Nuss 방법에 의한 소아 오목가슴 수술 후 정맥 통증자가조절법을 사용한 Fentanyl 과 Fentanyl-Ketorolac의 진통효과 비교

안기량,서은정,김천숙,강규식,유시현,정진헌,정지원 순천향의학연구소 2006 Journal of Soonchunhyang Medical Science Vol.12 No.2

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전신마취 후 점액으로 인한 기관내관 폐쇄 : 증례보고 A case report

안기량,엄희상,김지은 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Nasotracheal intubation is commonly and safely used in the anesthetic management of patients undergoing oral cavity surgery. But endotracheal tube obstruction causes serious complications, including pneumothorax, pulmonary edema, brain injury and death. We experienced a case of endotracheal tube obstruction due to mucous crust after general anesthesia. A 5-year-old woman with cleft palate was intubated with a 4.5 mm amored tube for general anesthesia. During the surgery, vital signs were within normal limits. In the intensive care unit, she exhibited sign of complete airway obstruction. We exchanged the tube with another tube after failure of suction. The airway obstruction was due to a dried mucous crust attached to the bevel of the endotracheal tube. We should keep in mind the presence of an amored endotracheal tube cannot be regarded as a guarantee of a patent airway.

전신마취 후에 발견된 좌측 내경동맥 폐색에 의한 뇌경색 : 증례보고 A case report

안기량,박해남,권진형 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Stroke is defined as a focal neurological deficit lasting more than 24 hours. The complication related to the central nervous system after general anesthesia is unusual and difficult to discover the exact causes. We experienced a case of an unexpected cerebral infarction after lung decortication and clousure of bronchopleural fistula (BPF). His medical problem included diabetus mellitus, pulmonary tuberculosis, and history of several episode of focal neurological deficit. Anesthesia was induced with thiopental and succinylcholine and maintained with 50% N_(2)0 and 2.0-3.0 vol% enflurane in oxygen. After approximately 10 h in intensive care unit, he was still very lethargic. Immediate brain magnetic resonance angiography(MRA) revealed acute cerebral infarction in left middle cerebral artery (MCA) and anterior cerebral artery(ACA) territory due to left internal carotid artery (ICA) obstruction. An emergency decompressive craniectomy was performed. Therefore cerebral thrombosis, hypotension could be considered the possible etiology. We concluded that cerebral infarction can unexpectedly develop during perioperative and after postoperative and that close monitoring of patient and adequate management are essential.

대퇴골 골절 환자에서 전신마취 시 발생한 숨겨진 뇌동맥류 파열 : 증례보고 A case report

안기량,유인상,강규식 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Spontaneous intracranial hemorrhage (ICH) occurs rarely during general anesthesia. It can occur in patients with intracranial aneurysm, hypertension, vascular malfomation, malignancy and blood dyscrasia. We experienced a case of death from massive intracerebral hemorrhage during the genernal anesthesia. she did not show any abnormal neurological sign, physical examination and coagulation abnormality on arrival in the operation room. Anesthesia was induced with thiopental and succinylcholine and maintained with 50% N2O and 2.0-3.0 vol% enflurane in oxygen. After operation, the patient showed delayed recovery from anesthesia and both pupils were dilated without light reflex. Immediate computerized tomogram (CT) of brain revealed hemorrhage in the right basal ganglia, frontotemporoparietal lobe and entire ventricles. An emergency craniectomy was peformed to remove the hematoma. Therefore high intracranial blood pressure relating to general anesthesia could be considered the possible etiology. We concluded that ICH can unexpectedly develop during perioperative and after postoperative, and that close monitoring of the patient and adequate management are essential.

Chlorobenzilate가 Mouse 간세포의 미세구조에 미치는 영향

安基亮,김완식,鄭鎬三,李圭植 한양대학교 의과대학 1985 한양의대 학술지 Vol.5 No.2

Chlorobenzilate which is the organophosphorus acaricide, is very toxic to man and livestock. Chlrobenzilate is accumulated in the fat tissue like other organophosphorus insecticide so that it is extremely toxic. Its toxicity on the central nervous system produce extreme convulsion but its mechanism has not been understood. And also the degenerative changes in the liver, kidney and brain are appeared by its chronic toxicity. Chlorobenzilate is hydrolysed in the liver that its metabolites ay damage the hepatic parenchymal cells. So the authors have undertaken to pursue the toxic effect of the chlorobenzilate on the organelles of the liver cells. Albino mice were used as experimental animals. The experimental animals sacrificed at 6 and 24 hours after administration of 641 mg (0.5ml) of chlorobenzilate per Kilogram of body weight. The specimens obtained from the liver were fixed in 2% glutaraldehyde-2.5% paraformaldehyde phosphate buffer (pH 7.2) and sliced with 600-800 A° thickness. The specimens were stained with uranyl acetate and lead nitrate and then observed with the electron microscope. The results were as follows. 1. Proliferation of smooth endoplasmic reticulum and depletion of glycogen particles were observed. 2. An increase in the number of secondary lysosomes, multivesicular bodies, and lysosomes were observed. 3. The atropy of the cisternae of the Golgi complex was observed. The disruption of the cisternae of rough endoplasmic reticulum was associated with detachment of the membrane bound ribosomes.

만성 근골격계 환자에서 Prolotherapy시 고농도 포도당용액에 첨가한 Sarapin^(®)의 효과

강규식,이호철,안기량 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Background: Musculoskeletal injury is a major cause of chronic pain due to a weakness of the tendons and ligaments. Currently, prolotherapy is used for treating chronic pain by strengthening the tendons and ligaments. This study was designed to evaluate the effects of prolotherapy using Sarapin^(®) in patients with chronic musculoskeletal diseases. Methods: Forty, chronic musculoskeletal disease patients were randomly divided into two groups. Group 1 (N=20) had been treated with a 15% dextrose solution, 0.2% lidocaine. Group 2 (N=20) had been treated with a 15% dextrose solution, 0.2% lidocaine and 25% Sarapin^(®). The VAS (visual analogue scales) were measured before the injection and two months after the injection. Incidence of side effect and complication were checked too. Results: Both groups showed that a post-prolotherapy VAS was significantly reduced compared to the pre-prolotherapy VAS in 80%, 85% but there was no significant difference. Side effect and complication were not significant difference between both groups such as dizziness during injection, new pain development, and a hematoma except pain after the injection. Conclusions: These results show that prolotherapy using Sarapin^(®) is another good method for treating chronic musculoskeletal diseases.

제왕절개술 환자에서 수술전 투여한 ketamine의 혈청 interleukin-6 및 수술후 통증에 대한 효과

김진수,김유재,안기량,김천숙,김일호,한찬수 순천향의학연구소 1997 Journal of Soonchunhyang Medical Science Vol.3 No.2

The inflammatory reaction to tissue damage during surgery may induce central sensitization followed by hyperalgesia. Previous studies suggest that central sensitization is related to N-methyl-D-aspartate (NMDA) receptor activation, which can be blocked with NMDA antagonist, ketamine. Thus, we compared the effect of preoperative intravenous and epidural low doses of ketamine with placebo on serum interleukin-6 (IL-6) level and postoperative pain. ASA class I and II women scheduled for C-sections received intravenous ketamine 0.15mg/kg(group 2) or placebo(group 1), or epidural ketamine(0.15 mg/kg) before the operation. IL-6 levels were measured before and during the operation, and 8, 24, and 48 hrs after the operation. Visual Analogue Scales(VAS) and Verbal Ration Scales(VRS) were measured at 8, 24, and 48 hrs after the operation. Serum IL-6 levels at 8, 24, and 48 hrs after the operation were significantly lower in the intravenous ketamine and epidural ketamine groups than in the control group. VAS at 8 hrs and 48 hrs after the operation were significantly lower in the epidural ketamine group. VAS at 8 hrs and 48 hrs after the operation were significantly lower in the epidural ketamine group than in the control and intravenous ketamine groups. In conclusion, in the preoperative intravenous and epidural administration of low doses(0.15mg/kg) of ketamine, both are effective in reducing postoperative IL-6 levels. Epidural Ketamine is more effective than intravenous ketamine in postoperative pain control.

수술실 오염도감소를 위한 수술실공조시스템에 대한 연구

김천숙,박은정,강규식,김지은,안기량,권진형,유시현,주영철,권순정 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1

Background: The OR(operating room) should provide an optimum environment that is safe for the patient and the working personnel. The air ventilation system of OR has been studied to decrease the contamination of air. We investigated the flow and contamination of the air in OR at our hospital. Method: Cultures in OR were made and the number of bacteria and fungi were calculated. A two-dimensional model for the cross-section of an operation room is developed for the CFD (computational fluid dynamics) analysis. The characteristics of air flow in the empty operation room and in the occupied operation room are calculated by using a CFD program. Results: The current air ventilation system of our hospital does not deliver the clean air to the operating site efficiently in occupied OR. Conclusions: We suggested a new location of air ventilation system which improves air venting with little increase of the cost of equipment.

요하지통 환자에서 두 개의 캐눌라를 이용한 박동성 고주파 신경근 응고술의 임상 연구

김천숙,배재영,배덕구,강규식,안기량,권진형,김지은,유시현 순천향의학연구소 2003 Journal of Soonchunhyang Medical Science Vol.9 No.1

Dorsal root ganglion(DRG) block by the local anesthetics and steroids which has done classically in low back pain(LBP) patients with radiculopathy has high incidence of recurrence rate and side effects of steroids. Recently a new technique of pulsed radiofrequency thermocoagulation(P-RFTC) was introduced and substituted for it because of the benefits such as relatively low recurrence rate, low risk of nerve injury and comfort during the procedure. We experienced 15 patients who had LBP with radiculopathy and no or little response to epidural steroid injection. When we performed DR ganglionotomy by P- RFTC under the C-arm guide in these patients, we tried to approach the exact DR ganglion using tow cannulas - the one for obtaining patient's subjective symptoms and injection of contrast dye, the other for making a RF lesioning after identifying the impedance of sensory and motor stimulation. In conclusion, DR ganglionotomy by P- RFTC using two cannulas in LBP patients is an easy and safe procedure with satisfactory results.

심한 척추후측만증 환자의 대퇴골절 복원술을 위한 부위마취 : 증례보고 A case report

김지은,박대용,유시현,강규식,권진형,김천숙,안기량 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Kyphoscoliosis is a disease manifested as lateral curvature of spine and accompanying rotation of the vertebrae, resulting in distortion of rib cage. Restrictive lung disease and pulmonary hypertension progressing to cor pulmonale are the major cause of mortality in patients with kyphoscoliosis. We had experienced a successful spinal and caudal epidural anesthesia for the open reduction and internal fixation with plate of fractured femur shaft in two patients with severe kyphosoliosis. We had chosen regional anesthesia as an anesthetic method because of there poor pulmonary function and severe deformities of thoracolumbar spine. We could achieve the adequate anesthetic sensory dermatome level, T_(5) and T_(8), for operation without any significant deterioration of blood pressure and respiration. We recommended that regional anesthesia is a useful anesthetic method for a patients with severe kyphoscoliosis when the operation on hip or lower extremity is required.