임신한 양에서 혈액희석이 모체와 태자의 혈역학 및 산소운반능에 미치는 영향

고홍,김계용 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.4

Massive bleeding during pregnancy has a significant effect on the mother and the fetus. To evaluate the safety of hemodilution as a therapy for hemorrhage during pregnancy, the author compared maternal and fetal hemodynamics and oxygen carrying capacity at varying conditions in gravid ewes. Six Corriedale-breed, near-term pregnant ewes (120-140 days gestation) were anesthetized with nitrous oxide, halothane and oxygen. After the vital signs became stable, the maternal and fetal parameters of hemodynamics and oxygen carrying capacity were measured as control values. After then, 15% of total estimated matemal blood volume (12.5 ml/kg) was removed over approximately 15 minutes and infusion of the same amount of a mixture of lactated Ringer's solution and 10% pentastarch was done simultaneously (15% bleeding). Twenty minutes later the same parameters were measured. After then, a second phlebotomy was performed to remove an additional 15% of the total estimated maternal blood volume and infusion of the same amount of a mixture of the same solutions was done simultaneously (30% bleeding). And the same parameters were measured. Data collections included matemal heart rate, systolic, diastolic and mean arterial pressure, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, hemoglobin, hematocrit, serum lactate, arterial and mixed venous pH, oxygen tension, carbon dioxide tension, oxygen saturation, and fetal heart rate, systolic, diastolic and mean arterial pressure, hemoglobin, hematocrit, serum lactate, and umbilical arterial and venous blood gas analysis. Matemal arterial blood pressure, heart rate, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure and carfiac output revealed no significant changes, and there was neither hypoxemia nor acidosis in gravid ewes. Serum lactate concentration at 30% bleeding increased significantly but within normal range. Oxygen flux, oxygen consumption and oxygen extraction ratio revealed no significant differences. In fetal lamb blood pressure was not changed, but heart rate, serum lactate concentration and oxygen extraction ratio were revealed significant increases in 15% bleeding and 30% bleeding cases. In conclusion, gravid ewe was well tolerated to acute hemodilution, and.fetal lamb was well compensated.

한국산 잡견에서 Clonidine 전처치가 Bupivacaine 정주에 의한 심독성과 심소생에 미치는 영향

고홍,함병문,안헌영,김광우,이주혜,손주태,정영균 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.1

Background : Bupivacaine is a amide type local anesthetic agent, widely used for its excellent quality of analgesia and long duration of action. But unintended intravenous injection causes severe complication such as convulsion and cardiovascular collapse, which is known for its difficulty in resuscitation. With all the study, the exact mechanism is still unclear and there are much debate on the method of resuscitation. Method : We studied the effect of clonidine pretreatment on bupivacaine-induced cardiac toxicity and resuscitation in anesthetized dog. Twelve dogs were divided into two groups. : saline pretreatment group (control, N=6) and clonidine pretreatment group(clonidine group, N=6). The dogs were anesthetized with N2O-O2-enflurane and vecuronium. Thoracotomy was done in 4th or 5th intercostal space for open cardiac massage. After confirming stability of vital signs, we administered clonidine(10 mcg/kg) or saline, and then administered bupivacaine with the rate of 2 mg/kg/min. When the electeocardiogram showed asystole, 20 mcg/kg of epinephrine was administered via central venous line and open cardiac massage with the rate of 120 beat/min. was performed. We observed electrocardiogram(lead II), arterial blood pressure, heart rate, dose of infused bupivacaine to be required for QRS widening and arrest, required time and administered dose of epinephrine for resuscitation. Results : Clonidine group showed significant decrease of heart rate after pretreatment(p$lt;0.05). There was no significant difference in required dose for QRS widening between two groups. The dose administered for inducing arrest was less in clonidine group than control group(p$lt;0.05). The time required for resuscitation was shorter in clonidine group than control group(p$lt;0.05). The total dose of epinephrine required for resuscitation was less in clonidine group than control group(p$lt;0.05). The blood concentration of catecholamine did not showed significant difference during the whole course of experiment. Conclusions : Above results demonstrated that clonidine, a central nervous system-mediated sympatholytic agent, facilitated cardiac arrest when bupivacaine was infused intravenously and cardiac rescucitation. (Korean J Anesthesiol 1997; 33: 15∼24)

제왕절개술시 단순 Bupivacaine 과 Fentanyl 이나 Morphine 의 혼합 사용에 의한 경막외마취 효과

고홍,최익현 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.4

The effects of adding 50 ug fentanyl or 3 mg morphine to 0,5% bupivacaine for the epidural anesthesia in cesrean section were evaluated. The 59 women for elective cesarean section were randomly allocated into 3 groups. The first group (n=15) was administered epidurally with 0,5% bupivacaine alone, the second group (n=18), 0.5% bupivacaine mixed with 50 ug fentanyl, and the third group (n=l6), 0.5% bupivacaine mixed with 3 mg morphine. No significant differences among the groups were noted in systolic and diastolic blood pressure, heart rate, respiratiory rate, and tidal volume. There were no significant differences among the groups in the incidence of adverse effects (nausea, vomiting, dizziness, hypotension, pruritus, urinary retention, respiratory depression) in the perianesthetic period and in the onset time of anesthesia up to T4 sensory dermatome. Durations of the anesthesia and postoperative analgesia are prolonged significantly in the second and third groups compared with the first. We found no differences in the neonatal outcome among the groups. Therefore, we conclude that the addition of 50 ug fentanyl or 3 mg morphine to 0.5% bupivacaine during epidural anesthesia for the cesarean section significantly prolongs the duration of anesthesia and postoperative analgesia with no deleterious effects on neonatal or maternal outcome.

대한마취과학회지 논문 119편의 통계검정 음성적 결과에 대한 사후 검정력 조사

고홍,이윤석 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.2

Background : Statistical type II error has seemed to be ignored commonly by medical researchers. To control and present a power value could be helpful to reduce this type of error and to improve a quality of scientific decision making. We performed the post-hoc survey of the power of the negative results in Korean Journal of Anesthesiology (KJA). Methods : One Hundred nineteen articles with negative results published in KJA during a year of 1997 were selected. We collected the numbers of the sample size and calculated the power of the given negative result only when applicable. And each author's attitude to negative results was taken by arbitrary criteria. Results : Median sample size of these negative results was 16 12 (median interquartile range). We can calculate the power only in 43 articles of 119 negative results. Median power is 18.0% (interquartile range 26.0). In thirty six articles (83.8% of 43) the powers are proved to be under 80.0%. And 22 articles (51.2% of 43) have the powers even under 20.0%. We couldn't find any author who included either power or effect size in the article, and there was only one article in which its authors considered their inadequate number of sample size. Conclusions : We conclude that authors of KJA tend to ignore statistical type II error. In 119 negative results published in KJA during 1997, the calculated powers were very low and were not reported in the text. (Korean J Anesthesiol 1999; 36: 286∼292)

소아에서 쇄골하정맥 도자시 도관의 상대정맥내 거치율을 증가시키는 방법

고홍,김지연,박재현,정철우 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.6

Background : Subclavian cannulation is useful for the patients who need long-term maintenance of central venous catheters, but the inadequate location of catheters produces some complications. In pediatric populations, the abnormal placement of subclavian catheters in the internal jugular vein (IJV) is frequent because the angle farmed by the subclavian vein and IJV is much larger than in adults. We would therefore propose a technique which will increase the location ratio of subclavian catheters in the superior vena cava (SVC). Methods : One hundred twenty three patients who received elective or emergent operations were divided into 4 groups which consisted of the neck rotation away from the cannulation site' group (RA), neck rotation toward the cannulation site' group (RT), neck tilt away from the cannulation site' group(TA), 'neck tilt toward the carmulation site group (TT). We cannulated each group and verified the location of the catheter tip i#o chest PA for each group. Results : The calculatio#n for the ratio of SVC location to the total cannulation of each group (%SVC) was done and the x^2 test was done. Total %SVC was 73.2% and %SVC of each group wme 64,9% for the RA group, 77.3% for the RT group, 61.8% for the TA group, and 93.3% for the TT group. A considerable difference was found for total %SVC in the g test. The location ratio of the TT group was higher than the others nnd there was no difference found between the RA, RT, TA groups. Conclusions : We can conlude that tilting the neck toward the cannulation site would produce a higher ratio of SVC location of the subclavian catheter than other neck pasitions. (Korean J Anesthesiol 2000; 38: 102A~I028)

Eisenmenger 씨 증후군 산모의 제왕 절개시 경막외 마취

고홍,박학수 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.1

Eisenmenger syndrome is defined as pulmonary hypertention with right-to-left or bidirectional shunt with peripheral cynosis. All patients with Eisenmenger syndrome are at markedly increased risk and poor prognosis. We experienced a case of 31-year-old, pregnancy 36 weeks with Eisenmengers syndrome secondary to PDA and Down syndrome. We carefully performed epidural anesthesia with fractionated doses of 2 % lidocaine and fentanyl. The sensory block reached to T6 level. Monitoring included ECG, invasive blood pressure, finger pulse oximetry and central venous pressure. Blood pressure was maintained with intravenous phenylephrine. Blood loss was promptly replaced with crystalloid solution and FFP. Postoperative pain was managed successfully with continuous epidural infusion of 0.2 % bupivacaine and fentanyl. The mother and baby were discharged home l week later without complicaton.

산과마취 영역에서의 자가 통증 조절

고홍 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5

칼슘 길항제:약물상호작용과 부작용

고홍 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.5

비탈분극성 근이완제의 전분할투여에 관한 연구

고홍,함병문,김용락 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.1

The authors studied the priming effects of the nondepolarizing neuromuscular blockers on the frequency of discomfort, intubation condition and the time interval between the administration of nondepolarizing neuromuscular blockers and endotracheal intubation. Thirty two patients were divided randomly into four groups: the patients administered vecuronium priming dose, 0.02mg/kg and intubating dose, 0.06mg/kg (Group I), vecuronium customary single dose, 0.1 mg/kg (Group II), pancuronium priming dose, 0.02 mg/kg and intubation dose, 0.06mg/kg (group III) and pancurnium customary single dose, 0.1 mg/kg (group IV). The results were as follows. 1) Seven patients complained discomfort after administration of priming dose in the priming groups. (Group I and III) 2) There was better intubating condition in the priming groups than the customary single dose groups. 3) The time intervals between the administration of intubating dose and the maximum depression of single twitch response were revealed 57.9±14.6 seconds, 11.5±27.2 seconds, 74.5±30.0 seconds and 101.4±13. 7 seconds in I, II, III and IV group respectively. The time interval in group I was significantly shorter than group II (p$lt; 0.05). And the interval in group III was also significantly shorter than group IV (p$lt;0.05). With the above results we conclude that the priming groups provide smooth and rapid intubation condition than the customary single dose group, in spite of small total intubating dose.

대한마취과학회지에 게재된 논문의 통계적 분석에 관한 고찰(1981 년 ~ 1990 년)

고홍,함병문,곽일용,김광우,최익현 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.1

The purpose of this study is to investigate the error of using statistics in the articles of the Journal of the Korean Society of Anesthesiologists from 1981 ta 1990 and to present a program that may be of some help correcting the statistical error. We classified statistically the journals into original articIe, review and case report, and original articles into that of usng inferential statistics, descriptive statistics and no statistics. Then, we analyzed the articles of inferential statistics in the aspect of our criteria for statistical errors. The proportion of using erroneous inferential statistics was 80-100% from 1981 to 1986 and it decreased by 60% afterwards. But the proportion was still 67% in 1990. The representative errors are the no statistical analysis in spite of the necessary cases, the p-value only without the description of statistical method and using t test inappropriately in the comparison of more than 3 groups without Bonferroni correction. The other errors in using statistics were confusion between related data and independent data, inadequate numbers for Chi-square test, inapproate follow-up to variance analysis and inapproate parametric test for data in nominal or ordinal scales