Evolution of pain management in lung cancer surgery: from opioid-based to personalized analgesia

황원정 대한마취통증의학회 2025 Anesthesia and pain medicine Vol.20 No.2

Pain management in lung cancer resection has undergone a paradigm shift from opioid-centric approaches to multimodal analgesia, and more recently, personalized strategies that integrate the principles of precision medicine. Historically, opioids have been the mainstay of perioperative analgesia. However, concerns regarding opioid-related adverse effects, including respiratory depression, immunosuppression, and potential oncologic implications, have driven the adoption of opioid-sparing techniques. Current strategies emphasize multimodal analgesia, combining nonsteroidal antiinflammatory drugs, acetaminophen, regional anesthesia, and adjunctive agents to enhance pain control while minimizing opioid exposure. However, growing evidence suggests that perioperative analgesics may differentially influence tumor biology depending on molecular and genetic factors, necessitating a more tailored approach. This has led to the emergence of precision oncoanesthesia, which aims to integrate tumor-specific genomic insights into perioperative pain management. Although promising, the clinical implementation of precision oncoanesthesia remains in its early stages, with key challenges including the lack of large-scale prospective studies, limited real- time genomic profiling in anesthetic planning, and variability in patient responses to analgesics. Future research should focus on identifying biomarkers that predict individual responses to perioperative analgesia and establishing evidence-based guidelines for precision- based pain management. By evolving beyond traditional opioid reliance and standard analgesic protocols, perioperative pain management in lung cancer surgery can align with emerging precision medicine approaches, ensuring effective pain control and optimized oncologic outcomes.

Persistent perioperative tachycardia and hypertension diagnosed as thyroid storm induced by a hydatidiform mole -a case report-

황원정,임대환,김은성 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.3

Thyroid storm is a critical complication of molar pregnancy. However, early diagnosis of it is difficult because it is a rare complication and usually presents nonspecific findings. In this case report, we present a woman with molar pregnancy who had persistent tachycardia and hypertension. She was diagnosed initially with preeclampsia and sepsis as complications of molar pregnancy. During dilation and curettage under general anesthesia with sevoflurane and remifentanil, tachycardia and hypertension remained even with continuous infusion of labetalol. The patient was subsequently diagnosed with thyroid storm associated with molar pregnancy. She was restored to a clinically euthyroid state 1 day after the operation, and her thyroid function test and β-hCG values were normal 3 months later. The anesthesiologists should bear in mind the possibility of thyroid storm in patients with molar pregnancies who show persistent tachycardia and hypertension.

와룡, 동해6갱, 호남광산의 자연정화시설내 슬러지 특성연구

황원정,오택근,이종운,김덕민,차종문 한국자원공학회 2016 한국자원공학회지 Vol.53 No.5

Passive mine water treatment system was used for the treatment of the mine water, and consisted of SAPS(Successive Alkalinity Producing System), OP(Oxidation/settling Pond) and wetland, etc. This study was carried out for physical and chemical analysis of sludges of Waryong, Donghae (6th adit) and Honam mine to investigate the basic properties of the sludges settled in the passive mine water treatment system. The water content of the sludges collected from SAPS was found to be about 50% to 72% and that of the sludges collected from OP was found to be about 59% to 73%. The particle size of sludges was various. From the XRF analysis, the content of Fe2O3 was over 70% at most sludges. The Cd concentration of sludges from the ICP-OES analysis exceeded the soil contamination standards of the heavy metals. 국내에 분포하고 있는 자연정화시설은 주로 석탄광에서 나오는 갱내수를 처리하기 위해 사용되고있으며 일반적으로 알칼리도 공급 시스템(Successive Alkalinity Producing System, SAPS), 산화·침전조, 소택지등으로 구성된다. 본 연구에서는 와룡, 동해6갱, 호남광업소의 자연정화시설 반응조에서 침전되는 슬러지의 기본적인 특성을 파악하고자 물리·화학적 분석을 수행하였다. 알칼리도 공급 시스템 슬러지의 함수율은 약 50~72% 으로 나타났고, 산화·침전조의 함수율은 59~73%로 나타났다. 입도분석 결과 슬러지의 입도가 다양한 것으로나타났으며, XRF 분석 결과 대부분 슬러지에서 Fe2O3의 함량이 전체에서 70% 이상을 차지하였다. 슬러지에대한 ICP-OES 분석 결과 Cd의 농도가 토양오염기준치를 초과하였다.

마취 전 복용에 주의해야 할 약물이나 음식

황원정 대한의사협회 2014 대한의사협회지 Vol.57 No.10

Decisions about stopping or continuing medications perioperatively should be based on withdrawal potential, thepotential for disease progression if therapy is interrupted, and the potential for drug interactions with anesthesia. Ingeneral, most medications are tolerated well through surgery and do not interfere with anesthetic administration. Therefore, most drugs should be continued through the morning of surgery. However, some medications are knownto influence surgical risk or surgical decisions (e.g., antiplatelet agents, anticoagulants, some hormonal therapies,and herbal remedies), so it is important to obtain a complete medication list from the patient and to advise adjustingdoses or discontinuing certain potentially complicating medications in advance of surgery. This article reviews generalrecommendations for perioperative management of a number of common medication classes.

간호대학생을 위한 알코올 진전섬망 대상자 간호 시뮬레이션 교육프로그램 개발

황원정,하정민 사단법인 한국융합기술연구학회 2025 아시아태평양융합연구교류논문지 Vol.11 No.3

알코올 진전섬망 사례는 지속적으로 증가 추세에 있음에도 관련 교육은 부족한 실정이다. 이에 본 연구는 간호대학생을 위한 시뮬레이션 기반 알코올 진전섬망 대상자 간호 교육프로그램을 개발하기 위해 수행되었다. 본 연구는 교육프로그램을 개발하기 위해 ADDIE 교육 설계 모델의 5단계 중 분석, 설계, 개발의 3단계를 활용하였다. 첫 번째 단계에서는 전문가 인터뷰를 통해 교육프로그램의 방향을 설정하기 위한 예비분석을 수행하였다. 두 번째 단계에서는 예비분석 결과와 연구자의 임상 경험을 바탕으로 교육프로그램 개발을 위한 교수 전략 설정을 수립하고 시뮬레이션 상황을 선정하는 등 기본 설계를 수행하였다. 마지막으로 전문가의 검토 의견을 바탕으로 교육프로그램을 개발하고 수정하였다. 간호대학생을 위한 알코올 진전섬망 대상자 간호 시뮬레이션 교육프로그램에는 훈련을 위한 임상 사례 및 시나리오, 표준화 환자 훈련 스크립트, 사전 및 사후 학습 자료, 디브리핑 도구 및 평가도구가 포함되었다. 개발된 교육프로그램은 간호 학생들이 알코올 진전섬망 환자를 돌보는 데 대한 이해와 숙련도 향상을 돕는다는 명확한 목표를 가지고 설계되었다. 본 연구에서 개발된 교육프로그램은 학습 여정에서 학생들에게 귀중한 지원과 지침을 제공하는 것을 목표로 포괄적인 문헌 검토 결과와 전문가의 통찰력을 바탕으로 세심하게 제작되었지만, 실제 교육 현장에 적용되기 위해서는 교육프로그램의 실제 적용 효과를 검증하는 후속 연구와 현실의 변화를 반영한 교육프로그램의 개선이 필요하다. Incidences of alcohol withdrawal delirium are increasing; however, there is a lack of adequate educational programs addressing this issue. This study aimed to develop a comprehensive simulation-based education program to equip nursing students with the knowledge and skills necessary to care for patients experiencing alcohol withdrawal delirium. The program was created using the ADDIE instructional design model, progressing through analysis, design, and development stages. During the analysis phase, expert interviews were conducted to establish the program’s direction, clarify educational objectives, and determine essential content. In the design phase, specific teaching strategies and simulated scenarios were developed based on the researcher’s clinical experience and expert feedback. During the development phase, the program underwent refinement through iterative expert reviews, resulting in the finalized version. The resulting educational program includes clinical case scenarios, standardized patient training scripts, pre- and post-learning materials, debriefing tools, and evaluation instruments. This program is designed to enhance nursing students’ understanding and practical skills in caring for patients with alcohol withdrawal delirium by integrating both theoretical knowledge and hands-on practice. It aims to improve students’ ability to manage patients in real-life situations by providing a comprehensive learning experience. Furthermore, the program is grounded in a comprehensive literature review and expert insights to ensure alignment with current clinical practices. This approach will enhance students’ ability to confidently care for patients in clinical settings, improving their readiness for real-world nursing challenges. To ensure its effectiveness in genuine educational contexts, additional research is necessary to verify the program’s impact and to evaluate improvements that align with real-world changes.

Relationship between anticipatory postural adjustment of the trunk, dual tasks and physical performance with chronic stroke survivors: a pilot test

황원정,조민권,정이정 물리치료재활과학회 2015 Physical therapy rehabilitation science Vol.4 No.1

Objective: The purpose of this study was to investigate the relationship between anticipatory postural adjustment (APA), single task, dual tasks and physical performances. The trunk muscles of APA consist of bilateral erector spinae (ES) and bilateral internal oblique (IO) adnominal muscles, during rapid stepping with the affected or unaffected leg in a sitting posture. Design: Cross-sectional study. Methods: In patients with chronic stroke, electrodes of surface electromyography (EMG) were attached on the bilateral erector spinae (ES), bilateral internal oblique adnominal (IO), and bilateral rectus femoris (RF) muscles. RF acts as the prime mover. The stroke patients performed hip flexion until 20˚ as fast as possible at each leg in a sitting posture according to a visual cue. The visual cue unexpectedly appeared on monitor in front of the stroke patient. The single task was the Timed Up and Go (TUG) test. The dual tasks were the TUGconitive, which increased cognitive capacity, and the TUGmanual task, which had an external focus. Results: All EMG data showed earlier onset latency before the prime mover. In affected leg raising, the onset time of unaffected ES muscle of the stroke patients was correlated with the single and dual tasks (p<0.05). In unaffected leg raising, the onset time of the affected IO muscle was related to all the tasks (p<0.05). Gait speed showed a relationship with the unaffected ES muscle only. Conclusions: The trunk muscles of the bilateral ES and bilateral IO play an important role in APA. The single and dual tasks using TUG test were correlated with the APA s of ES and IO muscles. Dual task by the TUG test is a good measuring tool for reflecting the real life in patients with chronic stroke.

Reversible endotracheal tube obstruction caused by meconium acting as a check valve

황원정,황지은,전준표 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.6

Walking behaviors for stroke survivors: comparison between straight line and curved path

황원정,Bora Choi,황수진 물리치료재활과학회 2019 Physical therapy rehabilitation science Vol.8 No.3

Objective: The purpose of this study was to compare walking conditions (straight line and curved path) on walking patterns in persons who had experienced hemiplegic stroke and to determine whether if they adapt their walking pattern and performances according to changes in environmental conditions. Design: Cross-sectional study. Methods: Forty-four hemiplegic stroke survivors participated in this study. This study measured walking performance in three different walking conditions, such as straight walking, the more-affected leg in the inner curve walking, and less-affected leg in the inner curve walking conditions, and a 2-dimentional gait analysis system was used as a primary measurement. This study also measured secondary clinical factors including the Timed Up-and-Go Test, the Trunk Impairment Scale, and the Dynamic Gait Index. Results: After analyzing, cadence and step length of the less-affected side, stride length in the more-affected side, and stride length in less-affected side were significantly different among the three different walking conditions in this study (p<0.05), but other temporospatial parameters were not significant. Cadence was the largest in the straight walking condition. Step length in the less-affected side, stride length in the more-affected side, and stride length in less-affected side were also the longest in the straight walking condition. Conclusions: The results of the study suggest that hemiplegic stroke survivors show walking adaptability according to changes in walking demands and conditions, and moreover, cadence and step and stride lengths were significantly different between straight and curved walking conditions.

중환자실 신규 간호사의 의사소통 상황 관련 교육 요구도 조사

황원정,하정민,박다혜,Hwang, Wonjung,Ha, Jeongmin,Park, Dahye 한국중환자간호학회 2024 중환자간호학회지 Vol.17 No.1

Purpose : This study sought to investigate novice nurses' communication education needs in the intensive care unit (ICU) using Importance-Performance Analysis (IPA) and Borich's need assessment model. This study identified communication challenges in clinical settings to develop a simulation program that enhances communication competencies based on educational requirements. Methods : A descriptive research design and a self-report questionnaire were used. The latter was developed and administered to 121 novice nurses with less than one year of experience in the ICU at various university hospitals in Korea. Data were collected via the online open chatroom from June 24th to July 28th, 2023. The communication education needs were identified using descriptive statistics, t-tests, IPA, and Borich's needs assessment model. Text analysis was used to categorize the participants' communication experience. Results : The results revealed that "communication with physicians," "communication with patients," and "communication with nurse on another shift" domains contained the most substantial educational needs for novice nurses working in the intensive care units. Conclusion : The results provide fundamental data for developing and enhancing customized communication education programs for novice ICU nurses. This valuable information could help ICU nurses and educators improve new nurses' communication skills, which would ultimately contribute to the advancement of nursing education and clinical practice.

Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation

황원정,전준표,강성희,정현식,김지영,박철수 대한마취통증의학회 2010 Korean Journal of Anesthesiology Vol.59 No.3

Background: The pre-transplant model for end-stage liver disease (pre-MELD) score is controversial regarding its ability to predict patient mortality after liver transplantation (LT). Prominent changes in physical conditions through the surgery may require a post-transplant indicator for better mortality prediction. We aimed to investigate whether the post-transplant MELD (post-MELD) score can be a predictor of 1-year mortality. Methods: Perioperative variables of 269 patients with living donor LT were retrospectively investigated on their association with 1-year mortality. Post-MELD scores until the 30th day and their respective declines from the 1st day post-MELD score were included along with pre-MELD, acute physiology and chronic health evaluation (APACHE)II, and sequential organ failure assessment (SOFA) scores on the 1st post-transplant day. The predictive model of mortality was established by multivariate Cox’s proportional hazards regression. Results: The 1-year mortality rate was 17% (n = 44), and the leading cause of death was graft failure. Among prognostic indicators, only post-MELD scores after the 5th day and declines in post-MELD scores until the 5th and 30th day were associated with mortality in univariate analyses (P < 0.05). After multivariate analyses, declines in post-MELD scores until the 5th day of less than 5 points (hazard ratio 2.35, P = 0.007) and prolonged mechanical ventilation ≥24 hours were the earliest independent predictors of 1-year mortality. Conclusions: A sluggish decline in post-MELD scores during the early post-transplant period may be a meaningful prognostic indicator of 1-year mortality after LT.