement of fluid or epherine. Methods : Sixty-nine parturients were studied by reviewing patients' anesthetic records. During lumbar epidural anesthesia to T4 sensory level, all patients were monitored with mean arterial blood pressure, and prevented from hypotension by administration of Ringer's lactated solution. But if hypotension has been sustained in spite of rapid fluid loading, intermittent ephedrine was injected. We studied the correlation of local anesthetic dosage, decrement of mean blood pressure and total required intravenous fluid volume, and difference of these variables between cases using ephedrine and not using. Results : The volume of local anesthetic to achieve a T4 sensory level was 21.20 3.81㎖, which did not correlate with age, weight and height, and did not influence the decrease of mean blood pressure and the volume of administered fluid. But the patients(n=30) who needed ephedrine were adminstered significantly larger dose of the local anesthetic and showed more decrease in the mean blood pressure than those(n=39) who did not. Conclusions : The dose requirement of local anesthetic during epidural anesthesia for the cesarean section is not determined by the age, weight and height of parturients. But when larger dose of local anesthetic is administered, the patients seem to be more hypotensive and need ephedrine as well as intravenous fluid administration. (Korean J Anesthesiol 1997; 33: 903∼907)