200년 사회적경제의 역사 속 한국의 사회적경제

김신양(Kim, Shin-yang) 안동대학교 민속학연구소 2022 공동체문화와 민속 연구 Vol.4 No.-

사회적 일자리 비용편익분석: 간병사업을 중심으로

정영호 ( Young Ho Jung ),노대명 ( Dae Myung No ),고숙자 ( Suk Ja Ko ),김신양 ( Shin Yang Kim ),장원봉 ( Won Bong Jang ),민동세 ( Dong Se Min ) 한국사회보장학회 2006 社會 保障 硏究 Vol.22 No.3

마취중 신부전 말기 환자에서 Lidocaine 의 약동학적 변화

신양식,김종래,이종석,박광원,김원옥 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.6

The pharmacokinetics of intravenously adminstrered lidocaine were studied in 5 normal patients with renal disease and 4 patients with end-stage renal failue during anesthesia. In both group of patinets, the half life, the volume of distribution and clearance were not significantly different. However, valuses were altered in comparison with those of subjuc without anesthesia. This alteration of parameters is thought to be the effect of reduced hepatic blood flow due to potent anestheics drugs. Our understanding of lidocaine pharmacokinetics in patients with chronic renal failure during anesthesia suggests that these patients can safely receive a normal loading and maintenanece dose with close monitoring for signs of lidocaine toxicity. even though the total plasma concentration may be within the therapeutic range.

Sevoflurane 흡입마취의 임상적 평가

신양식,김종래,최미영,홍정연,민경태 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.3

This study was aimed to evaluate the clinical usefulness of sevaflurane including an adjustability for anesthetic depth and an efficacy in 30 healthy patients who had no previous anesthetic complications or have not experienced general anesthesia within 1 month. After premedication with intramuscular administration of midazolam and glycopyrrolate, anesthesia was induced with thiopental sodium and succinylcholine and endotracheal intubation was done for all the patients. Anesthesia was maintained with 0.5 to 2.0 vol% of sevoflurane according to changes of blood pressure in response to surgical stimuli in N₂O(2 L/min)-O₂(2 L/min) following 4∼5 vo1% inhalation for initial 5 minutes. For the muscle relaxation, vecuronium or pancuronium bromide 0.08 mg/kg was injected initially with additional doses in needed. At the end of operation, administration of N₂O and sevoflurane was discontinued. Pure oxygen with 5 L/min- flow rates was inhaled until full recovery. The emergence time interval from the discontinuation sevoflurane to the response of verbal command was about 10 minutes. The systolic blood pressure during operation reduced by 10 mmHg from preinduction value (from 126 to 116 mmHg). And the heart rate just before incision inereased by 14 beats/min from the preinduction value (from 83 beats/min to 97 beats/min). Arterial blood gas study showed mild hyperventilation with PaCO₂ of 30 torr during operation, but PaCO returned normocapneic state during spontaneous breathing after recovery from anesthesia. There was no evidence of respiratory depression during perianesthetic periods. Complete blood counts, biochemical studies, serum electrolytes, and urinalysis at the preanesthetic period, the 1st and 7th postoperative days revealed clinically nonisgnificant changes. However SGPT increased to 30 IU/L in the 7th postoperative day from the preoperative value of 13 IU/L. No arrhythmia did occur during anesthesia, and no complaint including headache, nausea and vomiting ect, was seen after recovery.

항문주위수술을 위한 Jacknife 체위에서의 저비중 척추마취의 검토

신양식,김종래,이경민,이효근,남승철 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.4

The effect of anesthetic volume on the spread of hypobaric tetracaine were sutdied after intrathecal injection in thirty patients with prone jackknife and 15 degree Trendelenburg position for perinal surgery. The patients were assigned randomly into the one of three groups divided by the 3, 4, or 5 ml of volume of anesthetic solution. The results show that the volume of tetracaine in distilled water with hypobaric spinal anesthesia in prone jackknife and l5 degree Trendelenburg position had a important effect on the anesthetic dermatomal levels in spite of slightly rapid onset with large. volume. Therefore, we concluded that for the perianal surgery in prone jackknife position, as the volume of the anes- thetic solution with hypobaric spinal anesthesia, 3 or 4 ml of the volume are sufficient to get the adequate anesthetic levels.

고양이에서 Gentamicin 의 전처치가 Metocurine 의 근이완 작용과 그 가역에 미치는 영향

신양식,김종래,정현정,김순열 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.1

To determine the neuromuscular effect and its reversals of gentamicin, alone or in combination with metocurine, pharmacodynamic studies were done using a common peroneal nerve- anterior tibialis muscle preparation in 24 adult cats weighing 2.5-4.0 kg. The median effective dose of gentamicin obtained by cumulative dose-response study was 21.6±4.83 mg/kg. Under the pretreatment of gentamicin, the onset and duration of metocurine was 1.32±0.91 min and 28.8±10.95 min, respectively. There was no significant difference in the recovery indicies for its reversal between neostigmine and calcium. Each values of recovery indices were 1.85±0.65 and 2.05±1.00 min with neostigmine and calcium, respectively. These results suggested that gentamicin by itself had neuromuscular blocking effect. With the pretreatrnent of gentamicin, the onset of metocurine was shortened to one third and its duration was prolonged as much as seven times. Additionally, metocurine induced neuromuscular block with pretreatment of gentamicin waersed completely.

소아 일반외과 외래환자 마취(小兒 一般外科 外來患者 麻醉)의 임상적 평가(臨床的 評價)

신양식,김종래,홍정,심재선,김순열,남용택,황의호 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.4

This retrospecitve review covers our experience with outpatient anesthesia for pediatric general surgery in 2404 children, including both sexes up the age of 15 years over five years from Jan.1. 1986 to Dec.31. 1990. Except in 1990(27.1%), there was no significant difference in outpatients showing an annual average of 11.7% with the respect to the total pediatric ageneral surgical patients. Seventy-four percent of the patients including the youngest at 3 months were under 10 years of age. As anticholinergics, glycopyrrolate or atropine were injected intramuscularly into the children, 47 and 9 percent, respectively. Thiopental, ketamine or diazepam (42,15 or 1.8 percent respectively) were adminstered intravenously for sedation only at the immediate preanesthetic period. No sedative was given to forty-two percent of the children. In ninty-eight percent of the patients, general anesthesia was done and the most common inhalation anesthetic was halothane(65%). Succinylcholine ws administered to facilitate the endotracheal intubation to 97% of the patients, but vecuronium or pancuronium. were given to one or three percent of the patients, respectively, strictly for surgical manupulation. Excision of neck mass, incision & drainage of abscess and inguinal hernioplasty were indicated in 75% of the patients. In 1990 eighty-seven patients of the 141 total outpatient pediatric general surgery patients involved inguinal hernioplasty. The duration of operation and stay in the recovery room were about one hour. No complication was found. We believe that, from both medical and patient-parent viewpoints, the aims of ambulatory anesthesia in pediatrics are achieved by the standardization. and organization. Patients safety in anesthetic techniques of outpatient anesthesia is not only possible but also desirable in modern anesthesia.

내장신경차단에 관한 임상적 연구

신양식,이윤우,오흥근,윤덕미,김수연,김종래 대한통증학회 1988 The Korean Journal of Pain Vol.1 No.1

Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. One method used to control pain associated witb these malignancies is to block off the splanchnic nerve. In 1919 Kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hepatoma and cancer of the pan- creas, stomach, gall bladder, bile duct, and colon. During the period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactivelv grouped according to the stage of development of tecbnique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designated as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3, The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscellaneous cancer 49 cases respectively. 4) There were 57,7o who had had surgery, and 3.7% of whom had had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. For group 2 and 3, C-arm image intensifier was used. In group 1, a 22 gauze 10cm long needle was inserted at the lower border of the 12th rib on each side about 7cm from the midline. The average distance from the midline was 6.60±0.61cm on the left side and 6.60±0.83 cm on the right side in group 2, and 5.46±0.76 cm on the left side and 5. 49+0. 69 cm on the right side in group 3. The average depth to which the needle was inserted was 8.60±0.52cm on the left side and 8.74 ±0.60cm on the right sideroup 2, and 8.96±0.63cm on the left side and 9.18-0.57cm on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly, 51.8% on the left side and 54.4% on the right side of the Ll vertebra by lateral roentgeno- gram in group 3. The inserted needle points were located in the upper and anterolateral part, of the Ll vertebra 68.5% on the left side and 60.6% on the right side, on the anteroposterior rent-genogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows, the spread upward along the anterior margin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, 39.17 ±6.69 ml of 0.5% -1% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block 40.00±4,26 ml of 50% alcohol was injected for the semiperent block. In group 2, 13.754.B8ml of l% lidocaine were used as the test block and followed by 46.17±4.37 ml of 5o% alcohol was injected as the semipermanent block. In group 3, 15,63±1.19 ml of 1% lidocaine for test block followed by 15.62±1.20 ml of pure alcohol and 16.05±2.58ml of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanent block was 83.3 percent of the patients in group 1 who received relief from pain for at least In these unsuccessful cases, 2 cases in group 1 were controlled by narcotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But, in some cases it was 3 to 5 months before the 2nd block and in 1 cases even 7 years. 10)The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. ll)For the patients in group 3, the supplementaock most commonly used was a con- tinuous epidural block-it was used as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 12) The interval between the receiving of tbe alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerve block done in the prone position with pure and 50% alcohol immediately after an effective test block with l%. lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.

신장이식술시 마취유도제로서 Propofol 의 심혈관계 효과

신양식,김종래,남순호,최은환 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.2

A need has been recognized for a safe and effective induction for patients undergoing elective renal transplantations. We have evaluated the effect of propofol (injection rate; 50 mg/min, average dosage; 2.28±0.08 mg/kg, n=10) on a cardiovascular stability compared with that of thiopental (injection rate; 100 mg/min, average dosage; 5.22±0.18 mg/kg, n=10) as an induction agent. Blood pressure and heart rate as cardiovascular parameters were checked before induction(control), one, two, three minutes after induction, before and after orotracheal spray of lidocaine, and immediately, one and two minutes after endotracheal intubation. The results were as follows: 1) There were no significant cardiovascular changes in the propofol group during the whole induction period. 2) In the thiopental group, diastolic blood pressures checked just after intubation, which were 120.20±7.79 mmHg, were significantly higher than those of one or two minutes after induction, which were 86.30±4.36, 88.40±3.85 mmHg, respectively. The above results suggest that intravenous propofol (2.0~2.5 mg/kg) is a safe and effective induction agent for renal recipients. (Korean J Anesthesiol 1995; 29: 192~197)

Succinylcholine 으로 인한 Hyperkalemia 에 대한 Salbutamol 전처치의 효과

신양식,김종래,박광원,김윤애 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.2

In the present study, patients were traumatized with muscle-crushing injuries, or they were non-traumatized. The plasma concentration of potassium and sodium were measured before the induction of anesthesia and at selected intervals after the administration of succinylcoholine (SCC) in some patients were inhaled the B_2-agonist, salbutamol (about 800 ㎍) via an endotracheal tube and in the others were not given it. There was no significant difference in the base lines of potassium and sodium between the traumatized and nontraumatized patients. Salbutamol diminished the rise of potassium (-0.30 to 0.09 mEq/L) but did not affect the plasma sodium leve. There was no significant side-effect of this agent, but sinus tachycardia was the only thing noted. These results are consistent with the proposed mechanism that the decrease in serum potasium due to salbutamol is most likely a shift of potassium ions from the extracellular space to the intracellular space. Inhalation of salbutamol may be a useful method for the prevention of SCC-induced hyperkalemia without any serious side-effect in patients with preexisting hyperkalemia properties who have gone through trauma.