경막외 혈액봉합술을 이용한 자연성 두개내 저압성 두통 환자의 치험

박수석(Soo Seog Park),장 연(Yeun Jang),조은정(Eun 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.2

Postural headache due to spontaneous intracranial hypotension occurs without any diagnostic lumbar punctute, myelography, cranial or spinal injury, or spinal anesthesia. The clinical characteristics of the syndrome are disappearance of the headache or a notable decrease in its severity with recumbency, the finding of meningeal enhancement and subdural fluid collection on brain MRI, the pleocytosis and the increased CSF protein concentration. We report a case of a 40-year-old woman who exhibited the signs and symptoms of postural headache due to low CSF pressure. Her headache started suddenly at the occiput and radiated to frontal head. Magnetic resonance imaging (MR0 of her brain showed enhancement of the meninges and subdural fluid collection. Intrathecal radionuclide cisternography showed the delayed appearance of the isotope in the cranium and the minimal CSF leak at the left upper thoracic region. Her headache was relieved com- pletely after a lumbar (L2-L3) epidural injection of 12 ml of autologous blood and remained asymp- tomatic.

모르핀 정맥 투여시 척수 진통 작용 기전에 기여하는 Nitric Oxide

송호경(Ho Kyung Song),박수석(Soo Seog Park),김정태 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1

N/A Background: The role of nitric oxide(NO) in analgesia from opioids is controversial. On the one hand, IV morphine analgesia is enhanced by IV injection of NO synthase inhibitors. On the other hand, IV morphine results in increased release of NO in the spinal cord. There have been no behavioral studies examining the interaction between IV morphine and intrathecal injection of drugs which affect NO synthesis. Method: Rats were prepared with chronic lumbar intrathecal catheters and were tested withdrawal latency on the hot plate after 3-5 days of surgery. Antinociception was determinined in response to a heat stimulus to the hind paw before and after IV injection of mqrphine, 2.5 mg/kg. Twenty minutes after morphine injection, rats received intrathecal injection of saline or the NO synthase inhibitors, L-NMMA or TRIM, the NO scavenger, PTIO, or the NO synthase substrate, L-Arginine. Intrathecal injections, separated by 15 min, were made in each rats and measurements were obtained every 5 min. Result: Mophine produced a 60-70% maximal antinociceptive response to a heat stimulus in all animals for 60 min in control experiments. Intrathecal injection of idazoxane decreased antinociception of IV morphine. The NO synthase inhibitors and the NO scavenger produced dose-dependent decreases in antinociceptive effect of morphine, whereas saline as a control group and L-Arginine as the NO substrate had no effect on antinociception of morphine, Conclusion: The present study supports the evidences that systemic morphine increase the nitrite in cerebrospinal fluid and dorsal horn. These data suggest that the synthesis of NO in the spinal cord may be important to the analgesic effect of IV morphine and increased NO in spinal cord has different action from the supraspinal NO

고양이 흉수에서 Substance P 면역반응 신경원의 분포와 연접연구

이승균(Sung Kyun Lee),박수석(Soo Seog Park) 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

N/A Background: Though a nurnber of studies have described the distribution of substance P (SP)-like immunoreactivity in the spinal cord, they have been focused on lamina I and II of the dorsal horn and there are little morphological studies on the topographic distribu- tion and ultrastructure of the SP immunoreactive neurons especially in the ventral horn of the spinal cord. This study was conducted to identify distribution pattern of SP immunoreactive neurons and to difine the synaptic organization of their processes in ven- tral horn of the thoracic cord of the cat by preembbeding immunocytochemical method using SP antiserum. Methods: Five adults cats of either sex were used and deeply anesthetized by intramus- cular injection of ketamine. After removal of the spinal cord, samples of thoracic cord were taken and placed in fresh fixative at 4 ℃ for 2 hours. Transverse sections 50pm thick were processed using the preembbeding immunocytochemical method and incubated consecutively in the specific primary antibody and the 10% normal goat serum, the rabbit anti-substance P antiserum, the biotin-labelled goat anti-rabbit IgG and finally the avidin- biotin-peroxidase complex. The processed tissue sections were throughly washed and stained in the black with 1% uranyl acetate. Section were examined on a electron micro-scope. Results: l) SP immunoreactive neurons were observed in the gray matter around central canal. 2) In lamina I and II SP immunoreactivity was observed in both myelinated and unmy- elinated nerve fibers, but in ventral horn only in the unmyelinated nerve fibers. 3) SP immunoreactive axon terminals with small round and large dense core vesicles made chemical synapses onto the dendrites of motor neurons in the ventral horn. Conclusion: SP immunoreactive neurons might play an important role in modulation of motor neurons in the ventral horn of the thoracic cord of the cat.

성인 편도절제술 후 통증에서 Aceclofenac의 진통효과

이승균 ( Seung Kyun Lee ),박수석 ( Soo Seog Park ),박용수 ( Yong Soo Park ),황성재 ( Sung Jae Hwang ),송호경 ( Ho Kyung Song ) 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.2

DBA/2 계열 마우스의 절개통증에서의 행동양상

배다현 ( Da Hyoun Bae ),박수석 ( Soo Seog Park ),우영철 ( Young Cheol Woo ) 대한통증학회 2008 The Korean Journal of Pain Vol.21 No.1

흰쥐의 절개 통증모델에서 척수강내로 투여한 Magnesium Sulphate 의 효과

박종민,최종호,이재민,김창성,이해진,권오경,이윤기,양내윤,박수석,문동언 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.6

3384001224 Background: The mechanical hyperalgesia that follows peripheral tissue injury results from peripheral and central sensitization. Central sensitization is initiated and maintained by windup that can be prevented by N-methyl-D-aspartate(NMDA) antagonists. NMDA antagonists, therefore, have the potential to pre-vent and treat pain, although clinical uses are limited because of their side effects. This study was designed to evaluate the analgesic action of intrathecal (IT) magnesium sulphate in a rat model of postoperative pain and investigate the analgesic mechanism of magnesium. Methods: Forty-two Sprague-Dawley rats (300 ± 20 g) were prepared with a chronic IT catheter. Under brief enflurane anesthesia, a 1-cm incision including skin, muscle and fascia was made in the plantar aspect of the hind paw and closed. Normal saline, magnesium (30, 100, 300, 600 ㎍), NMDA 50 ng or NMDA 50 ng with magnesium 300 ㎍ was administered via the IT catheter after recovery. Response frequency, using Von Frey filaments, cumulative pain scores and motor deficits were assessed. Results: The mechanical hyperalgesia and nonevoked pain behaviors decreased significantly at 1 h or 1 h and 3 h after IT injection of magnesium 100 ㎍ or 300 ㎍ compared to the saline group without profound motor deficits in a rat model of postoperative pain. However, the rats administered with magnesium 600 ㎍ were lethargic due to severe motor weakness. Effective duration of magnesium decreased significantly in the group of NMDA 50 ㎍ with magnesium 300 ㎍ compared to that of magnesium 300 ㎍ administered alone, but the initial effects were similar between the two groups. Conclusions: We conclude that IT magnesium sulphate can modulate nociceptive processing after tissue injury and the analgesic mechanism of magnesium is involved in NMDA receptors. Magnesium,

흰쥐에서 술전 척수강내 국소마취제 투여가 술후 통증반응에 미치는 영향

박종민,송호경,조은정,장연,문동언,박수석,민진혜,지승은 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.6

Background : Preemptive analgesia is an antinociceptive treatment that prevents the development of central sensitization which contributes to the post-injury pain hypersensitivity. But controversies exist over the effectiveness and clinical value of preemptive analgesia. The aim of this study is to evaluate the preemptive effect of intrathecal bupivacaine on incisional pain in rats. Methods : Thirty male rats were divided into 3 groups, saline-treated control group (n=10), post- treatment group (n=10), and pre-treatment group (n=10) according to the time which intrathecal administration of bupivacaine was done. To evaluate postoperative mechanical hyperalgesia in injured feet, withdrawal frequency and withdrawal thresholds were measured by von Frey filaments at 30 min, 1 hr, 2 hrs, 3 hrs, 1 day, 3 days and 7 days after incision. Results : In control group, the withdrawal frequency increased from 0±0% before incision to 98.0±1.3% after the foot incision and the responses gradually declined during the postopetive 7 days to 52.0±4.7%. The median withdrawal threshold decreased from 148.43 mN before incision to 0.05 mN after foot incision and gradually increased during the postoperative 7 days to 6.79 mN. The post-treatment group showed no significant differences in the withdrawal frequency and withdrawal thresholds when compared with control group at post-operative 1 hour and thereafter (P<0.05). The pre-treatment group showed significantly lower withdrawal frequency and significantly higher withdrawal threshold compared with control group at postoperative 30 min and thereafter (P<0.05), and significantly lower withdrawal frequency and higher withdrawal threshold compared with post-treatment group at postoperative 2 hours and thereafter (P<0.05). Conclusions : We conclude that intrathecal bupivacaine administered before incision reduces postoperative delayed hyperalgesia in incisional pain model, and it may result from preventing the development of injury- induced central sensitization. (Korean J Anesthesiol 1 36: 1051∼1058)

흰쥐에서 뇌실내 Choline 투여로 유발된 고혈압에 대한 편측 경부 교감신경 절제의 효과

송호경,장연,박수석 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.1

Background: Brain acetylcholine is an important neurotransmitter in the control of blood pressure. Pharmacological activation of central cholinergic receptors by intracerebroventricular (ICV) administration of choline resulted in a marked pressure response in hypotensive experimental models, and the pressure response was associated with an increase in plasma vasopressin levels. The aim of this study was to determine whether a unilateral cervical sympathectomy affects the pressure response induced by ICV choline. Methods: Rats were prepared with a cervical sympathectomy or with a sham operation and a 23 G cannula was implanted into the lateral cerebral ventricle. They were divided into three group according to the pre-treated condition and the solution injected into the lateral cerebral ventricle; group 1 (ICV saline after sham operation), group 2 (ICV choline after sham operation), group 3 (ICV choline after cervical sympathectomy). Following the recovery period, pressure response was monitored for 50 min after injecting ICV choline or saline and plasma vasopressin levels were also assessed with an EIA kit at preinjection time, 10 min, and 50 min after ICV injection. Results: The baseline systolic blood pressure was 120.6 ± 3.9 mmHg in group 3 and 121.7 ± 9.0 mmHg in group 2 and there was no significant difference. The pressure response to ICV choline became evident within 1 min and reached a maximum magnitude in 10 min in both groups. Compared to the sham operated rats (group 2), the pressure response to ICV choline was significantly attenuated in sympathectomized rats (p < 0.05). However, the plasma vasopressin levels were not significantly affected by ICV choline or a cervical sympathectomy. Conclusion: While the unilateral cervical sympathectomy itself did not have any effect on blood

Prader-Willi증후군 환자의 마취관리

송호경,김정태,조은정,장연,박수석,지승은 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.6

In 1956, Prader and Willi first described a clinical syndrome that included severe neonatal hypotonia, hyperphagia, obesity, diabetes, hypogonadism, cryptorchidism, dental caries and mental deficiency. We have anesthetized a male patient who had Prader-Willi syndrome. He suffered for both pyoknee. General anesthesia was performed using N2O-O2-isoflurane. During induction and maintenance of anesthesia, we focused on the airway management, hypotonia, abnormal glucose metabolism, protection of aspiration and cardiovascular stabilization. Emergence of anesthesia was unremarkable. But he was expired from sepsis on the fourth postoperative day. (Korean J Anesthesiol 1999; 36: 1091∼1094)

흰쥐의 절개 통증모델에서 척수강내로 투여한 Gabapentin의 진통효과

송호경,권오경,조은정,정동석,장연,문동언,박수석,지승은 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.4

Background: Gabapentin, an anticonvulsant structurally related to gamma-aminobutyric acid (GABA), was recently reported to be effective in pain associated with reflex sympathetic dystrophy and neuropathy. However, the effects of intrathecal (IT) gabapentin in postoperative pain are unclear. This study was designed to evaluate the analgesic action of IT gabapentin in a rat model of postoperative pain which was similar to human postoperative pain states. Methods: Rats were prepared with chronic intrathecal catheter. Under halothane anesthesia, a 1 cm incision was made in the plantar aspect of the hind paw and closed. Rats were divided into 7 groups, a control group (saline 20 μl intrathecally n = 6); a GP 30 group (gabapentin 30 μg intrathecally, n = 6); a GP 100 group (gabapentin 100 μg intrathecally, n = 6); a GP 300 group (gabapentin 300 μg intrathecally, n = 6); a GP 1000 group (gabapentin 1,000 μg intrathecally, n = 6); a NS-GP group (saline 10 μl and gabapentin 300 μg intrathecally, n = 6)-GP group (D-serine 100 μg and gabapentin 300 μg intrathecally, n = 6). The rats were placed on an elevated plastic mesh floor, and withdrawal threshold was determined using calibrated von Frey filaments applied from beneath the test cage to an area adjacent to the wound. A cumulative pain score based on the weight bearing behavior of the rats, and motor deficit score, were also assessed. Results: In all group, the median withdrawal threshold for punctate hyperalgesia decreased from 148.4 mN before surgery to 1.5 mN-14.5 mN 2 hours after surgery-inducing hyperalgesia and remained unchanged during the 2hr testing period. The IT administration of gabapentin (30 300 μg) increased the median withdrawal threshold toward preincision values dose-dependently and the nonevoked pain scores were also decreased. But the effects of intrathecal gabapentin were reversed by IT D-serine. The Analgegic effects of gabapentin were observed at doses that had no significant effect on motor function or spontaneous activ. Conclusions: These observations suggest that intrathecal gabapentin can modulate the facilitation of spinal nociceptive processing by tissue injury and may offer a therapeutic agent for the treatment of postoperative pain. (Korean J Anesthesiol 1999; 37: 704∼710)