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한국 성인에서 폐동맥 카테테르의 삽입 길이에 관한 연구
최영균,이승건,김정훈,정순호,김영재,박진우,신치만,박주열 인제대학교 1999 仁濟醫學 Vol.20 No.1
한국 성인에서 우측 내경정맥을 통한 폐동맥 카테테르의 거치시 천자 부위에서 우심실, 폐동맥 그리고 폐쐐기압의 파형이 처음 보이는 거리를 측정하고 시간 경과 후 교정된 거리를 측정하여 폐동맥 카테테르 삽관을 위한 기준을 마련하고자 하였다. Objective : Pulmonary artery rupture, infarction and catheter knotting are infrequent but serious complications during insertion of pulmonary artery catheter. Predicting proper length of purimonary artery catheter is important for the prevention of these complications. Method: 50 patients scheduled for open heart surgery were randomly selected. We inserted pulmonary artery catheter via Rt. internal jugular vein, and measured the insertion length of pulmonary artery catheter from the puncture site to the Rt. ventricle(SV), the pulmonary artery(SP), and the pulmonary artery wedge(SW). At the end of surgery, the insertion length of pulmonary artery catheter from the puncture site to the repositioned pulmonary artery wedge (RSW) was measured. Result: The insertion length of pulmonary artery catheter from puncture site to the Rt. ventricle, the pulnlonary artery, the pulmonary artery wedge and repositioned pulmonary artery wedge were 30±3.3cm, 39±3.7cm, 46±5cm and 43±4.4cm(mean±SD)respectively. There was significant correlation between SV and patient's height (p<0.05). Conclusions : To prevent critical complications during pulmonary artery catheter insertion. It is recommanded not to advance the catheter more than 10cm unless expected wave form are appeared. After inserted spontaneous distal migration of catheter is expected, so we recommend to check pulmonary artery wave form frequently and draw it 5cm back before cardiopulmonary bypass to prevent pulmonary infarction
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Rocuronium의 애별투여방법이 모지내전근의 이완에 미치는 영향
최영균,김승수,이원진,조광래,이상은,김영환,임세훈,이정한,이근무,정순호,김영재,신치만 인제대학교 2009 仁濟醫學 Vol.30 No.-
Objective : There are controversies in pnmmg technique of rocuronium whether it can or can't shorten the onset time. We want to compare the effects of two different priming doses and intervals of rocuronium. Materials and Methods : After giving propofol, 50 patients were randomly assigned to 5 groups. Group I received a placebo, followed 3 min later by rocuronium 0.6 mg/kg. Priming doses and intervals of Group II, Ill, N, V were 0.06 rng/kg and 2 min, 0.12 mg/kg and 2 min, 0.06 rug/kg and 3 min, 0.12 mg/kg and 3 min, respectively. Total dose of rocuronium was 0.6mg/kg. Train of four (TOF) count or ratio and 1st twitch height of TOF (T1) were monitored with 15 secondsintervals. TOF ratio of each groups just before bolus injection, duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were compared. Results : Duration for TOF count to reach zero and duration for Tl to reach 95% depression after bolus injection were decreased in priming groups compared to Group 1 (P < 0.01) In group V, significant depression of TOF ratio just before bolus injection was seen (P < 0.05). Conclusion : Priming technique with rocuronium is effective method to shorten the onset of neuromuscular block. But priming dose of rocuronium itself could cause hypoxia and aspiration in awake patients and should be used carefully. Priming dose of rocuronium 0.06 mg/kg and 2 minutes interval maybe relatively safe method.
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경막외 Lidocaine이 Bispectral Index로 측정한 적절한 마취깊이에 필요한 Desflurane 농도에 미치는 효과
최영균,신상우,이근무,정순호,김영재,신치만,박주열 白中央醫療院 2004 仁濟醫學 Vol.25 No.1
Background: Epidural anesthesia potentiates sedative drug effects and decreases minimum alveolar concentration (MAC) of inhalation anesthetics. The authors hypothesized that epidural anesthesia also decreases the general anesthetic requirements for adequate depth of anesthesia as measured by Bispectral Index(BIS) Methods: After premedication with 0.02 mg/kg midazolam, 30 patients aged 20-75 yr were randomized in a double-blinded fashion to receive general anesthesia with either intravenous saline placebo or intravenous lidocaine control (1-mg/kg bolus does; 25 ㎕·kg-1·min-1). A matched group was prospectively assigned to receive epidural lidocaine (15 ml; 2%) with intravenous saline placebo. All patients receive 1.5 mg/kg propofol and 1mg/kg rocuronium for tracheal intubation. After 10 min of equilibration period with 3% end-tidal desflurane concentration, BIS was measured at every 30 second. If BIS score was above 50, vaporizer dial was increased by 0.5 vol%. If BIS score was under 45, vaporizer dial was decreased by 0.5 vol%. When BIS score was maintained between 45-50 by 3minutes, we checked the end tidal desflurane concentration and defined as MACBIS50(Minimum alveolar concentration at BIS 50). MACBIS50, BIS score, and mean arterial pressure were recorded. Results: The MACBIS50 of desflurane (2.5 0.49%) was significantly decreased with lidocaine epidural anesthesia compared with general anesthesia alone (3.1 0.59%) or with intravenous lidocaine (3.0 0.51%)(p<0.05). Conclusions: Epidural anesthesia reduced by 19% the desflurane required for adequate depth of anesthesia. This effect was not a result of systemic lidocain absorption, but may have been caused by deafferentation by epidural anesthesia or direct rostral spread of local anesthetic within the cerebrospinal fluid. Lower-than-expected concentrations of volatile agents may be sufficient during combined epidural-general anesthesia.
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복식자궁전적출술과 인공슬관절 치환술 환자에서 정맥내 자가통증조절이 수술 후 진통에 미치는 효과
최영균,남현옥,이정한,이근무,정순호,김영재,신치만 白中央醫療院 2005 仁濟醫學 Vol.26 No.1
Objective: Intravenous patient-controlled analgesia(IV PCA) is gaining wide spread popularity in the management of postoperative pain control. The purpose of this study is to evaluate the severity of pain after TAH and TKRA through comparing visual analogue scale(VAS) of pain of each patients who received identical IV PCA protocol, and to improve our IV PCA protocol. Methods: TAH group includes twenty female patients who were scheduled for TAH. TKRA group includes twenty female patients who were scheduled for TKRA. Each group received fentanyl 50㎍ about 30minutes before the end of surgery, followed by IV PCA with fentanyl 1500 ㎍, ketolorac 300mg, ondansteron 8mg, normal saline 56㎖(total 96ml, basal infusion rate 1㎖/hr, bolus dose 1㎖, lockout time 10 minutes). VAS scores were recorded at 1, 6, 12, 24, 48 hours postoperatively. Total bolus doses and patients' satisfaction were checked after the end of analgesia. Results: VAS scores of TKRA group were significantly higher than those of TAH group at 12, 24, 48 hours postoperatively. VAS scores of both group progressively decreased(P<0.05). Patients' satisfaction score showed no significant difference between two groups. Total bolus dose of TKRA group was significantly higher than that of TAH. Conclusion: The postoperative pain of TKRA was more severe than that of TAH. TKRA group needed more profound postoperative pain control than TAH group. We should consider the increase of early postoperative period analgesic doses to acquire optimal pain control of both group.
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최영균,오동익,이종영,손대희 대구대학교 환경기술연구소 2005 미래환경기술 Vol.1 No.2
The effect of humus soil on biological denitrification was investigated through NUR batch tests. Specific denitrification rate of HMLE(Modified Ludzack Ettinger process combined with Humus soil contactor) and CMLE(Control Modified Ludzack Ettinger process) sludges as well as COD consumed for denitrification could be estimated from the batch tests. Two linear phases of denitrification rate could be observed when acetate was used as a carbon source. However, denitrification behavior was composed of three linear phases when a primary settled municipal wastewater(PW) was used as a carbon source. The specific denitrification rates on SBCOD(slowly biodegradable COD) fraction in raw wastewater were estimated 4.82 and 3.73 mg N/g VSS·hr when HMLE and CMLE sludge was used as a seed sludge. It means that the hydrolysis rate of HMLE sludge on SBCOD fraction was higher than that of CMLE sludge. Actinomycetes, one of the soil microorganisms, was estimated 150,000 actinomycetes/ml in the biomass of HMLE process, which was 10 times higher than that of CMLE process. Actinomycetes was well known for its distinguished hydrolyzing ability on particulate organic matter. Almost of input COD was utilized for denitrification and cell synthesis when HMLE sludge was used as a seed sludge in NUR batch test. While, about 70% of input COD was comsumed when CBNR sludge was used. It means that substrate utilization rate, especially SBCOD utilization rate, of HMLE sludge was higher than that of CMLE sludge.
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