소아에서 하악골절 전신마취시 굴곡성 내시경과 유도선을 이용한 경비 기관내 삽관

이가영,염광원,김현정 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.1

Although the endotracheal intubation using laryngoscope can usually be performed under general anesthesia, it may be very difficult in situations such as head and neck trauma, hemorrage, or deformity. Recently we performed antegrade fiberoptic nasotracheal intubation with a guide wire. A 15-month aged female child with mandibular fracture was scheduled for open reduction and internal fixation under general anesthesia. She was anticipated difficult intubation due to displacement of the fracture site. After induction of anesthesia, we passed an adult fiberoptic bronchoscope (O.D. 3.8 mm, LF-2, Olympus optical co, Japan) to vocal cord via right nostril. Then a guidewire was inserted through the suction port of bronchoscope, and bronchoscope was removed in a state of guidewire in situ. We slid the endotracheal tube over guidewire according to Seldinger's technique. We think that nasotracheal intubation using an adult fiberoptic bronchoscope and a guidewire is good for children under 2 years old who are expected the difficult intubation. (Korean J Anesthesiol 1999; 36: 162∼164)

Intratracheal Pulmonary Ventilation (ITPV)

Ka Young Rhee,Kook Hyun Lee Korean Society of Critical Care Medicine 1997 Acute and Critical Care Vol.12 No.2

No abstract available.

노년기 자아통합 집단 프로그램 개발

이가옥(Ka-Oak Rhee),이현송(Hyun-Song Lee) 한국노년학회 2004 한국노년학 Vol.24 No.1

노년기의 자아통합감을 유지하는 것은 현대 사회에서 매우 중요한 과제이며, 에릭슨은 노년기에 이루어야할 핵심적 발달과제로 '자아통합'을 지적하였다. 에릭슨에 따르면 노년기에는 '자아통합'이라 하여 기본적으로 과거 경험을 재음미하고 검토해보며, 그들이 살아온 인생을 가치 있는 삶으로 평가ㆍ수용하여 자신의 삶에 대하여 정돈해 보고 싶은 내적인 욕구가 존재한다. 본 연구는, 노인의 자아통합 욕구에 부응하는 집단 프로그램을 설계하고 실행과정을 거치면서, 현실 적용 가능한 집단 프로그램을 개발하는 것을 목표로 하였다. 본 논문은 크게 세 부분으로 나누어진다. 먼저 자아통합 프로그램의 이론적 기초를 간단히 서술한 후, 본 프로그램을 목적, 구성 등의 프로그램 설계를 제시하고, 프로그램의 실행과정을 분석적으로 기술하였으며, 아울러 프로그램 실행시의 유의점을 논의하였다. This paper is focused on the development of a group program for achieving the self-integration of the elderly. In this program the elderly are assisted to reorganize, make sense of, and have positive feeling of their past experiences and whole lives. A whole process of a program development on the subject is explained; theoretical background, framework of the program, details for the execution of a group work, report of a pilot execution, and finally, evaluation of the program. The program has a broad schema consisting of three parts; building intimacy, sharing experiences, and self-evaluation. A leader assists the participants of six to seven persons to open their mind and reflect upon their own lives while listening to other's experiences in a group meeting. In the program the participants are supposed to have weekly meetings for seven weeks consecutively. The two times of pilot executions in different places show that the program works well in the real field. An independent evaluation also tells that the satisfaction of participants as well as the accomplishment of the objectives are substantially large for a pilot execution.

거대자궁경부근종의 1예

박경애(KA Park),이정(J Rhee),류청희(CH Yu),현은희(EH Hyun) 대한산부인과학회 1971 Obstetrics & Gynecology Science Vol.14 No.2

희유한 거대자궁경부근종의 1예를 경험하였기에 이에 대한 간단한 문헌고찰과 함께 보고하는 바이다. A case of rare giant cervical myoma is presented with a brief review of literature.

가토를 대상으로 Oleic Acid로 유발한 급성 호흡부전증에서 기관내 폐환기법이 사강과 기도내 압력에 미치는 효과

이국현,이가영,김광우,정성량,강양자 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.3

Background : Intratracheal pulmonary ventilation (ITPV) was developed to allow a decrease in physiological dead space during mechanical ventilation. To reduce anatomic dead space, a reverse thrust catheter (RTC) is introduced into an endotracheal tube (ETT) through an adapter and positioned just above the carina inside the ETT. ITPV can be combined with pressure control mode of mechanical ventilation to make hybrid ventilation(HV). The effect of HV on the reduction of dead space was compared with that of conventional mechanical ventilation(CMV) in rabbits with acute respiratory failure. Methods : Oleic acid of 0.06 ml/kg was injected to induce acute respiratory failure in 7 rabbits. PaO2 and PaCO2 were measured 30 minutes after the injection. Oleic acid was injected in another 7 rabbits to compare CMV with HV while increasing the respiratory rate(RR). Tidal volume, dead space(VD) and peak inspiratory pressure(PIP) were measured at the same RR. Results : PaO2 decreased significantly from 467± 68 mmHg to 156 6 mmHg at FIO2 1.0 after the injection of oleic acid. In another 7 rabbits, the VD's of CMV were 34± 10 ml, 27 ±10 ml, 20± 6 ml, and 18± 3 ml at respiratory rate of 20/min, 40/min, 80/min and 120/min, respectively. The VD's of HV were 28 ±11 ml, 16± 8 ml, 9± 4 ml, and 7± 3 ml at the same respiratory rates as in CMV. The VD's of HV were lower than those of CMV. The PIP's were lower in HV than in CMV. Conclusion: We conclude that HV, as the modification of ITPV, can be applied to acute respiratory failure to minimize the airway pressures and dead space of CMV. (Korean J Anesthesiol 1997; 32: 360∼365)

증례 : Kartagener 증후군 환자의 급성호흡부전 -비침습적 환기치료로 호전된 1예-

백경현 ( Kyung Hyun Paeck ),이가영 ( Ka Young Lee ),민경훈 ( Kyung Hoon Min ),박성주 ( Seoung Ju Park ),이흥범 ( Heung Bum Lee ),이용철 ( Yong Chul Lee ),이양근 ( Yang Keun Rhee ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1S

술후 회복기환자에서 기관내 튜브의 기낭 사용 여부에 따른 동맥혈 가스 분석치의 비교

이국현,이가영 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.1

An endotracheal tube (ETT) may be thought of as a mechanical burden to a spontaneously breathing patient because increases in airway resistance might result in increases in the work of breathing,when diameter of airway is decreased in the intubated patient compared with his own tracheal diameter. We hypothesized that air removal from ETT cuff would permit the airflow between ETT and tracheal wall and could make the airway resistance decrease. Postanesthetic patients after abdominal surgery were divided into two groups. ETT cuff was inflated in group 1 (n=25) and deflated in group 2 (n=25), while 5 l/min of oxygen was delivered through the ETT via a simple oxygen supplement device without a gas reservoir. The effects of balloon on gas exchange and respiratory pattern were evaluated at 5 and 30 minutes after admission to the recovery room. Postanesthetic PaO₂ was increased compared to preanesthetic value with oxygen supply. PaCO₂ values revealed no significant changes in preanesthetic and postanesthetic periods. Postanesthetic respiratory rate was increased significantly but there was no difference between two groups. However, there were three hypoxemic patients whose PaO2 were below 70mmHg in group 1. It was concluded that the use of balloon of ETT in postanesthetic recovery period might contribute to airway resistance and the work of breathing. Although almost of patients could make compensations to overcome the effects of balloon, there is a risk of postoperative hypoxemia if compensated inadequately.

증예(症例) : Kartagener 증후군 환자의 급성호흡부전-비침습적 환기치료로 호전된 1예

백경현 ( Kyung Hyun Paeck ),홍윤경 ( Yun Kyung Hong ),이가영 ( Ka Young Lee ),김소리 ( So Ri Kim ),민경훈 ( Kyung Hoon Min ),박성주 ( Seoung Ju Park ),이홍범 ( Heung Bum Lee ),이용철 ( Yong Chul Lee ),이양근 ( Yang Keun Rhee ) 전북대학교 의과학연구소 2006 全北醫大論文集 Vol.30 No.1

Kartagener 중후군 환자에서 급성호흡부전이 발생할 경우, 원인이 되는 호흡기 감염과 염증을 조기에 치료하고 이에 더불어 발생하는 심각한 호흡부전상태를 해결하기 위해 기관내 삽관을 통한 침습적 기계호흡을 대신하여 비침습적 양압환기를 시도해 볼 수 있다. 이러한 비침습적 양압환기는 효과적으로 적절한 가스 교환과 호흡근의 휴식을 가능하게 하여 생존율을 향상시키며, 반복되는 기관내 삽관 또는 기관절개술로 인한 합병증을 줄이고 언어, 식사 등의 일상생활을 가능하게 하여 삶의 질을 향상시킬 수 있는 장점을 가진다. 효과적인 비첨습적 양압환기를 위해서는 적절한 마스크의 선택과 정확한 착용이 중요하고 환자의 교육과 격려가 필요하다. 저자들은 Kartagener 증후군으로 치료받던 환자에서 폐렴과 동반되어 발생한 급성호흡부전을 항생제 치료와 함께 흡기시 양기도압과 호기시 양기도압을 조절하는 자발호흡 방식의 비첨습적 양압환기를 시행하여 성공적으로 치료하였기에 문헌 고찰과 함께 증례를 보고하는 바이다. Kartagener`s syndrome is characterized by the triad of situs inversus, bronchiectasis, and chronic pansinusitis. With pulmonary infection such as pneumonia or other certain conditions, pulmonary symptoms of Kartagener`s syndrome are aggravated and hypoventilation and hypercapnia are exacerbated. These conditions may induce acute respiratory failure (ARF). Noninvasive positive pressure ventilation (NPPV) is well tolerated and safe, and it has assumed a prominent role in the management of ARF. The attraction for NPPV relates primarily to its advantages over invasive mechanical ventilation. It is used in patients with ARF due to exacerbations in chronic obstructive pulmonary disease or cardiogenic pulmonary edema. We report a case that ARF in a patient with kartagener`s syndrome is successfully treated with NPPV.

통원 수술 환자의 퇴원 기준으로서 PAR Score와 Modified PADSS의 유용성

엄우식,이가영,김광우,최익현,전윤석,권윤상,김유홍 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5

Background : Although an ambulatory surgical practice continues to increase, there is a few data exist about patient discharge criteria. This study was undertaken to evaluate the usefulness and safety of Aldrete PAR (postanesthetic recovery) score and modified PADSS (modified postaneathesia discharge scoring system) on ambulatory surgery patients for recovery in Korea. Methods : Demographic, anesthetic data, Aldrete PAR score and modified PADSS on 279 patients were recorded. The time to dicharge, from recovery room and postoperative complications were evaluated, also. Results : PAR score and modified PADSS are correlated to length of stay in ambulatory surgery center. 24hr after discharge, 16% patients complained postoperative complications. Pain was most frequent postoperative complication. The PAR score was correlated with the occurrence of the complication. Conclusion : PAR score and modified PADSS are useful scoring systems to evaluate patients and make a decision to discharge the patients from ambulatory surgery center in safe. (Korean J Anesthesiol 1998; 35: 983∼987)

잡견에서 Bupivacaine 주입에 의한 심박출량 감소의 예측지표에 관한 연구

김진태,김지애,조현성,이가영,이국현 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.6