소아의 미추 마취시 사용한 Propofol 과 Midazolam 의 진정효과

서일숙,서봉호 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.5

Pediatric patients often could not be cooperated with physician during various procedures. So, many agents such as inbalation anesthetics and intravenous anesthetics have been used to decrease pain, anxiety and awareness during regional anesthesia in children. The purpose of this study was to compare propofol with midazolam and inhalation anesthetics for emergence time from sedation in caudal anesthesia of children. Forty five patients were randomly divided three groups. In propofol group(Group P, n=15), induction dose of 1.0 mg/kg propofol(Diprivan^ⓡ) was received followed by continuous infusion of 3∼5 mg/kg/hr. In midazolam group(Group M, n=15), induction dose of 0.15 mg/kg midazolam(Dormicum^ⓡ) was received followed by continuous infusion of 0.06∼0.08 mg/kg/hr. In inhalation anesthetic group(Group E, n=15), O₂-NO₂-Enflurane(3L/min, 3L/min, 0.6∼1.0 vo1% respectively) inhalated through face mask by non-rebreathing system for sedation. The blood pressure, heart rate, arterial oxygen saturation during anesthesia and emergence time, complications were measured. The results were as follows: 1) The blood pressure was significantly decreased in group M and E. Heart rate was also significantly increased in group M and E. 2) The arterial oxygen saturation was not significantly changed in each three groups. 3) In the group P and E, emergence time was shorter than in the group M. From the above results, we conclude that propofol is more excellent intravenous anesthetics than midazolam in respect to emergence time and hemodynamic changes in pediatric caudal anesthesia.

영아 전신마취에서 조절호흡 시 적합한 호흡수의 결정

서일숙,임승기,이성민 대한마취과학회 2004 Korean Journal of Anesthesiology Vol.46 No.2

만성 폐쇄성 폐질환자에서 척추마취후 발생한 경련발작 1례

서일숙 영남대학교 의과대학 1988 Yeungnam University Journal of Medicine Vol.5 No.2

만성폐쇄성 폐질환을 동반한 노인환자에서 척추마취하에서 치골상부 전립선 절제술을 시행하는 도중 척추마취와는 무관한 것으로 사료되는 원인불명의 경련 발작 및 혈압강하가 초래된 환자가 발생하였기에 그 원인을 규명하고 문헌적 고찰과 함께 보고하는 바이다. In the geriatric patient with COPD, incidence of postoperative pulmonary complication is higher than young patient. Therefore, some anesthesiologists preferred spinal anesthesia to general anesthesia for surgery of the perineum, lower extremities, and pelvic extraperitoneal organs. But, during spinal anesthesia, the same careful observation is required as during general anesthesia. We experienced a case of the convulsive seizure at about 1 hour after spinal anesthesia for open prostatectomy in a 76-year-old male patient wit COPD. It was suspected that his convulsive seizure be resulted from hypercapnea combined with hypoxia following upper airway obstruction. This patient was treated successfully by ultrashort acting barbiturate and controlled ventilation.

소아 전신마취에서 조절호흡시 적합한 호흡수의 결정

서일숙,이용환,김세연 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.4

Background: We experienced unintentional hyperventilation during mechanical ventilation in pediatric general anesthesia. It is very difficult to decide respiratory rate or tidal volume with a patient's condition for adequate ventilation while respiratory gas monitoring is unavailable in many cases. Therefore, we studied to find a proper respiratory rate (RR) with a fixed tidal volume during mechanical ventilation in general anesthesia. Methods: We studied 70 children weighing 10-30 kg during general anesthesia. An endotracheal tube was selected according to 3.5 + age (yrs)/4. After intubation with midazolam, thiopental sodium and succinylcholine, mechanical ventilation was applied: tidal volume 8-10 ml/kg, peak inspiratory pressure 15-20 mmHg, RR 20 (infant), 18 (under 3 yrs), 16 (under 5 yrs), 14 (above 5 yrs) breaths/min. We adjusted the RR for a PetCO_2 30-33 mmHg and arterial blood gas analysis was done 30 minutes each change. We calculated the RR for a PaCO_2 of 36 mmHg according to the equation: RR (applied) = estimated RR × estimated PaCO_2/ideal PaCO_2. In addition, the linear regression was analyzed between the age and RR. Results: The estimated regression for RR using Pcarson's correlation coefficient was as follows: RR = 19.25 - 0.07 × age (month). conclusions: The equation (RR = 19.25 - 0.07 × age [month]) could be an index for safe ventilatory management without severe hyper- or hypo0carbia in the pediatric general anesthesia. (Korean J Anesthesiol 2002; 43: 451~456)

소아 외래마취의 특성

서일숙 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.2

In recent years, health care cost containment concerns have resulted in an increase in outpatient (or same-day) surgery. Many procedures previously performed on an inpatient surgery basis have been shifted to outpatient settings. Anesthesia for outpatient surgery is exactly the same as inpatient anesthesia, except that the primary concern is the selection of patients who can be discharged safely on the day of surgery. The anesthesiologist should have a sound rational basis for choice of pharmacologic agents that are geared to expeditious patient discharge from the hospital. Cost concerns aside, outpatient surgery has many additional advantages in the pediatric setting. It minimizes the length of time the child is hospitalized, decreases separation anxiety, promotes parental involvement in the child's postoperative care in the more congenial environment of home, and decreases risk of nosocomial infection and iatrogenic illness.

Enflurane 마취시 혈압 및 맥박의 변화상에 대한 통계학적 관찰

박대팔,서일숙 영남대학교 의과대학 1986 Yeungnam University Journal of Medicine Vol.3 No.1

저자는 enflurane을 사용한 200예의 전신마위시술하에서 혈압 및 맥박의 변화상을 이론식을 도입하여 時系列型으로 표현하여 실현된 型의 類別과 분포상태를 분석하였던바 다음과 같은 결과를 얻었다. 1. 삽관시 혈압 및 맥박이 상승한다. 2. 삽관시 혈압 및 맥박이 상승하였다가 하강하여 20분 이내에 대체로 안정상태로 되었다. 3. 구조상으로 상승하강동치이행 (ADEE)형이 73-74%로 가장 많았고 다음은 상승동치이행(AEEE)형이 40∼44%였다 Observationn of changing pattern of blood pressure and pulse rate of enflurane anesthesia for 200 cases operations, performed during the past 4 years(1983-1986) in Yeungnam University Hospital have been evaluated clinically. In order to observe the influence of enflurane upon the blood pressure and pulse rate during general anesthesia, the authors prepared a formula, expressing changing of blood pressure and pulse rate by time series and analyzed the type and distribution pattern in the experiment. The results Obtained were as follows: 1. Blood pressure and pulse rate were increased at the time of intubation. 2. Generally, blood pressure and pulse rate were increased at the time of intubation and then stabilized withing 20 minutes. 3. Most common patterns were identified. ADEE type was 73∼74%. Which is not common type and AEEE type was about 40%.

상복부 술후 진통을 위한 요부 경막외 Narcotics의 투여효과

구본업,서일숙 영남대학교 의과대학 1985 Yeungnam University Journal of Medicine Vol.2 No.1

상복부 수술후 진통을 위하여 경막외 narcotics주입시 임상에서 경막외강 천자가 가장 많이 시술되고 있는 부위인 요부 경막외강에 morphine과 demerol을 각각 주입하여 진통효과를 관찰하였다. 전신 마취하에서 상복부 수술을 받은 환자 20명을 대상으로 하여서 morphine 1㎎을 주입한 10명의 Ⅰ군, demerol 10㎎을 주입한 10명의 Ⅱ군에서의 진통 효과를 관찰하였던 바 다음과 같은 결론을 얻었다. 1. Morphine을 주입한 Ⅰ군에서는 평균 진통 시간이 29.4시간이었다. 2. Demerol을 주입한 Ⅱ군에서는 평균 진통 시간이 4.0시간이었다. 3. Morphine을 주입한 Ⅰ군이 Demerol을 주입한 Ⅱ군보다 진통 시간이 훨씬 길었으며 통계학적으로 유의하였다. (P<0.05) 이상의 결과로 보아 상복부 수술후 진통 목적으로 마약제를 경막외강에 투여시 시술이 안전한 요부 경막외강내로 투여하여도 우수한 진통효과를 얻을 수 있으며 마약제로는 morphine의 투여가 demerol의 투여보다 더욱 진통 효과가 우수한 것으로 사료된다. To assess the effect of post-operative pain control of upper abdominal surgery through lumbar epidural narcotic injection, the 3rd or 4th lumbar epidural puncture was done, and were injected 1㎎. of morphine (GroupⅠ) or 10㎎. of demerol (GroupⅡ) mixed with 10㎖ of normal saline into the epidural space, after operation of the cholecystectomy in 10patients and antrectomy and vagotomy, subtotal or total gastrectomy in 10patients. Time interval of the post-operative analgesic effect between morphine and demerol groups were compared. The results of this study were as follows: 1. In the groupⅠ, average analgesic duration was 29.4 hours. 2. In the groupⅡ, average analgesic duration was 4.0 hours. It is concluded that post-operative pain control of upper abdominal surgery through the lumbar epidural narcotic injection was effective, and morphine injection was more effective than demerol.

주술기 저체온의 관리

서일숙 ( Seo Il Sook ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Anesthesia and surgery commonly cause substantial thermal perturbations. Mild hypothermia (33.0∼36.4℃) results from a combination of anesthetic-induced impairment of thermoregulatory control, a cool operating room environment, and factors unique to surgery that promote excessive heat loss. Perioperative mild hypothermia is extremely common and associated with adverse outcomes such as excessive sympathetic nervous system stimulation, prolonged drug metabolism, impaired platelet activity, impaired immune function and postanesthetic shivering. Prevention of perioperative hypothermia and post-anesthetic shivering improves the outcome in terms of reduced cardiac morbidity and blood loss, improved wound healing and shorter hospital stay. Core temperature monitoring, accompanied by passive and active methods to maintain normothermia, should be part of routine intraoperative monitoring for patients at high risk of perioperative hypothermia, particularly patients undergoing body-cavity surgery, surgery greater than 1 hour duration, younger children and the elderly.

전신마취시 흡기압력기준의 양압조절호흡이 폐포환기 정도에 미치는 영향

서일숙,강희주,김흥대 영남대학교 의과대학 1988 Yeungnam University Journal of Medicine Vol.5 No.1

흡입전신마취시에 마취호흡기를 사용할 경우 환자에게 가장 적절한 1회 호흡량을 흡입시킬수 있는 방법을 알아보기 위하여 전신마취환자 30명에게 흡기압력이 10㎝H₂O가 되도록 용량조절마취호흡기의 1회호흡량을 조절하고 호흡수를 분당 12회로 하여 기계조절양압호흡을 유지시켜 보았던 바 다음과 같은 결과를 얻었다. 1) PH : 7.39±0.01로서 정상범위내 이었다. 2) PaCO2 : 34±0.6㎜Hg로서 약간의 과환기상태 이었다. 3) PaO2 : 228.0±8.2㎜Hg 이었다. 4) Buffer base : 20.7±0.3mEq/ℓ로서 약간의 염기부족상태 이었다. 이상의 결과로 미루어 보아 전신마취시 충분한 근이완상태에서 기계조절호흡을 시행하는 경우 1회호흡량 조절은 흡기압력을 10㎝H₂O로 유지함이 가장 바람직한 것으로 사료된다. The study was undertaken to determine the most adequate tidal volume when used volume preset ventilator during anesthesia. The thirty patients were received controlled mechanical ventilation with constant inspiratory pressure of 10㎝H₂O and respiratory frequency of 12/minute. The results were as follows: 1) The PH was 7.39±0.01 and it is within normal limit. 2) The PaCO₂was 34±0.6㎜Hg and it is a slightly hyperventilatory state. 3) The PaO₂was 228.0±8.2㎜Hg. 4) The Buffer base was 20.7±0.3mEql and it is a slightly buffer base deficient state. From the above results. We concluded that if patients were fully relaxed during general anesthesia, it is desirable to maintain the inspiratory pressure of anesthetic mechanical ventilator to 10㎝H₂O for adequate alveolar ventilation.

B형 간염 항원 양성 및 간효소치가 증가된 환자에 Enflurane마취가 간에 미치는 영향

서일숙,박대팔 영남대학교 의과대학 1990 Yeungnam University Journal of Medicine Vol.7 No.1

전신마취를 필요로 하는 무증상 HBsAg양성간효소치가 증가된 환자 11명을 대상으로 enflurane으로 마취한후 술전, 술후 3일, 7일 및 10일에 간기능검사를 실시하여 그 변화를 비교검사한 결과 다음과 같은 결론을 얻었다. 1) SGOT, SGPT SGOT, SGPT는 술후 3일에는 술전수치보다 약간 증가하였으나 7일, 10일에는 현저한 증가를 보였다. 8예에 있어서는 술후 3일에 술전치보다 약간 증가한 양상을 보였고 7일, 10일에 술전치와 비슷하게 되었으나 3예에서는 3일에 SGOT, SGPT가 약간 증가하더니 7일, 10일에는 SGOT, SGPT가 300-500IU로 상당히 증가하여 간염치료를 하여 술후 2개월후에 술전치와 비슷하게 하강하였다. 2) Alkaline phosphatase, total protein, albumin, total bilirubin, and direct bilirubin은 술후 3일에 정상범위를 벗어난 변화를 보였으며 7일부터 정상범위내로 회복되었다. 이상의 결과를 보아 enflurane마취가 간기능에 큰 영향을 미치지 않는다고는 하나 HBaAg양성간효소치가 증가한 환자에게는 마취시 간염으로 이행될 가능성이 높으므로 상당히 조심을 하여 마취를 시행하여야 할 것으로 사료된다. Halothane is usually a safe and effective inhalation anesthetic agent but it rarely has damaged liver. The authors selected 11 patients who had HBsAg positive and increased SGOT, SGPT at Yeungnam university hospital. Their physical status was ASA class 1 and 2 . They had no previous history of operation or liver disease. The liver function tests were performed before surgery, and on 3rd, 7th and 10th postoperative days. The result were as follows : 1) The values of SGOT and SGPT were gradually increased on 3rd postoperative day and markedly increased on the 7th and 10th postoperative day 2) Alkaline phosphatase, total protein, albumin, total bilirubin and direct bilirubin were not significantly changed.