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구길회 ( Gill Hoi Koo ),정용훈 ( Yong Hun Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2
Background: As the problems of medical malpractices become a very serious social issue, it is necessary to increasingly relate law to medical practice and evaluate medical services. However, it is not easy to legally call someone to account, as medical services are highly specific, especially anesthetic management. Anesthesiologist can expect to be involved in legal action alleging malpractice, either as a defendant or expert witness. Methods: The anesthetic informed consent form was examined at 42 general hospitals in the Republic of Korea. The chief physician of the department of anesthesiology and pain medicine was asked for the anesthetic informed consent form they used in clinical anesthetic practice, and then what constitutes adequate informed consent analyzed. Results: All of the hospitals were using informed consent forms, but 42.9% of the hospital used a specific form to describe the complications or risks associated with anesthetic management. In 71.4% of hospitals, the anesthesiologists or anesthetic residents explained the anesthetic risk, but 28.6% of hospitals the anesthetic complications were explained by nurses or surgeons. In 76.2% of hospitals, the anesthetic risks were explained to both the patients and parents, but in 23.8% these were explained to parents only. Conclusions: We propose a new anesthetic informed consent form for adequate explanation and agreement to legal requirements. (Korean J Anesthesiol 2007; 52: 179~86)
담낭절제술 환자에서 늑막강내에 투여된 Bupivacaine의 진통효과
구길회(Gill Hoi Koo) 대한통증학회 1989 The Korean Journal of Pain Vol.2 No.2
N/A Inadequate pain relief after upper abdominal surgery increases the incidence of pulmonary compli- cations due to the difficulty in coughing and deep breathing. Kvalheim and Reiestad (1984) introduced intrapleural administration of local anesthetic solutions to produce analgesia following cholecystectomy performed through a subcostal incision, unilateral breast surgery and renal surgery. We studied continuous intrapleural administration of bupivacaine and epinephrine, and its effect in controlling pain after cholecystectomy. In 9 patients, an intermittent dosage technique was used. An intrapleural catheter was inserted and 20 ml of 0.5% bupivacaine and 1:100,000 epinephrine was administered. Results were as following: 1) Mean analgesic duration from the initial intrapleural injection to secondary administration of supplementary bupivacaine was 13.5 hours. 2) No specific changes were noted on vital signs and arterial blood gases. 3) Effective analgesia, produced by intrapleural bupivacaine resulted in significant improvement in tidal volume as measured by spirometry. 4) No signs of systemic toxicity and complications were encountered. 5) lntrapleural administration of a local anesthetics after cholecystectomy provides a satisfactory duration of analgesia.
천골강내(薦骨腔內)에 투여된 Pentazocine 의 진통효과
구길회 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.5
In relief of postoperative pain, the value of epidural or subdural injection of opioids including morphine, methadone, petidine and fentanyl is now well established. The advantages of epidural or subdural over parenteral opioids is prolonged duration of analgesia, which last from several hours to several days, without sympathetic and motor blockade. But undesirable side effects include pruritus, urinary retention, delayed onset of somnolence, and cardiovascular and respiratory depression. To reduce postoperative pain, we evaluated the effects of caudal pentazocine 0.2-0.4 mg/kg with lidocaine 1.5% 400 mg for perianal surgery in 36 cases. The results were as follows: 1) There was no difference in analgesic onset between the Control Group (used lidocaine only) and Group A and B (mixed use of lidocaine and pentazocine: Group A, 0.2 mg/kg pentazocine; Group B, 0.4 mg/kg) 2) Mean duration of analgesia following caudal pentazocine and lidocaine injection was over 12 hours, but was less than 5 hours in the used lidocaine only. 3) Urinary retention was observed in all groups; 3 case in the Control group, and 4 cases in Group A and B. 4) In Group A and B, 6 cases had not used analgesics within 24 hours after caudal anesthesia. 5) No specific clinical changes were noted in the vital signs in all groups.
구길회 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.8
Today, the medical disputes are increased with the background of increased awareness of human rights, depersonalization in patient-physician correlationship, commercialization of medieal delivery and non-existence of social compensation for medical damage. Especially the anes olagists worked at operative wards have the risk of several pmblems occurred from various surgical and medical causes, and be involved in legal action alleging malpractice. To reduce this problems of medical dispute, theoretically anesthesiologist must always establish the rapport with patients, and summary the patient's pertinent points of the history, results of physical exarnination, laboratory examination and interview, including a statement of any unusual risk, type of anesthesia planned, and the reasons for the choice of anesthesia after careful evaluation of patient's condition, and get the $quot;informed consent$quot; from patient. Therefore we investigated the statement of the informed consent for anesthesia in Korean general hospitals. Specific formula of anesthetic informed consent was used in only 7 hospitals (12.7%), and 19 of 55 generai hospitals (34.5%) get the informed consent in cases of high risk with cardiac, respiratory, central nervous system, hepatic and renal diseases.