전기경련요법시 Propofol 과 Etomidate 가 경련지속시간 및 혈역학적 변동에 미치는 영향의 비교

공명훈 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.1

Background : The clinical efficacy of electroconvulsive therapy (ECT) primarily depends on the adequacy of the seizure duration, but the intravenous anesthetics which are commonly used for ECT may possess anticonvulsant properties and shorten the seizure duration. lhe aim of this study was to compare the effects of propofol and etomidate on seizure duration and hemodynamic responses during ECT. Methods : 30 patients undergoing maintenance ECTs were evaluated and divided into two groups randomly. Hypnosis was induced with a bolus injection of either 1.5 mg/kg of propofol or 0.3 mg/kg of etomidate in each group. Time to unconsciousness, seizure duration, heart rate, mean arterial pressure and recovery time were measured after delivery of electrical stimulus. The dynamic energy (joules) delivered was recorded. Correlation between seizure duration and recovery time was calculated and the rates of seizure induction failure after first electrical stimulus were compared. Results: The seizure duration was shorter in the propofol group (34.0 ±3.8 s) than in the etomidate groop (50.0 ± 4.0 s)(P $lt; 0.01). The heart rate was significantly lower in the propofol group (132.1 ±3.8, 99.7 ± 6.2 bpm) than in the etomidate group (146.0 ± 4.2, 119.8 ± 7.5 bpm) at the time of ECT and 1 min after ECT respectively (P $lt; 0.05). The mean arterial pressure was significantly lower in the propofol group than in the etomidate group from the time of EC7 to 10 min after ECT (P $lt; 0.05). Conclusions : Propofol showed excellent hemodynamic stability and was a good hypnotic for ECT therapy, but etomidate might be a useful alternative to propofol in patients who have an inadequate seizure duration. (Korean J Anesthesiol 2000; 39: 29~36)

제왕절개술시 흡입마취제에 대한 임상적 비교 연구

공명훈,우설희,서병태 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.1

The maternal and neonatal effects of 50% O_2 -50% N_2O alone and 50% O_2-5O% N_2O combined with 0.5% halothane or 1% enflurane were studied in 37 parturients undergoing general anesthesia for cesarean section, All patients received thiopental and succinrlcholine for induction and were intubated and ventilated with a tidal volume of 10ml/kg and a rate of 10 breaths/min. until the delivery. Two of 11(18%) patients given O_2-N_2O alone had recall none in those patients receiving a potent inhalation agent had any recall. Blood loss was similar in the two groups. There were no statistically significant differences between groups in induction-todeliverr and uterine incision·to·delivery intervals, the frequencies of Apgar score$lt;7 at and 5 min., maternal and fetal blood gas tensions, and acid-base balance. It is concluded that analgesic concentrations of halothane and enflurane can be safely added to 50% O_2-5O% N_2O to prevent maternal awareness during general anesthesia for cesarean section while maintaining normal maternal and neonatal conditions.

Ethyl alcohol의 농도변화가 흰쥐 좌골신경에 미치는 형태학적 연구

공명훈,신정순 고려대학교 의과대학 1992 고려대 의대 잡지 Vol.29 No.3

Ethyl alcohol is one of the most commonly used neurolytic agents in the treatment of chronic intractable pain of various causes and the spastic muscular diseases. It is applied to the nerves or plexuses via direct injection, such as celiac plexus block or indirect route, such as subarachnoid injection. Like other chemical neurolytic agents, ethanol has several disadvantages and adverse effects and so limitation to its use. Ethanol neurolysis. also, is frequently not permanent in action and so performed repeatedly at various intervals. There were some efforts searching for optimal concentration of the ethanol and optimal interval to repeat the neurolytic block but still lack of data. The authors experimentally observed the morphological changes of the rat sciatic nerve four weeks after perineural injection of 50%, 75% and 100% ethanol through the light and electron microscope and compared the results with those of 0.9% normal saline in each ten cases. Also we observed other adverse effects. the skin change and muscular weakness. The results are as follows . 1. Three of ten cases in the group of 100% ethanol showed skin redness and one of them showed skin ulceration, discoloration and at last skin slough after three weeks. 2. Complete loss of motor function was not seen in any case. But six cases in the group of 100% ethanol. three cases in the group of 75% ethanol. and t재 cases in the group of 50% ethanol showed partial loss of motor function, such as limping gait. They all recovered after two weeks. but a case in the group of 100% ethanol did not even after four weeks. 3. In the light microscopic findings, four cases in the group of 50% ethanol and all cases in the group of 75% and 100% ethanol showed typical wallerian degeneration but the degree and extent of the degeneration were dose-dependent. 4. In the transmission electron microscopic findings, relatively large myelinated axons survived in the group of 50% ethanol, but they were all destroyed in the group of 75% and 100% ethanol. 5. The regeneration of the injured axons were observed at their various stages. In conclusion, 100% ethanol should be used clinically with special caution about the loss of motor function and skin injury. Because the integrity of the basement membrane of Schwann's cell must be maintained by the perineural injection, the regeneration of the injured nerves take place with certainty. But it is difficult to find out the optimal time for repeated neurolysis due to the variability of duration of regeneration.

CURARE CLEFT 는 언제나 근육이완제의 필요성을 의미하는가 ?

장성호,공명훈 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.1

A fifty-eight years old male patient was given general anesthesia for the clipping of aneurysm on the posterior communicating artery. The respiration of the patient was controlled with Ohmeda 7000 anesthesia ventilator. During the surgery there appeared curare cleft on the capnogram which did not disappear after the administration of neuromuscular blocker, but disappeared after the change of the anesthesia ventilator with another one. After that another curare cleft was made by the transient obstruction of the outlet of the excess patient circuit gas of the new anesthesia ventilator. It may be said that inappropriately functioning pop-off valve of the anesthesia ventilator can be one of the causes of curare cleft on the capnogram.

흰쥐에서 lidocaine의 좌골신경내 및 신경외 주입후 발생하는 형태학적 변화에 관한 실험적 연구

이정례,공명훈,신정순 고려대학교 의과대학 1991 고려대 의대 잡지 Vol.28 No.1

Under the local or regional anesthesia, there is a high incidence of inadvertent intraneural injection of local anesthetics. Several studies have reported that intraneural injection should be avoided because of possible nerve injury and also because some local anesthetics may exert direct neurotoxicity on the peripheral nerve. However some other studies showed that intraneural injection did not cause significant nerve injury and that clinically used concentration of lidocaine did not have neurotoxicity. The author experimentally observed the morphological neuronal changes or neurotoxicity through light and electron microscope two weeks after the intraneural injection of 0.9% normal saline, 2% lidocaine HCl, and 1% lidocaine HCl mixed with epinephrine(5 microgram/ml) to rat sciatic nerve and compared the results with perineural injection of the same agents. The results are as follows : 1. In the perineural injection groups, no morphological changes were observed except in the 2% lidocaine group, where occasional axonal degenerations were found. 2. In the intraneural injection groups, all cases showed the varying degrees of axonal degeneration and some showed the findings that suggested of regeneration. 3. In cases showing axonal degeneration, the Schwann's cells and macrophages exerted their phagocytotic action on the degeneration debris. 4. In all groups, there was no evidence of changes in the connective tissues of epineurium perineurium and endoneurium. It is concluded that for regional anesthesia intraneural injection should be avoided and if needed, paresthesia is carefully ellicited and that repeated injection at the short interval is undesirable.

국소마취제의 주사후 발생하는 말초신경손상에 관한 실험적 연구

신정순,공명훈,장성호 고려대학교 의과대학 1991 고려대 의대 잡지 Vol.28 No.2

The peripheral nerve is a common target of injection of local anesthetics. There has been significant increase in the use of local anesthetics at the operating theatre, or the field of control of pain. And the physicochemical properties of recently used local anesthetics are somewhat different from that of the earlier. So, the possibility of neural injury due to injection of the local anesthetics has increased but neglected due to its low incidence. There are some controversies about the neurotoxicity of local anesthetics. The author experimentally observed the morphological neuronal changes or neurotoxicity through light and electron microscope two weeks after the intraneural injection of 0.9% physiologic saline, 2% lidocaine HCl, and 0.5% bupivacaine HCl to rat sciatic nerve and compared the results with those of the perineural injection. The results are as follows : 1. In all the perineural injection groups. no morphological changes were observed. 2. In the intraneural injection groups, all cases showed the varying degrees of neural injury and some showed the findings that suggested of regeneration. 3. The observed findings of neural injury were axonal degeneration, segmentation of axon and myelin sheath, and phagocytotic Schwann cells and macrophages. 4. In all groups, there was no evidence of changes in the connective tissues of epineurium, perineurium, and endoneurium. 5. No specific difference was found between the neurotoxic effects of 2% lidocaine and 0.5% bupivacaine. In conclusion, if intraneural injection would be avoided, 2% lidocaine and 0.5% bupivacaine are safe local anesthetics to the peripheral nerves.

흰쥐에서 알코홀의 전투여가 halothane 마취시 간에 미치는 영향

이상동,공명훈,장성호 고려대학교 의과대학 1991 고려대 의대 잡지 Vol.28 No.3

Fifty nine male Sprague-Dawley rats were used to investigate the hepatic effects of halothane anesthesia in alcohol-treated rats. Sampling was done before intravenous injection of ethyl alcohol(400mg/kg) or saline(5m1/kg) through tail vein. And 24 hours laterall rats were exposed to halothane-N_(2)/O_(2) (1%-2ℓ/2ℓ) for two hours. Intracardiac puncture for blood sampling was done after intraperitioneal injection of pentobarbital (50mg/kg) and hepatectomy was done to get the tissue sample for microscopic examination 24hours or 96 hours after halothane anesthesia. Biochemical studies including liver and renal function variables (protein, albumin, total bilirubln, direct bilirubin, aspartate aminotransferase, alanine aminotransferse, alkaline phosphatase, BUN, creatinine) were done and the hepatic tissue was examined with light microscopy. The results are summarized as follows: 1) Twenty four hours after halothane anesthesia. protein albumin. total bilirubin. and alkaline phosphatase were significantly changed in both saline- and alcohol-treated rats. Serum transaminases level were not significantly changed in alcohol-treated group compared with saline-treated group (i.e. aspartate aminotransferase. alanine aminotransferase). Other parameters indicative of hepatic and renal function such as cholesterol. BUN and creatinine were not significantly changed. 2) There is no significant difference of histologic evidence of hepatic damage between alcohol- and saline-treated rats 24 hours after halothane anesthesia. 3) Ninety six hours after halothane anesthesia. protein. albumin and total bilirubin were significantly changed in both saline- and alcohol-treated rats. Serum transaminases and alkaline phosphatase level were not significantly changed in alcohol-treated group compared with saline-treated group (i.e., aspartate aminotransferase. alanine aminotransferase). Other parameters indicative of hepatic and renal function such as cholesterol. BUN, and creatinine were not significantly changed. 4) There is no significant difference of histologic evidence of hepatic damage between alcohol-and saline-treated rats 96 hours after halothand anesthesia.

전기경련요법시 Propofol 과 Thiopental 이 경련, 간기능 및 회복에 미치는 영향 비교

신현주,공명훈,최영석,이미경,김난숙,임상호 대한정맥마취학회 1998 정맥마취 Vol.2 No.1

서론: 전기경련요법(ECT) 때 사용되는 마취약제는 빠른 마취유도와 회복을 나타내야 하고 경련과 간기능에 최소한의 부작용을 나타내야 한다. 최근 수술이나 다른 치료를 하는 동안 propofol이 보편적으로 사용되어온 thiopental sodium 대신에 중요한 마취약제로 사용되고 있다. 따라서 본 연구에서는 ECT시 propofol과 thiopental이 경련과 간기능, 의식회복에 미치는 영향을 비교하였다. 방법: ECT를 받기로 계획된 미국 마취과학회 신체분류 Ⅰ, Ⅱ 11명의 환자를 대상으로 하였다. 각각의 환자는 3~4일 간격으로 연속적으로 ECT를 받는 동안 propofol 15 ㎎/㎏이나 thiopental 3 ㎎/㎏ 중 하나를 투여 받았다. 전기 경련기(MECTA-SR₁)를 사용하여 이마양쪽에 전기자극을 가한 후 경련지속시간을 측정하였다. 의식회복시간은 의식소실 후 부터 환자가 눈을 뜨라는 명령에 반응하는 시간까지로 측정하였다. 간기능 검사는 1주일 간격으로 시행되었다. 결과: 경련지속시간과 의식회복시간은 propofol군에서 thiopental군보다 의의있게 짧았다. 간기능 검사는 두 군간에 의의있는 차이가 없었으며 모두 정상범위를 유지하였다. 결론: ECT시 propofol은 thiopental sodium 대신에 유용하게 사용될 수 있는 약제로 사료된다.

기저 질환이 없는 청소년 환자에서 주술기에 발생한 발작성 심방세동-증례 보고-

정유진,이일옥,공명훈,김난숙,김희주,임병건 대한마취통증의학회 2013 Anesthesia and pain medicine Vol.8 No.4

Although the development of arrhythmias including atrial fibrillation (AF) is common under general anesthesia during surgery, the first episode of AF to occur during this period is rather uncommon. Moreover, most instances of AF are associated with old age,cardiopulmonary diseases as well as metabolic, endocrine, or genetic abnormalities. The occurrence of paroxysmal AF in the perioperative period in an adolescent without any underlying diseases or organic abnormalities has never been reported. Herein, we report a case of a 16-year-old adolescent whose paroxysmal AF was suspected before the anesthesia induction for strabismus surgery and diagnosed after anesthetic induction. Nevertheless, he was managed successfully with esmolol infusions during and after the surgery and thus recovered spontaneously.

경막외 아편양제제의 부작용을 감소시키기 위한 경막외 Droperidol의 적절한 투여 방법

조영욱,이일옥,공명훈,이미경,임상호,최영숙,김난숙 대한마취과학회 2004 Korean Journal of Anesthesiology Vol.46 No.3