편집위원회에 보내는 글 : 내피세포에서 Nitric Oxide 분비와 생산을 위한 세포신호전달경로

손주태,신일우 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1

Esmolol 투여가 기관내튜브 발관후 나타나는 심혈관계 반응에 미치는 영향

손주태,우민규,천현준 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.4

Transient increases in blood pressure and heart rate(HR) at the end of anesthesia and during extubation are common. Tomori and Widdicombe observed that mechanical stimulation of four areas of the upper respiratory tract (nose, epipharynx, laryngopharynx, tracheobnchial tree) induced reflex cardiovascular responses associated with enhanced neuronal activity in the cervical sympathetic efferent fibers. In susceptible patients, even this short period of hypertension and tachycardia can result in myocardial ischemia or increased intracranial pressure. The purpose of present study was to evaluate the effect of esmolol in attenuating cardiovascular responses to extubation under general anesthesia with endotracheal intubation. A sixty healthy patients who underwent elective noncardiac operation under general anesthesia (N₂O-O₂-enflurane) with endotracheal intubation were randomly divided into two groups : one was placebo group that received intravenous injection of 0.1 cc/kg normal saline, the other was esmolol group that received intravenous injection of 1 mg/kg esmolol. Extubation was performed when the patients could breathe spontaneously and open their eyes on command. In practice extubation was done between 2 and 4 minutes after drug(esmolol or saline) injection. The measurement of systolic blood pressure and heart rate was obtained one minute before extubation and every minute for 5 minutes after extubation, then rate-pressure product was calculated. The results were as follows; 1) When compared to pre-extubation systolic blood pressure, systolic blood pressure for 2 minutes after extubation in both groups increased significantly but systolic blood pressure was more rapidly returned to pre-extubation level in the esmolol group than in the placebo group. When compared to pre-extubation systolic blood pressure, after extubation the number of patients in whom systolic blood pressure increased more than 20% was significantly fewer in the esmolol group than in the saline group. 2) When compared to pre-extubation heart rate, heart rate at 1 minute after extubation in the placebo group increased significantly but heart rate after extubation in the esmolol group did not change significantly. 3) When compared to pre-extubation rate-pressure product, rate-pressure product for 2 minutes after extubation in both group increased significantly. At 4 minutes after extubation, rate-pressure product in the saline group increased significantly when compared to rate-pressure product in the esmolol group. These results suggest that intravenous injection of 1 mg/kg esmolol before extubation blocks heart rate elevation following extubation under general anesthesia and is effective for rapid return to the pre-extubation level of systolic blood pressure.

척추 천자바늘의 사면과 경막섬유의 주행방향의 관계가 20 대 남자에서 척추마취 후 두통에 미치는 영향

손주태 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.6

The incidence of postspinal headache is one of the well known complications of spinal anesthesia. The development of postspinal headache is related to age and sex of patients, needle size, needle configuration, pregnancy, direction of needle bevel, number of dural puncture. This study was done to see the effect of various gauge Quincke needles(22, 23, 24, 25, 26gauge) and needle bevel direction on the incidence, severity, onset and location of postspinal headache in the 200 male patients of the third age decade undergoing spinal anesthesia. There were one group consisting of 100 patients who underwent parallel insertion to longitudinal dural fibers and the other group consisting of 100 patients who underwent vertical. Each group consisting of 100 patients had five subgroups with 20 patients in related to each needle gauge. A system of criteria for registering postspinal headache and its severity is proposed. The following results were observed: 1) The incidence of postspinal headache was 10% in one group who underwent parallel insertion to longitudinal dural fibers but 27% in the other group who underwent vertical. 2) The severity of headache was mild level in all the 10 cases with postspinal headache of parallel insertion group but above moderate level in 14 cases of all the 27 cases with postspinal headache of vertical insertion group. 3) The small size of needle had a trend with lower incidence of postspinal headache than the large size. 4) The onset of postspinal headache was within 3 day after spinal anesthesia in the almost patients(92.5%) with postspinal headache. 5) The sites of postspinal headache were 59.5% in frontal, 18.9% in occipital, 16.2% in generalized, 5.4% in parietal region. In conclusion, the method of insertion parallel to longitudinal dural fibers is significantly lower incidence of postspinal headache than that of insertion vertical to longitudinal dural fibers in young males of the third age decade.

혈관 평활근 Adenosine Triphosphate(ATP)-Sensitive Potassium Channel 과 마취제

손주태 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.3

Lipid emulsion treatment for ventricular tachycardia induced by the toxicity of multiple herbs

손주태 대한응급의학회 2020 Clinical and Experimental Emergency Medicine Vol.7 No.2

A toxic dose of bupivacaine, a highly lipid-soluble amino-amide local anesthetic, causes conduction block and myocardial depression via the inhibition of cardiac sodium, potassium, and calcium channels, leading to QRS widening, ventricular tachyarrhythmia, and cardiac arrest. Although the “lipid sink theory” was initially one of the most widely accepted mechanisms explaining the effects of lipid emulsion treatment, the “lipid shuttle” concept, which states that the lipid phase of a lipid emulsion absorbs highly lipid-soluble local anesthetics such as bupivacaine from the heart, is now widely considered to be an indirect mechanism underlying the effect of lipid emulsion treatment.

폐의 림프관평활근종증(lymphangioleiomyomatosis)을 동반한 임산부의 제왕절개술을 위한 경막외 마취경험 1 예

손주태,이헌근,정영균,우민규 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.6

Lymphangioleiomyomatosis result from the proliferation of immature smooth muscle cells in the peribronchial, perivascular and perilymphatic areas of the lung. The disease primarily affects women of childbearing age, which has dyspnea, recurrent episodes of pneumothorax, pulmonary edema, chylous effusion and hemoptysis as symptoms. Most patients die from respiratory failure within 10 years after diagnosis. Definite diagnosis depends on histologic findings. We report our experience of anesthetic management for a pregnant woman with lymphangioleiomyomatosis which was confirmed with biopsy of inguinal lymph nodes.

대퇴골절 수술 후 회복실에서 나타난 지방색전증후군

정영균,손주태,황경일,강성준,김홍범,이헌근 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.4

The fat embolism syndrome is a serious and potentially life threatening complication of long bone trauma, blunt trauma and intramedullary manipulation. A 26-year-old woman underwent an intramedullary nailing of the femur under general anesthesia 45 hours after a traffic accident. The operation ended uneventfully and the patient was extubated in the operatirg room. About one hour after the patient arrived at the recovery room, she progressively developed tachycardia, tachypnea, cyanosis and drowsiness. The fat embolism syndrome was suspected because of the above clinical signs, and because pulmonary edema appeared on a simple chest A-P. During six days of intensive treatment in response to the fat embolism syndrome, the patient,s vital signs and ventilatory status progressively improved. The patient was uneventfully discharged from the hospital 19 days after her operation. (Korean J Anesthesiol 1999; 37: 731∼736)

A survey of post-craniotomy analgesia in Korea

정성태,손주태,최승호,윤명하 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.4

Background: There is increasing evidence that more aggressive pain management is needed in patients undergoing craniotomy in Korea. However, no consensus or standardized analgesic regimen has been established to date. To achieve this consensus, we undertook a survey of the current state of post-craniotomy pain management in Korea. Methods: A postal questionnaire was sent to anesthesiologists,neurosurgeons and nurses of neurosurgical departments at 44university hospitals in Korea. Of the 44 centers that were sent questionnaires, 35 centers returned these from their anesthesiology department resulting in a response rate of 73%, and 25 returned the questionnaires from their neurosurgery department (response rate: 57%). Results: Fifty-three percent of neurosurgeons answered that current postoperative pain management was adequate after craniotomy,whereas only 8% of anesthesiologists agreed. However, 72% of neurosurgeons also agreed that a more aggressive pain management was needed for post-craniotomy patients. Fifty-two percent and 23% of neurosurgeons used non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen as a first-line analgesic,respectively. Twenty-five percent of neurosurgeons used opioids as a first-line analgesic. Fifty percent of anesthesiologists used strong opioids alone or with NSAIDs as a first-line analgesic. About 10% of both groups used weak opioids as a first-line drug. Conclusions: Many clinicians agree that post-craniotomy pain is not adequately managed and more aggressive strategies are needed. Nevertheless, opioid analgesics are still avoided because of the concern of side effects despite no evidence to suggest increased risk when use carefully.

잡견에서 Halothane 마취하에 Sodium Nitroprusside(SNP)를 사용한 유도저혈압시에 Esmolol 의 영향에 관한 연구 : SNP 용량과 혈역학적 변수에 미치는 영향 Impact on the Hemodynamic Parameters and the Sodium Nitroprusside Dose Requirement

이국현,손주태,우민규 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.6

Background: The induced hypotension was used to decrease blood loss, thereby decreasing the need for blood transfusion and/or improving operating conditions at the surgical site. It was hypothesized that SNP-induced hypotension with fixed concomitant esmolol infusion(75 ㎍/kg/min) might prevent side effects such as reflex tachycardia and reduce SNP dose requirement during SNP-induced hypotension. Method: The concomitant infusion of 75 ㎍/kg/min esmolol was used to potentiate hypotension(30% reduction of mean arterial blood pressure) induced with sodium nitroprusside in six dog during halothane(lvo1%)-N₂O(50%)-O₂(50%) anesthesia. Mean arterial blood pressure, heart rate, cardiac output, mean pulmonary arterial blood pressure, central venous pressure, arterial blood gas analysis, and mixed venous oxygen saturation were measured and systemic vascular resistance was calculated in the each periods. Result: The results run as follows; 1) Compared to SNP-induced hypotension, there was significant reduction in SNP se requirement to maintain a 30% reduction of mean arterial pressure at the concomitant infusion of 75 ㎍/kg/min esmolol. 2) There were significant reduction in heart rate, mixed venous oxygen saturation and cardiac output, but significant increase in systemic vascular resistance and mean pulmonary arterial pressure at the coneomitant infusion of 75 ㎍/kg/min esmolol. 3) No rebound hypertension was observed at 30 minute after SNP and esmolol infusions were simultaneously discontinued. Conclusion: The result of present study suggests that esmolol infusion is a safe and effective pharmacologic means of potentiating SNP-induced hypotension during halothane-N₂O-O₂ anesthesia. Probably esmolol may act by counteracting side effects such as acute tolerance during SNP-induced hypotension.

경요도 방광절제술을 위한 척추마취 후 지속적인 발기를 지닌 환자의 마취관리

고지은,손주태,김희진,신일우,이헌근,정영균 대한마취과학회 2004 Korean Journal of Anesthesiology Vol.47 No.3