군 간호교육 발전을 위한 연구 -현 임상간호장교를 중심으로-

유경자 ( Kyung Ja Yoo ),정경임 ( Kyung Im Chung ) 국군간호사관학교 군진간호연구소 1982 군진간호연구 Vol.3 No.-

항응고제 사용 환자에서 지속적 경막외 제통술후 발생한 경막외 혈종 - 증례보고 -

유경연(Kyung Yeon Yoo),임웅모(Woong Mo Im),박준서( 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1

Epidural hematoma during anticoagulant therapy is a rare complication of central neural blockade, but it may result in serious neurologic sequelae. A 61-year-old male receiving warfarin due to heart failure was referred to the pain clinic for control of severe herpetic neuralgia. Epidural catheterization was done at T,, interspace. At that time, PT and aPTT were extremely prolonged. The next morning, severe back pain, motor paralysis and urinary difficulty developed. On spine MRI, epidural hematoma was detected at T, inter- space. Four days later, he died due to underlying diseases. Central neural blockade in pa- tient with anticoagulant therapy is contraindicated in most cases. If it is undertaken, close observation of patients neurologic functions and monitoring of coagulation profiles(PT, aPTT, etc) are necessary. If epidural hematoma develops, early surgical decompression is mandatory.

백서를 이용한 포르말린 통증 모형하에서 뇌실 내 Gabapentin의 효과

윤명하(Myung Ha Yoon),곽상현(Sang Hyun Kwak),정성수(Sung Su Chung),유경연(Kyung Yeon Yoo),정창연(Chang Young Jeong),임응모(Woong Mo Im) 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.2

N/A Background: Systemic or intrathecal administration of gabapentin has been shown to reverse various pain states. However, until now, the effect of intracerebroventricular (ICV) gabapentin to noxious stimuli has not been reported. The authors aim of this study was to determine the effect of ICV gabapentin on the inflammatory nociceptive model, formalin test, in rats. Methods: ICV catheters were implanted under halothane anesthesia. For the nociceptive test, 50μl of 5% formalin was subcutaneously injected into the hindpaw. The effect of ICV gabapentin, administered 10 min before formalin injection, were examined on flinching, mean arterial pressure and heart rate evoked by a injection of formalin. Results: Injection of formalin into the paw resulted in a biphasic flinching and cardiovascular response. ICV gabapentin produced a dose-dependent suppression of the flinching and mean arterial pressure response during phase 1. In contrast, in phase 2, ICV gabapentin did not attenuate the pain behavior. ICV gabapentin did not affect on the baseline mean arterial pressure and heart rate. Conclusions: ICV gbapentin was effective for the acute noxious stimulus but it had no effect on the facilitated states induced by tissue injury.

돌발성 난청환자의 종양괴사인자-알파 유전자 다형성

주명돈(Myung Don Joo),탁기홍(Ki-Hong Tak),남성일(Sung-IL Nam),이동혈(Dong-Hyul Lee),유경임(Kyung-Im Yoo),정인성(In-Sung Chung),이미영(Mi-Young Lee),신동훈(Dong-Hoon Shin),김태완(Tae-Wan Kim) 한국항공우주의학협회 2006 항공우주의학회지 Vol.16 No.3

개에서 Nicardipine 과 Sodium Nitroprusside 가 Stunned Myocardium 의 기능 회복에 미치는 영향

유경연,임웅모,나재형 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.4

Background: Cytosolic Ca^(2+) overload and oxygen derived free radicals may contribute to stunned myocardium. The pnt study was aimed to investigate the effects of nicardipine and sodium nitroprusside (SNP) on the functional recovery of postischemic reperfused myocardium. Methods: Fifty-seven halothane-anesthetized dogs were subjected to 15 minutes of 1eft anterior descending coronary artery (LAD) occlusion and 3 hours of reperfusion. They were randomly assigned to receive either intracoronary nicardipine (n=11) or SNP (n=10) alone or both (nicardipine plus SNP, n=10). Eleven dogs that received saline i.c. served as the controL Regional myocardial contractility was evaluated by systolic shortening (%SS), the preload recruitable stroke work slope (Mw), and intramyocardial pressure (IMPs). Diastolic function was assessed by time constant of myocardial relaxation (IMP-tau) and postsystolic shortening (%PSS), LAD blood flow was measured by a Doppler flowmeter as well. Results: LAD occlusion produced a significant reduction in systolic as well as diasto1ic functions to similar degrees in all groups. However, %SS was significantly higher in the nicardipine, SNP and nicardipine-SNP groups (67%, 56%, and 68% of baseline values, respectively) than in the controls (20%) at 3 hours of reperfusion. Furthermore, Mw recovered to the baseline with the onset of reperfusian in the three experimental groups. IMP-tau was restored to the baseline during early nperfusion in the SNP-treated groups but was significantly prolonged in the control and nicardipine poups throughout the seperfusion. LAD blood flow during reperfusion was higher in the SNP-treated groups in comparison to the control group. Conclusions: Treatment with either nicardipine or SNP enhances the recovery of mgional contractile function in the canine model of myocardial stunning. SNP not nicardipine is also beneficial in attenuation of early diastolic dysfunction. Nicardipine combined with SNP improved systolic as well as early diastolic functions more significantly when compared to either nicardipine or SNP alane.

Propranolol 이 Succinylcholine 에 의한 혈청 K+ 치 변동에 미치는 영향

유경연,정창영,임웅모,신성식 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.1

Succinylcholine induces a small increase in serum K^+(0.3∼0.5 mEq/l) in normal patients, but it may produce fatal increases in sensitive conditions, including severs burn, massive trauma, tetanus and neuromuscular disorders. Recently, interest has been focussed on the role of the adrenergic system in extrarenal potassium homeostasis. Accordin to this concept, beta-adrenergic stimulation enhances and conversely a blockade impairs celluar uptake of potassium. Meanwhile propranolol, a beta-adrenergic blocker, is an increasingly, common drug among surgical patients. Therefore, the present experiment was carried out on 66 patients in order to determine whether propranolol augments or prolongs the increases in serum K^+ following succinylcholine injection(2 mg/kg, I.V.). Serum K^+ and NaA^+ levels were measured just prior to induction and at 3,5,10,30,60,90 minutes following succinylcholine administration. The patients were divided into three groups: Group 1; 26 patients without propranolol treatment. Group 2; 20 patients pretreat with divided doses of propranolol(320 mg b.i.d. p.o.). and Group 3: 20 patients on chronic propranolol therapy. The results were as follows. 1) Baseline K^+ values were significantly higher in propranolol treated patients(Groups 2 and 3) than in non-treadted patients(Group 1). 2) The magnitude of maximum increases in serum K^+ following succinylcholine was 0.19 mEq/l, 0.16 mEq/l and 0.21 mEq/l in Groups 1, 2 and 3, respectively. 3) The time to peak increases in K^+ was 30 min, 5 min and 3 min following succiny lcholine in Groups 1, 2 and 3, respectively. 4) Serum Na^+ decreased singificantly following succinylcholine administration in all groups, but there was no significant difference among the groups at other ives. These results indicate that propranolol neither augments nor prolongs increases in serum K^+ following succinylcholine injection. Thus succiny lcholine can be used safely in the presence of a beta-adrengic blockade.

개에서 Protamine Sulfate 에 의한 혈압 하강 기전

정성수,유경연,임웅모,임성진,심승진 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.1

Introduction : Protamine reversal of heparin anticoagulation often produces profound hypotension. However, the precise mechanisms of its hypotensive effect have not been fully elucidated. Using a canine model, we explored the effects of cyclo-oxygenase inhibitor, indomethacin (INDO), and nitric oxide synthetase inhibitor, NG-nitro-L-arginine methyl ester (L-NAME) either alone or both on the cardiopulmonary responses to protamine. Methods : Fifty-four mongrel dogs in five groups were studied during 1.5% halothane anesthesia. GroupI(n=17) received heparin (300 IU/kg iv) followed by protamine (3 mg/kg iv over 30 s) 5 min after the heparin. The same protocol were used in groups II(n=11), III (n=12), and IV (n=7), except that L-NAME (20 mg/kg), INDO (10 mg/kg), and INDO (10 mg/kg) plus L-NAME (10 mg/kg) were infused over 10 min beginning 30 min before the protamine injection, respectively. Animals in group V (n=7) were given protamine (3 mg/kg) alone. Mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), left ventricular end-diastolic pressure (LVEDP), LVdP/dt and cardiac output and left circumflex coronary flow (LCX flow) via Doppler flowmeter and heart rate were continuously recorded in baseline conditions and up to 15 min. Plasma NOx (NO2-, NO3-) levels were also measured before (baseline) and 3, 5, 10, and 15 min after protamine injection. Results: In group I, protamine caused immediate but transient decreases of MAP (41%), cardiac index (CI, 58%), dP/dt (28%), and LVEDP (62%) and increases of MPAP (38%) and systemic and pulmonary vascular resistance indices (SVRI, 30%; PVRI, 316%). INDO significantly attenuated the hemodynamic responses to protamine, whereas L-NAME did not affect them at all. INDO plus L-NAME prevented protamine-induced hypotension, but CI ( 24%) and LVEDP ( 30%) showed similar changes as those in group II. Protamine increased MPAP but inconsistently, meanwhile no correlation was found between the magnitude of increase of MPAP and decrease of MAP at peak responses in groups I-IV. LCX flow increased significantly (124∼188%) immediately after protamine infusion without any changes in plasma NOx levels in groups I-IV. Neither significant hemodynamic effects nor NOx release was found in animals given protamine alone. Conclusion : Protamine in the presence of heparin induces profound hypotension which may be mediated by a prostanoid and other potent vasodilators. In addition, increase of PAP and NO release may not play a significant role in the protamine-induced hypotension. (Korean J Anesthesiol 1998; 34: 27∼38)

전자궁절제술 후 자가진통법을 이용한 정맥내 Morphine과 Ketorolac의 비교연구

곽상현,유경연,임웅모,윤명하,고병일 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.6

Background : Intravenous (IV) morphine is commonly used for postoperative pain management. Ketorolac has been proposed as a potent analgesic for treatment of moderate to severe pain. The purpose of this study was to determine the equianalgesic dose of morphine and ketorolac using intravenous patient-controlled analgesia (IV-PCA) system in human volunteers. Methods : Fourty-five patients undergoing elective total abdominal hysterectomy were randomly assigned to receive either morphine (n=22) or ketorolac (n=23) when postoperative pain first increased to 40/100 mm (by visual analogue scale; VAS). Until postoperative pain decreased to 40/100 mm, morphine and ketorolac group received repeated IV boluses of 3 mg of morphine and 18 mg of ketorolac respectively and then followed by a IV-PCA with morphine (basal infusion 0 mg/hr, PCA dose 1 mg/1 ml, lock-out interval 5 min) and ketorolac (basal infusion 0 mg/hr, PCA dose 5 mg/1ml, lock-out interval 5 min). Analgesic efficacy with VAS (0∼100 mm), PCA demand ratio andrate, analgesics consumptions, patient satisfaction and side effects were compared. Results : There were no significant differences in VAS, PCA demand ratio and patient satisfaction. Mean 48-hour morphine and ketorolac consumptions were 35 (SEM=2.9) mg and 224 (SEM=16.5) mg, respectively (ratio=1:6.4). Morphine group experienced side effects such as pruritus (45%), nausea and vomiting (41%) and respiratory depression (5%). However, ketorolac group only showed side effects such as nausea and vomiting (26%). Conclusions : We concluded the ratio of equianalgesic dose of morphine versus ketorolac using intravenous patient-controlled analgesia (IV-PCA) after total abdominal hysterectomy was 1 versus 6.4. (Korean J Anesthesiol 1999; 36: 1008∼1016)

산모의 적출 자궁근 자발운동에 미치는 아편양제제의 영향

곽상현,유경연,정창영,임웅모,김학송 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.6

Background : Effects of fentanyl, sufentanil, meperidine, and morphine on the spontaneous contractility of isolated human pregnant uterine muscle strips were determined. Methods : Uterine specimens were obtained from normal full-term parturients undergoing elective lower-segment cesarean section. Longitudinal muscle strips were made and mounted individually and vertically in tissue chambers to record their isometric tension. After establishment of rhythmic contractions in the buffer solution, opioid concentration-response curves were constructed. The responses to opioids were repeated in the presence of opioid receptor blocker, nitric oxide synthase inhibitor, β- adrenoceptor blocker, or cyclo-oxygenase inhibitor. Results: Fentanyl and meperidine caused concentration-dependent decreases of the uterine contractility, their IC50 (concentration which causes 50% inhibition of the amplitude of spontaneous contractions) being 6.8×10-6 M and 2.2×10-3 M, respectively. On the contrary, sufentanil and morphine w without significant effects on the contractility. Pretreatment with either naloxone, N-nitro-L-arginine methyl ester, atenolol, or indomethacin did not affect the uterine responses to opioids. Conclusions : These results demonstrate that fentanyl and meperidine may have direct inhibitory effects on the contractility of the human uterus. However, the opioid concentrations needed to significantly reduce the uterine contractility were at a supraclinical range. (Korean J Anesthesiol 2000; 39: 775- 779)

Isoflurane-N2O-O2 마취중 Verapamil 이 혈역학 및 페내 Shunt 에 미치는 영향

김기선,유경연,임웅모,하인호 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.2

The purpose of this study was to evaluate the effects of verapamil on hemodynamics and pulmonary gas exchanges during isoflurane-N2O-O₂(FIO₂, 50%) anesthesia. Hemodynamic measurements and arterial and mixed venous blood gas analyses were made in thirteen healthy patients immediately before (control) and at 1, 5,10min after 5mg of intravenous verapamil administration as single bolus. 1) Verapamil produced a rapid and transient reduction of 15% in mean arterial pressure resulting from a decrease in systemic vascular resistance. 2) Heart rate and cardiac index increased by 14%, 9% respectively only immediately after i.v. verapamil injection and restored thereafter toward control values. 3) SVI, MPAP, PCWP, PVR and CVP revealed only minor changes. 4) Verapamil did not cause any significant changes in intrapulmonary shunt. These findings suggest that during isoflurane-N2O-O₂(50%) anesthesia verapamil might safely be used, even in the presence of ventilation/perfusion inequalities, (i.e. lung disease, one lung athesia) provided patient has good cardiovascular reserve.