Esmolo과 lidocaine의 혼합사용시 기관내 삽관에 따른 혈압과 심박수에 미치는 영향

하정량,손용,김태요,윤재승,송윤강 圓光大學校 醫科學硏究所 1999 圓光醫科學 Vol.15 No.1

Background: Ultrashort acting β-adrenergic antagonist, esmolol and local anesthetics, lidocaine are well known about effects of hemodynamic stabilization to tracheal intubation. But, the effects of these drugs are still controversial. The aim of the present study is to assess whether a combination of both drugs are more effective than either drug alone. Methods: Forty eight patients, ASA physical status Ⅰ or Ⅱ, were randomly assigned to one of four groups (n=12 each): control (Group S), esmolol 1 ㎎/㎏ (Group E), lidocaine 1 ㎎/㎏ (Group L) and esmolol-lidocaine combination (Group M). Anesthesia was induced with thiopental 5 ㎎/㎏ intravenously, and then saline, esmolol, lidocaine and combination drug were administered as an intravenous bolus, and immediately followed by succinylcholine 1.5 ㎎/㎏. Tracheal intubation was done 90 seconds after intravenous injection of drugs, respectively. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. Results: There was a significant attenuation in systolic, diastolic arterial pressure and heart rates after tracheal intubation in esmolol-lidocaine group compared to other three groups. Conclusions: Combination of esmolol 1 ㎎/㎏ with lidocaine 1 ㎎/㎏ seems to be useful for attenuation of the increases in blood pressure and heart rates compare to either drug alone after tracheal intubation.

복강경 수술 시 체위 변화에 따른 폐기능의 비교

김경일,하정량 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.2

배경: 복강경하 수술시 두부거상 및 두부하위 체위를 각각 취하였을 때 동맥혈 가스 및 호흡기계의 변화에 차이가 있는지의 유무를 알고자 하였다. 방법: 복강경하 시술을 받을 산부인과 및 담낭절제술 환자를 대상으로 복강내 이산화탄소 압력은 12 ㎜Hg를 유지하였으며 각각 두부하위 및 두부거상 체위는 20°를 유지하였다 측정치는 최대 흡기압, 평균 기도압, 호기 일호흡량 및 동맥 Background: The purpose of this study is to investigate the influence of laparoscopic pneumoperitoneum with posture change on arterial blood gas and ventilation pressures. Methods: We studied patients undergoing laparoscopic gynecologic surgery and cholecystectomy utilizing 20°of Trendelenburg lithotomy position, and reverse Trendelenburg lithotomy position, respectively. Measurements were taken after induction in supine position, creation of pneumoperitoneum with an intraabdominal insufflation pressure of 12 ㎜ Hg and position change. We checked peak inspiratory pressure (PIP), mean airway pressure (mPaw), expiratory tidal volume (V_T) and arterial blood gas. Lung compliance (C_eff rs) Was calculated as quotient of tidal volume and PEP. Results: After insufflation of intraabdominal pressure of 12 ㎜ Hg, there was a significant increase of peak inspiratory pressure, mean airway pressure and PaCO_2, and there was a significant decrease of Lung compliance. Head up or down positions showed no significant respiratory changes compared to supine position. Conclusions: Creation of intraabdominal pressure reduced respiratory system compliance, and increased peak inspiratory pressure, mean airway pressure, and arterial carbon dioxide during laparoscopic surgery. Head down or up positions did not further alter those parameters.

환지통 환자에서 케타민 정주요법의 효과

최덕화,김정훈,하정량,주민철 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.2

Phantom limb pain is a kind of neuropathic pain which annoy patient severely for life. Postamputation pain syndromes have been described after the loss of body parts, including the nose, tongue, breast, finger, teeth, testes, penis, bladder, and anus. Because many peripheral sensory nerve synapse in the dorsal horn of the appropriate spinal cord segment. That axons that form the dorsal columns only send collaterals to the segmental apparatus; their first synapse is in the medulla, raising the possibility that abnormal activity in the dorsal column nuclei could also play a role in phantom sensation. After centralization, abnormal ephatic relays occur, patients complain of burning pain, cramping pain, proximal lancinating pain, and dullness. Now many remedies are available but a panacea dose not exit. Ketamine is an antagonist of the N-methyl-D-aspartate ( NMDA ) receptor that gas a crucial role in central sensitization. We met a 53 years old man who had suffered from phantom limb pain. He complain of tactile, stabbing, cramping, cold allodynia, paresthesia and burning pain. We tried nerve blocks two times and medicated various drugs but the outcome was not satisfactory. We tried ketamine infusion theraphy. We use PCA(Patient Controlled Analgesia) machine. Ketamine basal Infusion dose is 0.5mg/hr, bolus dose is Img, lockout interval is ten minutes. The patient injected ketamine for fifteen days. The result was excellent.

복강경하 산부인과 수술시 삽관 튜브의 고정위치 변화

최덕화,김향이,하정량 圓光大學校 醫科學硏究所 2002 圓光醫科學 Vol.17 No.2

Background: The purpose of this study was to evaluate changes in the distance between the tip of endotracheal tube(ETT) and the carina by the pneumoperitoneum with Trendelenburg lithotomy position during lapaorscopic gynecologic surgery. Methods: We selected clinical patients who received laparoscopic gynecologic surgery on 20 degree of Trendelenburg lithotomy position under about 12㎝ H_2O of abdominal insufflation pressure. We checked a distance from the tip of ETT to the carina using a fiberoptic bronchoscope. Group 1 (n = 24) was measured the distance after the intubation and the pneumoperitoneum with trendelenburg lithotomy positions 10 minute later, respectively. Group 2 (n = 20) was measured the distance after intubation. And then measurements were taken in the pneumoperitoneum with trendelenburg lithotomy position 10 minute later after the positioning of the ETT fixed with 1 ㎝ shortly. Results: There was a significantly difference in the distance from the ETT to the carina within the Group 1. In group 2, the distance of between the tip of the ETT and carina was not altered significantly. Conclusion: The ETT has been shown to migrate towards the carina during laparoscopic gynecologic surgery. We suggest that the safety position for the ETT during laparoscopic gynecologic surgery should be shorter than fixation length of the ETT in supine position.

마취유도제 차이는 기관내 삽관시 Verapamil과 Esmolol의 혈압과 심박수 변화에 영향을 미치는가?

손용,윤재승,정영표,하정량,최덕화 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.2

Background: Antihypertensive agents such as verapamil and esmolol are well known for their effects of hemodynamic stabilization on tracheal intubation. But hemodynamic discrepancies in these agents may result from different techniques of anesthetic induction. The aim of the present study was to compare and evaluate their efficacy in controlling hemodynamic responses to tracheal intubation under the different anesthetic induction agents. Methods: Seventy-two patients, ASA physical status Ⅰ or Ⅱ, were randomly assigned to one of six groups (n = 12 each): a Thiopental-Saline (T-S) group and a Propofol-Saline (P-S) group in saline 10ml; a Thiopental-Verapamil (T-V) group and a Propofol-Verapamil (P-V) group in verapamil 0.1 mg/kg; a Thiopental-Esmolol (T-E) group and a Propofol-Exmolol (P-E) group in esmolol 1 mg/kg according to the induction agents, thiopental or propofol. Anesthesia was induced with thiopental 5 mg/kg or propofol 2 mg/kg intravenous, respectively. Next, saline, verapamil and esmolol were administered as a bolus, and were immediately followed by succinylcholine 1.5 mg/kg. Tracheal intubation was carried out 60 s and 90 s after the intravenous injections of verapamil and esmolol, respectively. Systolic and diastolic blood pressure and heart rate were measured before induction and every minute for 5 minutes after tracheal intubation. Results: There was a significant attenuation in systolic and diastolic arterial pressure after tracheal intubation in the verapamil groups compared to the esmolol groups. Heart rates were significantly lower in the esmolol groups than in the verapamil groups after tracheal intubation. Conclusions: Verapamil 0.1 mg/kg and esmolol 1 mg/kg attenuated increases in blood pressure and heart rate after tracheal intubation. The different anesthetic induction agents did not influence the hemodynamic effects of verapamil and esmolol on tracheal intubation. (Korean J Anesthesiol 1999; 37: 221~226)

Dispute cases related to pain management in Korea: analysis of Korea Medical Dispute Mediation and Arbitration Agency data

이주환,송재경,국연희,하정량,김연동 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.1

Background: Various developments in imaging techniques, interventional procedures, and medications for pain management have beneficial consequences. However, the nature of pain management often results in physicians becoming involved in medico-legal disputes with patients who purposely or accidentally bring litigation. Methods: Data on medical disputes cases related to pain management were collected and analyzed through the Korea Medical Dispute Mediation and Arbitration Agency from 2012 to 2016. Results: In total, we identified 210 public-disclosed cases; of these, we identified 36 cases related to pain management. The department of orthopedics (n = 9, 25%) was the most related to these pain management cases. Pain management was most commonly offered for pain in the lumbar region (n = 13, 37%), lower extremities (n = 12, 34%), and for infection (n = 7, 19%). The time spent resolving disputes ranged from 8.0 to 17.5 months and the final settlement amount ranged from 1,800,000 to 15,000,000 Korean won. Causal relationships and medical malpractice were the most common controversial subjects of legal debate. Conclusions: Various characteristics of medical disputes related to pain management in Korea were identified. Information regarding medical disputes in pain management should be available to help prevent further disputes and litigation, which is also useful to both patients and pain physicians. Guidelines and recommendations for pain management are needed, especially those focused on medico-legal cases.

모르핀이 산화적 손상에 의한 신경아종 세포주 SH-SY5Y 의 세포고사에 미치는 영향

이창수,손용,윤재승,김태요,송윤강,정영표,하정량,최덕화,김정훈 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.2

Background: The effect of opioids on nitric oxide (NO)- and peroxynitrite-induced neuronal cell death is largely unknown. In the present study, we examined the effect of morphine on NO- and per- oxynitrite-induced cell death using a human neuroblastoma SH-SY5Y cell line, which abundantly expre- sses μ, 8, κ-opioid receptors. Methods: The cultured cells were pretreated with morphine and exposed to 3-morpholinosydnonimine (SIN-1) that simultaneously generates NO and superoxide, thus possibly forming peroxynitrite. The cell damage was assessed by using MTT assay and crystal violet staining. Morphological nuclear changes and enzymatic evidences of apoptosis of the cells after exposure to SIN-1 for 24 hours were evaluated by using 4', 6-diamidino-2-phenylindole (DAPI) staining and the measurement of pro-apoptotic protease (caspase-3) activity, respectively. Levels of reduced glutathion (GSH) were measured by monochlo- ronimane (MCB) assay. Results: Pretreatrnent of SH-SY5Y with morphine significantly inhited the apoptotic cell death. Morphine also inhibited SIN-1-induced caspase-3 (pro-apoptotic protease) activity in a dose-dependent ma1nner. However, naloxone (20 μM) could not antagonize completely the effect of morphine in SIN- 1-induced cell death. Pre-administered GSH and N-acetylcysteine (NAC) have been found to protect SIN-induced apoptosis, and the neuroblastoma cells treated with morphine had significantly elevated the levels of GSH. Conclusions: The present study shows that morphine protects the human neuroblastoma cell line SH- SY5Y frorn peroxynitrite-induced apoptotic cell death through elevated GSH levels.The protective action of morphine seems to be associated with inhibition of the apoptotic pathway. However, it is suggested that morphine protects the cells possibly via other unknown mechanisms in addition to the activation of opioid receptors. ( Korean J Anesthesion 2000; 38: 356~364 )

Propofol 및 Lidocaine 혼합사용 시 Fentanyl 의 기침 반사 억제효과

손용,윤재승,김귀순,김태요,송윤강,정영표,하정량 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.6