• 대한장애인치과학회지
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• 제5권1호
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• pp.18-22
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• 2009

A 26-year-old female patient with Down syndrome visited to recieve dental treatment under gnenral anesthesia 6 years ago. The patient had difficulties in oral examination, radiograph taking and laboratory test. The patient had congenital heart disease and medical consultation based on the echocardiography was provided by a cardiologist indicating that the patient could tolearte general anesthesia during dental treatment. And two times of general anesthesia were administered during a dental treament with the interval of 3 years and no postoperpative complicaton was reported. At the third dental operation, the patient had a relatively good condition and her prescreening test revealed no abnormalities. Without further consultation with a cardiologist, general anesthesia was administered to the patient. Anaesthesia was based on thiopental and ventilation of desflurane and $N_2O$ in oxygen via an endotracheal tube with an appropriate monitoring. During the maintenance of anesthesia, the blood pressure of the patient started to drop and the oxygen saturation also began to decrease. Consequently, the proceding operation was discontinued and also inhalation anesthesia was ceased. As the patient was recovered from anesthesia, her systemic conditions were alleviated. After the complete recovery of the patient, she visited the cardiologist, and the cardiologic test revealed her severe right ventricular dilatation. In the anesthesia of patients with congenital heart disease, information on their systemic conditions needs to be undated from the medical consultation, which assures the safety of treatment.

• 대한임상독성학회지
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• 제15권2호
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• pp.148-151
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• 2017

Methemoglobinemia is a condition in which the iron portion of hemoglobin, which binds to oxygen, is oxidized to produce methemoglobin, which increases blood concentration. There are many causes of methemoglobinemia, the most common being food, drugs, and chemicals. A 75-year-old male patient who had taken an herbicide did not notice any nonspecific symptoms. However, after 4 hours, his methemoglobin levels increased to 17.1%, while after 7 hours it increased to 26.5%, at which time intravenous administration of methylene blue 1 mg/kg (an antidote) was started. After a total of five doses of methylene blue at 1 mg/kg due to reactive methemoglobinemia for about 36 hours, the methemoglobin levels increased to 23.7%. Because no more methylene blue could be administered, 10 g of ascorbic acid (vitamin C) was administered intravenously. After 82 hours, ascorbic acid 10 g was administered six times for repeated reactive methemoglobinemia. No additional reactive methemoglobinemia was observed. The ventilator and endotracheal tube were successfully removed on day 5 after admission.

• 대한두개안면성형외과학회지
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• 제18권4호
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• pp.223-229
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• 2017

The beauty of the laryngeal mask is that it forms an air tight seal enclosing the larynx rather than plugging the pharynx, and avoid airway obstruction in the oropharynx. The goal of its development was to create an intermediate form of airway management face mask and endotracheal tube. Indication for its use includes any procedure that would normally involve the use of a face mask. The laryngeal mask airway was designed as a new concept in airway management and has been gaining a firm position in anesthetic practice. Despite wide spread use the definitive role of the laryngeal mask airway is yet to be established. In some situations, such as after failed tracheal intubation or in oral surgery its use is controversial. There are several unresolved issues, for example the effect of the laryngeal mask on regurgitation and whether or not cricoids pressure prevents placement of mask. We review the techniques of insertion, details of misplacement, and complications associated with use of the laryngeal mask. We then attempt to clarify the role of laryngeal mask in air way management during anesthesia, discussing the advantages and disadvantages as well as indications and contraindications of its use in oral and maxillofacial surgery.

• 한국임상수의학회지
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• 제20권4호
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• pp.496-500
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• 2003

A one-year-old male Japanese Chin with anorexia, retching, dyspnea and continuous coughing was brought to the Veterinary Teaching Hospital, Chungbuk National University. Chest radiographs showed moderate regional alveolar pattern with mild interstitial patterns in the caudo-dorsal lung fields and the ill-defined mass in the perihilar area which is consistent with perihilar lymphadenopathy. Although the dog showed severe eosinophilia in the complete blood count, the serum profile values were within normal ranges. There was no indication of any parasite infestation in the direct and floatation examination of feces, skin scraping test and heartworm examination. There was no growth of bacteria and fungi in the selected media such as Mueller Hinton broth, Sabouraud Dextrose agar and Potato Dextorse agar, which were inoculated with tracheal fluid collected using endotracheal tube and cultured for 3 days. In the tracheal fluid smear, most prominent cells were eosinophils, which are a almost 80% of total cells and other cells such as leukocytes, neutrophils and ciliated colummar cells were also observed. Any parasite was also not detected in its smear. Prednisolone (PDS; 1 mg/kg, BID SC), aminophylline (10 mg/kg, TID IV) and nebulization with gentamicin (50 mg) plus saline (3 ml) were given for 1 week. At 3rd day of treatment, blood eosinophil value was return to normal range and pulmonary condition was also improved. The allergen test with serum performed during therapy was positive in the 19 index including milk, barley, tomato pomace, catfish, bonito, house dust and wool, and borderline in 10 index including wheat, house dust mites and house fly. The patient is responding well to PDS therapy. Based on these findings, a possible diagnosis of pulmonary infiltration with eosinophils was made in this dog.

• 대한후두음성언어의학회지
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• 제18권1호
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• pp.44-50
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• 2007

Background and Objectives: The 585-nm pulsed dye laser (PDL) has recently been adopted by otolaryngologists because of its epithelial-sparing properties. Many authors have reported the use of PDL for treatment of various vocal cord lesions. This purpose of this study is to examine the effectiveness of 585-nm PDL in the treatment of vocal polyp. Materials and Methods: Eight patients with vocal polyp were treated with 585-nm PDL from Sep. 2006 to Nov. 2006 in Yong-dong Sevrance hospital. 5 of them went through local anesthesia and 3 of them went through general anesthesia. In order to control laser fiber, flexible digital transnasal laryngoscope was applied under local anesthesia and general anesthesia using LMA, and micromanipulator was used under general anesthesia using endotracheal tube. The evaluations of vocal function was done at pre-and postoperation. Results: All patients improved in the perceptual evaluation of voice after PDL surgery. The aerodynamic study revealed that 5 of 8 patients showed improvement in maximal phonation time, and 6 of 8 showed improvement in mean airflow rate during phonation. The acoustic analysis revealed that all patients showed improvement in Jitter and Shimmer, and 7 of 8 showed improvement in noise to harmony ratio. Conclusion: This study demonstrates promising results in the efficacy of 585-nm PDL for the treatment of vocal polyps, and it illustrates a new option for vocal polyp treatment as well as the advantage of PDL surgery.

• 대한간호학회지
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• 제49권5호
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• pp.575-585
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• 2019

Purpose: The purpose of this study was to develop predictive models for pressure ulcer incidence using electronic health record (EHR) data and to compare their predictive validity performance indicators with that of the Braden Scale used in the study hospital. Methods: A retrospective case-control study was conducted in a tertiary teaching hospital in Korea. Data of 202 pressure ulcer patients and 14,705 non-pressure ulcer patients admitted between January 2015 and May 2016 were extracted from the EHRs. Three predictive models for pressure ulcer incidence were developed using logistic regression, Cox proportional hazards regression, and decision tree modeling. The predictive validity performance indicators of the three models were compared with those of the Braden Scale. Results: The logistic regression model was most efficient with a high area under the receiver operating characteristics curve (AUC) estimate of 0.97, followed by the decision tree model (AUC 0.95), Cox proportional hazards regression model (AUC 0.95), and the Braden Scale (AUC 0.82). Decreased mobility was the most significant factor in the logistic regression and Cox proportional hazards models, and the endotracheal tube was the most important factor in the decision tree model. Conclusion: Predictive validity performance indicators of the Braden Scale were lower than those of the logistic regression, Cox proportional hazards regression, and decision tree models. The models developed in this study can be used to develop a clinical decision support system that automatically assesses risk for pressure ulcers to aid nurses.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권1호
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• pp.100-108
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• 2021

Purpose: Percutaneous endoscopic gastrostomy (PEG) tube placements are commonly performed pediatric endoscopic procedures. Because of underlying disease, these patients are at increased risk for airway-related complications. This study compares patient characteristics and complications following initial PEG insertion with general endotracheal anesthesia (GETA) vs. anesthesia-directed deep sedation with a natural airway (ADDS). Methods: All patients 6 months to 18 years undergoing initial PEG insertion within the endoscopy suite were considered for inclusion in this retrospective cohort study. Selection of GETA vs. ADDS was made by the anesthesia attending after discussion with the gastroenterologist. Results: This study included 168 patients (GETA n=38, ADDS n=130). Cohorts had similar characteristics with respect to sex, race, and weight. Compared to ADDS, GETA patients were younger (1.5 years vs. 2.9 years, p=0.04), had higher rates of severe American Society of Anesthesiologists (ASA) disease severity scores (ASA 4-5) (21% vs. 3%, p<0.001), and higher rates of cardiac comorbidities (39.5% vs. 18.5%, p=0.02). Significant associations were not observed between GETA/ADDS status and airway support, 30-day readmission, fever, or pain medication in unadjusted or adjusted models. GETA patients had significantly increased length of stay (eβ=1.55, 95% confidence interval [CI]=1.11-2.18) after adjusting for ASA class, room time, anesthesia time, fever, and cardiac diagnosis. GETA patients also had increased room time (eβ=1.20, 95% CI=1.08-1.33) and anesthesia time (eβ=1.50, 95% CI=1.30-1.74) in adjusted models. Conclusion: Study results indicate that younger and higher risk patients are more likely to undergo GETA. Children selected for GETA experienced longer room times, anesthesia times, and hospital length of stay.

• 대한간호학회지
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• 제53권1호
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• pp.39-54
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• 2023

Purpose: This study aimed to investigate the nationwide intention to delegate clinical practice of medical specialists in accordance with the enactment of the scope of practice for advanced practice nurses (APNs). Methods: Data were collected from October to December 2021 using Google Surveys. In total, 147 medical specialists from 12 provinces responded to the survey. The survey questionnaire was categorized into four legislative draft duties, according to the scope of practice (a total of 41 tasks): Twenty-nine tasks on treatments, injects, etc., performed under the guidance of a physician and other activities necessary for medical treatment (treatment domain); two tasks on collaboration and coordination; six tasks on education, counseling, and quality improvement; four regarding other necessary tasks. Participants were asked whether they were willing to delegate the tasks to APN. Results: The intention to delegate tasks to APN was higher for non-invasive tasks such as blood sampling (97.3%) or simple dressing (96.6%). Invasive tasks such as endotracheal tube insertion (10.2%), sampling: bone marrow biopsy & aspiration (23.8%) showed low intention to delegate in the treatment domain. Participants who were older, male, and had more work careers with APN, showed a higher intention to delegate tasks. Conclusion: To prevent confusion in the clinical setting, a clear agreement on the scope of APN practice as APN delegated by physicians should be established. Based on this study, legal practices that APN can perform legally should be established.

• Clinical and Experimental Pediatrics
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• 제46권12호
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• pp.1200-1206
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• 2003

목 적 : 중등도 신생아 호흡곤란 증후군 환아에서 인공호흡기 이탈시 low IMV, 기관내 CPAP, 기도 발관의 고전적 방법과 비침습적인 비강내 CPAP 조기 사용을 비교함으로써 비강내 CPAP의 활성화를 위해 본 연구를 시행하였다. 방 법 : 2001년 11월부터 2002년 6월까지 본원 출생아로서 중등도 신생아 호흡곤란 증후군으로 진단된 환아 중 폐 표면활성제를 투여한 뒤 인공호흡기 치료를 시행하고, 이탈시 비강내 CPAP으로 조기 전환한 환아 30례를 연구군으로 하고, 1999년 1월부터 2001년 9월까지 본원 출생아이며 중등도 호흡곤란 증후군으로 진단된 환아 중 폐 표면활성제를 투여하고 인공호흡기 치료를 시행한 뒤 low IMV, 기관내 CPAP의 과정으로 이탈한 환아 30례를 대상으로 하여 재태연령과 출생체중, 1분 및 5분 Apgar 점수, SMR 검사, 임상증상, 동맥혈 가스 분석, 인공호흡기 치료기간, 임상경과, 이탈 성공률, 이탈기간과 동반된 합병증등을 후향적으로 분석하였다. 결 과 : 1) 대상아의 특징 : 평균 재태연령은 연구군이 $28.3{\pm}1.6$주이고, 대조군이 $29.3{\pm}1.5$주였고, 평균 출생체중은 연구군이 $1,238.3{\pm}158.6gm$, 대조군이 $1,270{\pm}133.8gm$이었으며, 양 군에서 남아가 반수 이상이었으며, SMR은 양 군에서 약 양성으로 양 군간에 유의한 차이가 없었다. 신생아 호흡곤란 증후군은 양 군에서 중등도였다. 2) 양 군에서 동맥혈 가스 분석 및 호흡지표의 변화 : 인공호흡기 설정시 시행한 동맥혈 가스 분석상 pH, $PaO_2$는 연구군에서 각각 $7.3{\pm}0.1$, $39.7{\pm}3.4mmHg$, 대조군이 $7.3{\pm}0.1$, $39.3{\pm}3.9mmHg$였고, 평균 기도압은 연구군 $6.1{\pm}0.6cmH_2O$, 대조군이 $6.2{\pm}0.8cmH_2O$였으며, 산소화 지수는 연구군에서 $10.8{\pm}1.6$, 대조군에서 $11.8{\pm}1.9$를 나타내어 두 군에서 유의한 차이는 없었다. 환아가 안정화되었을 때 시행한 동맥혈 가스 검사에서 $PaCO_2$, $PaO_2$는 연구군에서 $37.4{\pm}4.6mmHg$, $88.8{\pm}5.9mmHg$였고, 대조군에서 $36.9{\pm}4.5mmHg$, $89.8{\pm}4.8mmHg$로 큰 차이가 없었다. 인공호흡기 이탈을 시도한 후 1시간과 12시간 뒤에 시행한 동맥혈 가스 검사에서 대조군의 $PaCO_2$는 각각 $41.4{\pm}4.0mmHg$와 $42.2{\pm}4.8mmHg$로 이산화탄소의 저류가 관찰되었으나 이탈을 성공한 뒤에는 $38.3{\pm}5.5mmHg$로 정상화되었다. 연구군에서는 이탈 전 기간동안 $PaCO_2$에 큰 변화가 없었다. 3) 양 군에서 임상경과 및 인공호흡기 치료기간 비교 : 연구군에서 30례 중 28례(93.3%)에서 이탈에 성공하였고, 나머지 2례는 반복되는 무호흡과 제반증상의 악화로 인공호흡기 치료로 전환되었다. 대조군에서는 30례 중 24례(80%)에서 이탈에 성공하였고 실패한 경우는 반복되는 심한 무호흡이 4례, 심한 호흡성산증이 2례 관찰되었다. 연구군에서 평균 인공호흡기 치료기간은 $2.5{\pm}2.2$일이며 비강내 CPAP으로 $1.4{\pm}0.6$일간 치료하였고, 대조군에서 인공호흡기 치료기간은 $2.9{\pm}3.3$일이었고 low IMV와 기관내 CPAP의 사용기간은 $1.5{\pm}0.8$일로 양 군에서 유의한 차이는 없었다. 4) 양 군에서 인공호흡기 이탈기간 동안 발생한 합병증의 비교 : 연구군에서 비강내 CPAP을 사용하여 이탈한 기간 동안 발생한 합병증은 공기누출 증후군 1례, 패혈증 1례, 비강과 구강의 미란이 2례가 있었으며, 비강내 CPAP의 고정의 문제가 2례에서 발생하였다. 또한 지속적 양압으로 인하여 1례에서 복부팽대 소견을 보였고, 2례에서 서혜부 탈장이 관찰되었으나 수술적 처지는 필요하지 않았다. 대조군에서는 공기누출 증후군 2례, 무기폐3례, 비강과 구강의 미란이 2례 있었으며, 기관 삽관으로 인한 문제로 자연적 발관이 1례, 기관내관 말단 위치가 기관분기부상방 0.2-2.0 cm 사이에 고정되지 않은 경우 2례, 점액으로 인한 기관내관이 막힌 경우가 2례 관찰되었다. 결 론 : 중등도 신생아 호흡곤란 증후군 환아에서 고전적인 low IMV, 기관내 CPAP의 과정을 거치지 않고 비강내 CPAP으로 전환하는 적극적인 인공호흡기 이탈이 가능하였고, 사용상의 어려움도 없었다. 따라서, 인공호흡기 이탈시 비침습적인 비강내 CPAP의 조기 사용을 시도해 볼 수 있을 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제46권4호
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• pp.500-511
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• 1999

연구배경: 비 혹은 안면마스크를 이용한 비침습적 양압호흡법(NPPV)은 안정된 만성호흡부전환자를 대상으로 사용되었으며, 최근 급성호흡부전환자를 대상으로도 시도되고 있다. 일부 연구에서 기계호흡이탈후 발생한 호흡부전에서 NPPV를 시도하여 기관내삽관을 피할 수 있음을 보고한바 있으나, 기계호흡이탈의 한 방법으로 시도된 예는 거의 없다. 본 연구자는 장기간 침습적 기계호흡중인 환자에서 의도적으로 ET를 제거한 후 NPPV틀 적용하여 새운 이탈방법으로서 효용성이 있는지를 알아보고자 하였다. 대상 및 방법: 1회이상 이탈시도가 실패하였고, 압력보조 요구량이 8-15cm $H_2O$, PEEP 요구량이 5-10cm $H_2O$ 사이이며, 기계환기 시작 후 10일 이상 경과되어 기관절개술 시행을 고려중인 환자로서 NPPV 적응증을 만족시키는 12명(14회)을 대상으로 하였다. 기관내관 제거 후 안면마스크를 이용하여 NPPV를 시작하였다. NPPV 적용 직전, 적용후 30분, 1-6시간, 6-12시간, 12-24시간, 2일째, 3일째, 그리고 NPPV 이탈 직전에 분당호흡수, 동맥혈가스검사, 압력보조수준, 그리고 호기말양압 수준을 측정하였다. 이탈후 기계호흡없이 48시간 이상 자가호흡을 유지한 예를 성공군으로 정의하였다. 결 과: 의도적 ET 제거후 NPPV에 의한 기계호흡 이탈을 시도한 14예중 7예(50%)에서 이탈에 성공하여 기관절개를 피할 수 있었다. 양군에서 나이, 입원당일의 APACHE III 점수, 기관내삽관 기간, NPPV 시행직전의 분당호흡수, 동맥혈가스검사, $PaO_2/FiO_2$, 압력보조수준, 호기말양압 수준에 차이가 없었다. 성공군에서 NPPV 전후의 분당호흡수, 압력보조수준, 흡기말양압, 동맥혈가스소견 및 $PaO_2/FiO_2$가 차이 없었으나 실패군은 NPPV 후 30분에 동맥혈 pH가 유의하게 감소하였다($7.40\pm0.08$ vs. $7.34\pm0.06$, p<0.05). 이탈실패의 원인은 동맥혈가스검사소견 악화 3예, 기도내 분비물 축적 2예, 마스크 부적응 1예, 그리고 늑골골절에 의한 flail chest 1예이었다. 결 론: 비침습적 양압호흡법은 급성호흡부전에 의한 장기적 기계호흡 환자에서 새로운 기계호흡이탈 방법으로 기대된다.