노인 환자에서 경막외 마취전 수액제제의 투여에 따른 저혈압 발생에 대한 비교 연구 : Comparison between Preanesthetic Administration of Crystalloid, Colloid and No Prehydration

신용섭 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

This study was designed to compare the incidence and frequency of hypotension and vasopressor therapy after epidural anesthesia and crystalloid, colloid and no prehydration in the elderly patents. Forty-five ASA GRADE 1 or 2 patients, aged 60 years of over, scheduled for orthopedic surgery under epidural anesthesia were randomized to one of three groups. Group 1 received 500 ml crystalloid solution(lactated Ringer's solution), group 2 received 500 ml colloid(6% hydroxyethyl starch) and group 3 received no prehydration over 15 minute prior to epidural anesthesia. Hypotension was defined as 30% decreased form baseline systolic blood pressure of systolic less than 90 mmHg, and was treated with ephedrine 5 mg boluses. The incidence of hypotension was not significantly different between the groups. The incidence of ephdrine use, incidence of nausea/vomiting and median total dose of ephedrine were not significantly different between the groups. The study has demonstrated that, in elderly patients, administration of crystalloid or colloid before epidural anesthesia did not decrease the incidence of degree of hypotension of need for vasopressor therapy compared with withholding prehydration.

최근 10년간 마취에 관한 임상적 고찰

신용섭,임정혁,최세진 충남대학교 의과대학 지역사회의학연구소 1988 충남의대잡지 Vol.15 No.1

To evaluate the specificity and the historical trends of the anesthetic agents and anesthetic methods used in Chungnam National University Hospital, anesthetic experiences of 21, 595 in total performed at Chungnam National University Hospital from January 1977 to December 1986 were analyzed stastically and clinically according to age, sex, surgical department, physical status, elective and emergency surgery, premedicants, induction agents, anesthetic methods, main anesthetic agent, anesthetic technique and muscle relaxants. The results were as follows: 1. The number of cases has been steadily increased. Considerable increase in the cases has been noted since 1985, when Chungnam National University Hospital was enlarged. 2. The distribution of the number of patients according to the age were 15, 332 cases (70. 9%) in the group of 16-60 years. 3. There were 12, 109 male (56. 1%) and 9,486 female (43.9/'0) cases. 4. 6, 128 cases (28.4%) were in general surgery, 4, 276 cases (19. 8%) in orthopedic surgery, 3, 138 cases (14.5%) in OB-GY and 1, 888 cases (8.7%) in ENT in order of numbers. 5. According to the ASA classification of physical status, most of the cases were belonged to the class 1 (33. 9%) class 2 (26.6%), class 1E (14.2%) and class 2E (12.5%). Almost cases were relatively in good physical status. 6. The rate of elective to emergency was 66. 5% (14, 370 cases) to 33. 5% (7, 225 cases). 7. As premedicants, a group of atropine, diazepam and hydroxyzine (33.4%) was given most frequently. Recently, glycopyrrolate has been used increasingly. 8. Thiopental sodium has been mainly used for intravenous induction agent. 9. General anesthesia has been used as the main method of anesthesia. 10. Halothane was the most commonly used anesthetic agent. Since 1979, the use of enflurane has been increased yearly. 11. The semiclosed circle breathing system was mainly employed. 12. Succinylcholine was given to most cases. Pancuronium was the most commonly used nondepolarizing muscle relaxant. Vecuronium has been used since 1986.

先加力 후 補修-補强한 鐵筋콘크리트 壓縮部材의 構造特性에 관한 實驗的 硏究

신용석,최진석,김판선,조철희,손순채,김정섭 대한건축학회 2003 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.23 No.2(구조계)

This study examined the Stress and structural characteristics of reinforced concrete compressive member repair and strengthening by CFS and GFS after pre-loading. The following results were obtained. The results of compressive testing by the kind of fiber suggested that: In CFS, Specimen increased by about 26.9% and strengthening after pre-loading, by about 111.8%, compared with after strengthening, In GFS, Specimen increased by about 69.0% and repaired and models after pre-loading, by about 76.7%, compared with after strengthening. In the compressive testing, strengthen with CFS-Specimen showed a brittle fracture and strengthen with GFS-Specimen represented ductile fracture. More increasing in stress of Specimen, and repair and Strengthening specimen after pre-loading than loading specimen after strengthening suggested the strengthen effect of fiber.

Midazolam의 투여가 전신마취시 혈중 Glucose 측정치에 미치는 영향

신용섭 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

This study examined the effects of midazolam on circulating concentrations of blood glucose and cardiovascular response and compaired with a comparable group of patients receiving thiopental as induction agent only. Twenty patients of ASA class 1 were randomly allocated to Control or Midazolam group. Blood glucose level in reponse to anesthesia and surgery were comparable in the two groups of patients. The use of midazolam as premedicant (0.05 mg/kg, intramuscularly) and intravenous induction agent (0.3 mg/kg) was not associated with significant increase in blood glucose and mean arterial pressure.

콘크리트용 잔골재로서 고막 패각의 활용성에 관한 연구

신용석,이설,김판선,조철희,김정섭 대한건축학회 2004 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.24 No.1(구조계)

1) As a result of compressive strength experiment, rupture compressive strength showed more increases in specimens of 15% and 20% of Cockle shells in those of non-mixture. Comparing compressive strength between no-mixed Specimens and Specimens of containing Cockle shells, Specimens containing Cockle shells showed higher strength in 60 days of age, and as ark Cockle is contained and age is elapsed, compressive strength is also increased. 2) To sum up the above experimental results, it is found that using splitted Cockle shells as aggregate for concrete by 10% - 20% showed the same or higher compressive strength and shear strength as concretes using general aggregate and it can be used as substitute aggregate of concrete. It is considered that for future use of splitted Cockle shells as substitute concrete aggregate, continuous researches of its durability, applicability and economy are needed.

전신마취에서 각성과 회복시 혈압 상승에 대한 Urapidil과 Labetalol의 효과

신용섭 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

The effects of urapidil on increase in blood pressure, heart rate and rate-pressure product(RPP) during emergence and recovery from general anesthesia were compared to that of labetalol. Urapidil 0.2 mg/kg(urapidil group) or labetalol 0.2 mg/kg(labetalol group) were injected before emergence from general anesthesia. The systolic, diastolic and mean arterial pressure and heart rate were measured continuously before giving the test drug, 1, 3, 5 minute after administration and just prior to endotracheal extubation. Also, the hemodynamic responses during recovery were measured at 1, 3, 5, 10, 15, 20, 25, and 30 minute after extubation. The blood pressure peak during emergence and recovery occurred significantly(p<0.05) just before the extubation in the both group. The significant increases (p<0.05) of systolic arterial pressure were measured at 1, 5, and 15 min after extubation in the urapidil group. The changes of diastolic and mean arterial pressure were not significant in the both group during recovery. The heart rates were significantly(p<0.05) increased just prior to extubation, 1 minute and 5 minute after extubation in urapidil group. The changes of heart rate were not significant in the labetalol group. There was not prolonged tachycardia in both group. The peak rate-pressure products were measured just prior to extubation in both group. However, increases in RPP were significantly more frequent in patients given urapidil. There were no significant differences in arterial pressure and heart rate between the two groups. The hemodynamic effects of relatively small dose of urapidil and labetalol appeared to be beneficial during emergence and recovery period in patients undergoing general anesthesia.

Morphine투여시 Fentanyl, Clonidine과의 병용과 투여시기가 수술 후 통증에 미치는 영향

신용섭 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.2

The spinal surgical patients were randomly assigned to two groups. One group received fentanyl(3㎍/kg) intravenously during general anesthetic induction, continuous morphine(l.0mg/hr) infusion through the patient-controlled analgesia(PCA) infusion system and a bolus dose of clonidine(3㎍/kg). Another group received a bolus intravenous morphine O.lmg/kg at immediately before the skin closure. Anesthesia was maintained with 50% of nitrous oxide and enflurane or isoflurane in oxygen. Both group received continuous intravenous morphine through the PCA infusion pump(infusion rate 0.5mg/hour, bolus dose 1.0mg) in the postoperative period for 48 hours after operation. Pain scores on Visual Analogue Scale were assessed 1, 2, 6, 24 and 48hour after surgery. There was significant difference between the two groups in VAS at only 1 hour after surgery. In conclusion, intravenous fentanyl administration during tie induction, intraoperative continuous intravenous morphine infusion and sngle dose of intravenous clonidine were effective in reducing postoperative pair immediately after surgery. However, further investigations with regard to of optimization of the agents used, their combination and timing of administration will be necessary.

Urapidil, Labetalol의 투여가 기관내 삽관시 심혈관계에 미치는 영향

신용섭,윤석화,손수창,이원형,이정은,황원재,김만수,김영주,김혜자,최세진 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

We have examined the comparative efficacy of small doses of intravenous urapidil and labetalol in blunting hemodynamic response to endotracheal intubation and surgical incision in 30 patients without cardiovascular diseases. After intravenous urapidil 0.2 mg/kg or labetalol 0.2 mg/kg anesthesia was induced with thiopental 5mg/kg. Endotracheal intubation was facilitated by vecuronium 0.15 mg/kg with priming principle and anesthesia was maintained with enflurane and nitrous oxide in oxygen. Systolic, diastolic and mean arterial pressure and heart rate were measured before administration of the drugs, 5 minute after administration, just prior to endotracheal intubation and 1, 3, 5, 10 minute after intubatin. Also the peak blood pressures and heart rate within 10 minutes after surgical incision were measured. Endotracheal intubation and surgical stimulation were associated with significant increases in blood pressures and heart rate in both urapidil and labetalol group. Comparison of the changes in systolic, diastolic, and mean artrial pressures and heart rate between urapidil and labetalol group showed no significant difference except peak systolic pressure after surgical incision. It is concluded that the pressor response to endotracheal intubation and surgical stimulation are not influenced significantly by urapidil 0.2 mg/kg or labetalol 0.2 mg/kg. However, urapidil and labetalol preloading may be similarly effective in the blunting of the increases in blood pressures with larger doses of the durgs during anesthetic induction.

전신 마취 중 복와위에서 동맥혈과 호기말 이산화탄소 분압 차이의 변화

신용섭 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

The variation of arterial to end-tidal carbon dioxide tension difference [P(a-ET)CO_2] was evaluated during general anesthesia in 15 ASA class 1 patients undergoing spinal surgery perfomed in the prone position. Also arterial oxygen saturation (SaO_2) monitored by pulse oxymetry and hemodynamic variables were simultaneously monitored. The variables were measured 5 min after induction of anesthesia in the supine position and 30 min, 60 min, 90 min and 120 min after placement in the prone position. Placing the patients in the prone position induced small increases in P(a-ET)CO_2 at 60 min and 90 min. But these changes were not statistically significant (P>0.05). There were stable measurements of SaO_2 by pulse oxymetry. Also relatively stable mean arterial pressure and heart rate were maintained. These results show that with proper positioning, the prone position does not induce any significant change of P(a-ET)CO_2. Thus P_(ET)CO_2 may be constantly of value when evaluating PaCO_2 during general anesthesia in the prone position.

Clonidine의 투여가 수술 후 통증 조절에 필요한 morphine 요구량에 미치는 효과

신용섭,한규철 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

To investigate the effect of intravenous clonidine on morphine requirements in the postoperative period, 20 ASA physical status 1 patients who had undergone spinal surgery were studied. Clonidine group (10 patients) received clonidine 3 ㎍/kg intravenously 30 min before endotracheal extubation and received morphine infusion through a patient-controlled analgesia device (bakground infusion, morphine 10 ㎍/kg/hour ; subsequent dose, morphine 20㎍/kg on demand ; lockout time 10 minutes). The control group (10 patients) received only morphine with same device. At the following times : 30 min, 1, 3, 5 and 24 hour after endotracheal extubation, pain intensity and sedation score were evaluated. Also, arterial blood pressure, respiratory rate and any side effects were recorded. There were no significant differences between the clonidine and control groups with respect to postoperative pain. The amount of morphine delivered was lower in the clonidine group compared to the control group, but there was no significant difference between clonidine and control groups. The clonidine group was accompanied by sdation and decreased arterial blood pressure 30 min after endotracheal extubation. There was no significant difference in respiratory rate at any time interval. These results suggest that during the 24 hours following spinal surgery, postoperative morphine requirements could not be reduced significantly by single intravenous administration of clonidine 3 ㎍/kg.