서울대학교 치과병원 장애인진료실의 외래환자마취 실태 분석

박창주,정준민,김현정,장기택,이상훈,염광원 大韓小兒齒科學會 2004 大韓小兒齒科學會誌 Vol.31 No.1

치과적 장애인이란 치과진료 시 치과의사에게 자발적인 협조가 힘든 사람을 의미한다. 본 연구는 서울대학 치과병원 장애인진료실에서 치료받은 치과적 장애인 환자들의 임상진료 실태를 마취과적으로 분석하고 향후 장애인 치과치료에 대한지침 을 마련하고자 하였다. 1999년 1월부터 2002년 10월까지 서울대학교 치과병원 장애인진료실에 내원한 장애인 환자들을 대상으로 조사한 결과, 총89명의 환자들에게 93건의 치과진료가 시행되었다. 환자의 대다수는 정신지체였고 전신마취 하 보존치료를 받았다. 주로 마취유도제는 thiopental, 근이완제는 vecuronium을 이용하였으며 산소, 아산화질소, enflurane을 함께 흡입시켜 마취를 유지하였다. 총 마취지속시간과 회복실 체류시간은 각각 164.4±57.2 분과 106.2±50.5 분이었고 회복 과정에서 심각한 합병증은 관찰되지 않았다. 본 연구는 외래환자마취에 기반한 서울대학교 치과병원 장애인진료실의 치료방침에 따라 특별한 문제없이 성공적인 마취가 가능하였음을 보여 주었다. 또한 증가하는 장애인 치과치료에 대한 수요를 충족시키기 위해서 적절한 시설과 인력을 갖춘 보다 많은 외래환자마취 센터의 필요성도 제시한다고 할 수 있다. Dentally disabled person means one who have difficulty in cooperating voluntarily with a dentist for routine dental care. Seoul National University Dental Hospital (SNUDH) Dental Clinic for Disabled has worked for them under outpatient anesthesia concept. The aim of this study was to determine the anesthetic characteristics of the patients attending for dental treatment at SNUDH Dental Clinic for Disabled in order to establish better future treatment plans. The data were drawn from the patients who visited SNUDH Dental Clinic for Disabled from January 1999 to October 2002. Total 93 dental treatments for 83 patients were enrolled in this study. Most patients had mental retardation and the conservative treatments were carried out under general anesthesia. Thiopental and vecuronium were mostly used for induction agent and neuromuscular blocker, respectively. Enflurane, with oxygen and nitrous oxide, was mostly used to maintain the anesthesia. Mean total anesthetic time was 164.4±57.2 minutes and mean duration at the post-anesthetic care unit was 106.2±50.5 min. Serious postoperative complications were not observed. These results showed our successful anesthetic outcomes without any severe side effect or complication and the needs of more outpatient centers for dental care for disabled.

2 . 연구원 활동 : 3 ) 발표논문요약 < 금속공학분야 >

(Kwang Hyun Yum),(Yoon Kil Baek),(Woo Young Yoon) 고려대학교 공학기술연구소 1997 공학기술연구소보 Vol.4 No.-

Bacillus amyloliquefaciens H41이 생산하는 Vibrio anguillarum 생육 저해인자의 정제

신현철(Hyun-Chul Shin),정경태(Kyung-Tae Chung),김광현(Kwang-Hyun Kim),김병우(Byung-Woo Kim),권현주(Hyun-Ju Kwon),이은우(Eun-Woo Lee),염종화(Jong-Hwa Yum),류은주(Eun-Ju Rhu),정유정(Yu-Jeong Jeong),김영희(Young-Hee Kim) 한국생명과학회 2008 생명과학회지 Vol.18 No.6

어류 질병 치료를 위한 probiont의 개발에 목적을 두고 어병균 Vibrio anguillarum NCMB1의 생육에 저해물질을 생산하는 Bacillus amyloliquefaciens H41균주를 분리하고 이 물질의 특성을 규명하기 위하여 정제를 시행하였다. 분리 균을 배양한 배양 상등액을 70% 염석, 투석하여 조 효소액으로 제작하고 조 효소액을 DEAE-sephadex, A-50 ion exchange chromatography, sephadex G-200 gel filtration column chromatography을 통하여 정제하고 SDS-PAGE 를 통하여 단일밴드를 확인하고 최종 회수율 2.9%을 얻을 수 있었으며 40.8배의 정제된 V. anguillarum NCMB1 생육저해물질을 얻을 수 있었다. 정제된 저해물질은 저해정도에 따라 단위를 설정하여 활성을 측정하였으며, 분자량은 48 kDa 로 확인되었으며 정제물질의 활성을 위한 최적 반응 pH와 온도는 pH 7.5와 30℃로 확인되었다. 금속이온의 효과에 있어서는 CoCl₂, HgCl₂, ZnSO₄, AgNO₃에서는 완전히 저해되는 양상을 나타내었고 MgSO₄, MnSO₄에서 미미한 효소활성의 증가를 나타내었다. 그리고 염에 관한 안정성은 일반 해수의 농도인 3%의 농도에서도 활성을 나타내는 것으로 확인되었다. 정제된 저해물질을 현재 상업적으로 사용하고 있는 화학처리제나 항생제와 함께 효율성을 비교 해 보았을 때 저해물질은 약 78%의 저해 활성을 나타내는 것을 알 수 있었고 항생제보다는 효율성이 낮았으나 독성검사를 위해 정제물질을 살아있는 어류에 투여하였으나 어떤 해수어도 폐사하지 않는 것으로 보아 어류 자체엔 독성을 나타내지 않는 물질로 나타났다. 따라서 B. amyloliquefaciens H41 균주가 생산하는 정제 물질이 V. anguillarum 생육에 저해물질로 작용하는 것으로 밝혀졌으며 친환경적인 특성을 가진 물질로 밝혀졌다. To study the possible use of probiotics in fish farming, we evaluated antagonism of antibacterial strain Bacillus amyloliquefaciens H41 against the fish pathogenic bacterium Vibrio anguillarum NCMB1. The purification of growth inhibition factor produced by B. amyloliquefaciens H41 was achieved by obtaining supernatant of this bacterium. The growth inhibition factor was purified to homogeneity by 70% ammonium sulfate precipitation, DEAE-sephadex A-50 ion exchange chromatography, sephadex G-200 gel filtration column chromatography, and sephadex G-50 gel filtration column chromatography with 40.8 fold of purification and 2.9% yield. The molecular weight of the purified growth inhibition factor was 48 kDa as determined by sodium dodecyl sulfate polyacrylamide gel electrophoresis. The optimum pH and temperature for the growth inhibition factor were pH 7.5 and 30℃, respectively. The activity of growth inhibition factor was enhanced slightly by some metal ions, such as Mg?², Mn?², but was inhibited by the addition of Co?², Hg?², Zn?² and Ag?². NaCl stability of the growth inhibition factor was observed with 50% residual activity at 3% NaCl concentration. Toxicity test showed that the purified B. amyloliquefaciens H41 growth inhibition factor did not affect the live of Japanese flounder (Paralichthys olivaceus) and the effectiveness was 78% of residual lethality compared to commercial antibacterial agents.

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)

Cimetidine, Ranitidine 및 Famotidine 전처치가 위액의 용량과 산도에 미치는 영향 비교

염광원,이원영,김현정 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.4

Background : Aspiration pneumonitis is one of the most severe anesthetic complications. The severity of this complication is associated with the acidic nature of aspirated gastric juice. H2 receptor antagonists inhibit gastric acid secretion and elevate the gastric juice pH. The purpose of this study was to compare the effects of preoperative night cimetidine, ranitidine and famotidine medications on gastric volume and pH. Methods : We studied 84 healthy patients, ASA physical status I or II, who were each randomly allocated to one of 4 groups. Group I ingested only 200 ml of milk up to 8 10 hours prior to anesthesia. Groups II, III and IV ingested 200 ml of milk and 400 mg of cimetidine, 150 mg of ranitidine and 20 mg of famotidine, respectively, on the evening before elective surgery. After the induction of anesthesia, gastric juice was collected with 18 French Salem sump tube, and gastric volume and pH were measured. Results : There were no significant differences in gastric juice volume among the numbers of the 4 groups. However, Group IV (famotidine) showed a significant high pH, compared with the other groups. Conclusions : Famotidine 20 mg, which is premedicated on the evening before elective surgery, is more effective in preventing aspiration pneumonitis than cimetidine 400 mg and ranitidine 150 mg. (Korean J Anesthesiol 1999; 37: 556∼562)

전신마취시 파모티딘 전처치가 위내용물의 용량과 산도에 미치는 영향

염광원,김현정,배성빈 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.4

Background: Severity of aspiration pneumonitis is associated with acidity and volume of aspirated gastric contents. Volume and acidity of gastric contents are influenced by food, drugs, and patient factors. However, most studies were performed without controlling these factors. The objectives of this study were to determine the effects of a 20 mg intravenous famotidine injection on gastric content volume and acidity. 1 to 2 hours prior to general anesthesia after controlling the last intake of food. Methods: One hundred twenty three healthy patients were randomly assigned to famotidine and control groups. All patients were requested to drink 200 ml of milk the night before surgery in order to control food related factors and fasting time. After induction of general anesthesia, volume and acidity of aspirated gastric contents were measured. Results: There were no significant differences in acidity of aspirated gastric contents between the two groups. However, the famotidine group showed a significant aspirated gastric volume reduction compared with that of the control group. Conclusions: Famotidine premedication by intravenous injection 1 to 2 hours prior to general anesthesia may be effective to prevent aspiration pneumonitis by reducing gastric content volume. (Korean J Anesthesiol 2001; 40: 443 ~447)

경비 기관내 삽관 후에 발생한 합병증에 관한 전향적 연구

염광원,김현정 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.1

Background : Nasotracheal intubation is commonly and safely used in the anesthetic management of patients undergoing head and neck surgeries. There are some kinds of reports about complications associated with nssotracheal intubation which are related to long intubation period in the intensive care unit. But there are few reports about complications after nasotracheal intubation in surgery patients. A prospective study was carried out to evaluate the incidence and outcome of complications of nasotracheal intubation in oral and maxillofacial surgery patients in the Seoul National University Dental Hospital. Methods : We studied 317 nasally intubated patients over 8 months. Endotracheal tubes softened by soaking in hot nonnal saline were used. After general anesthesia, we followed the hospital course of patients from the view point of the incidence and outcome of complications associated with nasotracheal intubation. Results: The overall complication rate was 27.1%. Nasal bleeding and benign nasal obstruction were the most frequent events, accounting for a mean of 15.5% and 9.8%, respectively. Other low incidence complication was ulceration of the nose, None of the complications were fatal or resulted in serious sequelae. There was a slight relationship between complications and age or intubation period. Conclusions : These results suggest that short term use of nasotracheal intubation may be as safe as orotracheal intubation. Complications may be associated with elderly patients and long intubation duration over than 24 hours in surgery patients. (Korean J Anesthesiol 2000; 39: 72~76)

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.

금식시간에 따른 위내용물의 양과 산도에 관한 연구

김현정,박은진,염광원 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5

Background : Gastric juice volume and acidity are influenced by food, drugs, and patient factors such as age, sex, weight, and fasting time. But almost studies were performed without controlling of these confounding variables. This study was designed to determine the change of gastric juice volume and acidity in relation to the fasting time within a constant food intake. Methods : Fifty-seven healthy patient randomly allocated to one of two groups. Group I was instructed to ingest 200 ml of milk up to 8 hours before anesthesia and Group II was instructed to drink 200 ml of water up to 1∼2 hours before anesthesia. After the endotracheal intubation the volume and acidity of gastric juice were measured. Relationships between gastric volume or acidity and fasting time were analysed using correlation analysis. The data were analyzed using Wilcoxon rank sum test, comparing Group I with Group II. Results : There is no significant relationship between gastric juice volume or acidity and the fasting time within the same food intake. Gastric juice volume and acidity of the patients who ingested milk at 8∼9 hours before anesthesia were similar to that of those patients who drank water at 1∼2 hours before anesthesia. Conclusion : It is necessary to individualize the fasting time of the patients and it seems that water ingestion up to 1∼2 hours before anesthesia may be safe. (Korean J Anesthesiol 1998; 35: 870∼876)

重患者의 呼吸管理 實態報告

金光字,金聖德,廉廣元,申玄羽,金庸榮,郭一龍 대한의학협회 1976 대한의학협회지 Vol.19 No.9