외래수술 환자관리

주진덕 대한의사협회 2014 대한의사협회지 Vol.57 No.11

One of the most significant changes in surgical practice during the past two decades has been the growth ofambulatory surgery. This change is owing to the increased popularity of minimally invasive surgical techniquesand the improvement of various anesthetic techniques. Therefore, implementation of perioperative patient careparadigm that reduces the time to discharge home and resumption of activities of daily life after a wide variety ofsurgical procedures is required.

개흉술후 발생한 근육잔떨림을 동반한 신경병증성 통증환자에서 Gabapentin과 화학적 흉부 교감신경절 차단술의 효과 : 증례 보고

주진덕,김대우,강유진,전연수,김용신,인장혁,류영빈,임용걸 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.3

Amitriptyline inhibits the MAPK/ ERK and CREB pathways and proinflammatory cytokines through A3AR activation in rat neuropathic pain models

주진덕,김유미,권소영,정홍수,박유정,김용신,인장혁,최진우,김진애 대한마취통증의학회 2019 Korean Journal of Anesthesiology Vol.72 No.1

Background: The pain-relief properties of tricyclic antidepressants can be attributed to several actions. Recent observations suggest that adenosine is involved in the antinociceptive effect of amitriptyline. The A3 adenosine receptor (A3AR) is the only adenosine subtype overexpressed in inflammatory and cancer cells. This study was performed to investigate the role of A3AR in the anti-nociceptive effect of amitriptyline. Methods: Spinal nerve-ligated neuropathic pain was induced by ligating the L5 and L6 spinal nerves of male Sprague-Dawley rats. The neuropathic rats were randomly assigned to one of the following three groups (8 per group): a neuropathic pain with normal saline group, a neuropathic pain with amitriptyline group, and a neuropathic pain with amitriptyline and 3-ethyl-5-benzyl- 2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate (MRS) group. Amitriptyline or saline was administered intraperitoneally and 3-ethyl-5-benzyl-2-methyl-4-phenylethynyl-6-phenyl-1,4-(±)-dihydropyridine-3,5-dicarboxylate (MRS-1191), an A3AR antagonist, was injected subcutaneously immediately before amitriptyline administration. The level of extracellular signal-regulated kinase P44/42 (ERK1/2), cyclic AMP response element-binding protein (CREB), and proinflammatory cytokines were assessed using immunoblotting or reverse-transciption polymerase chain reaction. Results: Amitriptyline increased the mechanical withdrawal threshold of the neuropathic rats. The level of phospho- ERK1/2 and phospho-CREB proteins, and proinflammatory cytokines produced by spinal nerve ligation were significantly reduced by amitriptyline administration. However, the use of MRS-1191 before amitriptyline administration not only reduced the threshold of mechanical allodynia, but also increased the signaling protein and proinflammatory cytokine levels, which were reduced by amitriptyline. Conclusions: The results of this study suggest that the anti-nociceptive effect of amitriptyline involves the suppression of ERK1/2 and CREB signaling proteins, and A3AR activation also affects the alleviation of the inflammatory response.

The comparison of sedation quality, side effect and recovery profiles on different dosage of remifentanil patientcontrolled sedation during breast biopsy surgery

주진덕,인장혁,김대우,정홍수,강재혁,염제화,최진우 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.5

Background: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. Methods: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST),Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. Results: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P <0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). Conclusions: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50’s side effects. Background: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. Methods: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST),Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. Results: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P <0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). Conclusions: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50’s side effects.

토끼에서 전신마취와 고위흉추 경막외마취사이의 혈역학 및 간혈류량의 변화

주진덕,이병호 가톨릭대학 (가톨릭신학대학) 대학원 1996 가톨릭大學醫學部 論文集 Vol.49 No.1

장기공여 뇌사환자의 관리

주진덕 대한의사협회 2014 대한의사협회지 Vol.57 No.2

Brain death is the irreversible end of all brain activity including involuntary activity necessary to sustain life. Since thefirst organ transplantation from a brain-dead donor in 1979, organ transplantation has been developing continuouslyin Korea. The Organ Transplantation Act was enacted in February 2000, making brain-dead organ donation legalin Korea, and the Korean Network for Organ Sharing (KONOS) was simultaneously launched, permitting theorganized procurement and distribution of organs. Once brain death is declared, aggressive fluid management, use ofvasopressors, and mechanical ventilation should be maintained between brain death and organ donation to keep allother vital organs completely functional, providing optimal opportunities for organ donation.

Validation of the Effectiveness and Safety of Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas: 10-year Experience of a Single Institution

주진덕,김한솔,김영훈,한정호,김재용 대한의학회 2015 Journal of Korean medical science Vol.30 No.11

This study was performed to validate the effectiveness and safety of concurrent chemoradiotherapy and adjuvant therapy with temozolomide for newly diagnosed glioblastoma multiforme as a standard treatment protocol. Between 2004 and 2011, patients newly diagnosed with glioblastoma who were treated with temozolomide during concurrent chemoradiotherapy and adjuvant chemotherapy were included from a single institution and analyzed retrospectively. The primary endpoint was overall survival, and the secondary endpoints were progression-free survival, response, and safety. A total of 71 patients were enrolled in this study. The response rate was 41% (29/71), and the tumor control rate was 80% (57/71). In the 67 patients who completed the concurrent chemoradiotherapy with temozolomide, the median overall survival was 19 months and the 1- and 2-yr overall survival rates were 78.3% and 41.7%, respectively. The median progression free survival was 9 months, and the 1- and 2-yr progression free survival rates were 33.8% and 14.3%, respectively. The mean duration of survival after progression of disease in salvage treatment group was 11.9 (1.3-53.2) months. Concurrent chemoradiotherapy with temozolomide resulted in grade 3 or 4 hematologic toxic effects in 2.8% of the patients. The current protocol of temozolomide during and after radiation therapy is both effective and safe and is still appropriate as the standard protocol for treatment of glioblastoma. An active salvage treatment might be required for a better prognosis.

실험연구 : 쥐에서 허혈 재관류 신장손상에 대한 반대편 신장의 허혈 선조정의 신장 보호효과

주진덕 ( Jin Deok Joo ),김대우 ( Dae Woo Kim ),강유진 ( Yoo Jin Kang ),김용신 ( Yong Shin Kim ),전연수 ( Yeon Soo Jeon ),인장혁 ( Jang Hyeok In ),최진우 ( Jin Woo Choi ),박연진 ( Yeon Jin Park ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2

Background: Acute renal failure (ARF) results from renal ischemic reperfusion (IR) injury and is a major contributor to the morbidity and mortality encountered during the perioperative period. It was previously demonstrated that ischemic preconditioning (IPC) of the heart, brain, and kidney offered protection against IR injury. Therefore, this study examined whether or not distant IPC can also be effective against IR injury in other organs. Methods: C57BL6 mice were classified into three groups, Sham group (n = 7), IR group (n = 7) and Cross IPC IR group (n = 7). The sham group was subjected only to a right renal nephrectomy (ligation of renal pedicle with silk). The IR group was subjected to 30 min of left renal ischemia after a right nephrectomy. The cross IPC IR group was subjected to right renal IPC (two cycles of 5 min of ischemia and reperfusion) followed 15 min later by a right nephrectomy and 30 min left renal ischemia. The left kidney was harvested 24 h after surgery and the histology and blood creatinine level was analyzed. The left kidneys were isolated 15 min after right nephrectomy (sham, n = 7) and right renal IPC (cross IPC, n = 7), respectively, and analyzed by western blotting. Results: The level of the intra-cellular signaling proteins, iNOS, Akt and ERK increased significantly as a result of the right renal IPC, and the renal functions were well preserved in the cross IPC IR group compared with the IR group. Conclusions: Cross renal IPC offers protection by elevating the iNOS, Akt and ERK levels due to the distant oxygen free radicals stream against the opposite renal IR injury in mice. (Korean J Anesthesiol 2007; 53: 229~33)

미세혈관감압술 후 오심 및 구토의 발생률

주진덕(Jin-Deok Joo),한정호(Jung Ho Han),김영훈(Young-Hoon Kim),김택균(Tackeun Kim),김재용(Chae-Yong Kim),오창완(Change Wan Oh),유정희(Jung Hee Ryu),전영태(Young Tae Jeon) 대한두개저학회 2012 대한두개저학회지 Vol.7 No.2

Objective : We searched the incidence of postoperative nausea and vomiting(PONV) after microvascular decompression(MVD), which might potentially results in an increased risk of postoperative intracranial hemorrhage and neurologic dysfunction. METHODS : Between 2004 and 2010, a total of 109 patients were diagnosed as having a neurovascular cross compression, and were treated with lateral suboccipital craniotomy with MVD. The incidence of PONV and the use of rescue antiemetics were identified at 1, 24 and 48 hours after surgery. RESULTS : Seventy-one(65.1%) patients were female, and the mean age of the patients was 49±10 years(range, 20~69). The overall incidence of development of PONV within postoperative 48 hours was 69.7%. The incidences of PONV at 1, 24, and 48 hours after surgery were 31.1%, 56.8%, 44.0%, respectively. PONV was most prevalent at 24 hours after surgery, and then the incidence decreased over time. In the early postoperative period, female was significantly more susceptible to PONV than male, especially at 1 hour after surgery(p=0.035). CONCLUSION : The incidence of PONV was high enough to be actively managed, especially within 24 hours after MVD. PONV was more prevalent in female in the early postoperative period.

신경병증성 통증모델 쥐에서 리도케인의 ERK 1/2와 CREB 단백질 억제효과

주진덕 ( Jin Deok Joo ),인장혁 ( Jang Hyeok In ),정홍수 ( Hong Soo Jung ),김용신 ( Yong Shin Kim ),김대우 ( Dae Woo Kim ),최우영 ( Woo Young Choi ),신은영 ( Eun Young Shin ),전연수 ( Yeon Soo Jeon ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3

Background: In addition to causing the loss of voluntary sensory and motor function, spinal cord injury (SCI) often creates a state of central neuropathic pain. Rats given SCI display increases in the activated form of transcription factors ERK 1/2, p38 MAPK, and CREB in the spinal cord, which correspond to allodynia in a model of neuropathic pain. The current study was designed to determine if lidocaine had an effect on the development of neuropathic pain in response to SCI. Methods: Male Sprague Dawley rats were anesthetized and then received a L5-L6 spinal nerve ligation (neuropathic rats). The levels of intracellular cell-signaling protein, ERK 1/2 and CREB were then assessed by western blot analysis of samples collected from a sham operated (control) group, a neuropathic pain and normal saline (NP+NS) group, and a neuropathic pain and 5% lidocaine (NP+Lido) group. Results: The increased levels of ERK 1/2 and CREB protein that were observed in the neuropathic pain model were reduced by continuous infusion of 5% lidocaine. Conclusions: The current results suggest that lidocaine therapy may be an effective method of preventing and treating central neuropathic pain following SCI, and that these effects may occur via the reduced expression of ERK 1/2 and CREB in the intracellular cell-signaling pathway. (Korean J Anesthesiol 2009; 56: 319~24)