자유연제 : 경장영양 환자의 설사관리에 관한 연구

신증수,이정숙,이송미,임성희 한국정맥경장영양학회 2001 한국정맥경장영양학회 학술대회집 Vol.2001 No.-

Nalbuphine 천골강내 주입에 의한 술후 제통효과

신증수,윤덕미,이경민,오흥근,Shin, Jung-Soo,Yoon, Duck-Mi,Lee, Kyung-Min,Oh, Hung-Kun 대한통증학회 1990 The Korean Journal of Pain Vol.3 No.1

Epidural injection of narcotics for postoperative pain relief has been well reported. Caudal nalbuphine was assessed as a postoperative analgesic in a randomized double blind study of 80 patients after perianal surgery. Caudal block was carried out with 1.5% lidocaine 25 ml (Group 1) in 20 patients, and mixed with nalbuphine 3 mg (Group 2) in 20 patients, nalbuphine 5 mg (Group 3) in 20 patients, and nalbuphine 10 mg (Group 4) in 20 patients. Pain relief was evaluated by the subsquent need for systemic analgesics (Pethidine). In group 4, the use of systemic analgesics was significantly reduced for the first 24 hours postoperatively. Urinary retention was not correlated with nalbuphin dose.

Liquid Heparin Anticoagulant Produces More Negative Bias in the Determination of Ionized Magnesium than Ionized Calcium

신증수,장철호,김정호 연세대학교의과대학 2006 Yonsei medical journal Vol.47 No.2

The ionized calcium level in blood is known to be falsely decreased when self-prepared liquid heparin anticoagulant is used, due to dilution and binding effects. The effect of liquid heparin on the determination of ionized magnesium is not as well understood. We compared the effect of liquid sodium heparin on the determination of ionized calcium and magnesium in 44 clinical samples using two types of user-prepared heparin syringes which differed in the amount of residual heparin from the BD PresetTM reference syringe. With the type 1 syringe, the liquid heparin was expelled once or twice such that some heparin could be left in the dead space at the syringe hub, while the liquid sodium heparin was thoroughly expelled from the type 2 syringe. The ionized magnesium levels obtained with the type 1 syringe were significantly lower than the reference value (by 0.068mmol/L) (p<0.0001), while the value obtained with the type 2 syringe differed less from the reference, by only 0.014mmol/L (p<0.0001). The heparin binding effect resulted in more negative bias in ionized magnesium (-0.026±0.032mmol/L) than in ionized calcium (-0.009±0.042mmol/L, p<0.0001). In conclusion, we recommend using lyophilized, calcium-balanced, heparinized syringes for the determination of ionized magnesium and ionized calcium due to the increased negative bias in ionized magnesium determinations. When user-prepared syringes are used, the thorough evacuation of heparin solution should be strictly prescribed.

Midazolam in ICU

신증수 대한정맥마취학회 2000 정맥마취 Vol.4 No.3

전신마취 후 발생한 포르핀성 신경병증

신증수,남용택,이명식 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.1

Acute intermittent porphyria(AIP) is a rare hepatic disorder resulting from defects in the synthesis of heme. This occurs in approximately 0.01% of the general population and is even rare in black and orientals. Acute episode of this disease can be triggered by surgery, certain drug, pregnancy, mensturation, fasting and etc. We report a porphyrinogenic neuropathy occured after general anesthesia in a oriental woman who presented with abdominal pain and other typical sign and symptom. 56 year-old female patient was diagnosed as acute appendicitis for 2 days of constipation and abdominal pain and appendectomy was performed under general anesthesia at local clinic. Anesthesia was induced with penthothal and maintained with halothane, and she was recovered from anesthesia without event. After operation she experienced difficult swallowing and generalized weakness which were aggrevated day by day. Therefore she was transferred to our hospital on fourth postoperative day. Physical examination revealed Grade II motor weakness of Gxtremities and decreased deep tendon reflex. Neostigmine test and Jolly test were done under impression of myasthenia gravis but revealed negative. Guillian-Barre syndrome was difficult to rule out in this patient, but urinalysis revealed increased δaminolevulinic acid and urine color changed dark under light. Therefore we diagnosed her as AIP. 6 days after appendectomy she complained severe dyspnea with vital capacity 350 ml and arterial blood gas analysis revealed PO₂ of 56 mmHg and PCO₂ of 44 mmHg under nasal oxygen 5 1/min inhalation. Therefore we diagnosed this peripheral neuropathy as AIP and report here with references.

환기의 병태 생리 효과

신증수 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.1

성인성 호흡곤란 증후군의 원인과 그에 따른 예후

신증수,남용택,정현정 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.1

Adult Respiratory Distress Syndrome(ARDS) is defined as a syndrome of acute respiratory failure characterized by noncardiogenic pulmonary edema with severe hypoxemia caused by right to left intrapulmonary shunting secondary to atelectasis and air space filled with edema fluid. On the past respiratory failure was thought to be the most common cause of mortality of ARDS in the past but recent research suggests the importance of non-pulmonary organ failure. And this has been increasingly recognized as a major cause of death in patients who develope a acute lung injury. Therefore the prognosis of ARDS depends on the associated clinical disorders. But there are very few reports about the prognosis and predisposing factor of ARDS in korea. We performed a retrospective study on ARDS in association with sex prevalance, in 103 ARDS patients. Age distribution, associated disease and prognosis. The results were as follows 1) ARDS occurred more frequantly in male.(male female=1.9: 1) 2) Common clinical disorders associcated with development of ARDS were sepsis(26%), pneumonia(16%), gastric aspiration(12%) and etc. 3) Overall mortality was 54%, but the mortality was high in trauma patient with 80%. 4) Mortality of ARDS increased by age.

Nalbuphine 천골강내 주입에 의한 술후 제통효과

신증수(Jeung Soo Shin),윤덕미(Duck Mi Yoon),이경민 대한통증학회 1990 The Korean Journal of Pain Vol.3 No.1

N/A Epidural injection of narcotics for postoperative pain relief has been well reported. Caudal nalbuphine was assessed as a postoperative analgesic in a randomized double blind study of 80 patients after perianal surgery. Caudal block was carried out with 1.5% lidocaine 25 ml (Group 1) in 20 patients, and mixed with nalbuphine 3 mg (Group 2) in 20 patients, nalbuphine 5 mg (Group 3) in 20 patients, and nalbuphine 10 mg (Group 4) in 20 patients. Pain relief was evaluated by the subsquent need for systemic analgesics (Pethidine). In group 4, the use of systemic analgesics was significantly reduced for the first 24 hours postoper- atively. Urinary retention was not correlated with nalbuphin dose.

중환자실 입실 우선순위 결정에 따른 입실환자와 입실거절환자의 예후 비교

이재훈,신증수,한솔,고신옥 대한마취과학회 2005 Korean Journal of Anesthesiology Vol.49 No.6

백서에서 산소독성으로 인한 폐유순도의 변화

김진옥,신증수,남용택,김진,정우희,배선준 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7

Oxygen therapy is clear benefit in the treatment of tissue hypoxia, but high concentrations and long term exposures of oxygen carry the risks of detrimental physiologic changes and tissue damages. Tissue damages involve decreased surfactant production,alveolar edema, and alveolar hemorrhage. In spite of these damage, diagnosis of oxygen toxicity is difficult in many clinical settings. In this study, we measured lung compliance to evaluate the oxygen toxicity in 60 white rat of 100-150 g body weight Rats were divided into 6 groups. Group I was control graup, exposed to room air, group II -group V were exposed to 100% oxygen, group II for 24 hours, group IlI for 48 hous, group IV for 72 hours, and group V for 96 hours. Group VI was exposed to oxygen in serial as 30% oxygen for 24 hours, 60% oxygen for 24 hours and then 100% oxygen for 96 hours. After oxygen exposure we obseved changes of lung compliance and pathologic findings, compliance of group V was 15.94 mL/cmH2O significantly lower than that of eontrol group (p$lt;0.05) and lung weight of group V was 2.16 g/100 g heavier than the other groups (p$lt;0.05). Although we found oxygen tolerance was developed in group V, we could not differentiate the degree of pathologic damage cauesd from oxygen toxicity by pathologic findings. We concluded that the measurement of lung compliance is valuable in diagnosis of oxygen toxicity and thus in reducing lung damages.