간이식 수술 전에 얼마나 많은 혈액을 준비하여야 할까?

김성주(Sung-Joo Kim),최승기(Seung-Gi Choi),이상민(Sang-Min Lee),김갑수(Gaab-Soo Kim),김유홍(Yu-Hong Kim),박연호(Yeon-Ho Park),최성호(Seong-Ho Choi),손태성(Tae-Sung Sohn),조재원(Jae-Won Joh),이석구(Suk-Koo Lee),이병붕(Byung-Boong Lee) 한국간담췌외과학회 1998 한국간담췌외과학회지 Vol.2 No.2

급성 진행성 폐포단백증 환자에서 시행한 수차의 기관지폐포세척술

김승재,양미경,김유홍 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.3

We had performed six times (4 in right lung, 2 in left lung) bronchoalveolar lavages in a patient who has hypertension and suffered cerebral vascular accident previously. The diagnosis of PAP was confirmed by an open lung biopsy and multiple bronchoalveolar lavages were done for two and a half months. Even though she showed slight improvement in chest radiographs, she showed minimal improvement in her clinical course until the third lavage was done. She had to receive tracheostomy and prolonged ventilatory care because her PAP was progressed rapidly and complicated with superinfection. In addition, she sustained pneumothorax as a complication of the prolonged ventilatory care and the lavages. She was discharged one month after the last lavage and her clinical course has been uneventful 10 months thereafter. (Korean J Anesthesiol 1999; 36: 547∼552)

재관류 손상시 발생하는 세포내 칼슘 이온축적에 대한 국소 마취제와 저온 관류/재관류의 효과

김명희,한태형,신백효,김유홍 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.4

서 론: 본 연구의 목적은 in vitro에서 뇌허혈 손상후 재관류시 나타날 수 잇는 소위 칼슘 파라독스(calcium paradox) 현상에 관여하는 Na^+/Ca^2+ exclunger에 대해서 국소 마취제 (lidocaine과 procaine)와 저온 관류가 어떤 영향을 미치는지 그 효과를 알아 보기 위한 것이다. 방 법: 실험 세포는 사람의 성상종양 세포를 이용하였고, 세포내의 칼슘 농도 변화는 fura-2 photometry system을 사용하여 측정하였다. 재관류 손상을 모사하기 위해 저 칼슘 용애겡 관류 수 1.5 mM 칼슘 용액에 재관류 시켰다. 결 과: 실험 세포가 저칼슘 용액에 일정 시간 ㅗ출되면 재관류시 상당히 의의잇는 칼슘 이온 축적이 Na^+/Ca^2+ exchanger의 reverse mode에 의하여 일어났으며 칼슘 이온 농도의 증가는 세포막의 Na^+ gradient 에 의존적이었다. 국소 마취제 lidocaime 과 procaine을 재관류시 첨가하엿을 때 세포내 칼슘 축적이 차단되었다. 또한 18℃로 저온 관류 또는 저온 재관류시에도 세포내의 칼슘 이온 축적이 감소 되었다. 결 론: 본 실험은 in vitro에서 재관류료 인한 세포내 칼슘 축적이, 국소마취제 사용 또는 저온 관류/재관류 로써 차단됨을 알 수 있었다. 이로써 in vivo에서 발생 할 수도 있는 허혈/재관류로 인한 중추 신경계 손상에 치료적인 면에서 가능성을 제공할 수 잇다고 생각한다.(korean J Anesthesiol 1996; 30; 392∼400)

통원 수술에 대한 인지도 및 만족도 평가

김진경,최수주,김광우,곽미숙,김유홍,박종도 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.1

Background : During last 20 years, ambulatory surgery has been recognized as a convenient and highly efficient medical field due to improved medical skill and new anesthetics suitable for ambulatory patients. Therefore, it has become to popular in United States and Europe. Recently Korean doctors began to recognize the importance of ambulatory surgery and run Day Surgery Center(DSC) at several hospitals. The aim of this study is therefore to share our experience in management of DSC. Methods : The analysis of information about DSC of Samsung Medical Center was based on questionnaire by 213 people(patients and their family) and 299 people who involved in our survey from August to September in 1995 and 1997, respectively. The contents of questionnaire were as follows: prerequisite knowledge of DSC, satisfactory levels of telephone visit, appointment and registration process, kindness of medical personnel, medical cost, medical technique and service of DSC, and problems to be improved. Results : Prerequisite understanding of DSC was 30 and 32.8% in 1995 and 1997, respectively, indicating small increase in two years. however, 92.8% of people involved in the survey in 1997 showed positive response to the system of DSC and also 94% were content with the whole medical technique and service of DSC in 1997, comparable with 66% in 1995. Conclusions : We report that ambulatory surgery is a promising medical area by reducing medical cost, increasing efficiency of hospital management and conferring satisfaction to patients. We expect that such a qualified medical service as ambulatory surgery will be settled down in our country in near future. (Korean J Anesthesiol 1998; 35: 138∼143)

통원수술시 악성고열증 환자의 마취관리 경험

이유미,조현성,최귀숙,전우재,강윤정,김유홍 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.5

Malignant hyperthermia is a potentially fatal hypermetabolic syndrome characterized by hyperpyrexia and skeletal muscle rigidity. We experienced a case of malignant hyperthermia after general anesthesia with halothane and succinylcholine in day surgery center. 2 years old male patient arrived to get congenital ptosis operation. He was relatively healthy and had no considerable past or family history of hereditary disease. Anesthesia induced with halothane inhalation and succinylcholine. After induction, he abruptly showed masseter muscle rigidity, total body rigidity, elevation of end-tidal CO2 tension, tachycardia and hyperthermia. Under the suspicion of malignant hyperthermia, all anesthetics were discontinued and vigorous emergency treatment was attemped with dantrolene sodium. The patient survived without any sequele and discharged after 11 days. About 10 months later, that same patient comes to our hospital to take the operation. We experienced successful anesthetic management for malignant hyperthermia. (Korean J Anesthesiol 1999; 37: 938∼942)

원위부 기관내 종양의 기관절제 및 재건술시 전신마취 경험

양미경,이육노,김유홍 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.1

A tracheal mass was detected in a woman who complained progressive cough and dyspnea developed 3 months ago. Tumor was located just 1 cm above carina almost obstructing the tracheal lumen and it was mobile with respiration. Curative tracheal resection & anastomosis was attempted with a right thoracotomy approach. In this patient, complete tracheal obstruction by the mass can occur during the induction of the anesthesia and the pre-resection period; therefore, we made cardiopulmonary bypass available before the induction. We successfully maintained the airway and provided the adequate ventilation during that critical period without using cardiopulmonary bypass. Here we report this case with a literature review. (Korean J Anesthesiol 1999; 36: 153∼157)

Clonidine 경구 투여가 복식자궁절제술을 받는 환자의 Cytokines와 스트레스 호르몬의 반응에 미치는 영향

이병달,김명희,김진경,신백효,김유홍,박종도,한태형 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.2

Background : Surgery cause alterations in immune and neuroendocrine responses. Cytokines and stress hormones are importanat mediators which modulate the various immune reactions. The aim of present study is to investigate whether clonidine premedication can affect on the concentrations of cytokines and stress hormones in abdominal hysterectomy patients. Methods : Twenty two healthy women undergoing abdominal hysterectomy were randomly allocated to two groups: eleven control patients and eleven clonidine(0.15 mg) pretreated patients. Variations in blood cytokines, Interleukin-1 (IL-1 ), IL-2, IL-6 and tumor necrosis factor- (TNF- ), and stress hormones, cortisol and ACTH were studied. Blood sampling were conducted 4 times in each patient: after induction, after incision, after surgery 1 h and 3 h. Cytokines assays were carried out with commercially available ELISA kits, and cortisol with radioimmunoassay and ACTH with immunoradiometric assay. Results : IL-1 increased early and the concentrations of IL-1 in clonidine treated group were significantly lower than control. The mean concentrations of IL-2 at 1 and 3 h after surgery were slightly higher than after induction in clonidine treated group. IL-6 increased significantly at 3 h after surgery in both groups. Clonidine lowered IL-6 during the whole period. TNF- , and cortisol and ACTH concentraitons were not affected by clonidin. Conclusions : Clonidine pretreatment decreased IL-1 and IL-6 concentrations, but not stress hormones in response to abdominal hysterectomy. (Korean J Anesthesiol 1998; 35: 327∼333)

신경교 세포의 재관류 손상:칼슘 파라독스 현상과 그 기전

이병달,김명희,신백효,김유홍 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.4

Background: Mechanisms of secondary injury (post-ischemic injury) in the central nervous system have recently reported in a vast of a mount of experiments. Among many factors which give rise to post-ischemic neuronal darnage, glial deterioration probably mediated by calcium paradox, could be another of the aggravation deleterious factors to the already ischemic neurophil. Methods: Here we have designed experiment to investigate calcium paradox in astroglial cell line, human astrocytoma U1242MG. Intracellular calcium alterations in experimental cells were monitored by using calcium indicating dye fura-2 and epifluorescent photometry system. Results: Intracellular free calcium changes during reperfusion phase after exposure to low calcium led to ptrompt increase in intracellular calcium level after 10 and 30 minutes. The was of calcium cntry during the reperfusion phasc was mediated by the reverse mode of Na^+/Ca^2+ exchanger. Cells that had a reduction of reperfusate calcium to 10 uM increased cell viability. Also we observed an inverse relationship between major enzymatic activity in the astrocy toma cells (i.e., glutamine synthetase activity) and the duration of reperfusion in the the same protocols. Conclusion: A relatively small amount of intracellular calcium increase by the reverse mode of Na^+/Ca^2+ exchanger during the reperfusion period is related to limitation of enzyme activity and viability 24 hours later. (Korean J Anesthesiol 1996; 30; 384∼391).

통원수술환자의 입원사례에 대한 연구

이상민,김지애,조현성,정익수,최덕환,김유홍,서재완,황원균 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.6

Background : The purpose of ambulatory facilities is to relieve the pressure on hospital beds and to make the process of surgery more convenient for the patient. One way of assessing the success of a ambulatory unit is to look at the number of patients requiring admission to hospital. Thus the author investigated the rate, distribution, and cause of admission cases to get help to reduce the admission rates. Methods : Total ambulatory surgeries were 15,512 cases for the period from March 1995 to January 1998. The medical records were reviewed and the patients admitted to hospital instead of being discharged home were analyzed retrospectively. Results : The overall mean rates of admissions for the period was 0.76 percent. The principal reasons for admissions were requestion by surgeon (0.53%), wish of patients (0.12%), surgery related admissions (0.08%) and anesthesia related admissions (0.03%), respectively. Conclusions : With proper assessment and selection of patients and surgical procedures, the admission rates of ambulatory surgery will be reduced acceptably low. Thus the efficiency of ambulatory unit will be increased. But it will reduce the use rate of ambulatory unit. For increasing the use rate of ambulatory unit, our hospital is broadening the patients' selection criteria. (Korean J Anesthesiol 1998; 35: 1142∼1146)

광봉(lightwand)과 Macintosh 후두경을 이용한 기관삽관시경추신전에 대한 방사선학적 비교

조현성,임재훈,이정진,김유홍,김수창,이상민,이수련,정익수 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.5

Background: Endotracheal intubation with direct laryngoscope requires movement of the head, neck, and cervical spine. Spine movement may be limited for anatomical reasons or because of cervical spine injury. The lightwand requires less neck flexion and head extension than the conventional laryngoscope. The purpose of this study was to compare the extension of cervical spine obtained with lightwand and Macintosh laryngoscope. Methods: Twenty patients requiring general anesthesia with endotracheal intubation were studied. Patients were placed on the operating table and anesthesia was induced. Intubation were performed on two occasions: with lightwands and Macintosh #3 laryngoscopes. Cricoid pressure was not applied. To determine cervical spine extension, five radiographs were taken in each patient (before induction, during mask ventilation, during intubation with lightwand, during laryngoscopy with the Macintosh blade: in the best glottic view or during intubation). Results: Of 20 cases, we excluded 2 cases due to the technical error. Significant reduction of radiographic cervical spine extension were found in the lightwand compared to Macintosh blade at all cervical level. Mean atlantooccipital extension angles were 6.2o and 11.7o for the lightwand and Macintosh, respectively. There were no significant differences between mask ventilation and intubation with lightwand. Conclusions: Lightwand may be better than the conventional intubation in patients whose cervical spine movement is limited or undesirable, especially in the patients in whom awake intubation is not available. (Korean J Anesthesiol 1999; 36: 783∼789)