중이수술 환자에서 Sevoflurane과 Remifentanil을 이용한 전신마취 시 Ondansetron과 Ramosetron이 술후 오심과 구토에 미치는 효과 비교

윤도근 ( Do Geun Yoon ),정상호 ( Sang Ho Jung ),하명화 ( Myung Hwa Ha ),송남원 ( Nam Won Song ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4

Background: In this randomized, double-blinded study, we evaluated the efficacy of ramosetron and ondansetron for preventing postoperative nausea and vomiting (PONV) after middle ear surgery. Methods: Seventy patients of either sex, ASA 1-2, scheduled middle ear surgery (mastoidectomy and tympanoplasty) under general anesthesia with sevoflurane and remifentanil were included. Patients were randomly divided into two groups and received IV ramosetron 0.3 mg (group R) or ondansetron 4 mg (group O) before the end of operation (n=35 each). The incidence and severity of PONV, pain score (VAS), rescue antiemetic, rescue analgesic and side effects were assessed following 6 hr, 24 hr and 48 hr after surgery. Results: The incidence of PONV showed no significant difference between groups at each time points after surgery. There were no difference in the severity of nausea, pain score, rescue antiemetic, analgesic drug usage and side effects between groups. Conclusions: Prophylactic therapy with ramosetron is as effective and safe as conventional prophylactic therapy with ondansetron for preventing PONV in patients undergoing general anesthesia for middle ear surgery. (Korean J Anesthesiol 2009;56:408~12)

증례보고 : 사지마비환자에서 기관절개술 시 근이완제의 사용없이 후두마스크를 이용한 정맥마취

염승훈 ( Seung Hun Yeom ),정상호 ( Sang Ho Jeong ),하명화 ( Myung Hwa Ha ),송남원 ( Nam Won Song ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.6

Quadriplegia is a serious or complete loss of motor function of all four limbs that is commonly caused by spinal cord injuries secondary to damage to the cervical spine. In this situation, there is a higher risk of pneumonia due to paralysis of the respiratory muscles. Tracheostomy is preferred over endotracheal intubation for the effective elimination of sticky bronchial secretion. The safest technique for a tracheostomy is to carry it out under general anesthesia with endotracheal intubation. However, endotracheal intubation may be difficult and cause other complications in patients with laryngotracheal stenosis caused by repeated tracheostomy and a limitation of neck movement as a result of the fixation of the cervical vertebral bodies due to the cervical spine fracture. We report a case of a tracheostomy performed sucessfully under intravenous anesthesia using a laryngeal mask airway without muscle relaxants in a patient with quadriplegia caused by a cervical spine injury. (Korean J Anesthesiol 2008; 55: 747~51)

과거 10 년간 마취례의 분석

김명희,송남원,이건화,유재현 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.4

1970년부터 1979년까지 10년간 부산 메리놀병원 수술실에서 행하여진 18,413예의 마취예를 분석하여 다음과같은 결과를 요약한다. 1) 성별의 비율은 65.1% : 35.9%로 남자가 많았다. 2) 연령별 분포를 보면 20~29세군과 30~39세군이 각각 24.6%와 21.4%로 거의 과반수를 차지하였고 60세 이상의 노인마취예가 연도에 따라 증가하는 추세를 보였고 10세 미만군에서는 3~9세군이 60.9%로 가장 많았다. 3) 수술과별로 보면 일반외과가 5,573예(30.3%)로 가장 많았고 산부인과의 5,343예(19.2%)와 합계가 약 50%에 달하고 있다. 4) 주마취제는 ether가 7,045예(53.5%), halothane 3,266예(24.8%), methoxyflurane이 1,572예(11.9%)로 대부분을 차지하였다. 5) 총 18,413예의 마취예 중 전신마취가 12,054예(65.5%)로 가장 많았으며 전신마취방법 중 반개폐식 순환법이 10,945예(91.6%)이고, 비재호흡법은 998예(18.4%)로 소아마취의 증가와 함께 증가하는 경향을 나타내었다. 6) 근육 이완제는 1974년까지 succinylcholine이 많이 사용되었으나 1975년이후 pancuronium이 소개되면서 그 사용이 매년 증가하였다. A total of 18,413 cases had anethesia at Maryknoll Hospital in Busan from January 1970 to December 1979. These data were analyzed statistically and the following results were obtained. 1) The number of general anethesia cases steadily increased while those of local anethesia decreased. 2) Of all departments, general surgery had the largest number of cases. 3) Sex ratio was equal when the OB-GYN cases were included. 4) The 20-30yr age group numbered nearly the total number of cases. 5) Geriatric and pediatric cases increased progressively. 6) Among anesthetic agents used, ether was used mostly, but halothane was used with increasing frequency. 7) Of the anesthetic techniques used in general anesthesia, the circle system was mostly used and the non-rebreathing system was used for all pediatric cases, which also have increased in number. 8) For induction of anesthesia, thiopental sodium was mainly used. Since 1975, pancuronium was mainly used in addition to S.C.C. for muscle relaxation.

Pheochromocytoma 척출술 2 례의 마취관리 경험

김재철,송남원,이건화,유재현 대한마취과학회 1983 Korean Journal of Anesthesiology Vol.16 No.1

The following is a report of the anesthetic experience in the surgical management of two cases of surgery for pheochromocytoma performed at Maryknoll Hospital, Busan, between the dates of June and July, 1982, The report covers the pre-surgical tests and the laboratory results on the two cases, which was similar, and the anesthetic agents halothane and enflurane, was used on the cases, respectively. During surgery using the anesthetic agent halothane, which was chosen because of the high blood pressure of the patient, and our effect to control it, we encountered dangerous arrythmia. In the case where enflurane was the anesthetic agent uaed, it was found that while the blood pressure of the patient was more difficult to control, the incidence of arrythmias was much less frequent. In one of the cases, becsuse of hemorrhage from the operative site during the immediate surgical period, re-exploration was done with adequate replacement of whole blood and catecholamines administered as needed during the anesthetic management. In comparing the two cases, the one case in which α-sdrenergic blockers were not administered during the pre-surgical period, when compared with the case in which the the blockers were used, showed, after removal ef the tumor, a decrease in the need for α-adrenergic stimulators.

경막외 Steroid 주입에 의한 요배하부통 관리

김명희,송남원,이건화 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.4

마취전투약제로 Combid Spansule 을 사용한 2,800 례의 임상경험

전재규,송남원,정정길 대한마취과학회 1976 Korean Journal of Anesthesiology Vol.9 No.2

Combid is a compound of Compaxine, which is a phenothiazine derivative, and Darbid that is a long acting anticholinergic synthetic. This medicant was originally intended for use in physical and emotional peptic ulcer cases. Because of it's pharmacological action, writers decided to consider the medicant as a preanesthetic medication. From a record of 2800 patients in the hospital for the year 1975 was administered as a premedicant at random, even though some contraindication did occur and is discussed later in this article, the following results were observed. 1. Because of the characteristics of:a long acting effect of Combid Spansule, it can be administered orally with sips of water, 2~3 hours prior to operation, eliminating needless preanesthetic shots, without affecting the N.P.O. rule. 2. Sedative and antisialogue effects of the drug have been also satisfactory, therefore it is recommended to use as a premedicant especiolly in Korea because ether is commonly used. 3. The drug has an additional antiemetic effect to prevent vomiting from ether anesthesia. 4. Some side effects were observed such as dry mouth, tachycardia, fever and extrapyramidal action that occur from overdosage. 5. The contraindications to be considered when using Combid Spansule as a premedicant include dehydration, fever, tachycardia and parkinsonism. 6. Please note the writers do not recommend this application for short procedure such as closed reduction of Colles fracture and simpIe spinal anesthesia due to the long lasting drying effect.

경모외강에(硬謨外腔)Xylocaine 주입이 뇌척추액압에 미치는 영향

전재규,송남원,정정길 대한마취과학회 1976 Korean Journal of Anesthesiology Vol.9 No.2

Many cases have been reported indicating that postspinal headache can be relieved immediately by an epiduralinjection of saline: also autologous blood has recently been used successfully instead of saline. C.S.F. changes in 20 cases were observed in the support of the concept; that a continuous leakage in association with hypovolemia and hypotension of C.S.F is the primary cause of postspinal headache. Subarachnoid pressure increased immediately with Xylocaine injection into lumbar epidural space. A spinal needle was inserted into the subarachnoid space at the level Ll-L2 and opening pressure of C.S.F. was read, epidural Tuohy needle was inserted at the 4~5. Twenty-five ml of Xylocaine was injected into epidural space and C.S.F. pressure changes were observed. This procedure was performed on 10 patients in lateral position and another 10 patients were tested in the sitting position. Sitting position: Condition Pressure rise Highest pressure change 350㎜ H₂O Lowest pressure change 60 ㎜ H₂O Average pressure change 191㎜ H₂O Average opening pressure 369㎜ H₂O Horizontal position: Highest pressure change 290㎜ H₂O Lowest pressure change 40㎜ H₂O Average pressure change 142㎜ H₂O Average opening pressure 165㎜ H₂O These pressure changes responded almost simultaneously as xylocaine was injected. The immediate relief of postspinal headache by injecting fluid into epidural space is simultaneous with the increase of C.S.F. pressure. In summary, the direct cause of postspinal headache is probably hypotension of C.S.F. pressure resulting from continuous leakage from spinal tap.

Electroconvulsive Therapy 를 위한 마취의 임상적 고찰

김재홍,김영생,이건화,송남원 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.2

This is the report of our clinical experience of 1365 cases of aneethesia for electroconvu lsive therapy at the Department of Anesthsiology, Maryknoll Hospital, during the period of March, 1989 to February, 1986. To prevent complications, such as compressed fracture of the spine, and to improve doctor-patient relationship, softening electroconvulsive therapy is the preferred treatment for indicated cases. The results were as follows: 1) Diagnostic distribution of the patients treated by E.C,T. were schizophrenia 74.3%, affective disorder 15.0%, other psychosis 10.7%. 2) Average number of treatments given to a patient were average 6.7 times, for the entire group,7.8times for schizophrenia, 8.2 times for the patients with mania,5.5 times for the Patients with major depression, 5.6 times for the patients with the other psychosises. 3) Medication required was sufficient with half the dosage of uaual surgical procedures ie, atropine sulfate 0.008 mg/kg, thiopental sodium 2.5 mg/kg, and succinylcholine 0.5 mg /kg. 4) Duration of apnea averaged 2 minutes 30 seconds, awakening averaged 10 minutes, and average duration per treatment was 15 min. 5) Few patients complained of discomfort or phobia, and less personnel and less effort were required. Complications and side effects due to anesthesia were minimal.

척추마취시 최면제 및 진통제 투여에 따른 저산소증의 발생 빈도에 대한 연구

최인철,조성두,김영생,송남원,하명화 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.6

Background : The purpose of this study was to find out the effect of hypnotics and analgesics on oxygen saturation by pulse oximetry in surgery patients under spinal anesthesia. Methods: Sixty-five patients classified ASA physical status 1 or 2 scheduled for surgery under spinal anesthesia were studied. These patients were divided into three groups. The 22 subjects of the first group did not receive either midazolam or fentanyl. The 22 subjects of the second group received midazolam. The 21 subjects of the third group received midazolam (0.03 mg/kg) and fentanyl (1.0㎍/ kg). Oxygen saturation was measured with a pulse oximetry. Measurements were made before spinal anesthesia, 5 minutes, and 10 minutes after starting of spinal anesthesia, 5 minutes, 10 minutes, 30 minutes, and 60 minutes after the start of the operation or intravenous injectian of drugs. In addition, measurements were made on arrival in the recovery room, and 5 minutes, 10 minutes, 20 minutes, and 30 minutes after amval in the recovery room. Results : There were statistically significant differences in oxygen saturation at 5 minutes after the start of the operation or intravenous injection of drugs. The mean oxygen saturation for the first group was 98.2±1.8%, for the second group 97.9±2.6%, and for the third group 92.4±2.8%. Hypoxia cases at 5 minutes after the start of the operation or intravenous injection of a drug occurred in 4.5% of the first group, 9.1% of the second group, and 57.1% of the third group Conclusions: We concluded thsat oxygen saturation monitoring should be done routinely in patients receiving hypnotics and analgesics during spinal anesthesia, and oxygen should be administered to patients who develope hypoxia during spinal anesthesia. (Korean J Anesthesiol 2000; 39: 792-797

소아 사시교정술시에 발생한 안구심장반사

김재홍,박경수,조성두,이건화,송남원 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.6

The oculocardiac reflex is developed by surgical or nonsurgical procedures to the eyeball, including traction on extraocular muscles, This reflex is a decrease in heart rate, although other arrhythmias, including A-V junctional rhythm, A-V block, ventricular premature beat, and cardiac arrest, have been reported. This is the report of our experience of oculocardiac reflex during strabismus surgery in children at Department of Anesthesiology, Maryknoll Hospital during the period between February, 1986 and January, 1987. The results are as follows : 1) In group I (0.02 mg/kg, atropine sulfate premedication), oculocardiac reflex was developed 15 cases of 42 cases (35.7%), and in group Ⅱ (0.01 mg/kg, glycopyuolate premedication), oculecardiac reflex was developed 17 cases of 49 cases (34.7%). Comparing group Ⅰ with group Ⅱ, there were similar effect to prevention of the oculocardiac reflex (p$gt; 0.05). 2) In each group, developing of the oculocardiac reflex following traction of medial and lateral rectus musclwere 30.0% and 26.3% in group Ⅰ, and 28.2% and 28.2% in group Ⅱ respectively. This was not significant statistically. 3) The oculocardiac reflex following traction of extraocular muscles was disappeared soon after stopping surgioal manipulation. And, intravenous administration of anticholinergic or retrobulbar block were not used for prevention of the reflex.