• 대한치과마취과학회지
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• 제9권2호
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• pp.116-118
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• 2009

The automatic implantable cardioverter defibrillator (AICD) has been widely used to treat recurrent malignant ventricular arrhythmia. Here, we case report 18 yr old patients implanted with Automatic implantable cardioverter defibrillator (AICD) who underwent surgical extraction under intravenous sedation and discuss the anesthetic implications for surgery.

• 대한수의학회지
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• 제23권1호
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• pp.17-23
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• 1983

Experimental hypocalcemia was induced in normal goats by intravenous infusion with various concentration of $Na_2$-EDTA solution. 1. Progressive depression of reflexes and body temperature, paresis, and cardiac arrest were observed in two groups infused with 4% and 8% EDTA solution, whereas paresis and cardiac arrest were not observed in 3% EDTA group. 2. The patterns of electrocardiogram were changed according to the decrease of plasma Ca level in all of 7 goats. When plasma Ca decreased to 6mg per 100ml or below, sinus bradycardia or tachycardia and prolongation of QT interval were showed, while atrioventricular block was noted in case which the plasma Ca level decreased to 4mg per 100ml or below. Fibrillation and cardiac arrest were evident in case which the plasma Ca level decreased to as low as 3mg per 100ml.

• 대한신경집중치료학회지
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• 제11권2호
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• pp.81-85
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• 2018

Proper glucose management in hospitalized patients can improve clinical outcomes. In particular, intensive care unit (ICU) patients are known to have significantly higher rates of mortality from changes in blood glucose due to severe comorbidities. Improving glucose control in ICU patients, therefore, can improve mortality and prognosis. Several studies related to the management of blood glucose in the ICU patients have been conducted. Intensive glucose management of surgical ICU patients has been successful. However, studies on medical ICU patients did not demonstrate positive effects of strict glycemic control. There is no independent glucose management goal for neurological ICU patients. However, maintenance of the usual glucose control target of 140-180 mg/dL is recommended for ICU patients. Intravenous insulin infusion is essential for glucose control in ICU patients not consuming a regular diet, and caution should be exercised to prevent hypoglycemia.

• 대한약학회:학술대회논문집
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• 대한약학회 2003년도 Proceedings of the Convention of the Pharmaceutical Society of Korea Vol.2-2
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• pp.118.2-118.2
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• 2003

Propofol(2, 6-diisopropylphenol) is rapid, short-acting intravenous anaesthetic agent. It is used for the induction and maintenance of general anaesthesia or sedation. The recommended doses are 2-2.5mg/kg given as a titration infusion over about 30min to achieve anaesthesia. Recently, we encountered 4 fatalities related to propofol. One death is a suicide by self-administered of propofol and the others are therapeutic misadventures during surgical care. The propofol level in the blood and tissues were determined by gas chromatographic analysis with mass spectral detection. (omitted)

• 기본간호학회지
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• 제9권2호
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• pp.323-334
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• 2002

Purpose: This study was designed to verify preemptive effects of intravenous patient-controlled analgesia (IV-PCA) infusion on postoperative pain in women having a total abdominal hysterectomy. Method: The research design was a nonequivalent control group post test only design. The participants in this study were 50 women who were scheduled for a total abdominal hysterectomy at a University affiliated Hospital in Suwon, Korea. The subjects were divided into two groups. For the experimental group, IV-PCA infusion was started before the skin incision and for the control group. IV-PCA infusion was started after the skin was closed. Each group was evaluated in terms of pain score by the visual analogue scale (VAS) and the number of times they pushed the button for IV-PCA at postoperative hours 1, 2, 3, 6, 12, and 24. The data were collected from July 1 to December 10, 2001. Collected data was analyzed by SPSS/PC + program. Result: 1. There was no difference between the two groups, over six points for the number of times the control button for IV-PCA was used. Group differences and interaction effect were not significant. 2. There was no significant difference in pain scores between the two groups, over seven time points. A significant interaction effect was observed between groups and measurement Points in time. 3. There was a significant difference in the requirements for additional analgesia between the two groups, 32% of the control group received additional analgesia. Conclusion: Preemptive analgesics administration may have a better effect in relieving postoperative pain than the usual analgesic treatment which is started after surgery.

• Tuberculosis and Respiratory Diseases
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• 제60권4호
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• pp.419-425
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• 2006

배경: 중증 지역사회 획득 폐렴은 항생제의 발달과 보조요법의 발전에도 불구하고 사망률이 높은 질환으로 호흡부전으로 진행되어 기계환기가 필요한 경우 사망률은 더욱 증가하게 된다. 최근 중증 지역사회 획득 폐렴에서 저용량 하이드로코르티손 주입이 사망률을 감소시킨다고 보고되었다. 본 연구는 기계환기가 요구된 중증 지역사회 획득 폐렴 환자에서 하이드로코르티손 정주의 효과를 알아보기 위하여 시행하였다. 방법: 2005년 2월부터 7월까지 중증 지역사회 획득 폐렴으로 기계환기를 유지한 13명의 환자(남:여=10:3, 평균 연령: $68.6{\pm}14.1$)를 대상으로 하이드로코르티손을 240mg을 부하로 정주하고 시간당 10mg을 지속적으로 7일간 주입하였다. 대조군은 연구 기간 이전 중증 지역사회 획득 폐렴으로 기계환기를 유지하고 스테로이드 치료를 하지 않았던 13명의 환자를 대상으로 하였다. 하이드로코르티손 주입 전과 주입 8일째 두 군 간의 임상적, 생리적 지표의 차이와 최종 결과를 비교하였다. 결과: 1) 하이드로코르티손 주입 전 주입군과 대조군의 나이, 성별, 내원 당시의 SAPS II, SOFA 점수, 체온, 백혈구 수, PaO2/FiO2(P/F) 비, P/F 200이하인 환자수, 흉부방사선 사진 점수, 폐손상 점수, 카테콜라민 의존성 패혈성 쇽의 빈도 등은 유의한 차이가 없었다. 2) 하이드로코르티손 주입 8일 후 대조군에 비해 주입군이 P/F비가 100이상 호전된 환자의 비율과 흉부 방사선 점수가 호전된 환자의 비율이 유의하게 높았다(61.5% vs. 15.4% p=0.016, 76.9% vs. 23.1% p<0.05). 이외 다른 임상적 및 생리적 지표들은 주입군과 대조군 사이에 유의한 차이는 없었다. 3) 두 군 간에 기계환기 유지기간, 중환자실 재원기간, 병원내 재원기간, 재원 10일째와 30일째의 사망률은 유의한 차이가 없었다. 결론: 기계환기가 요구되는 중증 지역사회 획득 폐렴에서 하이드로코르티손 정주는 산소화와 흉부 방사선 점수의 빠른 호전을 보이지만 최종 치료 성적에 대해서는 많은 환자를 대상으로 한 전향적 무작위 대조 연구가 필요할 것으로 사료된다.

• Pediatric Infection and Vaccine
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• 제15권2호
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• pp.180-187
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• 2008

목 적 : 가와사끼병에서 염증의 심한 정도는 장기간의 발열 기간, 초기 정맥용 면역글로불린 치료의 불응성에 의해 반영되며, 관상 동맥 병변의 고위험도와 관계가 있다. 본 연구자들은 IVIG 불응군의 특성을 알아보기 위해, IVIG 반응군과 비교하는 연구를 시행하였다. 방 법 : 2004년 3월부터 2008년 2월 동안, 가톨릭대학교 의정부 성모병원에 입원한 가와사끼병 환아들을 두 군으로 나누었다. IVIG 반응군(25명)은 IVIG 초기 치료 이후 24시간 이내 $37.5^{\circ}C$ 미만으로 해열되는 환아들로, IVIG 불응군(14명)은 24시간 이상 발열이 지속되거나 잠시 해열된 이후 가와사끼병 증상과 관련된 발열이 재발되는 환아들로 정의하였다. 모든 환아들에 대해 IVIG 투여 당일, IVIG 투여 전에 첫 번째 혈액을 채취하였고, 두 차례의 IVIG (1 g/kg)가 투여 후 12시간 이내에 두번째 혈액을 채취하였다. 채취된 혈액으로부터 말초혈액 검사를 실시하였으며, 또한 혈청을 분리하여 CRP, 총단백, 알부민, 면역글로불린(IgG, IgA, IgM), 혈청 지질 (총 콜레스테롤, HDL-콜레스테롤, LDL-콜레스테롤, 중성지방) 및 전기영동법(protein electrophoresis)으로 혈청 글로불린(${\alpha}1-$, ${\alpha}2-$, ${\beta}-$ 및 ${\gamma}-$글로불린) 값들을 측정하고, 이들 값의 변화를 평가하였다. 결 과 : IVIG 불응군은 IVIG 반응군에 비해 발열 기간이 길었으며, 관상 동맥 병변의 비율이 유의하게 높았다(각각 P<0.001). IVIG 불응군에서 IVIG 투여 전 호중구의 비율과 CRP, ESR이 해열군보다 유의하게 더 높은 수치로 나타났고(각각 P<0.001, P<0.001, P=0.001), 혈청 총단백질, 알부민 수치는 유의하게 낮은 수치를 보였다(각각 P=0.02, P=0.01). 또한 IVIG 투여 후에는 IVIG 투여 전에 비해 총 백혈구 수와 CRP의 유의한 감소가 없었다. IVIG 불응군에서 HDL-콜레스테롤 수치는 IVIG 투여 후 해열군보다 유의하게 더 감소하였다(P=0.02). 결 론 : 초기 IVIG 치료에 반응하지 않는 가와사끼병 환아들은 보다 심하고 연장된 염증 반응을 보이며, 높은 비율의 관상 동맥 병변을 나타낸다. 가와사끼병에서 염증 반응의 강도는 IVIG 투여 직후의 호중구 수, CRP 및 HDL-콜레스테롤 등의 염증 지표 수치의 변화에 의해 반영된다.

• Journal of Yeungnam Medical Science
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• 제21권2호
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• pp.198-206
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• 2004

gemcitabine과 carboplatin으로 치료받은 경력이 있는 진행성 비소세포폐암 환자 25명을 대상으로 2차 화학요법으로 paclitaxel과 cisplatin을 사용하여 다음과 같은 결과를 확인하였다. 전체 25명 중 5명에서 부분반응이 관찰되었으며, 반응군의 반응지속기간은 2~11개월로 중앙값 4.3개월이었다. 전체 환자의 무진행생존 기간은 0~11개월로 중앙값 3.3개월이었으며, 생존기간은 1.3~39개월로 중앙값 7.4개월이었다. 전체 83회의 화학요법 중 WHO 3도의 혈소판감소증이 1회에서만 관찰되었으며, 비혈액학적 부작용도 감내할만 하였다. 이상의 결과 paclitaxel과 cisplatin 복합화학 요법은 진행서 비소세포폐암 환자에서 2차 요법으로 사용하였을 때 부작용이 적으며 효과적인 치료법의 하나로 판단된다.

• 대한치과마취과학회지
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• 제7권2호
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• pp.114-119
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• 2007

Background: Dental disabilities mean the poor cooperation for dental treatment because of patient's inherent disability, severe fear and anxiety, and communication problem. Sedation and general anesthesia are usually used for behavioral control in dentally disabled patients. In particular, sedation (conscious and deep) can help them to tolerate the proper dental treatment effectively and safely. Methods: From March 2002 to September 2007, total 35 sedation were carried out in 33 patients (male : female = 20 : 13) with dental disabilities at Seoul National University Dental Hospital and Hanyang University Medical Center. Patients' dental charts and sedation records were retrospectively reviewed. Results: Tooth extraction (19 cases) was the most common dental treatment performed under intravenous sedation (30 cases). Occasionally, inhalation sedation using Sevoflurane 1-2% was adapted (5 cases). Deep sedation (28 cases) was carried out using midazolam 2-3 mg bolus injection and propofol infusion via TCI (4.2 ${\pm}$ 0.9 mg/kg/h), and conscious sedation (7 cases) was carried out using midazolam bolus onlywithout severe complications. The duration of dental treatment was 25.5 ${\pm}$ 12.3 min and that of sedation was 43.2 ${\pm}$ 9.7 min. Conclusion: Sedation for dentally disabledpatients should be selected for effective behavioral control in conjunction with general anesthesia, considering the duration and pain-evoking potentials of dental treatment, the type and severity of patients' disabilities, and the experience of dental anesthesiologists altogether.

• Advances in pediatric surgery
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• 제14권1호
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• pp.67-74
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• 2008

The usefulness of totally implantable central venous port for long-term intravenous infusion is widely accepted in children. Usually the catheters are placed through the internal or external jugular vein. In case of jugular vein cut-down, two separate incisions are needed for catheter and port respectively. Patients also feel uncomfortable as the catheter run through the neck. However these disadvantages can be overcome by using the cephalic vein (CV). We reviewed our experiences on CV cut-down for totally implantable central venous port in children. From January 2002 to December 2006, 201 patients (M:F=127:74) underwent 218 central venous port insertions. Mean age at operation was 5.9 years (2 months - 19 years). Indications included chemotherapy (N=167), long-term intravenous antibiotics infusion (N=36), and total parenteral nutrition (N=15). CV was selected preferentially. The incision includes the deltopectoral triangle laterally, and both the CV cut-down and port insertion were achieved with a single incision. The number of insertion through external, internal jugular vein, and CV was 77, 66 and 75, respectively. The median age, height and body weight were higher in CV cut-down group. The youngest age for CV cut-down was 8 months, the shortest height was 69 cm and the smallest body weight was 5.9 kg. Of 118 trials of CV cut-down, cut-down was successful in 75 cases (63.6 %). CV was absent in 10 cases(8.4 %) and CV was sacrificed after catheter tip malposition in 10 cases (8.4 %). There was only one complication, in which the catheter was inserted into the minute branch of subclavian artery. The CV cut-down method for totally implantable central venous port was safe and feasible in selected groups of patients in children. In addition, preservation of jugular vein and a more favorable cosmetic effect are other benefits of CV cut-down.