도관 거치 후 발생한 족배동맥 가성동맥류

강포순,이규창,선금태,이예철 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.3

Pseudoaneurysm occurs rarely after percutaneous cannulation of a peripheral artery. A 90 years old male patient with cholangiocarcinoma of distal common bile duct was underwent palliative surgery. Arterial cannulation of a dorsalis pedis artery was done for continuous arterial blood pressure monitoring and blood sampling, and it was removed 7 days after cannulation. Pseudoaneurysm was developed 25 days after cannulation. We report the pseudoaneurysm of dorsalis pedis artery and describe the related mechanisms and predisposing factors. (Korean J Anesthesiol 1998; 35: 558∼561)

Rifampicin을 투여받은 흰쥐에서 Cimetidine이 Halothane 대사 및 Halothane 마취후 간에 미치는 영향에 관한 연구

강포순,장성호 고려대학교 의과대학 1993 고려대 의대 잡지 Vol.30 No.1

The H2-receptor antagonist, cimetidine, through binding of its imidazole ring to cytochrome P-450, has been known to inhibit drug metabolism, and the antituberculous drug, rifampicin, through microsomal enzyme induction, has been known to increase drug metabolism. The intermediate metabolites of halothane appear to be involved in the etiology of halothane-induced hepatotoxicity. This study was done to determine the effect of cimetidine on halothane hepatotoxicity in rats pretreated with rifampicin. Ninty six Sprague-Dawley rats were divided into three groups. Saline was administered orally daily for 7 days in group Ⅰ (N=31). Rifampicin (100mg/kg) was administered orally daily for 7 days in group Ⅱ (N=33) and group Ⅲ (N=32). Cimetidine (180mg/kg) was injected intraperitoneally one hour before halothane anesthesia in group Ⅲ. All of the three groups were exposed to halothane-N_(2)O-O_(2) (l%-3L/min-3L/min) for two hours 24 hours after the last treatment with saline or rifampicin. Blood sampling was done before any treatment as control. Blood sampling and hepatectomy for light microscopic examination 24 hours after halothane anesthesia were done in one half of the rats from each group and the remaining were examined 96 hours after halothane anesthesia. The measurements we examined were values of liver function test (alanine aminotransferase : ALT) and aspartate aminotranferase : AST), metabolites of halothane (bromide and fluoride) and the histologic scores of light microscopic findings of liver tissue 24 hours or 96 hours after halothane anesthesia. The results were as follows ; 1. The values of liver function test 24 hours after halothane anesthesia showed increasing tendency in all three groups, but there were no statistical significance in all three group except the value of AST in group Ⅲ. 2. The values of ALT and AST 96 hours after halothane anestheisa decreased and showed significant statistical difference from those of 24 hours after anesthesia in group Ⅱ. 3. Serum concentrations of bromide and fluoride 24 hours or 96 hours after halothane anesthesia showed no significant statistical differences among three groups. But bromide concentration 96 hours after halothane anesthesia was less than the values 24 hours after halothane anesthesia (p<0.05). 4. The histologic evidences of hepatic changes were not shown in all groups 24 hours and 96 hours after anesthesia. The above results concluded that neither cimetidine nor rifampicin does affect halothane metabolism and hepatic changes after halothane anesthesia.

성인에서 술전 섭취한 수액이 위액량 및 산도에 미치는 영향

강포순,조재군,이규창,우남식,이예철,정정일 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.3

Background: To decrease the risk of pulmonary aspiration of gastric contents, patients are routinely asked not to eat or drink anything for at least 6 to 8 hours before surgery. We studied to evaluate whether the volume and pH of gastric fluid immediately after induction of anesthesia is correlated with water ingestion. Methods : Fifty patients, scheduled for elective surgery, were randomly divided into two groups. Control group(n=25) were fasted overnight and received no water. Experimental group(n=25) were fasted overnight and received 150 ml water approximately 2 hours before the induction of anesthesia. Gastric fluid was obtained via multiorifice gastric tube with the patient in three different positions. The volume of gastric fluid was recorded and its pH was measured. Results : The gastric volumes were no differences between the two groups. The gastric pH values were significant differences. The incidence of patients with the high risk factors of gastric volume greater than 25 ml and pH less than 2.5 was decreased in experimental group. Conclusions : We concluded that surgical patients could be permitted to ingest 150 ml water approximately 2 hours before the induction of anesthesia. (Korean J Anesthesiol 1998; 34: 510∼513)

고비중 Bupivacaine을 사용한 안장차단마취에서 척수강내 투여한 Tramadol 및 Clonidine의 효과

강포순,김정일 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.2

Background: The saddle block with heavy bupivacaine is confinal to the lower lumbar and sacral dermatomes. We reduced the infusion dose of bupivacaine to confine the blocked area to the perineum, and evaluated intrathecal bupivacaine with intrathecal bupivacaine and tramadol or clonidine for their anesthetic and analgesic effect in patients undergoing hemorrhoidectomy. Methods: Sixty patients (ASA Ⅰ - Ⅱ, aged 20 to 55) scheduled for hemorrhoidectomy were divided into three groups. We gave a 0.2 ml placebo (0.9% normal saline) in the control group (n = 20), 0.2 ml tramadol (10 mg) in the tramadol group, and 0.2 ml clonidine (50 ㎍) in the clonidine group (n = 20) intrathecally 1 minute after saddle block with 0.5% heavy bupivacaine 2 mg. We compared the effects of the sensory and motor blocks by using the analgesic time and the degree of anal relaxation and the side effects. Results: The analgesic time was greater in the tramadol group than is the control group (P < 0.05), and in the clonidine group if was group then in the tramadol group (P < 0.05) and the control group (P < 0.01). Anal relaxation for hemorrhoidectomy in the tramadol group and the clonidine group was better than that of the control group. The incidence of paresthesia of the foot in the clonidine group (n = 16) was higher than in tramadol group (n = 3) and the control group (n = 1) (P < 0.01). The incidence of patients with urinary retention was significantly lower in the control group than in the tramadol group (n = 3) and the clonidine group (n = 4). Conclusions: Both bupivacaine 2 mg with tramadol and clonidine were efficient in hemorhoidectomy provided good conditions for hemorhoidectomy. (Korean J Anesthesiol 1999; 37: 227~232)

제왕절개술후 통증치료시 지속적 경막외 국소마취제와 Tramadol의 병용투여의 효과

강포순(Po Soon Kang),조재군(Jae Kun Cho) 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1

N/A Background: Tramadol administered epidurally is known to have one-thirtieth the potency of morphine for treatment of pain following abdominal surgery. We designed a prospective, randomized, controlled study to evaluate the analgesic efficacy and safety of combined epidural infusion of bupivacaine and tramadol with 2-day infusor as ompared to bupivacaine and morphine combined epidural infusion. Methods: Sixty healthy women scheduled for Cesarean delivery were assigned randomly in double- blind fashion: Group 1 (n=20) were given a mixture of morphine 10 mg(1 ml), 0.5% bupivacaine 40 ml a#nd normal saline(NS) 40 ml; Group 2(n=20) a mixture of tramadol 300 mg(6 ml), 0.5% bupivacaine 40 ml and NS 54 ml; Group 3(n=20) or a mixture of tramadol 500 mg(10 ml), 0.5% bupivacaine 50 ml and NS 50 ml, of continuous dose via epidural route following 1% lidocaine 6 ml as bolus dose for 48 hours postoperatively. We evaluated the analgesic efficacy and side effects of these three groups using visual analogue pain scale (VAPS) and verbal rating scale (VRS). Results: VAPS of group 1 and 3 were lower than group 2, and VAPS of group 1 was lower than group 3(12, 24, 36, 48 hours), VRS of group 1 and 3 were lower than group 2 (12, 24, 36 hours). There were incidences of pruritus was 16 patients in group l. Conclusions: Tramadol does possess the analgesia effect of morphine, but has the added analgesia following increment. Further research to determine the most effective administration method and reguired dosage of tramadol is further needed.

지주막하 마취시 두통예방을 위한 경막외 자가혈액 봉합법에 대한 효과

김윤수,강포순,이예철,임정애,이근상 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5

Background: Post-dural puncture headache (PDPH) is one of the well-known complication of spinal anesthesia. Epidural blood patch is the treatment of choice for PDPH but is rarely used for the prevention of PDPH after spinal anesthesia. The purpose of this study is to observe the effectiveness of epidural blood patch for prevention of PDPH and to evaluate the complications after epidural blood injection. Methods: Three hundred patients (ASA I or II) receiving spinal anesthesia were studied. They were randomly devided into two groups. Patients in Group I, the control group, were maintained in a supine position for 24 hour after spinal anesthesia. Patients in Group II, the study group, received 3 ml of autologous blood in the epidural space after spinal anesthesia. PDPH was evaluated for 5 days. The incidence, location, onset, and duration of headache in the patients presenting with PDPH were measured for 5 days, and the complications following epidural blood patch in Group II were observed for 2 weeks. Results: The incidence of PDPH in group I was 11%, but 0% in group II. There were no specific complications following epidural blood patch in Group II. Conclusions: This study suggest that the 3 ml epidural autologous blood patch is an useful method for the prevention of PDPH in patients with spinal anesthesia. (Korean J Anesthesiol 1998; 35: 933∼938)

찬송가와 독경이 수술실에서 마취전 환자의 불안에 미치는 영향

김성곤,강포순,이예철,임정애 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.6

Background: Most surgical patients experience preoperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contribute to postoperative pain. Music has been recognized as a way to reduce anxiety and fear. The effect of hymn and sutra-chanting on the preanesthetic patient's anxiety in the operating room were studied. Methods: 98 patients were divided into two groups according to the religionist or atheism. Group I(n=50, religionist) and Group II(n=48, atheism) listened to hymn or sutra-chanting according to the patients religion and choice. At ward, hemodynamic variables including systolic and diastolic blood pressure and pulse rate were measured as control values. Hemodynamic variables and measurements of anxiety score with Hamilton anxiety rating scale were made at pre-music and post-music in the operating room. Also, patients response to the music was measured on the postoperative 5-6th day. Results: There were no difference between ward, pre-music, and post-music in terms of systolic pressure, diastolic pressure and pulse rate except the systolic pressure at pre-music that is grater than that of controls in both groups. Both group, anxiety score at post-music was significantly lower than that of pre-music (10.2±3.4 vs 4.4±2.9, 11.0±3.2 vs 5.7±3.1). At post-musie, anxiety score in Group I showed significant reduced compaired with Group II (p$lt;0.05). Patients showed relatively good satisfaction with music in both groups. Conclusion: The results suggest that music with hymn and Sutra-chanting were effective to reduce preanesthetic anxiety in both religionist group and atheism group.

Effects of increasing the dose of ropivacaine on vertical infraclavicular block using neurostimulation

양춘우,강포순,이규창,권희욱,이명종,김혜영,최은경,임현경,김철웅 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.1

Background: Use of an infraclavicular block is appropriate for surgery of the upper limb. However, it does not consistently block the entire brachial plexus. The aim of this study was to investigate whether increasing the dose of ropivacaine could enhance the success rate, onset time, and efficacy of the sensory and motor block during the use of a vertical infraclavicular block using neurostimulation in upper limb surgery. Methods: Two hundreds and ten patients were prospectively randomized into three groups: Group 1 (30 ml of 0.5%ropivacaine; n = 70), Group 2 (40 ml of 0.5% ropivacaine; n = 70), and Group 3 (40 ml of 0.75% ropivacaine; n = 70). Patients in each group received a vertical infraclavicular block using neurostimulation and obtained a distal motor response of the ulnar or median nerve. Recorded outcome measures included block success rate, onset time, sensory and motor blocks, and adverse events. Results: No differences were found in the block success rate among the three groups (92.8%, 97.1%, and 94.2% for Groups 1, 2, and, 3, respectively; P = 0.346). There were no significant differences in onset time (P = 0.225) among groups, nor was there enhancement in the sensory block, but the motor block was enhanced. Local anesthetic toxicity was observed in five female patients from group 3 (P = 0.006). Conclusions: Although the efficacy of the motor block was significantly improved, success rate, onset time, and efficacy of sensory block were not enhanced significantly among groups despite differences in volume and volume/concentration of the local anesthetic. Background: Use of an infraclavicular block is appropriate for surgery of the upper limb. However, it does not consistently block the entire brachial plexus. The aim of this study was to investigate whether increasing the dose of ropivacaine could enhance the success rate, onset time, and efficacy of the sensory and motor block during the use of a vertical infraclavicular block using neurostimulation in upper limb surgery. Methods: Two hundreds and ten patients were prospectively randomized into three groups: Group 1 (30 ml of 0.5%ropivacaine; n = 70), Group 2 (40 ml of 0.5% ropivacaine; n = 70), and Group 3 (40 ml of 0.75% ropivacaine; n = 70). Patients in each group received a vertical infraclavicular block using neurostimulation and obtained a distal motor response of the ulnar or median nerve. Recorded outcome measures included block success rate, onset time, sensory and motor blocks, and adverse events. Results: No differences were found in the block success rate among the three groups (92.8%, 97.1%, and 94.2% for Groups 1, 2, and, 3, respectively; P = 0.346). There were no significant differences in onset time (P = 0.225) among groups, nor was there enhancement in the sensory block, but the motor block was enhanced. Local anesthetic toxicity was observed in five female patients from group 3 (P = 0.006). Conclusions: Although the efficacy of the motor block was significantly improved, success rate, onset time, and efficacy of sensory block were not enhanced significantly among groups despite differences in volume and volume/concentration of the local anesthetic.

Metocurine Iodide 와 Vecuronium Bromide 의 분할 투여방법이 안압에 미치는 영향

최영석,강포순 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.1

We measured the intraocular pressure changes in forty female patients (aged from 20 to 50) without a history of ocular or cardiovascular disease who were classified physical status 1 and 2, and scheduled for elective surgery. They were divided into 4 groups. Group l (n=10); metocurime 0.03 mg/kg as a priming dose and metocurine 0.27 mg/ kg as a intubating dose. Group 2 (n= 10); vecuronium 0.008 mg/kg as a priming dose and vecuronium 0.072 mg as a intubating dose. Group 3 (n=10); vecuronium 0.008mg/kg as a priming dose and metocurine 0.27 mg/kg as a intubating dose. Group 4 (n=10); metocurine 0.03mg/kg as a priming dose and vecuronium 0.072 mg/kg as a intubating dose. In this study, metocurine and vecuronium were used with the priming principle. We also measured changes in blood pressure, pulse rate and T1% of Train of four stimulation and evaluated the discomfort after the administration of the priming dose and the difficulties of intubation. The results were as follows, 1) Compared with the control value, there was no increse in intraocular pressure following intubation in all four groups and intraocular pressure of 2 and 4 minutes following intubation decreased significantly in all four groups. The greatest decrease was seen in group 3, but it was not significant when compared to the other three groups. 2) While a transient increase in blood pressure was seen in all four groups, the lowest increase was seen in group 3 as compared to the control value. Blood pressure 4 minutes following intubation decreased significantly in grop 3. 3) A significant decrease in the T1% of the Train of four stimuli at one minute after administration of the intubating dose was seen in group 3 compared to the other three groups. 4) Group 3 showed the lowest number of difficult intubation. In conclusion, the combination of vecuronium and metoeurine with the priming principle provide optimal conditions for smooth and rapid intubation with no elevation of intraocular pressure, blood pressure and heart rate changes for ocular surgery.

Ranitidine 정주 후 발생한 아나필락시스 2예-증례 보고-

구자현,강포순,조춘규,정성미,임영수,김성후,안성민,권희욱 대한중환자의학회 2010 Acute and Critical Care Vol.25 No.4

Histamine type 2 (H2) receptor antagonists are widely used for stress ulcer prophylaxis in critical and postoperative care. Though ranitidine is one of the most commonly used H2 receptor antagonists, with a low incidence of adverse reactions, a few anaphylactic reactions associated with ranitidine have been reported. This report describes 2 additional cases of anaphylaxis induced by ranitidine used for stress ulcer prophylaxis.