내시경적 역행성 담췌관 조영술시 전처치로 사용한 Midazolam 과 Propofol 의 효과 비교

구영권,서규석,문영수 대한정맥마취학회 1998 정맥마취 Vol.2 No.2

서론: 상부 위장관 내시경(diagnostic upper gastrointestinal endoscopy, 이하 endoscopy)은 시술시 오심과 구토의 고통이 심해 benzodiazepine계 midazolam을 전처치하여 환자에게 안정과 기억상실을 유도하였다. 최근에는 작용시간이 짧고 회복이 빠른 정맥마취제인 propofol이 endoscopy에 많이 이용되고 있다. 본 연구에서는 endoscopy보다 시술시간이 길고 환자의 고 통이 더 심한 내시경적 역행성 담췌관 조영술(endoscopic retrograde cholangiopancretography, 이하 ERCP)시에 두 약제를 전처치하여 효과를 비교하였다. 방법: 진단 및 치료 목적으로 ERCP를 시행한 환자 58명을 대상으로 임의로 2개군으로 분류한 후 midazolam 투여군은 0.06 ㎎/㎏, propofol 투여군은 0.6 ㎎/㎏의 용량으로 내시경 삽관 2분전에 30초간에 걸쳐 정주하였다. 필요에 다라 처음 용량의 1/2을 추가 투여하였다. 시술중 3단계에 걸쳐 혈압, 혈중 산소포화도(이하 SpO₂) 맥박수를 측정하였으며 환자의 진정효과와 항구토효과를 주관적으로 평가하고 의식회복후 visual analog scale(이하 VAS)을 이용하여 환자의 만족도를 표시하였다. 결과: 1) 양군 모두 내시경 삽관 전후 SpO₂는 변화를 보이지 않았으며 맥박수는 증가하였다. 2) 투여 전후의 혈압의 변화는 midazolam군에서 의미있게 증가하였으며 propofol군에서는 비교적 안정성을 보였다. 3) Propofol 투여군이 midazolam 투여군보다 진정 효과를 보이고 구토가 적었으며 주관적인 만족도도 높았다. 4) Propofol군에서만 진정효과의 유지를 위하여 추가 투여의 필요성이 인정되었다. 5) 양 군에서 특이한 합병증은 발견되지 않았다. 결론: Propofol은 midazolam에 비해 ERCP의 검사 및 치료에 있어 진정효과와 항구토 효과가 우수하며 혈역학적 안정성이 뛰어나나 반복투여해야 하는 단점이 있다.

리도카인을 이용한 경막외 마취시 Nitrous Oxide가 감각차단에 미친 영향

구영권(Young Gwon Goo),우수영(Soo Young Woo),조강 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1

N/A Backgroud: Systemic administration of opioid can prolong the duration of epidural anesthesia. The authors examined the effect of nitrous oxide (NO) on the level of sensory block induced by epidural lidocaine. Methods: Twenty minutes after epidural injection of 2% lidocaine (below 70 years: 20 ml, 70 years and above: 15 ml), the level of sensory block was assessed (2nd stage). Patients were randomly assigned to receive either medical air (control group, n-15) or 50% N2O in oxygen (N2O group, n 15) for 10 minutes, the level of block was reassessed (3rd stage). Pateints were given room air (control group) or 100% oxygen for 5 minutes and room air for 5 minutes (N2O group), and the level of block was reassessed (4th stage). Results: At the 3rd stage, N2O group showed 4.3 cm cephalad increase in the level of sensory block (p-0.005), but control group revealed 1.43 cm regression. After discontinuation of gas, the level of block regressed in both group (p 0.000). At the 4th stage, NO group revealed 3.5 cm cephalad increase (p 0.048) and control group 1.97 cm regression (p=0.001) as compared with the 2nd stage. Conclusions: The level of sensory block induced by epidural lidocaine was significantly increased cephalad by concommitant use of 50% NO for 10 minutes.

요관경하배석술을 위한 Propofol 단독 정맥마취의 평가

김운영,구영권,주경화,신혜원,서규석,어홍선,유탁근 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.3

Background: Propofol is an intravenous anesthetic characterized by rapid induction and prompt recovery. Recently, its is used widely in clinical practice, especially when early discharge is advisable. We conducted this study for the evaluation of the effects of propofol as a sole intravenous anesthetic on the operation with minimal pain such as TUL(transurethral lithotripsy). Methods : Patients were recruited for ASA class 1 and 2 from those who received TUL operation. Propofol was administered 2 mg/kg for induction and continuously infused at the rate of 1.2∼1.4 mg/kg/hr after the loss of consciousness. With the stabilization of the vital signs, we reduced the dose of propofol to 1.0∼1.2 mg/kg/hr. We checked the patients' movement, vital signs, recovery time and monitored the appearance of the symtoms such as nausea, vomiting postoperatively. Results : 1) The average time of operation was 15 12 minutes. 2) The average recovery time was 15 9 minutes(range 2∼30 min). 3) Blood pressure and peripheral oxygen uration(SpO2) were declined during anesthesia, but SpO2 was normalized in the recovery room. 4) No significant complications were observed. 5) Mild movement of the patient was noticed in the begining of operation, but it did not affect the surgical procedure. Conclusions : Propofol was effective as a sole intravenous anesthetic to minimize postoperative complications such as nauea, vomiting for TUL with minimal pain. (Korean J Anesthesiol 1998; 34: 531∼536)

전신흡입마취에서 Nitrous Oxide의 농도와 사용시간에 따른 기관내튜브의 기낭내 압력 및 용량에 미치는 영향

주경화,구영권,서규석 乙支病院 1997 乙支醫報 Vol.20 No.1

Sodium Nitroprusside(SNP)를 사용한 유도 저혈압 마취시 Renin 활성치, Aldosterone, Epinephrine, Norepinephrine의 변동

강기택,구영권,우성,조강희,백세민 인제대학교 1991 仁濟醫學 Vol.12 No.3

악안면 성형재건술 환자 10명을 대상으로한 sodium nitroprusside(SNP) 유도 저혈압 마취에서 SNP를 주입한 후에 체내의 renin-angiotensin-aldosterone system과 sympathoadrenal system이 활성화되었음을 관찰할 수 있었다. Sodium Nitroprusside (SNP) is used during induced hypotension to decrease bleeding in operation site by direct relaxation of vascular smooth muscle. It is known that the infusion of SNP increases plasma renin activity and this activation of remain-angiotensin system is one physiologic mechanism opposing the hypotensive action of SNP. The purpose of this study was to determine plasma renin activity and activation of sympathoadrenal system following infusion of SNP for hypotensive anesthesia in 10 patients needed maxillofacial reconstructive surgery. Blood samples for analysis were drawn according the time sequence of SNP infusion ; Stage 1; After the induction and before SNP infusion, Stage 2 ; 30 min after when mean arterial pressure maintained 60-70 torr and within 30 min after SNP infusion, Stage 3;Before slopping of SNP, Stage4; 30 min after stopping of SNP. The results were as followings, 1) The duration of anesthesia and infusion of SNP were 197.7±131.3 Min and 100.2±40.3 min. 2) Total doses of 0.01% SNP solution were 115.2±36.4 ml through hypotensive anesthesia 3) PRA in stage 2,3 and 4 (25.3±7.6, 26.2±7.2 and 24.5±8.2 ng/dl/hr respectively) were significantly increased compared with the value of stage 1 (8.9±7.0ng/dl/hr) and the level of aldosterone in stage 2, 3, 4 (28.4±12.7, 33.6±20.0 and 32.9±18.0 mg/dl respectively) were significantly increased compared with the value of stage 1 (13.4±9.1 ng/dl). The increased values of PRA and aldosterone fowllowing infusion of SNP were continued eyen after the time of stopping SNP. 4) Norepinephrine in stage 2, 3(545±157.5, 347.7±115.0 pg/ml respectively) and epinephrine in stage 2,3 (178.4±58.7, 132±55.7 pg/ml respectively) were significantly increased compared with the values of stage 1(norepinephrine ; 236.2±107.3, epinephrine ; 111.8±73.9 pg/ml) and they were returned to the control value after slopping of SNP infusion 5) Sodium potassium and chloride were not changed significantly during SNP induced hypotensive anesthesia. In summary, the activity of renin-angiotesin-aldostprone system and sympathoadrenal system were increased following infusion of SNP during SNP induced hypotensive anesthesia.

Effect of lidocaine (40 mg) mixed to prevent injection pain of propofol on the intubating conditions and onset time of rocuronium

소상영,김희윤,구영권,박상일,박해진,정우석 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.64 No.1

Background: To analyze how lidocaine 40 mg mixed prevents injection pain of propofol affects the onset time of rocuronium, tracheal intubating conditions and intubation related hemodynamic changes. Methods: This study consisted of 70 patients with an American Society of Anesthesiologists (ASA) physical status class 1 or 2 for general anesthesia. All the patients were randomly allocated into two groups: propofol 2 mg/kg plus normal saline 2 ml (Group C) and propofol 2 mg/kg plus 2% lidocaine 40 mg (Group L). Each group was administrated intravenously during induction and the patient was intubated 1 minute after an injection of 0.6 mg/kg of rocuronium. The time at disappearance of the first twitch and intubation scores were recorded. Also, blood pressure and heart rate were measured at the baseline, after intravenous injection of propofol, before intubation, and at 0, 1, 2, 3 and 5 minutes after intubation. Results: There were no significant differences between group C and L (P > 0.05). Conclusions: 40 mg of lidocaine mixed with propofol to prevent injection pain did not affect the onset time of rocuronium, intubating conditions and intubation related hemodynamic changes.

전처치로 경구 투여된 Captopril 이 Sodium Nitroprusside 유도 저혈압 마취시 혈장 Renin 활성도, Aldosterone, Catecholamines 및 전해질 변동에 미치는 영향

조강희,우성,구영권,강기택 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.5

Sodium nitrorusside (SNP) is used for induced hypotension to decrease bleeding in operation site by direct relaxation of vascular smooth muscles. It is known that the infusion of SNP increases plasma renin activity (PRA) and this activation of renin-angiotensin system is one of physiologic mechanism opposing the hypotensive action. Captopril, the renin-angiotensin converting enzyme inhibitor, could reduced the dose of SNP during induced hypotension through blocking of the cardiovascular effect of renin-angiotensin system. The present study investigates the effect of captopril on PRA, aldosterone, elecholamines and electroytes and whether the pretreatment with captoril can reduce the dose of SNP. Forty patients who needed the induced hypotension for maxillofacial reconstructive surgery were studied. They were pertained to ASA class I and II and classified to 4 groups. Ten patients were pretreated with captopril 3 mg/kg, 10 min. before induction. And ten patients were 1 mg/kg, the other ten patients were 0.5 mg/kg and remainder served as control group. Blood samples for analysis were drawn according to the time sequence of SNP infusion; Stage 1; after the induction and before SNP infusion Stage 2; 30 min. after SNP (when mean arterial pressure was 60-70 torr) infusion Stage 3; before stopping infusion of SNP Stage 4; 30 min. after stopping infusion of SNP The results were as follows: 1) The duration of anesthesia were not stastically different among four groups. 2) Total dose of SNP were significantly decreased in each captopril group. 3) PRA and each value of control group were significantly increased compared with stage l. But there were no significant increase in stages 2, 3, 4 compared with control group PRA. 4) Aldosterone level of all captopril groups were decreased in all stage compared with control group. 5) Epinephrine and norepinephrine were significantly incerased in control group and returned to control level after stopping of SNP infusuon. In captopril group 3 mg/kg, norepinephrine of stage 2.3.4 were not significantly increased than stage l. Epinephrine in captopril 3 mg/ kg group, there were no significant changes except for stage 2. 6) While sodium was decreased in stage 3,4 compared with stage 1 in control group, potassium and chloride were not changed. In summary, captopril can reduce significantly the total dose of SNP required to produce induced hypotension during operation.

경량화 유리창 청소장치 로봇 개발

김재열,전진모,구영권,감승호,한지훈,정준혁,서준우,민성훈,한운영,송윤혜 제어로봇시스템학회 2014 제어로봇시스템학회 각 지부별 자료집 Vol.2014 No.12

개심술환자에서 Fibrinogen Degradation Products 와 Fibrin Degradation Products 농도의 변화

조강희,우성,박성섭,류승철,구영권 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.3

There were many researches, which qualitative or quantitative assays were performed about fibrinolysis and the degree of activation of coagulation system. Authors measured fibrinogen degradation products(FbDP) and fibrin degradation products(FbDP) by monoclonal enzymeimmunoassay, instead of polyclonal method in 12 cases of cardiopulmonary bypass(CPB). 1) The increase of FgDP after sternotomy is verifying the significant fibrino(geno) lysis occured by stimulation of sternotomy. 2) By the result that FgDP was significantly increased compared with FbDP, primary fibrinogenolysis is more important phenomenon than secondary fibrinolysis during CPB. 3) FbDP and FgDP were most significantly increased immediately before the end of CPB and after CPB. 4) Increased FgDP was decreased after CPB but FbDP was still elevated 5 hours after CPB. According to the above results, CPB induced primary fibrinogenolysis and secondary fibrinolysis in open heart surgery.

개에서 혈액희석에 의한 급성 정상혈량성 빈혈이 조직 산소화에 미치는 영향 : 전신 산소소모량, 동맥혈 actate, 동맥혈 케톤체비 및 위점막내 산도의 비교 A Comparison of Systemic Oxygen onsumption, Arterial Lactate, Arterial Ketone Body Ratio and Gastric Intramucosal pH

김영재,조강희,박주열,신치만,구영권,김환덕 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.3

Background : The reduction in hematocrit (Hct) by hemodilution tends to cause an increase in cardiac output and a proportional decrease in arterial oxygen content. Additionally the reduction of systemic oxygen delivery (DO2) leads to significant differences in regional blood flow. It is therefore important to characterize the effects of hemodilution on regional oxygen metabolism in individual organs. This study was undertaken to evaluate and compare the effects of acute normovolemic anemia induced by hemodilution. Methods : Six dogs were anesthetized and mechanically ventilated. Catheters were inserted in the right femoral and pulmonary arteries for blood sampling, and a gastric tonometer catheter was inserted into the gastric lumen. Baseline measurements of systemic hemodynamics, arterial ketone body ratio (AKBR), gastric intramucosal pH (pHi) and arterial lactate were recorded. Hemodilution was then begun by 6% pentastarch and was made in four levels of hematocrit values of 20%, 15%, 10% and 6%. Results : Mean arterial pressures of Hct 10% and 6% was decresaed (P < 0.05) and Hct 15% and 10% increases in cardiac output and pulmonary capillary wedge pressure (PCWP) were observed. Central venous pressure and mean pulmonary arterial pressure were incresed (P < 0.05) at Hct 15%, 10% and 6%. DO2 progressively decreased (P < 0.05). AKBR and pHi began to decreased at Hct 15%. Arterial lactate decrease at Hct 15% and was above 7.4 mmol/L at Hct 6%. Conclusions : By the measurements of AKBR and pHi, the disturbance of splanchnic oxygenation can be detected early compared to those of O2 in terms of oxygen metabolism and the critical point of DO2 during acute normovolemic anemia induced by hemodilution. (Korean J Anesthesiol 1999; 37: 478∼488)