갈색세포증 적출술의 마취관리 : 2예 보고 Two Cases Report

조성두,윤지영,김영생,송남원,권욱환 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.8

Two patients underwent anesthesia for pheochromocytoma involving adrenal gland and extra- adrenal space. Patient 1 was not diagnosed as pheochromocytoma before surgery and thus proper preoperative evaluation and care was not possible. During surgery and anesthesia, the patient showed a marked blood pressure variation, arrythmia and tachycardia. Pulmonary edema occurred intraoperatively, but subsided with positive end expiratory pressure and the use of diuretics and morphine. Patient 2 was preoperatively diagnosed as pheochromocytoma and was thus given prazosin and nifedipine (for 11 days) preoperatively. Blood pressure and pulse rate throughout the surgery and anesthesia were stable and no intra- and postoperative complication occured. We believe that careful preoperative preparation is essential to minimize intraoperative hemo- dynamic disturbance and their sequelae.

신이식술의 마취 관리

조성두,김영생,송남원,이용균,전순희 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.5

Fifty-one operations for transplant of a kidney have been performed in the period 1900-1993 at Maryknoll hospital. We have analysed the case records with special reference to the techniques and problems of anesthesia. Our anesthesia procedures in the recipinents were as follows: 1) Preanesthetic preparation with dialysis. 2) Premedication with glycopyrrolate and fentanyl. 3) Thiopental and succinylcholine for halothane or enflurane for maintenance. 4) N₂O-O₂-relaxant (vecuronium) with halothane or enflurane for maintenance. 5) Antagonism against the relaxant with nestigmine or pyridostigmine. 6) Transfusion and fluid infusion with CVP was maintained around 10 cmH₂O. Most patients with renal failure are poor risk due to such factor as hypertension, anemia, hyperkalemia, acidosis, bleeding tendency, and hyper- or hypovolemia, although these factors may be controlled to a great extent by dialysis. Therefore every anesthesiologist should keep in mind the risk factors for anesthetic amnagement of patient in renal failure.

윤상갑상막 및 윤상기관인대를 이용한 역행성 기관내 삽관

조성두,김영생,송남원,윤상민 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.2

Numerous devices and techniques have been devised to facillitate the difficult endotracheal intubation. Percutaneous retrograde intubation was first described by Waters, who used a Tuohy needle to puncture the cricothyroid membrane and an epidural catheter as a guideline in 1963 and many variations on the technique have been described. Failure to intubate 2 male adult patients were planned retrograde tracheal intubation using the cricothyroid membrane. While the patients were awake, and after adequate local anesthesia was obtained, a 16G Medicut was punctured through cricothyroid membrane. After confirmation of the intratracheal position by aspiration of air into syringe, the opening of the Medicut was directed upward foward the larynx and the epidural catheter was inserted through it and advanced retrograde between the vocal cords and into mouth. The epidural catheter tip was passed through the Murphy's eye from outside to inside and out of the tracheal tube. By keeping the catheter taut and coincidently pulling back, the tube was advanced into trachea. Correct positioning of the tracheal tube inside the trachea was confirmed by end-tidal carbon dioxide monitoring and auscultation. Another 2 male adult patients were intubated by using cricotracheal retrograde approach method. We experienced successful retrograde tracheal intubation without significant complications using an epidural catheter through cricothyroid membrane and cricotracheal ligament in 4 male adult patients who were predicted impossibility of simple orotracheal intubation. (Korean J Anesthesiol 1995; 29: 304~309)

마취중 Aprotinin 투여후 발생한 아나필락시양 반응에 의한 �

조성두,최현길,송남원 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.3

A number of drug administered during anesthesia can provoke pathologic response by immunologic or nonimmunologic mechanisms. Known drugs involved in hypersensitivity reactions are muscle relaxants, local anesthetics, narcotics, barbiturates, contrast media, protamine and antibiotics. Clinical manifestations of anaphylaxis are diverse, but during anesthesia, cardiovascular collapse is predominate. We experienced a case of anaphylactoid reaction with erythema on upper thoracic region, severe hypotension, tachycardia and ventricular fibrillation. After defibrillation, the patient was recovered. During follow-up, we knew that this patient was exposed aprotinin repeatedly, and suspect the possibility of anaphylactoid reaction due to aprotinin. (Korean J Anesthesiol 1997; 33: 562∼566)

원가족 역동과 조직에서의 갈등관리 양식 : 자기분화의 매개효과

조성두,박영석 가톨릭대학교 사회과학연구소 2009 社會科學硏究 Vol.25 No.-

Many studies on conflicts have focused on social, characteristic, or situational factors as a source of conflict. A number of family therapists, however, have argued that family-origin dynamics are repeated in various forms in the work places. The purpose of this study is to examine the relation between family-origin dynamics and conflict management style in organization. In this study, parenting attitude acts as family-origin dynamics, and the self-differentiation scale serves as a mediator between parenting attitudes and conflict management styles. This study is based on the questionnaires completed by 374 adults aged 20 and older who are, or were employed in corporations. Pearson Correlation, linear regression, and AMOS were used for the accurate analysis of the collected questionnaires. The results are as follows: First, positive parenting attitude has significant correlations with self-differentiation and positive conflict management styles. Second, regression analyses show that parenting attitude is responsible for 64.5 percents of self-differentiation, and self-differentiation explains 14.8 percents for collaborative conflict management style. Last, the result of mediation effect analysis reveals full mediation effect. The results in the study suggest that conflicts in organization would be approached from family-origin factors. 갈등의 원인에 관한 많은 연구들은 주로 사회문화 요인, 성격 요인, 상황 요인 등에 관한 분석들이 주를 이루고 있다. 여러 가족이론 연구자들은 개인의 어린 시절 가족 내에서의 역동이 성인기의 조직생활 장면에서 다양한 방법으로 되풀이 된다는 주장을 하였다. 본 논문에서는 원가족 역동과 그것이 성인기에 표현되는 자아분화가 조직에서의 개인의 갈등관리 방식에 미치는 효과를 다루고자 하였다. 본 연구를 위해 전국소재의 20세 이상 성인 남녀 직장인, 또는 직장경험이 있는 374명의 설문지응답을 바탕으로 상관계수를 산출하였으며 회귀분석을 실시하였다. 또한 자아분화의 매개효과 검증을 위하여 AMOS의 구조방정식 모델 검증을 실시하였다. 분석결과, 부모의 양육태도로 측정된 원가족 역동은 자아분화에 유의미한 영향을 끼치고 자아분화는 갈등해결양식에 유의미한 효과를 가지는 것으로 나타났다. 또한 자아분화는 원가족 역동과 갈등관리양식 사이에서 완전 매개 효과를 보였다. 이와 같은 결과를 통해 개인이 조직 내에서 나타내는 갈등관리양식은 가깝게는 성인기의 자아분화 정도, 멀게는 어린시절의 원가족에서의 역동으로부터 영향을 받고 있음을 알 수 있었다. 이는 조직 내 갈등관리에 관한 교육, 상담 또는 코칭에서 원가족에서의 문제를 다룰 필요가 있음을 시사한다.

폐 침수시의 심장 박출량과 혈압의 변동

조성두,남기용,Cho, Sung-Doo,Nam, Kee-Yong 대한생리학회 1967 대한생리학회지 Vol.1 No.1

Cold $(0^{\circ}C)$ or warm $(25^{\circ}C)$ fresh and sea water were flooded into the lungs of rabbits through tracheal canule. Respiratory arrest ensued in 19.5 minutes in the warm fresh water flooded rabbits and was the longest survival time among the experimental groups. The survival times in the other groups were: 2.32 minutes in cold fresh water group, 2.75 minutes in .warm sea water group, and 4.57 minutes in cold sea water group. Cardiac output was measured by means of T-1824 dilution technique after 2 or 3 minutes of flooding in 27 rabbits. Blood pressure was observed by mercury manometer throughout the survival time in 40 rabbits. The following results were obtained. 1. Cardiac output in the warm fresh water flooded and sea water flooded animal was smaller than that of control rabbits. In the cold fresh water flooded animal cardiac output was greater than that of the control animal. 2. Time constants of T-1824 dilution curve of experimental group were elongated than the normal curve. 3. Central blood volume showed an increase in the fresh water group, a decrease in cold sea water group and no change in warm sea water group. 4. In all of the experimental groups arterial blood Pressure showed an abrupt and great variations after flooding of lungs and lasted about 30 seconds. Thereafter, arterial pressure remained at a plateau level until the sudden fall to zero and this was almost coincided with the time of respiratory arrest. The Plateau level of arterial Pressure in fresh water group was about 10 mmHg higher than the control value, and it was lower than the control value in warm sea water group. In cold sea water group the plateau was made up by fluctuations around the control value. 5. Osmosis of water through the lung alveolar membrane occured in all animals. Fresh water caused hemodilution and sea water caused hemoconcentration. 6. In sea water flooded animal more volume of water was recovered through the tracheal canule than the volume injected into trachea. This was interpreted as the consequence of the shift of water from plasma to alveolar sac. 7. Relative freight of lung was greater in fresh water group than sea water group. In all animal lung edema ensued. 8. The mechanisms of cardiac output variations were discussed.

하행 대동맥류 수술시의 마취관리

조성두,김영생,송남원,이용균,전순희 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.5

The rupture of the aorta commonly follows major blunt truma to the thorax. It was markdly increased in recent years, paralleling the rising number of vehicular accidents. The patient underwent surgical repair with femoro-femoral partial bypass 40 days after injury. The anesthesia for descending aortic surgery presented problems involving large hemodynamic alterations during thoracic aortic cross-clamping, protection of the heart and brain from large increases in pressure occuring above the cross clamp, and prevention of spinal cord and renal ischemic damage below the cross-clamp. One lung ventilation was also employed with this anesthetic technique. A 23 years old male patient with traumatic aneurysm of descending thoracic aorta was treated successfully.

술중 발생한 긴장성기흉 감압후 발생된 양측성 재확장성 폐부종

조성두,송남원,최현길 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2

Reexpansion pulmonary edema(RPE) is a complication of the treatment of lung collapse secondary to pneumothorax, pleural effusion or atelectasis, and generally believed to occur ipsilaterally when a chronically collapsed lung is rapidly reexpanded by evacuation of large amount of air or fluid. Clinical manifestations of RPE are dyspnea, tachypnea, cyanosis, frothy blood-tinged sputum, wet rale, and expiratory wheezing. Hypotension and decrease in organ perfusion can occur. We experienced intraoperative tension pneumothorax probably due to positive pressure ventilation or pleural injury during central venous catheterization through internal jugular vein. And bilateral RPE combined with acute renal failure occurs after spontaneous decompression of tension pneumothorax with chest tube insertion, even with brief duration of lung collapse. (Korean J Anesthesiol 1997; 32: 316∼319)

[자식이 쓰는 부모님 자서전] 아버지는 내 편

조성두 샘터사 2012 월간 샘터 Vol.512 No.-

복강경 담낭절제술의 전신마취시 활력징후와 폐가스 교환의 변화

조성두,김영생,송남원,윤지영,권욱환 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7

Laparoscopic cholecystectomy is a relatively new surgical procedure, enjoying ever-increasing popularity and presenting new anesthetic challenges. Anesthetic problems are mostly due to physiologic changes associated with systemic absorption of the intra-peritoneally insufflated carbon dioxide (CO₂). We studied systolic and diastolic arterial pressure, heart rate, arterial blood gas, end-tidal CO₂ and peak inspiratory pressure changes in 30 patients who underwent laparoscopic cholecystectomy, before CO₂ insufflation (control value), 15 minute after CO₂ insufflation, after gall bladder delivery out, 15 minute after CO₂ excretion. After CO₂ insufflation, systolic and diastolic arterial pressure, peak inspiratory pressure, end-tidal CO₂ were increased sigmficantly in comparison to control values (P-value$lt;0.01). Also, in arterial gas analysis, arterial blood carbon dioxide tension (PaCO₂) was increased and pH was decreased significantly but arterial blood oxygen tension (PaCO₂) was not changed significantly. After CO₂ excretion, systolic and diastolic pressure, end-tidal CO₂ were increased in comparison to control values (P$lt;0.01) and pH was decreased significantly. But peak inspiratory pressure and PaCO₂ were not statistically significant. In conclusion, minute ventilation should be corrected during general anesthesia for laparoscopy with CO₂ insufflation according to continuous monitoring of end-tidal CO₂ and arterial carbon dioxide tension.