흰쥐에서 急性出血性 쇽에 의한 血小板 形態 變化의 電子顯微鏡的 觀察

蔡秉國,張聖鎬,辛正順 고려대학교 의과대학 1988 고려대 의대 잡지 Vol.25 No.1

Experimental studies have suggested that increased and liberated lysosomal enzymes contribute directly to the pathophysiology of hemorrhagic shork by exerting a splanchnic vasoconstrictor effect in the pancreas and in the entire splanchnic region. The major sources of these enzymes are thought to be the intestinal epithelium, liver, pancreas, spleen or kidney. On the other hand, blood platelet also contain large amount of lysosomal enzymes. Response of rat platelet to hemorrhagic shock was examined through using ultrastructural technique. The blood platelet of the rat pretreated with saline responded to hemorrhagic shock with decrease of α-granules and the development of the platelet canalicular system which opens to the extracellular environment and the pseudoped formation . So, these facts suggest that the granules observed to be released from platelet have strongly contributed to the rise in serum lysosomal enzyme. Glucocorticoid has been considered controversial in the treatment of hemorrhagic shock. Glucocorticoid, however, seems to stablized lysosomal membranes, providing cellular protection in hemorrhagic shock. The effect of dexamethasone almost completely inhibited morphological alterations in rat platelet 180 minutes after induction of hemorrhagic shock, and delayed the decrease of α-granules.

氣管內 揷管을 위한 d-Tubocurarine chloride(d-Tc)의 定量에 대한 臨床的 考察

蔡秉國,吉燦一,辛正順 고려대학교 의과대학 1982 고려대 의대 잡지 Vol.19 No.1

Administration of succinylcholine for endotracheal intubation may cause untoward reactions such as elevation of intraocular pressure, increased plasma potassium level, increased intragastric pressure, bradycardia, and development of postoperative muscle pain, etc. Several attempts have been made to minimize the development of muscle fasciculation following administration of succinylcholine such as pretreatment with small doses of nondepolarizing neuromuscular blocking agent, self-taming of succinylcholine, or the use of hexafluorenium. When small doses of nondepolarizing neuromuscular blocking agent are given before succinylcholine administration, larger doses of succinylcholine should be given to chieve satisfactory relaxation. So, this study was intended to determine the adequate doses of d-tubocurarine chloride(d-Tc) for endotracheal intubation in patients with relative contraindication of using succinylcholine. We Observed the degree of vocal cord relaxation 3 minute after d-Te administration by fiberscopic examination and measured changes in mean blood pressure (MBP) and heart rate, just before, and after intubation, and 5 minutes after intubation. The total number of patients in this study was 100, and the patients were divided into five groups: Group 1, consisting of 10 patients, recieved 0.3㎎/㎏ of d-tubocurarine. Group 2, of 32 patients, recieved 0.4 ㎎/㎏ of d_Tc. Group 3, of 16 patients, recieved 0.45㎎/㎏ of d-Tc. Group 4, of 26 patients, recieved 0.5 ㎎/㎏ of d-Tc. Group 5, of 16 patients, recieved 0.6 ㎎/㎏ of d-Tc. The conclusions are summarized as follows; 1) The adequate doses of d-Tc for endotracheal intubation is 0.5 ㎎/㎏. 2) Maximum reductions in MBP were present 3 minutes following d-Tc administration in each group. 3) Heart rate did not change significantly after d-Tc administration in each group.

개심술시 전신마취와 병용된 흉추 경막외 마취가 술중 및 술후 Stress Hormone과 심혈관계 지수변화에 미치는 영향

김형미,채병국,신정순 고려대학교 의과대학 1993 고려대 의대 잡지 Vol.30 No.1

Combined anesthesia refers to any combination of regional and general anesthesia, usually a combination of epidural and general anesthesia. Combined anesthesia has been associated with less sedation, earlier ambulation, higher pulmonary flow rates, improved oxygenation, blunting of the stress response and better pain control in the postoperative period. Currently the most commonly employed method of anesthesia for open heart surgery patients is general anesthesia supplemented with opioids and postoperative pain control with IM morphine. This study was undertaken to compare the total doses of fentanyl and vecuronium, duration of endotracheal intubation and ventilatory support, cardiovascular changes, changes in arterial blood gas, changes in cortisol and β-endorphin, and the postoperative pain score in 40 open heart surgery patients given a routine anesthetic regimen or combined anesthesia. Group A (n=20) was given general anesthesia, maintained with a nitrous oxide (2L/min)-oxygen (2L/min)-isoflurane (0.5-2.0 Vol. %) gas mixture and fentanyl (initial dose 10 ㎍/kg with additional doses as required) with routine postoperative care with IM morphine sulfate and Group B (n=20) was given light general anesthesia nitrous oxide (2L/min)-oxygen (2L/min)-isoflurane (0.2-0.5 vol. %) and a continuous epidural infusion of a combination of 0.125% bupivacaine and fentanyl (10 ㎍/ml) through an infusion pump from the start of the operation until the third postoperative day. The results were as follows ; 1. The total amount of fentanyl given to Group B was significantly lower than the amount given to Group A. 2. The duration of endotracheal intubation and ventilatory support was significantly shorter in Group B compared to Group A. 3. The heart rate was slightly higher in Group B compared to Group A, but the only significant difference was seen 30 minutes after skin incision. There was no significant difference in the systolic pressures between the two groups but comparison of the diastolic pressures before cardiopulmonary bypass (CPB) and before skin closure showed significantly higher pressures for Group B. The pulmonary artery pressure (PAP) remained stable in Group A while in Group B, the PAP gradually increased to show a significant increase on POD2. The pulmonary capillary wedge pressure (PCWP) was significantly higher in Group B compared to Group A on POD2 The cardiac output (CO) and cardiac index (CI) was stable in Group B while for Group A, there was a significant decrease from during operation to POD2. The systemic vascular resistance(SVR) showed a significant increase in Group A from during operation to POD1 and POD2 and a significant difference between Group A and Group B on POD1 and on POD2. The pulmonary vascular resistance (PVR) increased significantly from during the operation to POD2 in both Groups A and B. The stroke volume (SV) and stroke volume index(SVI) were significantly greater in Group B compared to Group A on POD2. 4. Analysis of arterial blood showed no significant difference in pH and PCO2 while the PO2 of samples taken before CPB were significantly higher in Group B compared to Group A. The bicarbonate of samples taken before skin closure was significantly lower in Group B compared to Group A. 5. Changes in serum cortisol levels showed significantly lower values before skin closure, POD2, POD3 for Group B compared to Group A. The serum β-endorphin levels were consistently lower in Group B than in Group A although not statistically significant. 6. Postoperative pain relief was evaluated as good, fair, and poor the scores for Group A were 20%, 60%, and 20% and for Group B 75%, 15%, and 10%, showing a higher percentage of good pain relief for Group B. In conclusion, the beneficial effects of combined anesthesia are a reduction in the total dose of all anesthetic agents given, a reduction in duration of endotracheal intubation and postoperative ventilatory care, minimal cardiovascular changes, attenuation of the stress response, and a better quality of postoperative pain control showing that combined anesthesia is an attractive alternative to general anesthesia for open heart surgery patients.

양측 하악 매복지치 동시 발치를 위한 의식하 진정의 비교 연구: Propofol, Fentanyl과 Diazepam, Morphine

김영균,채병국,최현규,Kim, Young-Kyun,Chae, Byung-Kook,Choi, Hyun-Kyu 대한치과마취과학회 2003 Journal of Dental Anesthesia and Pain Medicine Vol.3 No.2

Background: The purpose of this study was to compare the availability of propofol and fentanyl (P + F) with diazepam and morphine (D + M) for intravenous conscious sedation during third molar surgery. Methods: Forty patients without systemic disease were operated under IV conscious sedation administered by either of the two techniques. Monitoring consisted of continuous observation of pulse rate, blood pressure, oxygen saturation, and the respiratory rate and were recorded every 15 minutes. Cooperation score was measured 5 and 15 minutes after induction of IV sedation. Following the operation, the surgeon and patients completed questionnaires including pain visual analog scale, amnesia, and side effects. Results: The P + F group was significantly more cooperative than the D + M group. The side effects of D + M group included pain on injection, nausea/vomiting and abdominal pain. The side effects of P + F group included talkativeness, nausea/vomiting, temporary apnea, pain on injection and vertigo. Conclusions: In this study, there were following benefits in the P + F group; more cooperative status and less pain perception. But respiratory depression developed in some patients.

일차 구개성형술 후 발생된 지속적인 술후출혈

심정환,김영균,채병국 대한악안면성형재건외과학회 2001 Maxillofacial Plastic Reconstructive Surgery Vol.23 No.5

A 11-month-old infancy was referred for treatment of cleft palate. The patient's congenital deformities had included oronasal fistula on the soft palate and bifid uvula. Furrow double-opposing Z-plasty was performed under general anesthesia. However, postoperative bleeding developed at ward. Despite the pressure of operative wound, venous oozing continued and hemoglobin concentration and RBC were decreased (Hb: 5.5g/dL, RBC :1.98×106/mm3). The patient was pale and confused and transferred to Surgical Intensive Care Unit(SICU) We could not keep the peripheral venous line and there was a high risk of hypovolemic shock. Emergency transfusion was performed through the central femoral venous line and emergency operation for bleeding control was carried out. We explored the operation site and found bleeding point from the posterior pharyngeal wall. Electrocoagulation and surgicel packing were carried out and bleeding was stopped.

의학교육에 있어서의 Tutorial System

박정율(Jung Yul Park),채병국(Byung Kook Chae),유세화(Se Wha You) 한국의학교육학회 1996 Korean journal of medical education Vol.8 No.1

안면의 화학적 박피술을 위한 Deep Sedation 마취시 Midazolam-Ketamine과 Midazolam-Fentanyl을 사용한 방법의 비교

장성호,이혜원,임혜자,김난숙,채병국,안덕선 고려대학교 의과대학 1995 고려대 의대 잡지 Vol.32 No.2

For the facial chemical peeling with 30-50% trichloroacetic acid, deep sedation was done for the patients to lessen the perception of pain. This time the authors tried to compare midazolam (0.1mg/kg)-ketamine (1mg/kg) (ketamine group) and midazolam (0.1mg/kg) -fentanyl(3-4ug/kg) (fentanyl group) techniques for the sedation of the patients. Total 232 patients were included in this study and 133 of them received midazolam-fentanyl and the remaining 99 received midazolam-ketamine. All the patients in both groups were given 0.5mg/kg (initial) and 0.2mg/kg/min (continuous infusion) of esmolol for the control of tachycardia and hypertension. The results were as follows : In both groups small pox and acne scar occupied most of the portion of the cases. Recovery time was shorter in the fentanyl group(p<0.05) and frequency of dream was greater in the ketamine group (14.2%) than fentanyl group (1.5%) (p<0.006). The status of emotion and mood was better in the fentanyl group than the ketamine group(p=0.0026, P=4.88 E-10 respectively). The preference of the patients for anesthetic techniques made no difference in both groups. The increase in blood pressure and heart rate were higher in the ketamine group than those in the fentanyl group(p<0.05) and the fentanyl group revealed no change in heart rate. The decrease in arterial oxygen saturation was greater in fentanyl group (p<0.001), but the risk of decrease in SaO₂ less than 85% is possible in both groups, so even if we choose either one anesthetic technique for the facial chemical peeling vigilant monitoring of SaO₂ seems to be necessary, and further improvement in technique to block the increase in blood pressure is needed.

의학교육에 있어서의 Tutorial System : 학내 도입을 위한 제의 Proposal for Introduction to Current Curriculum

박정율,이기찬,이훈갑,채병국,유세화,최종상,조재홍 고려대학교 의과대학 1997 고려대 의대 잡지 Vol.34 No.2

Tutorial system in medical education in general is a system which deals with problem-oriented, self-directed, and small group learning to encourage students to assume responsibility for their own learnings and to provide capabilities to cope with the environment where greater expansion of medical knowledge is being piling up. But it is not just another system to tried out in short time. Rather it requires a new curriculum with many different types of resources and requires certain period of time to evaluate the effects and drawbacks. Each medical school should customize upon its basic status of current system when in attempt to adapt this system. The purpose of this study was first to review the basic concept of this system and prerequisites for the introduction of an ideal and practical model for our institution. Basic resources in medical school and medical center were reviewed and evaluated. Then, short- and long-term ideal plan for future curriculum based on present status is proposed. Although situation in our medical school is in the stage of advancement both academically and structurally, authors believe that our school should adapt this system in a customized fashion for the time being and improve upon the method of applying as it fits in place of new curriculum in future. Finally, authors wish to stress that this system should not be considered as just another a new curriculum nor it can be accomplished in short time with few trained teachers. Rather, every staff member of school should have an enduring mind to make this system work to provide a better learning environment for our medical students.

급성 술후 통증 조절을 위한 경막외차단 2,381예의 임상적 평가

장문석(Moon Suck Chang),채병국(Byung Kook Chae),이 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.2

A retrospective study was performed to evaluate the effects, and side effects, of epidural an- algesia for postoperative pain relief of 2,381 surgical patients who received general-epidural, or epidural anesthesia only. Anesthesia records, patients charts, and pain control records were reviewed and classified according to: age, sex, body weight, department, operation site, epidural puncture site, degree of pain relief by injection mode 8r, epidural injectate, and side effects (including nausea, vomit- ing, pruritus, urinary retention and respiratory depression). The results were as follows: 1) From the total of 2,381 patients, there were 1,563(66%) female patients, 1,032(43%) patients were from Obstetrics and Gynecology. 2) Lower abdomen, thorax, lower extremity and upper abdomen in the operation site, and lumbar, upper, lower thoracic in puncture site were order of decreasing frequency. Length of epidural injection for pain relief averaged l.72±1.02 days. 3) Ninety three percent of the patients experienced mild or no pain in the postoperative course. Analgesic quality was not affected by the kind of epidural injectate. 4) Nausea occurred in 3.2% of all patients, vomiting in 1.l%, pruritus 0.9%, urinary retention 0.6%, respiratory depression 0.08%. 5) Frequency of nausea was higher with female patients compared to male patients(p<0.05). 6) Pruritus frequency was higher with male patients than female patients(p<0.05); and more frequent with patients who received epidural injection with morphine than patients who re- ceived epidural injection without morphine(p<0.01). 7) Urinary retention was higher in female patients, and more frequent with patients who had received epidural injection with morphine than epidural injection without morphine(p<0.05). 8) There were two cases of respiratory depression. The course of treatment consisted of: ces- sation of epidural infusion, then administration of oxygen and intravenous naloxone. We conclude that postoperative epidural analgesia with a combination of local anesthetics and opiate is an effective method for postoperative pain relief with low incidence of side ef- fects. However, patients should be carefully evaluated as rare but severe complications of respiratory depression may ensue.