증례 : 전신마취후 발생한 전격성 간염 ( Cases Report : Fulminant Hepatitis following General Anesthesia )

문순홍(Soon Hong Moon),정미화(Mi Hwa Jeong),강화자(Hwa Ja Kang),김동수(Dong Soo Kim) 경희대학교 경희의료원 1988 慶熙醫學 Vol.4 No.4

90년대 한국 폐기물관리 정책의 성평등성 분석

문순홍(Soon-Hong Moon) 한국도시행정학회 2000 도시 행정 학보 Vol.13 No.2

It was in the first half of 90’s that the Korean waste management policies have made the basic framework aiming to minimization. But it does not seem easy to bring the policy aim into reality. Total amounts of waste has been continuously increasing 7.1 % per year up to now 1998, while house waste has been decreasing after 1993. This article purposes to analyse Korean Waste Management Policies from the viewpoint of gender. At the beginning point of research there were a couple of questions: Did the reduction of house waste amounts depend on the mobilization of unpaid women’s labor?; Did’nt this overburden of household work have causal relation with social structure so called "patriarchy"? From these questions I assume that Korean Waste Policies have increasing the house work through systemic muti-level-cause-network related to androcentric structure and culture. To certify this assumption, I review the concept "mainstreaming" and gender analysis accepted in Peking Conference 1995, and the feminist political ecology putting an attention on gender analysis in environment policy. As well known the world in ecology is half-open and multi-leveled, so the political ecology in policy analysis is a set of research method experiments focusing the interactional dynamics between an individual action(choice) and half-open multi-leveled decision making circles. This article is composed of three parts. Chapter 2 gives feminist color on political ecology in order to elaborate several gender analysis questions in a framework. With these inquiries Korean waste management policy’s history is reviewed in chapter 3. And I argued that the overburden of women' housework under Korean waste management policy has multi-level causes, and it should be compensated by structural transformation toward gender equality and 'feminine principle'.

녹색국가 논의의 구조와 과정-녹색국가의 유형 및 단계를 결정하는 변수들

문순홍(Soon-hong Moon) 한국인문사회과학회 2002 현상과 인식 Vol.26 No.1ㆍ2

The concept of 'sustainable development' is not the limited into environment conservation in narrow term. The real sense of sustainable development amounts to the change of societal development. This paper defines provisionally the state involving in sustainable development as green state, and starts the question, where the greening of Korean state has been going to and what is its measure indicators. With this backdrop, the paper aims to categorize forms of green stare, to match steps to them, and to draw the facilitating factors to greening ? Korean state.<br/> The composition of the paper is like following due to the peculiarity of Korean intellectual society, which is lack of discussion of green thought, let alone green state. Chapter 1 handles basic concepts such as 'green', 'state' and selects green-friendly definition of state. Chapter 2 finds various definitions beyond the operational definition in introduction, through reviewing historical debates on state's tole in green thought Chapter 3 puts forms of green state on the definitions and recomposes them of discursive structure of green state. Chapter 4 elaborates the steps of greening state under the tide of 'green state as a process' and it is examparly proposed the factors to measure the degree of greening state and prognosizes the present situation of Korean state on the way to the' green state in chapter.

증례 : 전신마취중 발생한 악성고열증 ( Cases Report : Malignant Hyperthermia Syndrome During General Anesthesia - A Case Report )

문순홍(Soon Hong Moon),신옥영(Ok Young Shin),이두익(Doo Ik Lee),김동수(Dong Soo Kim) 경희대학교 경희의료원 1988 慶熙醫學 Vol.4 No.3

심판막 치환술을 받는 환자에서 Fentanyl-O2 마취중의 심혈관 반응

문순홍,권무일 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.6

Intravenous administration of high dose of fentanyl is gaining wide popularity as the sole anesthetic agent for patients undergoing cardiac surgery because of its favorable characteristics such as, simplicity, stable hemodynamics and supression or modification of stress response to surgery. But some investigators reported the necessity of supplementary anesthetic agent in addition to fentanyl to maintain hemodynamic stability during the surgical procedure. Therefore, we measured the heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), and rate pressure product(RPP) at induction, tracheal intubation, skin incision, and sternotomy time to evaluate the cardiovascular responses to surgical procedure under fentanyl-O₂ anesthesia on 12 patients with acquired valvular heart disease. The patients were anesthetized with a loading dose (30μg/kg fentanyl for induction and 1.5μg/ kg/min until sternotomy) followed by continuous infusion of fentanyl (0.3μg/kg/min untihe end of cardiopulmonary bypass.) The patients required total doses of 108±4.6μg/kg fentanyl for the entire operation. These measurements were compared with control data (before induction). The results were as followings: 1) During induction (infusion of fentanyl 30μg/kg), HR, SBF, DBP, MAP, and RPP revealed no significant change compared with control data. 2) During intubation and skin incision, HR, SBP, DBP, MAP, and RPP slightly increased but were not statistically significant (p$gt;0.05) 3) During sternotomy, SBP increased from 119.8±16.36 torr to 136.5±15.22 torr, DBP increased from 79.1±12.76 torr to 95.4±10.87 torr, MAP increased from 99.4±13.96 torr to 115.5±12.70 torr, and RPP increased from 10929±2206 torr.beats/min to 13889±2865 torr. beats/min (p$lt;0.05). HR increased from 90.7±8.71 beats/min to 100.2±13.79 beats/min, but was not statistically significant(p$gt; 0.05). 4) One of the patients had recall of the sternotomy and spreading of the chest with the sternal retractor. These data demonststhetic doses of fentanyl and O produce minimal change in cardiovascular dynamics during the surgical procedures except sternotomy time. Our findings suggest that fentanyl-O₂ anesthesia may be an attractive anesthetic technique in patients with valvular heart disease undergoing valve replacement operations but, will be needed considerations about infusion method, dosage of fentanyl and use of supplementary anesthetic agent according to patients conditions.

제왕절개술 산모에 있어서 경막외강내 몰핀 단독 투여시와 몰핀-클로니딘 병용시 수술후 통증 조절 효과에 대한 연구

박장수,김정원,문순홍,신동엽,홍기혁 인제대학교 1994 仁濟醫學 Vol.15 No.4

제왕절개술을 받은 산모의 술후 통증 조절을 위하여 경막외강내로 몰핀을 투여하여 좋은 통증 조절 효과를 거두고 있으나, 오심, 구토, 소양증, 요저류, 호흡 억제 등의 부작용이 있어 사용상 제한점이 되어왔다. 본 연구에서 저자들은 경막외강내로 진통효과를 가진 클로니딘을 몰핀과 병용하여 투여한 결과 몰핀의 투여량을 줄임으로써 몰핀에 대한 부작용의 발현을 감소시키고 우수한 통증 조절 효과를 거둘 수 있었다. Clonidine has been known to have analgesic effect, when it was especially given epidurally and intrathecally. So clonidine can be an alternative to morphine for patients witty chronicpain severe side effects from morphine. We gave bolus of 600 microgram of clonidine and continuous infusion of morphine 4 milligram and clonidine 960 microgram for 48 hours to 20 cesarean sectioned females postoperatively via epidural catheter. Compared with epidural morphine alone, clonidine bolus and continuous morphine mixed with clonidine has rapid onset of analgesic effect and far less side effects such as pruritus, nausea and vomiting. But clonidine can cause severe hypotension and bradycardia, so careful titreation of dosage and post infusion close monitoring are required.

지속적 경막외마취에 의한 전자간증 환자의 제왕절개술

신동엽,김성주,문순홍,박장수,홍기혁 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.4

Background: Adequate evaluation and monitoring for pre-eclamptic paturient and capable assistance before induction for anesthesiologist, must be taken to avoid sudden severe maternal hypertension with intubation during a Rapid Sequence intravenous induction. Such event predispose the paturient to intracranial hemorrhage and pulmonary hypertension with pulmonary edema. To diminish danger of hypertension that can be developed during general anesthesia and facilitate control of blood pressure, 24 women presenting for cesarean section were studied. Methods: All received 17.9±2.6ml of 0.5% bupivacaine, including 3ml of test dose, through the epidural catheter inserted in T-L interspace using 18 gauge Tuohy needle to the patients with a lateral decubitus position. We measured blood pressure and heart rate in 5, 10, 15, 20, 30, 45, and 60 minutes after injection of 0.5% bupivacaine and 15 minutes after transferred to recovery room. Results: The blood pressure of the patients started to decrease in 5 minutes and mot decreased in 20 minutes after injection, the heart rate had little change but decreased significantly in 45 minutes. Apgar Scores of the neonates at 1 and 5 minutes were 7.3±2.0 and 9.2±1.5. The patients used ephedrine and crystalloid solution for correction of hypotension were 6 of 24 women and had no any systemic toxicity or neurologic symptoms by local anesthetics(bupivacaine). Conclusion: Continuous epidural anesthesia for cesarean section in preeclamptic patients is recommended for safe anesthesia.

성인에서 하지의 지혈대가 대사에 미치는 영향

이승환,강화자,문순홍,이두익,신광일 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.3

The use of a pneumatic torniquet to obtain a blood less field in the extremities is essential in the precise operations of present-day plastic and orthopedic surgery. There have been studies conducted regarding systemic and metabolic change in response to torniquet ischemia and complication, associated with torniquets have been reported such as injuries to nerves, muscles and blood vessel. The purpose of this investigation was to examine changes in the systemic circulation, blood gases serum potassium and base status on release of torniquet ischemia in adult. The results were as follows: 1) The mean blood pressure and heart rate did not change significantly after torniquet release. 2) The pH decreased significantly after the torniquet release. 3) The PaO2, and PaCO2, did not charge significantly after torniquet release. 4) The HCO3, and BE decreased significantly after torniquet release (P$lt;0.05). 5) The serum potassium levels tended to increase after torniquet release but the changes was not significant. There-fore to minimize the predictable complications, the ventilatory control and rapid volume replacement are needed during the time imediately preceeding and following torniquet release.

경막외 마취시술로 발생한 우발성 경막하 차단 1례

박장수,김정원,문순홍,신동엽,홍기혁 인제대학교 1994 仁濟醫學 Vol.15 No.3

경막외 마취는 마취과영역에서 부위마취의 큰 비중을 차지하고 있으며 경막외 마취시 발생하는 합병증중에서 경막하 신경차단내지는 지주막하 신경차단은 때때로 환자의 생명징후와 의식상태에 심각한 변화를 초래할 수 있기 때문에 경막외 마취시 세심한 주의와 관찰이 필요하다. 저자들은 자궁전절제술을 시행받던 65세 환자에서 발생한 우발적 경막하 신경차단을 경험하였기에 문헌고찰과 함께 보고하는 바이다. Dural puncture is a well recognized complication of lumbar eqidural anesthesia causing extensive block after extradural injection of local anesthetic solutions in patients whose dura has been punctured. A somewhat obese 64 year old woman underwent transvaginal hysterectomy under lumber epidural anesthesia. After the first injection of 0.5% bupivacaine 60mg, an extensive block with hypotension developed. Such an extensive anesthesia thought be cased by leakage of anesthetic agent into the subdural space.

피부표면에서 경막외강까지의 거리

김성주,김철호,신동엽,문순홍,홍기혁 인제대학교 1995 仁濟醫學 Vol.16 No.3

1994년 3월부터 1994년 8월까지 인제대학교 상계백병원 마취과에서 경막외 마취 및 통증 완화를 목적으로 경막외 카테터 삽입을 시행한 589명을 대상으로 하여 피부에서 경막외강까지의 거리를 측정함으로써 경막외강에 카테터를 정확하게 거치시키는데 도움을 주고자 문헌 고찰과 함께 보고하고자 한다. Lumbar epidural analgesia is a well established method for providing postoperative pain relief. Placement of a needle in the epidural space is probably one of the two technically demanding procedures performing by anesthesiologists. Authors studied 589 patients who received epidural analgesia for postoperative pain control. The distance to the epidural space from skin surface was measured by 18G Tuohy needle with marks at each 1cm from the tip. The mean distance was appeared to be 3.92cm, which was correlated with other anatomic measurements, but it was varied with the lumbar inter-space measured. Most epidural spaces were identified at 3 to 5cm and 92.4% of the cases were less than 5cm. This study suggests that if the epidural space has not been identified within a depth of 6cm, redirection or re-insertion of the needle should be considered.