관상동맥 우회술에 대한 마취 : 6예 보고 Six cases report

김교상,이동호,전세웅,서정국,유희구,전종헌,김경헌,승익상 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.1

Six aortocoronary bypass surgeries were performed from May 1987 to September 1987 at Han Yang University Hospital utilizing the following anesthetic regimen. Preoperatively patients were given nitroglycerin, propranolol and nifedipine to maintain the hypodynamic state of the cardiovascular system. Anesthesia was induced and maintained with morphine, diazepam, and oxygen and supplemented with halothane with or without N2O. Nitroglycerin, sodium nitroprusside and dopamine were used to stabilize the hemodynamics during the intraoperative and postoperative periods, respectively. Six cases of aortocoronary bypass surgery were peformed safely without mortality.

Sugammadex의 임상사용

김교상 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.4

An ideal reversal agent could be given at any time after the administration of a neuromuscular blocking agent, and should have no muscarinic side-effects. Sugammadex is a modified γ-cyclodextrin designed to encapsulate rocuronium bromide, providing a rapid reversal of neuromuscular blockade. Sugammadex is a revolutionary investigational reversal drug currently undergoing Phase III testing whose introduction into clinical practice in Korea may change the face of clinical neuromuscular pharmacology. The dose of sugammadex for reversal of moderate block (when T2 is detectable) is approximately 2 mg/kg, the dose is 4−8 mg/kg for profound block (post-tetanic count 1−2) and a larger dose of 16mg/kg for immediate reversal. The use of sugammadex has not been reported to be associated with recurrence of block provided a dose that is adequate for reversal has been used. Sugammadex appears to have an acceptable safety profile. Volatile agent such as sevoflurane seems not to influence the sugammadex ability to reverse the rocuronium neuromuscular blockade.

가토에서 Mivacurium 과 Rocuronium 의 상호작용

김교상,유희구,박영주,심재항 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.4

Background: Mivacurium has a considerably shorter duration of action than any other currently used nondepolarizing agent. Rocuronium, on the other hand, has a brief onset but an intermediate duration of action. The current study was undertaken to characterize the interaction between mivacurium and rocuronium in rabbits. Methods : In the first study, the dose-response relations of mivacurium, rocuronium and their combination were studied in thirty rabbits during thiopental anesthesia. Rabbits, randomly assigned to three groups(n=10), received mivacurium 10, 20, or 30 μg/kg; rocuronium 50, 70, or 90 μg/kg; or an equieffective combination of both drugs(0.3 ED50 mivacurium 0.3 ED50 rocuronium; 0.5 ED50 mivacurium 0.5 ED50 rocuronium; or 0.7 ED50 mivacurium 0.7 ED50 rocuronium, where ED50 is the dose producing 50% depression of the twitch height). In the second study, twenty rabbits were randomly allocated to two groups(n=10) to receive mivacurium 0.18 mg/kg or rocuronium 0.6 mg/kg. When the twitch height recoved to 25%, each rabbit received mivacurium 16.4 μg/kg. Results : The calculated ED95 and ED50 for mivacurium were 29.1 4.2(mean SD) and 16.4 3.3 μg/kg, respectively. Corresponding rocuronium was 95.1 6.7 and 61.5 5.3 μg/kg, respectively. The interaction between mivacurium and rocuronium was found to be synergistic. The measured ED50 of the mixture was only 54% of the predicted value assuming a purely additive interaction. In the second study, the times after mivacurium until 95% in mivacurium and rocuronium group were 18.1 4.6 min and 37.7 5.7 min, respectively(P<0.0001). Conclusions: The combination of mivacurium and rocuronium is synergistic interaction and after rocuronium induced neuromuscular block, mivacurium becomes a longer acting agent than the shorter agent. (Korean J Anesthesiol 1998; 34: 686∼693)

Glucose Oxidase 검사법에 의한 혈당치를 이용한 Diascan-S 자가 혈당 측정기의 정확도에 관한 연구

김교상,이동호,김성종,이홍식,심재철,전세웅,서정국,유희구,전종헌,김경헌 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.3

On department of anesthesiology, Hanyang university hospital, we used to the Diascan-S for portable blood glucose monitoring during surgery with anesthesia. So, we try to know about the accuracy, the precision and the specificity of that instrument. Period to check for blood glucose was devided to 3 groups that are on just after induction, the operation of main lesion, the end of surgery and we compared to the blood glucose level by the Diascan-S and the standard reference test. Central laboratory used glucose oxidase method to check blood glueose as the standard reference test. Thereafter we got the conclusions as follow. 1) We had got to good correlation between the blood glucose level by Diascan-S and the stan-dard reference test. (Y=65+0.64X, correlation coefficiency 0.58, p value; 0.0000) 2) When the blood glucose levels had devided as below from l00 mg/dl, 100 mg/dl to 150 mg/ dl and above 150 mg/dl, we only got to good correlation blood glocose level by Diascan-S and the standard reference test from 100 mg/dl to l50 mg/dl. (Y=11+2.5X, correlation coefficieny ; 0.51, p value ; 0.0000) 3) When we had tested for blood glucose on ]ust after anesthesia induction and the operation on main lesion, the end of surgery, the results of each period have a good correation each other by Diascan-S and the standard reference test. (a) Just after anesthesia induction Y = 51+0.50X, correlation coefficiency 0.52, p value 0.0000 (b) Operation for main lesion Y = 80+0.38X, correlation coefficiency 0.45, p value 0.0000 (c) End of surgery Y = 61+0.54X, correlation coefficiency ; 0.62, p value 0.0000 4) The condition of instrument had devided to two conditions of Diascan-S as was calibrated by technician reqularly or not, got to more confident correlation coefficiency when the Diascan-S had calibrated by technician reqularly. (a) had calibrated reqularly Y = 40+0.62X, correlation coefficiency 0.65, p value: 0.0000 (b) had not calibration Y = 77+0.42X, correlation coefficiency ; 0.36, p value: 0.0026 By above results, we got conclusions that portable glucose monitoring instrument(Diascan-s) can use to know to change of blood sugar during anesthesia. And then, if we got the result of blood glucose level as belows 100 mg/dl or above 150 mg/dl when used Diascan-S, should try to test again and must compared to standard reference test of central laboratory. Diascan-S must be calibrated by technician reqularly if we try to get more accurate results of blood glucose by Diascan-S.

가토에서 Magnesium Sulfate정주량에 따른 Mivacurium의 근이완 효과

김교상,이재기,원석규 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.4

Background: Magnesium sulfate(MgSO4) has long been used in the treatment of pre-eclampsia and hypertension. Mivacurium was found to undergo hydrolysis by plasma cholinesterase at 70-88% of the rate of succinylcholine. This study has been conducted to evaluate the time course of mivacurium-induced neuromuscular block according to the pretreatment doses of MgSO4 in rabbits. Methods: This study was done using a common peroneal nerve-anterior tibialis muscle preparation in sixty adult rabbits. The onset and recovery times of mivacurium(0.16 mg/kg) were evaluated after the infusion of a placebo in group 1, MgSO4 30 mg/kg in group 2, MgSO4 50 mg/kg in group 3 and MgSO4 70 mg/kg in group 4, respectively(n=15 each). Results: The mean serum concentration of magnesium was 2.4 mEq/L in group 1, 3.3 mEq/L in group 2, 4.3 mEq/L in group 3 and 5.5 mEq/L in group 4, respectively. The mean time from injection of mivacurium to 95% recovery of twitch amplitude was 32.7 min. in group 1, 32.9 min. in group 2, 30.4 min. in group 3 and 33.0 min. in group 4, respectively. Conclusions: The results of the present study suggested that the neuromuscular blocking actions of mivacurium are not affected according to the pretreatment doses of MgSO4. (Korean J Anesthesiol 1997; 32: 510∼517)

가스유량에 따른 흡입마취제의 섭취

김교상,이동호,김윤기,이청,전세웅,서정국,유희구,김경헌,승익상 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.6

Any factor which increases rebreathing (such as a decrease in inflow rate or an increase in ventilation) or increase uptake (such as an increase in solubility or in cardiac output) will lower the inspired anesthetic concentration. This in turn, will be reflected in an slower rate of anesthesia induction. In a circle absorption system, the inspired anesthetic concentration may be reduced from the inflowing concentration by rebreathing of anesthetic depleted gas. Semiclosed system, most widely used modern anesthetic system was tested to determine what effect the inflow rate had on the rate of rise of anesthetizing alveolar concentration of halothane and enflurane. The results were as follows: 1) High fresh gas inflow rate put the inspired anesthetic concentration close to that of inflow more rapidly. 2) In halothane anesthesia with 4 and 6 L/min of fresh gas flow, the anesthesia induction time was about 20 and 15 minutes respectively. But there was marked delay of the development of anesthesia by 2 L/min of fresh gas fiow. 3) In enflurane anesthesia, the anesthesia induction time was within about 10 minutes without respect to inflow rate. With these results, in general inhalation anesthesia with halothane or enflurane when a semiclosed technique and 100% oxygen are employed, a total gas flow at 4 to 6L per minute is recommended to establish a satisfactory induction and maintenance level of anesthesia.

후두근과 무지내전근에서 Succinylcholine 이 Vecuronium 의 근이완 효과에 미치는 영향

김교상,전세웅,전정우 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.5

서 론: Succinylcholine은 다음에 투여되는 비탈분극성 근이완제의 근이완 효과를 항진, 또는 억제한 다는 보고가 있으나 확실치가 않으며, 각 근육에 대한 반응이 다를 것으로 추정된다. 따라서 본 연구 에서는 후두근과 무지내전근에서 succinylcholine이 vecuronium의 근이완 효과에 미치는 영향을 관찰하여 보았다. 방 법: 정상 성인 80명을 무작위로 4군으로 나누어 생리식염수와 succinylcholine 0.5, 1.0, 1.5 mg/kg을 각각 정주 후 근이완이 100% 회복된 후에 vecuronium을 축적용량방법(cumulative dose method; 첫 용량: 15 ㎍/kg, 추가량: 10 ㎍/kg)으로 반응곡선을 얻었으며, 마취유지는 thiopental sodium, midazolam 및 fentanyl로 유지하였다. 후두근의 반응은 이마와 갑상연골에 전극을 부착한 후 희귀후두신경(recurrent laryngeal nerve)을 자극하여 기관내 삽판 cuff의 압력 변화로 측정하였으며, 무지내전근의 반응은 척골신경을 자극하였으며, 두 근육 모두 단순연축자극을 동시에 시행하였다. 결 과: Vecuronium의 축적용량반응곡선이 무지내전근보다 후두근에서 유의하게 좌측으로 전이하였으며, succinylcholine에 의한 vecuronium반응곡선의 좌측 전이는 두 근육에서 모두 유의하게 이루어졌으나 succinylcholine의 용량의 차이와는 무관하였다. Vecuronium의 ED_90은 후두근에서는 38.9±3.1 ㎍/kg인데 비해 무지내전근에서는 51.3 ±4.2 ㎍/kg이었다. 결 론: Vecuronium의 근이완 효과가 succinylcholine에 의해 두 근육에서 모두 항진되며, 무지내전근보다 후두근에서 vecuronium의 근이완 효과가 더 강하였다. (Korean J Anesthesiol 1996; 30: 590 ∼594)

Glycopyrrolate와 Pyridostigmine의 혼합 정주가 심박수와 혈압 변동에 미치는 영향

김교상,이동호,전세웅,서정국,유희구,김경헌,승익상,권진형 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.3

Anesthesiologists should have close relationship with muscle relaxants and their reversals in clinical practice. Nowadays, the nondepolarizing blocker is interested more than the depolari\zing blocker and its reversibility. The composition of atropine, neostigmine and glycopyrrolate has been investigated for many years in Korea. This study was undertaken to investigate the effects of glycopyrrolate (7㎍/kg) and pyridostigmine (200㎍/kg) mixture for pancuronium reversal on the heart rate and the blood pressure during halothane and enflurane anestesia. The results were as follows: 1) In the halothane group; singivicantly increased man blood pressure as compared with the enflurane group at 2.4 and 6 minutes and no significant difference was found after 8 minute. 2) In the halothane group; significantly increased pulse rate at 2 and 4 minutes and decreased after 12 minute. 3) In the enflurane group; significantly increased pulse rate at 2,4 and 6 minutes and no increase after 8 minute. 4) In the halothane group; significnatly decreased pulse rate as compared with the enflurane group after 6 minute and thereafter. 5) There was no significant arrhuthmia but 2 cases of the bradycardia were overved in the halotane group at 14 minute whch were treated by atropne.

가토에서 국산 Vecaron 과 Vecuronium 의 비교 연구

김교상,이동호,김동환,신우종,전세웅,서정국,유희구,염종훈,전종헌,최환영,승익상,김경헌 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.4

The introduction of musele relaxants was an epoch-making event in the development of clinical anesthesia and their use has hecome essential to anesthesia practice. Vecuronium, one of the newest muscle relaxant, has many advantages; it is rapid and short-acting, noncumulative, has minimal side reactions and is promptly antagonized by anticholinesterases was introduced recently our clinical anesthesia practice. Fortunately, domestic product of vecuronium as vecaron was introduced lately. Therefore, this study was performed to evaluate the effects of vecaron and as compare with vecuronium. The results were as follows: 1) Similar effects of muscle relaxation was observed in both group except the onset time of twitch depression was shorter in vecuronium group than vecaron group. 2) Blood pressure and heart rate was increased during intubation in groups. 3) Recovery index was slightly prolonged in vecuronium group than vecaron group but no significance was observed. However, this recovery index of vecuronium was slightly shorter than previous observations.

깊은 근이완의 회복을 위한 Anticholinesterases 의 사전예비정주법

김교상,전정우,이명의,한정욱,민용진,전민선,나도준 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.12

The success of accelerating the onset of neuromvacular blocking drugs by giving them in divided doses encouraged others to attempt the same $quot;priming principle$quot; using reversal agents. Naguib et al and Abdulatif et al demonstrated that the reversal time(time to reach a TOF of 0.75) was reduced when the reversal agent was administered in divided doses at T, 10% of control. But Donati et al and Szalados et al either could not detect any differences in the rate of reversal when anticholinestereses were administered in divided doses. This study hes been conducted to evaluate the reversal effects of neostigmine or pyridostigmine with priming principle in the rabbit after pancuronium injection when pro- found relaxation(PTC=0) was confirmed. Rabbits(n=60) were randomly allocated to 4 groups. After pancuranium 0.2mg/kg IV, the onset and recovery times were evalusted. When the profound relaxation(PTC=0) was confirmed at Smin. after pancuronium injection, neostigmine 50 ㎍/kg and atropine sulfate (atropine) 20 ㎍/kg we injected in group 1. At thst time, neostigmine 10/kg and atropine 4 ㎍/kg were injected and after 3min. neostigmine 40㎍/kg and atropine 16 ㎍/kg were injected in group 2. At that time, pyridostigmine 250 ㎍/kg and atropine 20 ㎍/kg were injected in group 3. At that time, pyridostigmine 50 ㎍/kg and atropine 4 ㎍/kg were injected and after 3min. pyridostigmine 200 ㎍/kg and atropine 16 ㎍/kg were injected in group 4. The results were as follows : 1) The time until 75% recovery of twitch amplitude was 53.1±12.4min. in group 1, 44.9±212.1min. in group 2, 54.9±9.7min. in group 3 and 48.2±7.1min. in group 4. The reversal times were tended to reduce when the reversal agents were administered with $quot;priming principle$quot; at the profound relaxation. 2) At the profound relaxation the reversal effects of neostigmine were greater than that of pyridostigmine.