미추마취시 Lidocaine 과 혼합한 약제가 진통의 발현 및 지속시간에 미치는 영향

라은길,양홍석 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.1

Background : caudal anesthesia is a safe and reliable technique for surgical anesthesia as well as an alternative to narcotics for postoperative analgesia for procedure below umbilicus. Onset time and duration of local anesthetics had been influenced by local anesthetics with combined drugs. We wanted that the time required for the onset of local anesthesia should be short and long enough to allow time for the contemplated surgery. Method : To investigated the effect of lidocaine with combined drugs, 120 ASA physical status I, II patients who underwent perianal surgery with caudal anethesia. The patients were diveded into 5 groups : control group received 1.5% lidocaine 27ml, group I received lidocaine with epinephrine (1:200,000), group II received lidocaine with morphine 2mg, group III received lidocaine with fentanyl 50 g, group IV received lidocaine with clonidine 75 g. We have compared the onset time and duration of analgesia of 5 groups. Results : 1. The onset time of analgesia for pin prick test were not significantly changes between groups. 2. The duration of analgesia was significantly more prolonged in group II(863.8 222.1 min) than other three group I, III, IV. 3. The most common side effect was urinary retention(20 cases, 16.7%) in all groups(n=120). 6 cases(24%) in group II(n=25), 2 cases(8%) in group III(n=25) were complained of pruritus. Bradycardia and hypotension were observed in group IV(n=20) (each 1 cases, 5%). Conclusons : It is suggested from the above results that the morhine group during caudal anesthesia can produce more prolonged duration of analgesia. (Korean J Anesthesiol 1997; 32: 91∼96)

성상 신경절 차단이 기관내 삽관에 따른 심혈관계 반응에 미치는 영향

라은길(Eun Gil Rah),윤정수(Jung Su Yoon),오현주(Hy 대한통증학회 1994 The Korean Journal of Pain Vol.7 No.2

N/A The impact of cardiovascular changes occurred by endotracheal intubation is risky for pa- tients with ischemic heart disease, or intracranial pathologic conditions typically impairing ce- rebral autoregulatory mechanisms. Therefore, multiple approaches have been utilized to limit the impact of intubation and re- duce damage of central nervous and cardiovascular systems. These approaches include modifi- cations in intubation technique to diminish circulatory stimuli and pharmacologic modifica- tions of either the sensory afferent path or the circulatory response itself. We tried the stellate ganglion block, a kind of sympathetic block, for the same purpose and evaluated the results. The results of study are as follows, 1) Blood pressure and heart rate increased significantly after intubation as compared with preintubation in both control group and SGB group. 2) The difference of the two groups is not found. We conclude the above method does not control cardiovascular consequences of endotracheal intubation.

외래환자 마취시 Propofol-Fentanyl 과 Propofol-N₂O 의 비교

김진윤,김경중,라은길,박선규 대한정맥마취학회 1997 정맥마취 Vol.1 No.4

외래 수술의 마취에 있어서 짧은 작용 시간을 가진 마취제와 보조제의 선택은 대단히 중요하다. Propofol은 현재 외래환자에서 가장 널리 사용되고 있는 마취제중 하나이다. Propofol은 약제의 진통작용이 미약하기 때문에 단독사용시 약제의 사용량이 증가하게 되므로 N₂O나 opioid 등을 보조제로 사용하게 된다. 본교실에서는 외래환자의 마취에 propofol을 사용하면서 각각 N₂O와 fentanyl을 보조제로 사용하여 수술중 환자의 혈압 및 심박수의 변화, 수술후 회복시간, 부작용을 관찰하여 비교하였다. 방법: 외래수술을 받기로 예약된 26명의 환자를 대상으로 각각 propofol-N₂O 마취(N군)와 propofol-fentanyl 마취(F군)를 시행하였다. N군의 환자들은 laryngeal mask airway(LMA) 삽입후에 O₂와 N₂O를 각각 1.5L/min와 3 L/min로 흡입시키며 마취를 유지하였고 F군의 환자들은 LMA 삽입후에 O₂와 air를 각각 1 L/min와 3 L/min로 흡입시키면서 fentanyl을 정주하여 마취를 유지하였다. 마취유도 전후 환자의 혈압 및 심박수의 변화, 회복시간, 부작용을 관찰하였다. 결과: 마취유도 전후 혈압의 변화, 술후 회복시간, 부작용은 양군간에 차이가 없었다. F군에서 N군에 비해 심박수가 의의있게 감소되었다. 결론: Propofol을 사용하여 외래환자를 마취할 때 N₂O와 fentanyl 모두 적절한 마취제로 사료된다.

제왕절개술에서의 Propofol-Fentanyl, Propofol-Ketamine 마취와 Propofol-아산화질소 마취의 적용

오수원,구길회,라은길,권종필 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.1

Background: According to the increasing rate of cesarean section, the efforts of seeking safer and more satisfactory obstetric anesthesia techniques have been continued. Propofol, 2,6 di-isopropyl phenol, is a relatively new intravenous anesthetic agent and has been used for induction and maintenance for total intravenous anesthesia (TIVA). Authors examined the anesthetic technique using following anesthetics combinations; N2O-propofol, fentanyl-propofol, ketamine-propofol and made comparison of these ones for intraoperative hemodynamic stability, maternal and fetal safety. Methods: Sixty patients (ASA physical status 1 or 2) scheduled for cesarean section were randomly allocated into three groups, group N (propofol-N2O, n=20), group F (propofol-fentanyl, n=20), group K (propofol-ketamine, n=20). We checked the changes of blood pressure and heart rates during operation, anesthetic induction time, neonatal status (Apgar score, umbilical vein blood gas analysis), presence of intraoperative awareness and recovery time. Results: No significant differences in intraoperative hemodynamic changes, induction time and baby status. Total propofol dosages were greater in group N than group K (p<0.05) and maternal recovery time was prolonged in group K than group N or F (p<0.05). Conclusions: Anesthetic management using propofol-N2O or propofol-fentanyl or propofol-ketamine for cesarean section would provide satisfactory anesthesia without significant adverse effects to both mother and fetus. (Korean J Anesthesiol 1999; 36: 13∼20)

외래환자 마취시 Propofol-fentanyl 과 Propofol-N2O 의 비교

김경중,김진윤,라은길,박선규 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.3

Background : The choice of anesthetic agents and adjuvants during outpatient surgery is of critical importance. Propofol is widely used for the induction and maintenance of outpatient anesthesia. Because propofol lacks analgesic properties, very high concentrations may be required when propofol is used as the sole anesthetic drug. Propofol is used with adjuvants such as nitrous oxide or opioid. This study was designed to evaluate the intraoperative hemodynamic response, recovery characteristics and side effects of propofol-fentanyl anesthesia compared with propofol-N2O anesthesia for outpatient surgery. Methods : Twenty six healthy and unpremedicated patients scheduled for outpatient surgery were randomly allocated to receive either propofol-N2O anesthesia(N-group) or propofol-fentanyl anesthsia (F-group). The patients in N-group were ventilated with nitrous oxide 60∼70% in oxygen and the patients in F-group were ventilated with oxygen 40% in nitrogen via laryngeal mask airway(LMA). Results : There was no sinificant difference in blood pressure during anesthesia, recovery time and side effects between two group. There was significant decrease of heart rate in F-group. Conclusion : We concluded that nitrous oxide and fentanyl are reasonable adjuvants of propofol anesthesia in outpatient anesthesia. (Korean J Anesthesiol 1997; 33: 441∼446)

무호흡상태의 개에서 기관지내 지속적인 공기주입이 심폐기계에 미치는 영향

박선규,김석주,라은길,김진윤 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.4

Background : Mass casualties from organophosphrous inhalation die from respiratory depression. Gas supplies and equipment are limited for mechanical ventilation of multiple subjects. Endobronchial insufflation of air (EIA) requires only a compresssor and airway catheters. We examined clinical usefulness of EIA in a model of apnea produced by tetrodotoxin (TTX) infusion. Methods : Five anesthetized dogs were applied the conventional mechanical ventilation (CMV) while 12 mcg/kg TTX was infused IV over 90 min to produce apnea. EIA at 1 L/kg/min was delivered through a 35 cm long 0.8 cm I.D. catheter with a forked end placed astride the carina. Measurements of cardiovascular and respiratory function were made after TTX (time=0) on CMV, and then serially for 4 hours of EIA. Results: All dogs survived through 4 hours study. PaO2 decreased significantly within 30 min and then slowly increased significantly after 60 min. PaCO2 increased significantly within 30 min and decreased significantly after 60 min. HR increased significantly after 20 min and MAP increased significantly after 60 min. Mean SD of PaO2, PaCO2, pHa, SaO2, cardiac output, mean pulmonary pressure, mean arterial pressure, systemic vascular resistance, central venous pressure and Qs/Qt are shown in table. Spontaneous respiratory efforts slowly returned after 45 min of EIA and resulted in the improvement of gas exchange. Conclusion : EIA is a field ventilatory technique useful when other equipment may not be available. The airway catheter can be placed by cricothyroidotomy. EIA supports life and produces normal survivors in apneic dogs. (Korean J Anesthesiol 1998; 35: 599∼606)

임상연구 : 한국 성인에서 굴곡성 기관지경으로 측정한 이중관 기관지 튜브 사용시 안전역

박정원 ( Jung Won Park ),라은길 ( Eun Gil Rah ),이보령 ( Bo Ryoung Lee ),백종화 ( Chong Wha Baek ),정용훈 ( Young Hun Jung ),오수원 ( Soo Won Oh ),우영철 ( Young Cheol Woo ),김진윤 ( Jin Yun Kim ),구길회 ( Gill Hoi Koo ),박선규 ( 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.44 No.2

양성 전립선 비대증 환자의 술후 통증치료

박선규(Sun Gyoo Park),김진윤(Jin Yun Kim),라은길(E 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.2

N/A Background: Postoperative bleeding is a common complication in transurethral tesection of prostate (TURP). Some patients become restless and combative after operation, particularly when in pain, producing bleeding from the prostatic bed. So many patients may be necessary to pain control for reduce bleeding. The purpose of this study is to compare recently used two methods for post-operative analgesia. Methods: We studied 40 patients, ASA physical staus 1, 2, undergone TURP under general anesthesia. the patients divided into two groups: continuous epidural pain control group g, n=20) received an epidural bolus of morphine 2 mg and 1% lidocaine 10 ml followed by a epidural 0.08% bupivacaine 40 ml and morphine 4.5 mg (basal infusian rate 0.5 ml/hr), intravenous patient-controlled analgesia (IV-PCA) group (II, n=20) received an intravenous bolus of fentanyl 50-100 μg followed by a IV-PCA morphine 30 mg, ketorolac 180 mg and droperdol 2.5 mg (basal infusion rate 0.5 ml/hr, bolus 0.5 ml, lock-out interval 15 min). This study conducted the analgesic efficacy, side effect and patient's satisfaction for 1 day after TURP. Results: Continuous epidural pain control group had more significant analgesia than IV-PCA at postoperative 30, 60 min, but no significant difference was observed later in both group. Nausea and pruritus were scantly developed in both group but the incidence was no significant differeance. Patients responded good satisfaction over 70% in both group. Conclusions: Postoperative continuous epidural pain block and IV-PCA are both effective methods of postoperative pain control with lower incidence of side effects.