신생아호흡곤란증후군에 대한 임상적 고찰

고신옥,오흥근,한동권 대한마취과학회 1986 Korean Journal of Anesthesiology Vol.19 No.2

Forty neonate with respiratory distress syndrome were transferred from nursery after birth to the ICU at Severance Hospital, Yonsei Medical Complex between March 1981 to July 1983 and ventilatory support was given with the pressure-cycled ventilator, Babylog I, Bourns BP 200, in ICU. We have analysed the 40 cases according to sex, incidence, symptoms and signs, birth weight and gestation weeks and time to the ventillator support, ICU days and mortality. The results were as follows 1) THe proportion of the patients was 0.7% neonates and the overall mortality was 52.5%. 2) Obstetric and delivery backgrownd were as follows. Ceasarean section, 19 cases; pre-eclampsia, 5 cases; placenta-previa, 5 cases; spontaneous premature rupture of membrane; 4 cases. 3) The percentage and mortality of male patients was 57.5% and 57.1%, higher than famale patients. 4) All the patients showed symptoms and signs within 12 hours after birth. 5) Mortality of those cases born with less than 32 wks gestation was 15%, but above 32 wks the mortality was 35%. 6) The number of babies born with a birth weight below 2,000 grams was 27 and the mortality for them was 70%. 7) The number of cases who had ventilator support begun at 10 hrs, 11∼20 and 21∼30 hours after symproms and signs developed, were 30, 5 and 5. 8) The number of ventlator days less than 4 days duration was 27 cases with a 70% mortality but those above 5 days was 13 cases with 16% mortality. In 1981, the number of patients with ventilator days less than 2 days was 11 case and 2 cases used the ventilator for 7∼8 days. But in 1983 the number of patients with less than 4 ventilator days was 6 cases, and 7 cases used ventilator for more than 5 days. 9) The number of patients with ICU days less 5 days was 23 cases and a mortality of 78% and those of 6∼10 day stay was 6 cases with a mortality of 50%. The number of patients with ICU days above 15 days was 18 and all survived. In 1981, 10 cases stay in the ICU for less than 5 days. Only 2 cases stayed in the ICU for 6∼10 days. In 1983, 6 cases stayed in the ICU for less than 5 days,but 4 cases stayed in the ICU for more than 15 days. 10) Complications were neonatal hyperbilirubinemia, pneumothorax, pneumomediastinum, sepsis, disseminated intravascular coagulopathy, bronchopulmonary dysplasia, and cerebral hemorrhage. From the above results the mortality rate decreased year by year and this is attributed to the early application of ventilator support and adequate intensive care.

항문주위수술의 마취방법에 대한 임상적 고찰

高信玉,吳興根 대한마취과학회 1977 Korean Journal of Anesthesiology Vol.10 No.3

We have analysed statistically 792 cases who had perianal surgery from Jaunary 1967 to December 1976, The results were as follows; 1. Caudal block was the most commonly used technic. (62.8%) Hypobaric spinal anesthesia was used in 12% and general anesthesia in 16.8%. 2. Most patients were in the jack-kinife position during anesthesia and operation. 3. For premedication meperidine and secobarbital were commonly used(46.3% and 28%). 4. The most common diagnosis was hemorrhoids. (54%) 5. Ratio of males to females was 2 to 1. In age distribution 76.7% of cases were in the 20 to 50 year range. In adults, caudal block is the best anesthetic technic for perianal surgery and spinal anesthesia with a hypobaric solution in a jack-knife position is the second choice. In children and adults, in whom regional anesthesia is not indicated, general anesthesia with the lithotmy position would be suitable.

심포지움 : 기계환기기의 근본원리

고신옥 대한결핵 및 호흡기학회 1993 워크샵 Vol.2 No.-

전투약이 체외순환중 평균동맥압 및 관유량에 미치는 영향

고신옥,오흥근,정화성 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.3

This study was performed ot compare the effect of premedicant with triflupromazine, one of the phemothiazine derivatives, and more common drugs such as morphine, hydroxyzine or atropine on flow rate and mean arterial pressure. A total of 54 cases who had open heart surgery for acquired or cngenital heart diseases were divided into 3 groups depending on the main premedicants. Group Ⅰ : 22 cases had triflupromazine, pethidine, hydroxyzine and atropine in divided doses. These cases were induced with a small amount of thiopental, morphine and succinylcholine and maintained with either nitrous oxide(50%), oxygen, gallmine and methoxyflurane in analgesic concentrations or with morphine fractionation. Group Ⅱ : 26 cases were given morphine, hydroxyzine and atropine as premedicants. Anesthesia was induced with thiopental, morphine and diazepam and maintained with morphine, nitrous oxide and oxygen. Group Ⅲ : 6 cases were premedicated with hydroxyzine and atropine only and maintained with halothane. After induction, surface cooling was begun using a blanket, combined with internal cooling during bypass. In guroups Ⅰ and Ⅲ rectal temperature was maintained between 28 and 32℃. In group Ⅱ, however, temperature was lower than other groups. After the main intracardiac procedures, rewarming was performed with combined surface and internal techniques. In most case a bypass time of longer than 1 hour was required with the longest times in group Ⅲ, 129.80±21.49min. in duration. The longest anesthetic time was in the child group of group Ⅲ, 430±45.82min. in duration. Urine output during bypass in subgroup of methoxyflurane and morphine of group Ⅰ was 8.95±0.33 and 12.15±0.36㏄/㎏/hr. In group Ⅱ the subgroup maintained with morphine in the adult and child and halothane, outputs were 11.63±0.14, 19.79±0.26 and 8.43±0.33㏄/㎏/hr. respectively. In group Ⅲ maintained with halothane, output was 8.64±0.22㎖/㎏/hr. Mean arterial pressure(MAP) during bypass in most cases was maintained between 50 to 100 torr. In group Ⅰ, the methoxyflurane subgroup, pressures were lower than in any other group, and higher flow rate was required than in any other group. Average MAP during cross clamp on the aorta of group Ⅰ-methoxyflurane, group Ⅱ-morphine adult, group Ⅲ were 56.61±12.47, 78.79±17.33, and 74.06±19.09mmHg respectively. MAP below 50 torr immediately after beginning bypass was more frequent in group Ⅱ(34.8%) than in other groups, and MAP above 100torr after aorta clamping was observed more in group Ⅱ(65.2%) and in group Ⅲ(50%) than in group Ⅰ(10.05%). Time to extubation was longer in group Ⅱ, the morphine subgroup, than in other gorups 19.02±1.26 hours in the adult group and 20.05±2.69 hours in the child group. Post-op recovery in ICU averaged 4.17±0.65 days being longer in group Ⅰ, the morphine subgroup, than in other groups. With this experience, we may conclude that group Ⅰ with triflupromazine premedicants, as compared with the other groups. showed less esophageal and rectal temperature gradients during cooling and rewarming states, less acid base imbalance, better urine output, lower requirement of vasopressors or dilators to keep MAP with more flow rate in reasonable range during bypass and shorter time to extubation after surgery.

연세의대 의학교육학과 교수 개발 프로그램(2005) (Faculty Development Program)

고신옥,Go, Sin-Ok 연세대학교 의과대학 2005 의학교육논단 Vol.7 No.2

기계환기보조받는 중환자에게 Midazolam 지속적 주입에 의한 진정

고신옥,방은치,남상범 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.5

Background: Midazolam is distinguished from other benzodiazepines by its water solubility, rapid onset, short duration, and lack of accumulation of active metabolites. These pharmacokinetic cbaracteristics support its use by continuous infusion. We evaluated the continuous infusion dose of midazolain for adequate sedation of ventilated patients with hemodynamic and respiratory monitoring. Methods: We started continuous infusion of midazolam at a rate of 0.5∼1.0 ㎍/kg/minute after bolus injection of 3.0 to 5.0 mg and adjusted infusion dose monitoring sedation scale in the 15 patients. Blood pressure, heart rate and central venous pressure were monitored before and 30 minute, 1, 2, 3 and 6 hours after midazolam infusion. Arterial blood gases were measured and peak inspiratory pressure was monitored. We evaluated liver and kidney function before start of infusion and after discontinuation of midazolam infusion. Results: The mean loading dose, infusion rate and total dose of midazolam were 4.1±0.9 mg, 1.2±0.4g/kg/minute and 251.9±84.0 mg. The mean duration of infusion was 59.0±37.0 hours. After infusion, systolic and diastolic blood pressure and heart rate and central venous pressure remained stable when compared with those of the preinfusion state. Arterial blood gas and peak inspiratory pressure remained unchanged. The function of liver and kidney did not deteriorate after infusion. Conclusions: Continuous infusion of midazolam at a rate of 1.2±0.4 ㎍/kg/minute after 4.1±0.9 mg intravenous bolus injection was a safe and effective method for sedation of ventilated patients in intensive care unit without hemodynamic disturbance.

혈역학적으로 불안정한 중환자에서 산소공급과 산소소모 : 생존환자 대 비생존환자, 패혈증환자 대 비패혈증환자의 비교 Comparisons between Survivors vs Nonsurvivors and Septic vs Nonseptic Patients

고신옥,방은치,이세실 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.2

Background: To maintain adequate oxygen delivery and oxygen consumption is essential to care of the critically ill patients. The authors undertook this study to evaluate the patterns of oxygen delivery and oxygen consumption in hemodynamically unstable patients. Methods: Twenty hemodynamically unstable patients were studied, Pulmonary artery catheters were inserted and the hemodynamic variables including oxygen delivery and oxygen consumption were calculated immediately, and 1, 8, 24 hours, respectively after catheterization, and immediately before catheter removal. Patients were divided into survivor and nonsurvivor groups, and the hemodynamic data were compared. The same patients were divided into septic and nonseptic patient groups and same study was done. Results: There were no statistical differences in oxygen delivery and oxygen consumption between the survivors and the nonsurvivors, and the septic and the nonseptic patients. But oxygen delivery and oxygen consumption of the survivors were higher than those of the nonsurvivors. Conclusions: Although we could not find statistical significance, we concluded that supranormal level of oxygen delivery and oxygen consumption could improve the outcome of critically ill patients.

척추후측만곡을 동반한 만성폐쇄성폐질환 환자에게 Nasal Mask BiPAP을 이용한 호흡보조

고신옥,방은치,전성식,박병학,남용택,이원영 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.6

Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU. (Korean J Anesthesiol 1997; 33: 1207∼1211)

다발성 늑골골절에 기관지 파열이 합병된 환자의 치험예

고신옥,오흥근 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.4

Major fracture of the intrathoracic airway following chest trauma is a potentially lethal injury which can be repaired successfully if the diagnosis is made early. Cough, dyspnea, cyanosis, hemoptyala, mediastinal emphysema or pneumathorax, and a deterioration of the patient's clinical condition out of proportion to the apparant closed chest injury should alert the clinician to the possibility of this entity. This report describes the patients who admitted to the intensive care unit for ventilator support and left main bronchus rupture was recognized after 21-trauma-way with the aid of bronchogram. After then pneumonetomy was done and transferred to the general ward after weaing from the ventiltor support. From the above report it can he concluded that the bronchogram with the aid of fiberoptic bronchoscope is easentially necessary for the diagnosis of the major airway injury.

중환자실 영역에서 환자감시의 현재와 미래

고신옥 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2