수술 후 호흡관리

고신옥 대한외과학회 2001 대한외과학회 학술대회 초록집 Vol.2001 No.5

항문주위수술의 마취방법에 대한 임상적 고찰

高信玉,吳興根 대한마취과학회 1977 Korean Journal of Anesthesiology Vol.10 No.3

We have analysed statistically 792 cases who had perianal surgery from Jaunary 1967 to December 1976, The results were as follows; 1. Caudal block was the most commonly used technic. (62.8%) Hypobaric spinal anesthesia was used in 12% and general anesthesia in 16.8%. 2. Most patients were in the jack-kinife position during anesthesia and operation. 3. For premedication meperidine and secobarbital were commonly used(46.3% and 28%). 4. The most common diagnosis was hemorrhoids. (54%) 5. Ratio of males to females was 2 to 1. In age distribution 76.7% of cases were in the 20 to 50 year range. In adults, caudal block is the best anesthetic technic for perianal surgery and spinal anesthesia with a hypobaric solution in a jack-knife position is the second choice. In children and adults, in whom regional anesthesia is not indicated, general anesthesia with the lithotmy position would be suitable.

중환자실에서 신대치요법이 급성신부전 중환자 예후에미치는 영향

고신옥,김수환,서봉수 대한마취통증의학회 2004 Korean Journal of Anesthesiology Vol.46 No.5

Background: The worldwide standard of renal replacement therapy for acute renal failure patients is intermittent hemodialysis (IHD). Continuous renal replacement therapy (CRRT) has recently emerged as an alternative modality. We performed the study to find the effects of renal replacement therapy on outcome of the acute renal failure patients in the ICU. Methods: 373 adult patients under the diagnosis of acute renal failure (ARF) in the ICUs (medical-surgical and coronary care unit) at Severance Hospital Yonsei University College of Medicine between January 1, 1998 and July 31, 2002 were included. Patients with ARF were divided into two groups depending on their need for renal replacement therapy. Renal replacement therapy group was subdivided into IHD and CRRT group. Results: There was significant difference in the mortality between renal replacement group and non-renal replacement group, 74.4% vs. 45.2% (P < 0.001). Renal function recovery rate of renal replacement group was lower compared to that of non-renal replacement group, 36 % vs. 59% (P < 0.001). APACHE II score, ventilator support, vasopressors, number of organ failure, and oliguria during RRT were higher in CRRT group than in IHD group (P < 0.001). CRRT group was associated with higher mortality rate, CRRT 86.2% vs. IHD 42.2% and lower renal function recovery rate, CRRT 9.8% vs. IHD 63.0% (P < 0.001). Conclusions: Although the result of this study implies that IHD is associated with better survival and better renal recovery, the preferred use of CRRT in severely ill patients with an unstable circulatory system must be reminded. (Korean J Anesthesiol 2004; 46: 593~598)

중환자실 입실 우선순위 결정에 따른 입실환자와 입실거절환자의 예후 비교

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

Background: We constructed a prospective study to evaluate the outcome of patients referred to an intensivist for ICU admission as well as the factors associated with ICU admission refusal. Methods: Patients referred for ICU admission to medico-surgical ICU in our hospital for 16 weeks were included in this study. We classified the reasons for refusal into three categories: inappropriate referral; triage; futility. Also we classified admitted patients into two categories: immediate admission; delayed admission. After initial evaluation of a patient by an intensivist, we checked the patient's outcome for following 28 days. Results: 632 patients had been referred for ICU admission during study period. Among them, 445 (70%) patients were admitted and 187 (30%) patients were refused ICU admission. 116 patients were refused because of inappropriate referral, 52 for triage and 19 for futility. 394 patients were admitted immediately and 51 were refused initially but were later admitted. When 116 inappropriate referral patients were excluded, the mortality rates for immediate admission, delayed admission and triage/futility were 14.4%, 39.2% and 56.3%, respectively (P < 0.05). Standardized mortality ratio was 0.70 for immediate admission, 1.20 for delayed admission, 1.28 for triage and 1.30 for futility (P < 0.05). The factors associated with refusal for ICU admission were age, medical division, diagnostic group and high Mortality Probability Model II0 (MPM II0) grades. Conclusions: Because the triage decision for ICU admission influences the patients’ outcome, an intensivist must carefully come to a decision when admitting patients to ICU by considering the appropriate guidelines for ICU admission and triage.

The Effects of Repetitive Alveolar Recruitment on Oxygenation and Compliance in ARDS patients

고신옥,신증수,장철호 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.6

Background: If the effects of alveolar recruitment are beneficial, but of short duration, repetitive recruitment maneuvers (RMs) will be necessary to maintain oxygenation. This study was performed to assess the effect of repetitive alveolar recruitment, with high-sustained inflation pressure on oxygenation and compliance of the respiratory system, in patients with acute respiratory distress syndrome. Methods: Ten adult patients on ventilator support, with controlled mechanical ventilation, received three repetitive RMs with a high-sustained inflation pressure. The time intervals from the first to second RM and from the second to third RM were 8.42 ± 0.56 hours and 12.43 ± 1.45 hours, respectively. Recruitment was conducted by setting the ventilator mode to a continuous positive airway pressure of 40 cmH2O for 40 seconds. After each alveolar recruitment, the previous ventilator settings in the pressure control mode were re-established with a high positive end expiratory pressure. The FIO2, PaO2/FIO2 and lung compliance (tidal volume/[plateau pressure - PEEP]) were recorded with reference to the arterial blood gas analysis at both 30 minutes pre and post recruitment. Results: The FIO2 was able to be decreased from 0.9 to 0.5 while maintaining the PaO2 at higher than 80 mmHg after three recruitments. The PaO2/FIO2 improved from 98 to 288 and the compliance of the respiratory system improved from 26 to 41 ml/cmH2O after three recruitments. Conclusions: Our results suggest that repetitive recruitment can be used to maintain the beneficial effects of alveolar recruitment in patients with acute respiratory distress syndrome when supported using a lung protective mechanical ventilation strategy.

연세의대 의학교육학과 교수 개발 프로그램(2005) (Faculty Development Program)

고신옥,Go, Sin-Ok 연세대학교 의과대학 2005 의학교육논단 Vol.7 No.2

중환자실에서 일어나는 근육 약화

고신옥,나성원 대한중환자의학회 2011 Acute and Critical Care Vol.26 No.4

Critical care has focused on recovery from acute organ failure and resuscitation. Neuromuscular abnormalities related to critical illness is not uncommon in critically ill patients, but they were relatively underestimated and unnoticed. Intensive care unit acquired weakness (ICUAW) leading to severe functional impairments in ICU survivors can be divided into two disease entities: critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Electrophysiologic study, muscle biopsy and physical examination are helpful to diagnose ICUAW. Several researches and reviews identified many risk factors including systemic inflammation, corticosteroids, hyperglycemia, and immobility. Additional research is needed to identify the pathogenesis of this disorder and to testify its preventive or therapeutic modalities.

인공 호흡기 구동 양식

고신옥 대한결핵 및 호흡기학회 2002 워크샵 Vol.15 No.-

뇌사 장기 공여자에서 반복 폐포모집술로 호전된 저산소혈증

고신옥,한동우,김애스터 대한마취통증의학회 2004 Korean Journal of Anesthesiology Vol.46 No.5

Brain-dead potential donors manifest devastating physiological changes associated with pulmonary edema, profound hemodynamic and metabolic abnormalities. These derangements may be more significant after apnea tests which result in severe hypoxemia and cardiovascular complications. De-recruitment can occur following apnea tests in the brain-dead donor whose ventilator support has been maintained with high positive end-expiratory pressure (PEEP), and recruitment maneuvers are intended to open collapsed lung units. We report a brain-dead potential donor with severe hypoxemia and hemodynamic instability after apnea tests, which improved after multiple alveolar recruitments with adequate vasoactive drugs. Multiple high-pressure recruitment maneuvers will be helpful for expansion of lung collapse with improvement of severe hypoxemia after de-recruitment which could be developed with apnea tests in brain-dead organ donor. (Korean J Anesthesiol 2004; 46: 636~639)

심포지움 : 기계환기기의 근본원리

고신옥 대한결핵 및 호흡기학회 1993 워크샵 Vol.2 No.-