위암 및 대장-직장암 환자에서 수술 후 통증조절방법에 따른 진통효과 및 부작용 비교

김지훈(Ji Hoon Kim),권성준(Sung Joon Kwon),이흥우(Heung Woo Lee),유희구(Hee Koo Yoo) 대한외과학회 2004 Annals of Surgical Treatment and Research(ASRT) Vol.67 No.1

마취유도 시 Remifentanil, Lidocaine, Nicardipine, Nitroglycerin이 기관내삽관에 의한 혈역학적 변화에 미치는 영향

김현정 ( Hyun Jung Kim ),전종헌 ( Jong Hun Jun ),유희구 ( Hee Koo Yoo ),김교상 ( Kyo Sang Kim ),최원진 ( Won Jin Choi ),조영현 ( Yung Hyun Cho ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.54 No.6

실험연구 : 흰쥐의 열손상에 의한 통각과민에서 말초 μ와 κ 아편양 수용체 작용제의 효과

전용석 ( Yong Suk Chun ),전종헌 ( Jong Hun Jun ),심재철 ( Jae Chul Shim ),김교상 ( Kyo Sang Kim ),서정국 ( Jung Kook Suh ),유희구 ( Hee Koo Yoo ),승익상 ( Ik Sang Seung ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.44 No.2

소아 비뇨기과 환자의 수술후 통증관리를 위한 미추마취

유희구,이상률 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.4

In this study, caudal anesthesia was performed with 0.25% bupivacaine and 0.25% bupivacaine-1% lidocaine mixtures at the end of operation. Anesthetics were administered randomly with the volume of 0.5 ml/kg, 0.75 ml/kg, 1.0 ml/kg and 1.25 ml/kg individually. The results were as following: 1) The more the volume of loeal anesthetics administered, the higher the spinal dermatome was blocked(P$lt;0.005) and adequate analgesic levels were achieved. Body height classification by under and over 100 cm does not have statistically significant to determined of local anesthetic dosage. 2) Volume of local anesthetic solution required to block a spinal segment and body weight was most correlated to each other. At least 0.75 ml/kg or 1.0 ml/kg of local anesthetics are average amount for adequate pain control of pediatric urologic patients. 3) Only 17(24%) in 70 patients were required additive analgesic during postoperation 24 hours. 4) Local anesthetic volume required to block per a spinal segment was gradually increased with increased age and it markedly increased from 7 years old patients, this results have statistically significant correlationship. 5) The average volume of local anesthetic solution in patients under and over 100 cm in body height were 0.95±0.235 ml/spinal segment and 1.576±0.443 ml/spinal segment respectively(P$lt; 0.0005). 6) Analgesic duration did not depend on operation site and body height(cm), analgesic duration tend to prolonged a little in patients who had undergone penoscrotal operation. 7) There was no statistical difference in analgesic durations between 0.25% bupivacaine group and 0.25% bupivacaine-1% lidocaine mixture group. With above results, we suggest that caudal analgesia in pediatric urologic patients who had undergone inguinal or penoscrotal operation would be simple, safe and effective method for postoperative pain relief.

체외순환하 개심술시 혈중 2,3-Diphosphoglycerate농도의 변동에 관한 임상적 연구

박동호,김완식,유희구 한양대학교 의과대학 1985 한양의대 학술지 Vol.5 No.1

The derangement of blood flow due to increased shunt and decreased cardiac output may be a characteristic of congenital heart disease and a threat to a life accompanying with the impairment of oxygen supply to the vital organs and peripheral tissues. Therefore, open heart surgery under extracorporeal circulation has been performed to minimize the derangement of blood flow. It has been noted not only various beneficial outcomes but also increasing tendency of the surgery and decreasing of the complications. It is said that the amount of oxygen supplied to the vital organs and the peripheral tissues after open heart surgery may be an important role in determining the prognosis of the patient. The hemoglobin oxygen dissociation curve has been used not only as an indicator of oxygen carrying capacity to vital organs and peripheral tissues but also affected by acid base equilibrium, temperature, PaCO2 and 2,3 diphosphoglycerate concentration in arterial blood. The concentration of 2,3 DPG has been a factor to change the hemoglobin oxygen affinity. In congenital heart disease, the increased 2,3 DPG concentration was noted as a compensation and therefore, oxygen carrying capacity to vital organs and peripheral tissues was enhanced as a result of decreased hemoglobin oxygen affinity. Nevertheless, changes of hemoglobin concentration, PaO2, pH, CaO2 and 2,3 DPG concentration in arterial blood were seen due to hemodilution of prime solution and mechanical factor of heart lung machine in open heart surgery under extracorporeal circulation. To clarify the correlations of these changes, hemoglobin concentration, PaO2, pH, CaO2 and 2,3 DPG concentration in arterial blood were comparatively analysed at several times: before and 20 minutes after extracorporeal circulation, recovery room, 2nd days and 7th days after open heart surgery. The results were as follows: 1. The correlation between the changes of 2,3 DPG concentration and hemoglobin concentration in arterial blood was not seen after extracorporeal circulation. 2. The changes of 2,3 DPG concentration and PaO2 in arterial blood was noted after extracorporeal circulation without correlation. 3. The pH in arterial blood increased after extracorporeal circulation but the correlation with the change of 2,3 DPG concentration was not obtained. 4. The correlation between the changes of PaO2 and 2,3 DPG concentration in arterial blood was not seen after extracorporeal circulation. 5. A decrease of 2,3 DPG concentration in arterial blood to 0.972 μmol/ml at 20 minutes after extracorporeal circulation was thought to be an effect of oxygenator and hypothermia technique which was used during extracorporeal circulation. 6. The correlation among the changes 2,3 DPG concentration, hemoglobin concentration, PaO2, pH, CaO2 in arterial blood was noted before extracorporeal circulation. But it was not obtained after extracorporeal circulation. It may be a result of a disturbance in physiologic equilibrium by extracorporeal circulation.

Epidural Catheter 를 이용한 역행성 기관내 삽관 시행 3예 보고

유희구 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.3

Sometimes, anesthesiologist may have get a chance as if he can not intubate with ordinary direct laryngoscopy. At that time he must decided that intubation technique will try to again or not. If we have a decision as we will try to continue for intubation and we can not use any other intubation technique, we can have a decision to use retrograde intubation technique so as to intubate in trachea instead of direct laryngoscopy. If patient have much secretion, blood clot and laryngeal edema after had many times of direct laryngoscopy, fiberoptic bronchoscopy will be impossible. Since Buttler and Cirillo on 1960, retrograde intubation technique was improved markedly. Especially, most important improved point about this technique is that what things are used for guide wire. Recently, most of authors have been used for guide wire as CVP catheter, Swan-Ganz introducer wire or epidural catheter. But I used to epidural catheter for guide wire and patients have not any complication with this retrograde intubation technique. Finally, we concluded that retrograde intubation technique is one of good intubation technique and can do without any complicaions.

Etomidate 와 Midazolam 이 가토 복부대동맥과 폐동맥에 미치는 영향

서정국,유희구,염종훈 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7

Etomidate and midazolam are newly developed and used in clinical trials. Etmoidate, a carboxylated imidazole derivative, decreases systemic vascular resistance and increases the pulmonary artery pressure in vivo. Midazolam, a water soluble derivative of benzodiazepine, decreases pulmonary artery pressure and is useful for pulmonary hypertensive patients. This study was designed to investigate the direet effects of etomidate and midazolam on vascular tension of the rabbit abdominal aorta and the pulmonary artery in vitro. In the vascular preparations with or without endothelium, changes in tension were measured following cumulative administration of etomidate (10^(-6)M, 10^(-5) M, 5×10^(-4) M) and midazolam (10^(-6)M, 10^(-5)M, 10^(-4)M). Vascular effects of these drugs were also studied in the preparations pretreated with indomethacin, nitro(w)-L-arginine methyl ester (L-NAME) and methylene blue. The results wer as follows; 1) Etomidate and midazolam induced vasorelaxation and the degree of relaxation depended on he concentration. 2) After denudation of the endothelium, vasorelaxant effect of etomidate and midazolam was efficiently decreased in abdominal aorta but not in pulmonary artery. 3) Indomethacin reduced vasorelaxing effect of etomidate efficiently, but didn't affect vasorelaxing effect of midazolam. 4) Following pretreatment of vascular preparations respectively with L-NAME and methylene blue, the relaxing responses to etomidate (10^(-5) and 5×10^(-5) M) of both abdominal aorta and pulmonary artery were depressed. Also, depressed was the relaxing response of abdominal aorta to midazolam (10^(-5) M). The results of present study suggest that etomidate and midazolam possess vasorelaxing effects in both rabbit aMominal aorta and pulmonary artery. The vascular effect of etomidate is mediated via the nitric oxide pathway and also in part, by PGI2, whereas part of the vascular effect of midazolam is associated with the nitric oxide pathway.

당뇨병성 자율신경 병증이 병발된 환자에서 전신마취가 혈압 및 심박동에 미치는 영향

최원일,유희구,안유헌 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.5

Background : In diabetes mellitus patient with general anesthesia can be especially quite fatal if autonomic neuropathy were involved in the autonomic nervous system of cardiovascular system. This research was designed to study for incidence of diabetic autonomic neuropathy(DAN) in diabetic patients and to check the effects of the cardiovascular system by general anesthesia in DAN patients. Methods : DAN was diagnosed by 5 different diagnostic criterias and that criterias were suggested by Ewing and Clarke. For evaluation of the effects between autonomic neuropathy and general anesthesia in diabetes patients with DAN, systolic blood pressure, diastolic blood pressure, heart rates were measured on 5 points from start of anesthesia to 5 minutes prior to completion of operation, and was checked about incidence of dysrhythmias and using of vasopressor drugs during anesthesia. Results : Incidence of DAN were 11 cases within 33 diabetes patients. Among the 11 cases, 10 cases developed neuropathy in parasympathetic nervous system and 3 cases developed neuropathy in sympathetic nervous system. There were no statistical significance of the changes of systolic blood pressure, diastolic blood pressure and heart rate between control group and DAN patients under general anesthesia except just after intubation. Also, the incidence of dysrhythmias and using vasopressors during anesthesia were checked and compared. Conclusions : We concluded as follow. 1) It is essential to the safe anesthetic managements that diabetes patients are anesthetized after having diabetic autonomic function test before anesthesia. 2) If we are going to do general anesthesia for DAN patient, anesthesiologist have to pay more vigilance on the change of blood pressure and pulse rate, especially on just after intubation period. (Korean J Anesthesiol 1997; 32: 800∼808)

3 % Calcium Chloride 와 10 % Calcium Gluconate 정주량에 따른 혈중 이온화 칼슘농도의 변동과 심혈관계에 미치는 영향

한인수,유희구,전종헌,김경곤 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7

Total 87 patients were divided into 4 different dosage and try to observe what was affected to cardiovascular system depends on the increasing the plasma ionized cakium concentration (3% calcium chloride; 4 mg/kg, as its double 8 mg/kg and 10% calcium gluconate; 14 mg/kg, as its double 28 mg/kg). The results were as follows; 1) Though using double dosage of 3% calcium chloride and 10% calcium gluconate, could not get to increase as double of plasma ionized calcium concentration. 2) Plasma ionized calcium concentration was increased to the highest level on 1 minute after intravenous administration with each dosage and after increasing to highest level was show to be decreased gradually during 30 minutes after injection. 3) Heart rate was decreased until 30 minute after injection with each dosage of 10% calcium gluconate with statistically significancy (p$lt;0.05) but when 3% calcium chloride were used, the change of heart rate following increase of calcium concentration have not any statistically signi- ficancy. 4) When 3% calcium chloride and 10% calcium gluconate were used, mean arterial pressure (MAP) and increasing of plasma ionized calcium concentration have not any statistically signi- ficancy. 5) Changing of cardiac index (CI) following plasma ionized calcium concentration, have only statistically significancy after each dosage of 10% calcium gluconate was injected but each dosage of 3% calcium chloride have not any statistically significancy respectively. With the above results, equivalent dosage of 3% calcium chloride and 10% calcium gluconate were increased as similar change of plasma ionized calcium concentration but 10% calcium gluconate 14 mg/kg, 28 mg/kg are only have statistically significany between the change of PR, CI and increasing plasma ionized calcium concentration (p$lt;0.05).

유도저혈압하 가토에서의 Vecuronium의 근육이완 효과

김교상,유희구,승익상,전세웅 한양대학교 의과대학 1988 한양의대 학술지 Vol.8 No.1

The introdiction of muscle relaxant was an epoch-making event in the development of clinical anesthesia and its use became essential in anesthesia practice nowadays. The vecuronium, one of the latest muscle relaxant, is known to be most ideal because of its many advantages such as rapid acting, non-accumulating character, minimal side reaction and promptly antagonized by anticholinesterases. Deliberate (or induced) gypotension has been an anesthetic technique in order to minimize blood loss, thereby decreasing the need for blood transfution and improving the vision of surgical field. There have been, however, no references on the efficiency of muscle relaxant under the condition of induced hypotension yet. This study has been conducted to evaluate neuromuscular blocking effects of vecuronium in the rabbit under sodium nitroprusside induced hypotension. The results were as follows. 1. After I.V. administration of vecuronium 0.05mg/kg, spontaneous recovery index were 218.4 seconds (3.64 min.) in the normotensive group and 339.7 seconds (5.66 min.) in the sodium nitroprusside induced hypotensive group. The recovery was markedly prolonged in teh induced hypotensive group. 2. When neostigmine was injected (40ug/kg) upon the appearance of T after vecuronium administration, recovery index were 98.9 seconds (1.65 min.) in the normotensive group and 128.8 seconds (2.15 min.) in the sodium nitroprusside induced hypotensive group. Here again, marked prolongation was observed in the induced hypotensive group. 3. Recovery indices of spontaneous recovery and neostigmine reversal were significantly prolonged during sodium nitroprusside induced hypotensive period, but neuromuscular effect of vecuronium and its reversal by neostigmine were completely obtained.