편도절제술을 받는 소아에서 수술 후 오심 및 구토에 대한 Propofol과 Ondansetron의 예방적 효과

김영재,구봉근,이정한,이근무,정순호,최영균,신치만 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: To examine the prophylactic effect of ondansetron and propofol against postoperative nausea and vomiting(PONV) in children undergoing tonsill ectomy Methods and Materials: Sixty children(aged 3-11 years) who underwent tonsillectomy received antiemetics (ondansetron group; ondansetron 0.1mg/kg, propofol group; propofol 0.5mg/kg) or not (control group) at the end of surgery. Anesthesia was induced with ketamine(1mg/kgiv) and rocuronium(0.5mg/kg) and maintained by inhalation anesthesia with 2-3vol% sevoflurane in 50% N_(2)O/O_(2). Premedication was given as atropine 0.01mg/kg iv. Ketorolac(1mg/kg) was injected for postoperative analgesia immediate after induction. They were monitored the incidence of PONV at operation room, postanesthetic care unit(PACU) and admission room. Results: No significant differences were observed in the total incidence of PONV among the groups. But ondansetron and propofol group made a difference(p<0.05) in the incidence of PONV at operation room compared with control group. Conclusion: In children undergoing tonsillectomy, ondansetron(0.1mg/kg) and propofol(0.5mg/kg) may have a prophylactic effect against PONV at operation room.

전신마취 후 발생한 악성고열증 환자의 치료 경험

이근무,정승환,이정한,정순호,최영균,김영재,신치만,박주열,이영민 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Malignant hyperthermia is the disorder of calcium regulation within skeletal muscle associated predominantly with anesthesia. It is triggered by volatile anesthetics and depolarizing neuromuscular blocking agents. We experienced a case of malignant hyperthermia. 50 years old female patient was transferred to our emergency room that she was developed tachyarrhythmia and high fever. She was taken arthroscopic examination under the general anesthesia with enflurane and succinylcholine. We suspected malignant hyperthermia and promptly treated her with dantrolene sodium. She was developed disseminated intravascular coagulopathy and acute renal failure then we were intensive care to her. She was discharged without sequela. We experienced successful management of malignant hyperthermia.

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.

경막 천자 후 두통 치료 목적의 자가 혈액 봉합술 시행 중 발생한 기뇌증

정순호,김책,김영환,임세훈,이정한,이근무,최영균,김영재,신치만 인제대학교 2006 仁濟醫學 Vol.27 No.-

A 57-year-old woman who was suffered from chronic back pain and radiating pain to left leg visited the local pain clinic. An accidental dural puncture happened at the L4-5 intervertebral space during the procedure with the loss of resistance technique using air. The epidural needle was removed, and a new insertion was done at the L3-4 intervertebral space with administration of the 0.5% lidocaine 8 ml mixed triamcinolone 40 mg. On the next day, she visited again the local pain clinic with complaining of headache. During an epidural autologuous blood patch procedure, she complained of a severe headache, nausea, vomiting, and developed generalized tremor of abrupt onset. There was no evidence of a dural puncture during the procedure. She was referred to our hospital at once. A brain CT scan showed air-filled cavities in basal cistern. She was given conservative treatment during 14 days. After 10 days, follow up brain CT scan showed no air-filled cavity in basal cistern. She was discharged from our hospital without complications.

췌장암 환자에서 알코올 내장신경 신경파괴블럭 후 발생한 간염

이상은,최석환,김영환,임세훈,이정한,이근무,정순호,최영균,김영재,신치만 인제대학교 2008 仁濟醫學 Vol.29 No.-

Splanchnic neurolytic block(SNB) with alcohol improves the management of pancreatic cancer pain. Adverse effects of alcohol SNB which include regional pain, hypotension, diarrhea, and acute alcohol intoxication are common, but acute hepatitis caused by alcohol neurolytic block is rare. A 63-year-old patient with pancreatic head cancer and liver metastasis had complete pain relief after both retrocrural tansdiscal SNB with 100% alcohol 10 ml. But, 1 day later, liver function test showed a high elevation in the aspartate aminotransferase (AST, 2182 IU/L) and alanine aminotransferase (ALT, 1807 IU/L). The patient had slight jaundice, general weakness, chilling, nausea and vomiting after SNB. Both AST and ALT decreased to 46 and 119 IU/L within 10 days with only supportive therapy. But, 19 days later, the patient died due to pneumonia. Our case illustrates the importance of clinical surveillance especially in patient with hepatic disease after alcohol SNB.

전기경련요법에서 remifentanil이 혈역학에 미치는 효과

정순호,이상은,임세훈,이정한,이근무,최영균,김영재,신치만 白中央醫療院 2005 仁濟醫學 Vol.26 No.1

Objective: Electroconvulsive therapy (ECT) is often associated with transient hypertension and tachycardia. Acute hemodynamic change may produce serious complications. Remifentanil is a potent ultra short acting opioid and has been found to reduce blood pressure and heart rate. The goal of this study was to evaluate effects of remifentanil on seizure duration, recovery parameters and hemodynamic changes during ECT. Methods: Ten ASA Ⅰ, Ⅱ patients enrolled in this prospective, randomized trial, each receiving more than four electroconvulsive therapy. Patients were randomized to receive placebo, group P (propofol 1mg/kg+0.9% normal saline 1ml, n=10), and propofol with remifentanil, group R (propofol 1mg/kg+remifentanil 1ug/Kg n=10). Supplemental dose of propofol was given as required to achieve loss of consciousness. We recorded hemodynamic parameters, seizure duration, and recovery parameters. Results: Seizure duration and recovery parameters were similar in group R and group P. Blood pressure and Hear rate after ECT were significantly lower in group R. Conclusions: Remifentanil(1ug/kg) attenuated the acute hemodynamic response to ECT under propofol anesthesia without adversely affecting the duration of seizure activity and recovery profile. Adjunctive use of remifentanil may be good alternative regimens for ECT.

동일한 혈관 내에 발생한 이식형 약제 주입기 카테터의 위치이상

오대석,김영재,김명훈,조광래,임세훈,이정한,이근무,정순호,신치만 仁濟大學校 白病院 2010 仁濟醫學 Vol.31 No.-

저자들은 56세 여성 환자의 왼쪽 쇄골 하 정맥에 시행한 이식형 약제주입기 카테터의 삽입 후 발생한 비정상 위치에 대한 증례를 보고하고자 한다. 카테터의 끝은 환자의 늘 어진 가슴, 체위, 신체의 움직임, 카테터의 유동성 등의 영향으로 천자된 정맥 내에서 견인되고 뒤쪽으로 이동하였다. 환자는 어떠한 증상도 호소하지 않았지만 비정상 위치의 카테터는 심각한 합병증을 유발할 수 있기 때문에 제거되었다. 따라서 시술자는 약제주입기 삽입 전에 환자의 신체 상태와 단순 흉부 촬영상을 확인하고 카테터의 비정상 위치가 발생할 수 있는 위험 징후를 알아차려야 하겠다.

극단 저체중 신생아에서의 동맥관 개존증 결찰술을 위한 진정맥 마취 경험 2례

최영균,고명진,이상은,조광래,김영환,임세훈,이정한,이근무,정순호,김영재,신치만 仁濟大學校 白病院 2010 仁濟醫學 Vol.31 No.-

Running title: Cases of anesthesia for extremely low birth weight infant. Extremely low birth weight infants (birth weight < 1000 g) are prone to various morbidities such as respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, patent ductus arteriosus, necrotizing enterocolitis and retinopathy. To accomplish successful anesthetic management, many precautions must be continuously taken during the operation. First, inspired oxygen concentration should be adjusted to avoid oxygen toxicity. Second, body temperature must be maintained adequately. Third, hemodynamic parameters should be kept stable. We report 2 cases of successful anesthetic management for extremely low birth weight infant who underwent ligation of patent ductus arteriosus at the neonatal intensive care unit.

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.

임상연구 : 수술 전 심전도 이상소견의 빈도

신치만 ( Chee Mahn Shin ),변태경 ( Tae Kyung Byun ),이재승 ( Jae Seoung Lee ),이근무 ( Kun Moo Lee ),정순호 ( Soon Ho Cheong ),최영균 ( Young Kyun Choe ),김영재 ( Young Jae Kim ),박주열 ( Ju Yuel Park ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.6