전신마취하 구강악안면외과 수술환자에서 마취 및 수술시간이 술후 회복에 미치는 영향

염광원(Kwang Won Yum),남일우(Il Woo Nam),심유진(Yu Jin Shim),표성운(Sung Woon Pyo),한원일(Won Il Han),김규식(Kyoo Sik Kim) 대한구강악안면외과학회 1992 대한구강악안면외과학회지 Vol.18 No.3

To evaluate the effect of the duration of general anesthesia and surgery on the postoperative recovery, the 66patients with oral-maxillofacial surgery were divided into 5 experimental groups. According to he duration of anesthesia and surgery, the patients who had the 2 hours, 2 to 3 hours, 3 to 4 hours, 4 to 5 hours duration of anesthesia and surgery and more than 5 hours duration of anesthesia and surgery were allocated as a patient of experimental group A, B, C, D or E. The recovery indexes such as patient s mobility, respiratory status, change of systolic blood pressure, status of consciousness and skin colour were used to measure the patient s recovery state immediately after arriving on postoperative recovery area, and to measure the time to score the 10 points (full recovery state) of the recovery indexes in the postoperative area. Also the total duration of the patient s staying at postoperative area was measured. The following results were obtained: 1. There were no significant difference in patients from experimental group A to D on the average scores of the recovery indexes immediately after arriving on the postoperative recovery area. 2. In patients of experimental group E, the scores of the recovery indexes were significantly lower than the patients of any other experimental group. 3. The average full recovery time of the patients in the experimental group A was significantly shorter than the patients of any other experimental group. 4. The average full recovery time in patients of the experimental group B was also significantly shorter than the patients of experimental group E. 5. There was no significant changes on the average total duration of the patient s staying at the postoperative area in the patients of the experimental group A and B, but these patients were significantly shorter than the patients of the experimental group C, D or E on the patient s average total duration of staying at the postoperative area.

TWO CASES OF FIBREOPTIC ENDOSCOPIC INTUBATION

염광원(Kwang Won Yum) 대한구강악안면외과학회 1985 대한구강악안면외과학회지 Vol.11 No.1

구강개폐가 곤란한 2명의 남, 여 환자에서 Fibreoptic Endoscope을 이용하여 기관튜브를 삽관하여 마취관리를 효과적으로 시행하였기에 보고하는 바이다.

Lidocaine의 후두분무후 기관튜브삽관이 혈압 및 심박수에 미치는 영향

염광원(Kwang Won Yum),김경원(Kyoung Won Kim),김병린(Byeong Rin Kim) 대한구강악안면외과학회 1989 대한구강악안면외과학회지 Vol.15 No.2

The effects of endotracheal intubation with laryngoscope on the blood pressure and the heart rates were evaluated in 20patients with oral surgery under general anesthesia. The 20 patients were divided into 2 groups. One group of 10 patients were sprayed on the larynx with 4% lidocaine, 120㎎, 3 minutes before intravenous administration of pentothal sodium and succinylcholine. The results are followings ; 1. The systolic, diastolic, and mean arterial blood pressure were significantly increased in both group after intubation, but the degree of changes in blood pressure was more remarkable in patients without lidocaine spray. 2. The heart rates were significantly increased in both group after intubation and no significant changes were observed in patients with lidocaine spray compared with the control group after intubation. 3. The mean arterial pressure was significantly increased in both group after intubation, but the degree of increase in mean arterial pressure was more significant in patients without lidocaine spray. 4. The heart rates were increased significantly in both group after intubation.

비강 삽관시 Lidocaine정주가 맥박 및 혈압에 미치는 영향

염광원(Kwang Won Yum),조용석(Yong Seok Cho),유준영(Jun Young You) 대한구강악안면외과학회 1992 대한구강악안면외과학회지 Vol.18 No.1

In 45 patients undergoing oromaxillofacial surgery under the general anesthesia, the blood pressure (systolic and diastolic) and heart rates were measured to evaluate the effects of the nasotracheal intubation on the hemodynamic changes. And for evaluating the effects of lidocaine on the blood pressure and heart rates after nasotracheal intubation, lidocaine HCl 1.0mg/kg and 1.5mg were administered intravenously. The following results were obtained: 1. The significant increase of systolic blooc pressure were olserved from one to three minutes after nasotracheal intubation in patients without I.V. lidocaine injection. Compared with the systolic blood pressure before nasotracheal intubation. 2. In patients with Ⅳ lidocaine, 1mg/kg before masotracheal intubation. There were the significant increses of syotolic blood pressure of one and two minutes after nasotracheal intubation compared with systolic blood pressure before nasotracheal intubation. 3. In patients with Ⅳ lidocatine, 1.5mg/kg before nasotracheal intubation, there was significant increase one minute after intubation compared with the systolic blood pressure before intubation. 4. There were the significant decrease of systolic blood pressure one minutes after nasotracheal intubation in patients with Ⅳ lidocaine, 1mg/kg and compared with the value of control group. 5. There were the significant decreases of systolic blood pressure after nasotracheal intubation in patients with Ⅳ lidocaine 1mg/kg one to these minutes after intubation compared with the values of control group.

Dental Treatment for Handicapped Patients in Day Care Units: 2 Years' Experience at Seoul National University Dental Hospital

박창주,염광원,김현정,Park, Chang-Joo,Yum, Kwang-Won,Kim, Hyun-Jeong The Korean Dental Society of Anesthsiology 2002 Journal of Dental Anesthesia and Pain Medicine Vol.2 No.1

연구배경: 장애인의 치과치료는 일반인의 치과치료와는 달리 많은 문제점들을 가지고 있다. 이러한 장애인 환자의 치과치료를 위하여 서울대학교 치과병원에서는 치과마취과를 중심으로 임상 각과가 협진하여 외래마취 기반 하에 1999년부터 장애인 진료실을 운영하고 있다. 이번 연구에서는 서울대학교 치과병원 장애인 진료실의 치료방법을 소개하고 그 동안 치료받은 장애인 환자들의 자료를 바탕으로 마취과적인 특징을 분석하였다. 방법: 2001년 1월부터 2002년 5월까지 치료받은 총 54명의 장애인 환자들의 치료기록지와 마취, 그리고 회복실 기록지를 검토하였다. 환자의 성별, 나이, 전신질환, 수술 전 시행된 검사, 치료에 참여한 협진과, 마취 유도제와 유지제, 총 마취시간과 회복실 체류시간, 그리고 회복실에서 관찰된 합병증을 조사하였다. 결과: 총 54명의 환자들을 대상으로 58건 치과치료가 시행되었다. 한 건의 의식진정 법을 제외하고는 모두 전신마취 하에서 치과치료가 시행되었다. 마취유도제는 thiopental sodium, 근이완제는 vecuronium과 succinylcholine가 가장 많이 사용되었으며 마취 유지를 위해서는 enflurane과 isoflurane의 흡입마취제를 이용하거나 TCI를 이용한 propofol 지속정주를 이용하였다. 총 마취지속시간은 $160.2{\pm}55.5$분이었으며 회복실에서의 체류시간은 $132.8{\pm}50.1$분, 그리고 완전한 회복을 확인하기 위해 병동에 단기 입원시킨 소아환자에서는 $58.7{\pm}16.8$분이었다. 회복실에서 심각한 합병증은 발생하지 않았다. 지속적인 감시를 위하여 4명의 환자가 입원을 권유받았으나 특별한 합병증 없이 다음 날 퇴원하였다. 결론: 서울대학교 치과병원 장애인 진료실은 외래마취에 대한 기존의 연구들보다 긴 마취시간과 회복실 체류시간을 보였다. 그러나 별다른 합병증 없이 일회 방문으로 장애인 환자들에게 필요한 치과치료를 모두 제공할 수 있었다.

임상연구 : 상하지 광체적변동파형(Photoplethysmogram)의 진폭과 맥파전도시간을 이용한 지속적 동맥혈압 추정

서광석 ( Kwang Suk Seo ),김정수 ( Jung Soo Kim ),안원식 ( Won Sik Ahn ),박광석 ( Kwang Suk Park ),김현정 ( Hyun Jeong Kim ),염광원 ( Kwang Won Yum ),구의경 ( Eui Kyoung Goo ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2

Background: The amplitude (AMP) of Photoplethysmogram (PPG) is used as a marker of vasodilatation. The pulse transit time (PTT), which shows a good correlation with blood pressure (BP), is not strong enough to detect the changes in BP. This study examined the sensitivity of the combined effect of the finger and toe AMP, and the PTT of PPG as a marker of the changes in BP during general anesthesia. Methods: Forty patients receiving maxillofacial surgery under general anesthesia were enrolled in this study. During surgery, the intra-arterial BP, ECG, finger and toe PPG signals were measured. Using the R-wave from the ECG, the AMP and PTT was derived from PPG data. The correlation between BP and PPG parameters (AMP and PTT) were compared. New parameters that show high correlation with the BP were found. Regression equations for calculating the BP using the PPG parameters were formulated. Results: The new parameter, log (fingerAMP/toeAMP), showed the highest correlation in each patient (mean correlation coefficient in the systolic BP: -0.846, diastolic BP: -0.858). However, when the data from all 40 patients were combined, the correlation coefficient of the toe PTT was highest (systolic BP: -0.726, diastolic BP: -0.646). The regression equation showed the highest correlation between the actual BP and calculated BP when the toe PTT and log (fingerAMP/toeAMP) were included. Conclusions: The AMP of the toe and finger PPG can be used to estimate the invasive continuous blood pressure. (Korean J Anesthesiol 2007; 53: 159~68)

정신지체와 만성신부전을 동반한 결절성경화증 환자의 전신마취 하 치과치료

서광석(Kwang-Suk Seo),이소영(So-Young Lee),백경원(Kyung-Won Baek),김현정(Hyun-Jeong Kim),염광원(Kwang-Won Yum) Asia association of Disability and Oral health 2005 International Journal of Disability and Oral Healt Vol.1 No.1

치과 환자에서의 $Perfusor^{\circledR}$ fm 자가통증조절기를 이용한 Propofol 자가진정조절법

박창주,염광원,김현정,Park, Chang-Joo,Yum, Kwang-Won,Kim, Hyun-Jeong 대한치과마취과학회 2002 Journal of Dental Anesthesia and Pain Medicine Vol.2 No.2

Background: Patient-controlled sedation (PCS) has been blown for a safe and effective sedative method on the same pharmacological concepts of patient-controlled analgesia. Many different kinds of infusion devices have been used but they often have too long nominal infusion rate and lockout time. $Perfuser^{\circledR}$ fm (B. Braun, Germany) is a new PCA device with 999.9 ml/hr nominal infusion rate and minimum 1 min lockout time. In this study, the feasibility of propofol PCS using $Perfuser^{\circledR}$ fm was examined in order to provide a safe satisfactory sedation for dental patients. Methods: Eleven healthy patients presenting for oral surgery were studied. Propofol PCS was performed using $Perfuser^{\circledR}$ fm, which was set to deliver a bolus dose of 5 mg with 999.9 ml/hr nominal infusion rate and 1 min lockout time. Propofol loading dose was randomly assigned to a bolus dose ${\times}$ 0, 2, and 3 (initial bolus). Patients were told to press the bolus button as often as they needed to relieve discomfort. Results: Total infused dose of propofol was mean 1.8 mg/kg/hr and D (Delivery)/A (Attempt) ratio was mean 72.8%. All patients was awake and there were no clinically significant intraoperative side effects during the sedation. Almost all patients were very satisfied with this type of PCS. Conclusion: Propofol PCS using $Perfuser^{\circledR}$ fm infusion pump provided good conscious sedation for dental procedures.

정신지체가 동반된 뇌성마비 환자의 임플란트 치료를 위한 CT 촬영 시 진정법 시행

서광석(Kwang-Suk Seo),이주환(Ju-Hwan Lee),신터전(Teo-Jeon Shin),이영은(Young-Eun Yi),김현정(Hyun-Jeong Kim),염광원(Kwang-Won Yum),김명진(Myung-Jin Kim) Asia association of Disability and Oral health 2008 International Journal of Disability and Oral Healt Vol.4 No.1

A 33-years-old female pateint with cerebral palsy showing spastic quardriplegia and severe mental retardation was scheduled for dental implant restorations. Before implant surgery we had to take implant CT. But, because of her involuntary motion and communication difficulty, sedation was needed in order to take CT. After 8 hour NPO, propofol infusion sedation with TCI (target controlled infusion) system was administered. The propofol blood concentration of the patient was maintained 2-3 μ/ml to keep deep sedation to prevent uncontolled movement. During sedation, we monitored ECG, pulse oximetry, blood pressure, capnometry for patient safety. Oxygen was administered via nasal prong for preventing hypoxemia and to keep airway during sedation some bands were applied to lift mandible. Total duration was 20 minutes for taking CT, and she was discharged from hospital after 30 minute rest without complication.

Relationship between Bispectral Index, Sedation Score and Plasma Concentration, during Midazolam Sedation

박은진,박창주,염광원,김현정,Park, Eun-Jin,Park, Chang-Joo,Yum, Kwang-Won,Kim, Hyun-Jeong The Korean Dental Society of Anesthsiology 2001 Journal of Dental Anesthesia and Pain Medicine Vol.1 No.1

연구배경: 임상적으로 진정법을 시행할 경우 뇌의 상태에 대한 접근은 매우 중요하다. 환자의 뇌에 대한 마취제의 영향을 측정하기 위해 개발된 Bispectral Index (BIS)는 환자의 진정을 방해하지 않고 객관적인 진정정도를 평가할 수 있다. 그러나 이는 항상 진정 깊이의 임상적인 척도와는 일치하지 않는다. 이번 연구에서는 진정법 시행시 환자의 진정 정도를 측정하기 위한 BIS의 유용성을 검증하기 위하여 BIS, 진정점수, 그리고 midazolam의 혈중 농도와의 관계를 연구하였다. 방법: 25명의 건강한 성인 지원자들을 대상으로 무의식을 유도하기 위하여 midazolam 0.08 mg/kg을 정맥으로 주입하였으며 환자의 의식 상태를 진정 회복 시까지 관하였다. BIS와 진정점수는 진정 전과, midazolam 투여 후 10, 20, 30분 간격으로 측정하였다. Midazolam의 혈중 농도는 주입 후 10분 경과 후에 정맥혈 채취 후 HPLC를 이용하여 측정하였다. BIS는 BISTM monitor (Aspect Medical Systems, USA)으로 측정하였으며 또한 진정 정도는 진정 점수로도 평가하였다. 결과: BIS 수치는 진정점수와 유의한 상관관계를 보였다(r = 0.676, p < 0.05). 혈중 midazolam 농도가 감소함에 따라 혈중 농도는 진정점수와 유의한 상관관계를 보였다(r = -0.656). Midazolam 투여 후 10분에서 BIS 수치와 midazolam의 혈중 농도는 유의한 상관관계를 보이지 않았지만(r =0.467) 진정 후 수치는 진정 전 수치와 명확히 구분되었다. 결론: BIS는 환자의 수면상태의 효과적인 척도로 알려져 있으며 진정점수와도 높은 상관관계를 보였다. 그러나 항상 진정 깊이를 나타내는 임상적인 척도와는 일치하지 않았다. 그러므로 진정법 시행동안 BIS 만을 사용하는 것은 더욱 많은 주의가 필요하며 매 주어진 시간마다 다양한 진정 점수 측정방법으로 환자의 의식을 감시하는 것이 추천된다.