슬관절경수술 후 Morphine, Bupivacaine 그리고 Epinephrine을 함유한 Bupivacaine의 관절내 주사가 술 후 진통에 미치는 효과

정락경,한종인,김종학,김치효,이귀용,이춘희,조연진 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.2

목적 : 슬관절경 수술 후 관절강내 morphime bupivacaine epinephrine을 첨가한 bupivacaine을 주사하여 통증 억제 효과 및 수술 소요시간과 종류가 술 후 통증에 미치는 영향을 비교분석하여 효과적으로 임상에 적용하기 위하여 본 연구를 시행하였다. 방법 : 1994년 8월부터 1995년 7월까지 이화대학부속 목동병원에서 계획수술로 슬관절경 수술이 시행된 19~61세 사이의 남녀 40명을 대상으로 하여 전신마취하 슬관절경 수술 후 생리적 식염수 20ml 투여한 대조군, 생리식염수 20ml고 morphine 1mg 혼합투여군, 0.25%bupi-vacaine 20ml 투여군, 0.25% bupivacaine과 200㎍ epinephrine 혼합 투여군으로 분류하여 술 후 1,2,3, 4 및 24시간동안 VAS 를 이용하여 통증을 비교하였다. 결과 : 1) 통계학적인 의의는 없었으나 대조군에 비하여 bu-pivacaine 및 bupivacaine과 epinephrine혼합투여군이 술 후 1시간 이후부터 24시간까지, morphine 투여군은 술 후 3시간 이후부터 통증 억제 효과를 나타내는 경향을 보였다. 2) 수술시간이 60분 미만의 비교적 간단한 수술인 진단적 슬관절경술등 보다 120분 이상의 마모성 관절성형술에서 술 후 통증은 더 심한 경향을 보였다. 결론 : 본 연구에서 전신마취하 슬관절경 수술 후 술 후 통증을 효과적으로 제거하기 위하여 생리식염수, 생리식염수와 morphine 1mg, 0.25% bupivacaine 50mg, epinephrine 200ug고 0.25% bupivacaine을 각각 20ml 관절강내 투여하여 술 후 1,2,3,4 및 24시간 동안 통증이 정도를 비교하여 bupivacaine및 ep-inephrine과 bupivacaine의 혼합용약을 관절강내 주사한 경우 통증억제 효과를 나타내는 경향을 보였고, morphine은 지연된 통증억제 효과를 나타내는 경향을 보였으나, 통계학적으로 의의있는 차이를 발견할 수 없어 앞으로 morphine과 bupivacaine의 관절강내 투여시 용량 및 용적과 통증 관찰 시기를 적절하게 조절하여 더욱 연구해야 할 것으로 사료된다. Objectives : There are controversies about the analgesic effects of intraaarticular morphine and local anethetics bupivacaine. This study sought to compare the effects of saline with mor-phine, bupivacaine with or without epinephrine, administrated intraarticularly upon pos-toperative pan following arthroscopic knee surgery under general anesthesia. Methods : In a double-blined, randommized manner, 40 patients received one of saline(20ml, n=10), morphine(1mg in 20ml NaCl, n=10), bupivacaine(0.25%, 20ml, n=10), bu-pivacaine with epinephrine(0.25%, 20ml, 200ug of epinephrine, n=10) intaarticularly at the completion of surgery. The pain scores by VAS were determined after 1,2,3,4 and 24 hours after intraarticular administration. Results : There were no significant statistical differences between four groups in the pain score. The maximal pain scores were 37.5 in control group, 48.0 in morphine group, 33.6 in bupivacaine group postoperative 1 hour and 32.9 in bupivacaine with epinephrine group pos-toperative 2 hours. The pain scores were decreased as the time went by and were minimin as 21.4 in control group, 17.6 in morphine group, 11.2 in bupivacaine group and 12.3 in bu-pivacaine with epinephrine group 24 hour postoperatively. Conclusion : Though there were no significant statistical significances with those doses, there were tendencies that the bupivacaine group with or without epinephrine had the postoperative analgesic effect rather than control group, and morphine group had a slow onset of analgesic ef-fect. So, we should study to decide the dose or volume of the drugs and appropriate time to evaluate for the anagesic effects after knee arthroscopy further.

Univent 튜브의 기관지 폐색 커프 용적과 압력에 관한 연구

정락경 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.1

Baokground : The manufacturer has recommended that 6-7 ml of air be used to seal the bronchial blocker cuff of Univent tubes high Fessure type. However overinflatiun of the cuff might result in pressure damage to mucosa. This study was performed to evaluate the appropriate sealing volume and pressure of the bronchial blocker cuff. Methods : Univents were inserted in 26 patients. The bronchial blocker was connected to a pressure gauge and the cuff was inflated by 0.5 ml increment until the bronchus was sealed in supine and lateral positions under 20-25 mmHg airway pressure. The sealing volume and pressure were recorded. Results : In males, the sealing volume for the left bronchus (3.8±0.4 ml) was smaller than for the right bronchus (5.4±1.0 ml) in both positions significantly (p $lt; 0.05). In females, the sealing volume for the left bronchus (2.8±0.4 ml in both positions) was snlaller than the volume for the right bronchus (3.7±0.8 ml in supine position, 3.9 ± 0.9 ml in lateral position) significantly (p ). The seating volume far females was smaller than for males significantly (p$lt;0.05), for all sealirlg pressures, there were no significant differences .statistically. Conclusions : The bronchial blocker of Univent is a high pressure type and the sealing volume is higher for the right bronchus than for the left bronchus. furthermore the sealing volume is less than the volume which is recommended by the manufacturer. (Korean J Anesthesiol 2000; 38: 89∼93)

저체온이 맥박산소계측기로 측정한 산소포화도에 미치는 영향

정락경,이춘희 梨花女子大學校 醫科大學 醫科學硏究所 1992 EMJ (Ewha medical journal) Vol.15 No.3

Although pulse oximetry is a potentially useful diagnostic tool under anesthesia. there are concerns regarding its reliability for measuring oxygen saturation (SpO_2 ; arterial oxygen saturation by pulse oxymeter) in hypothermic or low perfusion states. To test pulse oximeter reliability under hypothermic condition 30 data from 14 patients were collected. Subjects were divided into group I which was as body temperature>36℃ and group 2 which was body temperature 36℃. The results were as follows: 1) There were no differences between group I and group 2 in the SaO_2(arterial oxygen saturation by blood gas analyzer) and SpO_2. 2) The SpO_2 in group I was underestimated by 1.20±0.85% than SaO_2 in group 1(P<0.001). 3) The SpO_2 in group 2 was underestimated by 0.60±1.03% than SaO_2 in group 2(p<0.05). Although the SpO_2 was underestimated under hypothermic condition, the pulse oximeter with expired CO_2 tension monitor decreased the frequent invasive arterial blood gas analysis. And it was useful tool for the detection of the hypoxia which is most commom cause of preventable anesthesia related death.

임신 및 체위가 피부로부터 경막외강까지의 깊이에 미치는 영향

정락경 梨花女子大學校 醫科大學 醫科學硏究所 1996 EMJ (Ewha medical journal) Vol.19 No.4

목 적 : 본 연구는 경막외차단시 합병증을 감소시키고 성공적인 차단을 실시하기 위하여 일반 환자 및 임산부에서 피부로부터 경막외강까지의 깊이와 이에 영향을 끼치는 요소와 특히 임신 및 체위와의 관계를 파악하고자 시행하였다. 대상 및 방법: 1996년 4월부터 7월까지 이화대학교 부속 목동병원에서 경막외마취하에 계획 및 응급 수술을 시행 받는 환자 중에서 미국마취과학회 신체 분류상 제 1또는 2급인 남녀 환자 105명(남자 40명, 여자 65명)을 대상으로 하였다. 경막외마취를 실시하기 위하여 요추를 굴곡한 상태에서 측와위나 좌위를 취한 후 정중 접근법을 택하여 제2~3 이나 제 3~4 요추간에 Tuohy침을 척추면에 가능한 수직이 되게 삽입한 후 경막외강은 저항소실법으로 확인하였다. 피부-경막외강 까지의 깊이는 1cm 간격으로 주사침에 표시된 눈금에 따라 측정하였다. 모든 측정치는 평균±표준편차로 표시하였으며, 각 군간의 비교는 unpaired Students t-test나 분산 분석하였으며, 신장, 체중, 체부피지수(body mass index ; BMI, 체중/신장^2). 척추간 위치 및 체위와 피부-경막외강 까지의 깊이의 관계는 다중 회귀 분석을 사용하여 비교한 후 p<0.05를 통계학적으로 유의 하다고 하였다. 결 과 : 대상 환자 전체의 피부-경막외강의 깊이는 최소 3.2cm, 최고 6.1cm 이었으며, 평균4.5±0.7cm 이었다. 피부-경막외강 깊이에 영향을 미치는 요소는 남자와 비임산부 여자는 체중과 BMI 였으며, 임산부는 BMI였다. 체위나 임신 여부 및 신장과 연령은 피부-경막외강의 깊이에 영향을 끼치는 요인이 되지 못하였다. 피부-경막외강 까지의 깊이는 임산부는 4~5cm이 88.4%, 비임산부는 3.5~4.5cm에서 64.9% 분포하였으며, 5.5cm 이상인 경우는 각각 3.2%, 10.8% 였다. 결 론 : 피부-경막외강까지의 깊이는 평균 약 4.5cm 이며 이는 체중이나 BMI와는 관계있으나 체위나 임신 여부와는 상관없으며 따라서 경막외차단시 마취과 의사의 숙련도나 선호도에 따라 체위를 선택하여 조심스럽게 천자하되 피부-경막외강의 깊이가 3~6.5cm의 범위를 벗어나는 경우에는 다시 경막외천자를 시행하는 것이 좋을것으로 사려 된다. Objectives : This study was performed to assess the factor affecting the distance from skinto epidural space Methods : The distance from the skin to epidural space(DSES) was measured in 105 patients who received lumbar epidural anesthesia. The relationship between patient factors [age, weight, height, body mass index(BMI : weight/height^2), pregnancy] and technical factor(posture) versus DSES was investigated using multiple regression analysis. Results : The mean DSES was 4.5±0.7cm. DSES correlated positively with weight and BMI in non-obstetrics(including male), and BMI in obstetrics. But, DSES did not correlated with posture. Conclusion : The patient's weight and BMI in non-obstetrics and BMI in obstetrics but posture during epidural needle placement are important factors influencing DSES.

수술전 마취과 자문 환자의 분석

정락경,이춘희 梨花女子大學校 醫科大學 醫科學硏究所 1993 EMJ (Ewha medical journal) Vol.16 No.1

Preoperative consultation interwines anesthesiology, surgery and internal medicine. Its goalis the efficient transfer of information in each consultant's speciality to other members ofthe team caring for the patient thus increasing the liklihood of satisfactory outcome and decresaing the morbidity and the mortality. Form January 1988 to December 1992 at the anesthetic department of Ewha Womans University Hospital, 775 patients who were consulted to department of anesthesiology preoperativelywere analized annually, according to age, ASA classification, depaartments, causative diseases.recommendations and anesthetic methods. The results were as follows : 1) The ratio of anesthetic consultation to operation was 3.8% Annually consultation ratiowas increased about twice from 2.0% in 1988 to 4.1% in 1992. 2) The number of 61∼70 years of age was the greatest number of cases as 156 cases(20.1%).each 132 cases(17.0%) were in 51~60 and 71~80 years of age, 45 cases(5.9%) over 81 yearsof age and 26 cases(3.4%) under 1 year of age. Over 61 years of age were 333 cases(43.0%). 3) According to ASA clssification. 406 cases(52.4%) in class 2 was the greatest and theorder was 332 cases(42.9%) in class 3, 22 cases(2.8%) in class 4. The almost cases were inclass 2 and 3. 4) Comparing between departments, the order of the greatest number of cases was 239 cases(30.9%) of orthopedic forgery. 151 cases(19.5%) of general surgery. 131 cases(16.9%) of urologyand 114 cases(14.7%) of chest surgery. 5) Comparing between causative diseases. the order of the greatest number of cases was389 cases of repiratory diseases. 326 cases of cardivoascular diseases. 124 cases of endocrinedisease and 89 cases of hepatic diseases. 6) About preoperative recommendations. the number of the checklists for the respiratorydiseases was 249 cases 173 cases for the cardiovasclar disease and 153 cases for the hematologicdiseases. 177 cases was anesthetic permission that was taken by anesthesiologist with sufficient explanations to patients and relatives about the risk of anesthesia and surgery. The numberof consultation to other department was 96 cases and 272 cases was no more necessaries ofmanagements. 7) According to anesthetic managements, the number of general anesthesia was 484 cases(62.5%) and that of regional anesthesia was 159 cases(20.5%). Among the regional anesthesiathe incidence of epidural anesthesia was increased annually and up to 96 cases(12.4%) andthat of spinal anesthesia was decreased to 57 cases(7.3%).

이중관 기관지튜브와 Univent튜브를 사용한 일측 폐환기시 최고흡기압과 유순도 변화

이귀용,정락경 梨花女子大學校 醫科大學 醫科學硏究所 1999 EMJ (Ewha medical journal) Vol.22 No.4

연구목적 : 일측 폐환기 마취시에 사용하는 이중관 기관지튜브 및 Univent튜브에 의한 최고흡기압과 유순도의 변화를 관찰하고자 본 연구를 시행하였다. 방법 : 일측 폐환기 마취하에 선택적 흉곽수술을 받는 환자 22명을 대상으로 하였다. 12명에서 이중관 기관지튜브를 10명에서 Univent튜브를 삽관하여 앙와위 상태에서 양측폐 환기, 우측 일측 폐환기 시행중 최고흡기압, 유순도, 맥박 산소포화도, 호기말 이산화탄소분압을 측정하였다. 결과 : 양측 폐환기에 비해 일측폐 환기시 최고흡기압은 유의하게 증가하였으며 유순도는 감소하였다. 일측폐 환기시 이중관 기관지튜브군은 Univent튜브군 보다 최고흡기압은 유의하게 증가하였으며 유순도는 감소하였다. 산포포화도는 일측폐 환기시에도 차이가 없었다. 호기말 이산화탄소분압은 이중관 기관지튜브군에서 일측폐 환기시 양측폐 환기시보다 유의하게 증가하였으나 정상범위를 유지하였다. 결론 : 일측 폐환기 마취에 널리 사용되는 이중관 기관지튜브와 Univent튜브를 비교한 결과 Univent튜브가 최고흡기압과 유순도 변화를 적게 일으키므로 일측 폐환기 마취시 튜브선택에 있어 장점이 될 수 있다고 생각한다. Objects : One-lung anesthesia offers advantages during thoracic surgery, but has the disadvantage of causing hypoxemia and affects the respiratory mechanics. We investigated the peak inspiratory airway pressure(PIP) and compliance during one-lung ventilation using different tubes. Methods : In healthy 12 patients undergoing thoracic surgery, left-sided double lumen endobronchial tube was inserted. In 10 patients, Univent tube was inserted and fixed the blocker using the bronchofiberscope. The PIP, compliance, end-tidal CO_2 and SpO_2 were measured using a Capnomac Ultima?? during two-lung and right one-lung ventilation. Results : During two-lung ventilation, there was no difference between the two groups During one-lung ventilation PIP increased and compliance decreased significantly than two-lung ventilation. In the double lumen tube group, PIP increased significantly and compliance decreased significantly than Univent tube group. There was no significant changes in the end-tidal PCO_2 and SpO_2. Conclusion : Univent tube provide lesser changes of PIP and compliance during one-lung anesthesia in supine position than double lumen endobronchial tube.

부인과 복강경 수술 시 Trendelenburg 자세와 기복 상태가 국소 뇌산소포화도에 미치는 영향

김이정,정락경,김동연,김윤진,김종학,한종인 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.2

Background: The Trendelenburg positon and pneumoperitoneum for gynecological laparoscopic surgery can affect cerebral oxygenation through the change of cerebral blood flow. The aim of this study was to evaluate the effect of pneumoperitoneum in a 20o Trendelenburg position on regional cerebral oxygen saturation (rSO2). Methods: Thirty-three female patients of American Society of Anesthesiologists I and II physical status who were undergoing gynecological laparoscopic surgery were enrolled. The rSO2 was monitored with near-infrared spectroscopy (INVOS 5100, Somanetics,Troy, USA). The rSO2, the rate of change in the rSO2, the mean arterial pressure (MAP), heart rate (HR), arterial partial pressure of CO2 (PaCO2) and O2 (PaO2) and end-tidal CO2 (ETCO2)were measured at the following times: immediately before the pneumoperitoneum and when placing the patient in the Trendelenburg position (T0), 5, 10, 15 and 20 min after pneumoperitoneum and position change (T1, T2, T3 and T4). Results: Both the right and the left rSO2 increased significantly during pneumoperitoneum in a Trendelenburg position compared with the value at T0 (from T1 to T4) (P < 0.01). The MAP and PaCO2 also increased significantly (P < 0.01). Conclusions: During the gynecologiccal laproscopioc surgery,cerebral oxygenation, as assessed by rSO2, increased even though the Trendelenburg position and pneumoperitoneum could increase MAP, intracranial pressure and PaCO2, which is considered to be maintained by cerebral autoregulation.

Factors Affecting Maternal and Fetal Outcomes of Non-Obstetric Surgery and Anesthesia during Pregnancy: a Retrospective Review of Data at a Single Tertiary University Hospital

조수영,정락경,So Hee Jin 대한의학회 2020 Journal of Korean medical science Vol.35 No.16

Background: Anesthesia during pregnancy for non-obstetric surgery is generally known to have a negative impact on maternal and fetal outcomes. We assessed the risk of adverse outcomes in fetuses and mothers associated with non-obstetric surgery. Methods: This retrospective study analyzed clinical data on pregnant women who received non-obstetric surgeries at a tertiary university hospital. We reviewed maternity admissions using hospital administrative data during the last 16 years. The outcome assessment included the presence of preterm labor, premature birth, abortion, or stillbirth and the data of newborns. Statistical analyses were performed using the t-test, χ2 test, and multiple logistic regression was used for risk analysis. Results: The incidence of non-obstetric surgery during pregnancy was 0.96%. Gestational age at or above 20 weeks increased the risk of all adverse events 4.5 fold when it was compared to gestational age less than 20 weeks, although the events were only preterm labor or premature birth and no fetal loss. All fetal loss cases occurred in patients at less than 20 weeks of pregnancy. The risk of adverse outcome increased by 2% for every 1 minute increase in anesthesia time. Babies of the mothers who had the adverse outcome event showed lower birth weight and higher neonatal intensive care unit admission rate than those of babies of the mothers without any adverse event after the surgery. Conclusion: Physicians should acknowledge and prepare for common possible adverse events at the stage of pregnancy after non-obstetric surgery, and effort to shorten the duration of surgery and anesthesia is needed.

Hydrothorax with alveolar-pleural fistula mimicking re-expansion pulmonary edema during liver transplantation -a case report-

우재희,정락경,백희정,김윤진 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.2

We present a case of an alveolar-pleural fistula with hepatic hydrothorax in a patient undergoing orthotropic liver transplantation,which was detected by drainage of transudate through an endotracheal tube during operation. A standard endotrachealtube was changed to a double-lumen tube to provide differential lung ventilation. The patient was diagnosedwith an alveolar-pleural fistula by direct vision of an air leak during positive-pressure ventilation through a diaphragmaticincision. There was still a concern about worsening his ventilation due to persistent aspiration of pleural effusiontowards the ipsilateral lung during the remaining operation period. Surgeon repaired the defect on the exposed lungsurface via diaphragmatic opening. Anesthesiologists should consider an alveolar-pleural fistula as a possible differentialdiagnosis with re-expansion pulmonary edema when transudate emanating from the endotracheal tube is obtained inpatients with massive hydrothorax.

급성 임신성 지방간 산모의 응급 제왕절개술시 전신마취 : A case report

임정아,정락경,김동연,이귀용,김치효 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.2