편도선절제술후 성상신경절 차단이 제통효과에 미치는 영향

임용걸(Yong Gul Lim),김대우(Dae Woo Kim),박용진(Yo 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1

N/A Background: The tonsillar region is innervated by the sensory components of the glossopharyngeal nerve(IX) which communicates with certain part of cervical sympathetic ganglion. Some authors suggest stellate ganglion block(SGB) is effective for treatment of recurrent tonsillitis. The goal of this study was to evaluate the effect of SGB in controlling pain after tonsillectomy. Methods: Forty five patients, evaluated to ASA class 1 and 2, scheduled for tonsillectomy under general anesthesia were randomly assigned to 1 of 3 groups (group I: control; group II: SGB with 1% lidocaine 5 ml; group m: SGB with 2% lidocaine 2.5 ml plus 0.5% bupivacaine 2.5 ml), SGB was performed at the end of surgery. Postoperative pain was assessed with Numeric Rating Scale(NRS) NRS assessment was made 30, 60, 90 min, 2 h, 4 h, 24 h, 48 h after tonsillectomy. Results: Pain scores, after 30 min in group II, III and 60, 90 min in group III were significantly lower than group I(p<0.05). Conclusions: We found SGB was effective in controlling pain after tonsillectomy but further studies are required needs to prolong duration of relief.

인슐린 분비종양 1예

조석남(Seog Nam Cho),김준기(Jun Gi Kim),장윤식(Yoon Sik Chang),임용걸(Yong Gul Lim),허미경(Mi Kyung Hur),임근우(Keun Woo Lim),박우배(Woo Bae Park),전정수(Chung Soo Chun) 대한외과학회 1988 Annals of Surgical Treatment and Research Vol.34 No.2

백서 신경병증통증 모델에서 유도된 ERK 1/2와 CREB 신호 단백질에 대한 Ketamine의 억제효과

최진우 ( Jin Woo Choi ),인장혁 ( Jang Hyeok In ),김용신 ( Yong Shin Kim ),강유진 ( Yoo Jin Kang ),임용걸 ( Yong Gul Lim ),조수민 ( Su Min Cho ),신은영 ( Eun Young Shin ),주진덕 ( Jin Deok Joo ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.2

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 MAPK and CREB in the spinal cord, which correspond to allodynia in a model of neuropathic pain. This study was conducted to determine if low dose ketamine had an effect on the activation of ERK 1/2 and CREB in the development of neuropathic pain. Methods: This study was conducted to evaluate ERK 1/2 and CREB protein in a sham operated (control) group, neuropathic pain and normal saline (NP+NS) group and neuropathic pain and ketamine (NP+Keta) group. To accomplish this, male Sprague-Dawley rats were anesthetized and then subjected to L5-L6 spinal nerve ligation (SNL, neuropathic rats). The total amounts of ERK 1/2 and CREB protein were then assessed by western blot analysis. In addition, changes in the amounts of ERK 1/2 and CREB mRNA were evaluated by RT-PCR. Results: There was a significant increase in the amount of ERK 1/2 and CREB in the NP+NS group when compared with the sham group. However, the amount of ERK 1/2 and CREB protein induced due to SNL were significantly reduced by continuous infusion with ketamine in the NP+Keta group. Conclusions: The results of this study revealed a positive linkage between NMDA receptors and the ERK-CREB signaling pathway. Therefore, NMDA receptors could be the target of future therapeutic approaches. Additionally, the results of the present study provide additional evidence that low dose ketamine effectively prevents and treats central neuropathic pain following SNL. (Korean J Anesthesiol 2009;57:210∼6)

Changes in Osteopontin Expression in the Rat Lumbar Spinal Cord Following the Avulsion of Lumbar Nerve Roots

전연수(Yeon-Su Jeon),김인범(In-Beom Kim),이은진(Eun-Jin Lee),문세호(Se-Ho Moon),임용걸(Yong-Gul Lim),천명훈(Myung-Hoon Chun) 대한해부학회 2004 Anatomy & Cell Biology Vol.37 No.1

이 연구는 흰쥐의 허리신경뿌리 찢김손상 후 허리척수에서 osteopontin (OPN)의 발현을 in situ hybridization 조직화학법, 면역세포화학법 및 western blot 분석법으로 조사하였다. 정상 동물에서 OPN을 발현하는 세포는 앞쪽뿔에 위치한 운동신경원과 사이신경원이었다. 찢김 손상 후 1일부터, OPN 발현세포 수는 앞뿔과 중간부위에서 증가하였고, 3일에는 비교적 강한 OPN이 손상 받은 쪽의 회색질 전 부위에 걸쳐 증가하였다. 7일에는 OPN 발현 양상이 3일의 것과 유사하였으나, 앞뿔과 중간부위에서 OPN 발현 세포수는 최고치를 나타내었다. 이들 발현세포는 신경세포였다. 찢김 손상후 14일에는 뒤뿔에 위치한 OPN 발현 세포는 거의 소실하였고, 발현 양상이 1일의 것과 유사하였다. 28일에는 OPN 발현 세포가 정상에서 보다 더 감소하였다. 이 결과로 찢김 손상 후 허리 척수에서 증가 발현된 OPN은 신경원의 손상과정에 중요한 역할을 할 것으로 생각된다. This study investigated the expression of osteopontin (OPN) in rat lumbar spinal cords after lumbar nerve root avulsion, using in situ hybridization histochemistry, immunocytochemistry and western blot analysis. Cells expressing OPN were motoneurons and interneurons in the ventral horn, but no signals were observed in neurons in the dorsal horn of the normal lumbar spinal cord. From day 1 after avulsion injury, OPN mRNA-labeled neurons increased in the ventral horn and the intermediate zone. By day 3, relatively strong OPN mRNA signals were found throughout the gray matter of the injured side of the spinal cord with OPN mRNA-labeled cells scattered in the superficial dorsal horn. By day 7, the labeling patterns for OPN mRNA were similar to those on day 3, but the numbers of OPN mRNA-labeled cells in the ventral horn and the intermediate zone peaked. At this point, these labeled cells were also more densely packed and the intensity of signals was stronger. Interestingly, these labeled cells were neurons, but not glial cells such as astrocytes or microglia. This OPN mRNA-labeled cell profile in the dorsal horn had nearly disappeared by day 14 after avulsion injury, and the labeling pattern became similar to that on day 1. By day 28, after avulsion injury, the numbers of OPN mRNA-labeled cells decreased further below control values. These results suggest that increased expression of OPN in the rat lumbar spinal cord after avulsion injury might play an important role in the pathogenesis of damaged neurons.

갈색세포종의 임상적 고찰

송병주(Byung Joo Song),김준기(Jun Gi Kim),박우배(Woo Bae Park),전정수(Chung Soo Chun),임용걸(Yong Gul Lim) 대한외과학회 1988 Annals of Surgical Treatment and Research(ASRT) Vol.34 No.3

로피바카인 경막외 마취 시 케타민첨가 용량에 따른 마취시간의 연장

주진덕 ( Jin Deok Joo ),전연수 ( Yeon Su Jeon ),최진우 ( Jin Woo Choi ),인장혁 ( Jang Hyeok In ),김용신 ( Yong Shin Kim ),강유진 ( Yoo Jin Kang ),김대우 ( Dae Woo Kim ),임용걸 ( Yong Gul Lim ),김기현 ( Ghi Hyun Kim ) 대한통증학회 2005 The Korean Journal of Pain Vol.18 No.1

임상연구 : TIVA 및 VIMA시 내분비 스트레스 반응 및 마취특성 비교

정홍수 ( Hong Soo Jung ),김대우 ( Dae Woo Kim ),최진우 ( Jin Woo Choi ),강유진 ( Yoo Jin Kang ),임용걸 ( Yong Gul Lim ),유건희 ( Keon Hee Ryu ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3

Background: Anesthetic procedures are major potent stimulus for the neuroendocrine hormonal axis, which results in release of the stress hormone. It is important to know the influence of specific anesthetic procedures on those host responses. We compared endocrine stress response and anesthesia characteristics for TIVA (total intravenous anesthesia) and VIMA (volatile induction and maintenance of anesthesia). Methods: Forty patients scheduled for elective total abdominal hysterectomy were randomly assigned to TIVA or VIMA group. The patients in TIVA group (n = 20) received target controlled infusion (TCI) of propofol and fentanyl TCI with Stelpump software, and the patients in VIMA group (n = 20) received sevoflurane-nitrous oxide for induction (6%) and maintenance (1.5%) of anesthesia. Blood sampling was done 5 minutes before induction (baseline blood sample, BBS), just after intubation (intubation blood sample, IBS), just after extubation (extubation blood sample, EBS), and at arrival in recovery room (recovery room blood sample, RBS). Plasma concentration of glucose, cortisol, epinephrine, norepinephrine were measured. Bispectal Index (BIS) and systolic, diastolic blood pressure, heart rate, induction and recovery profiles were also measured. Results: In both groups, there was significant increase of the blood cortisol and glucose level in EBS and RBS. But only in VIMA group, there was significant increase of the blood cortisol level in IBS. There was no change of the blood epinephrine and norepinephrine in both groups at EBS and RBS, but only in VIMA group, there was significant increase of epinephrine and norepinephrine at IBS. Blood pressure and heart rate increased significantly at IBS in VIMA group, compared with TIVA group. Conclusions: In VIMA group, there was significant increase of stress response and hemodynamic change only during induction of anesthesia. However, in TIVA group, there was no significant increase of stress response and hemodynamic change during induction, maintenance and recovery of anesthesia. (Korean J Anesthesiol 2006; 51: 278~84)

실험연구 : 흰쥐 뇌에서 고속원심 분리법을 이용한 신경줄기세포 추출 및 배양

김현숙 ( Hyun Sook Kim ),정미영 ( Mee Young Chung ),김창재 ( Chang Jae Kim ),채준석 ( Jun Seuk Chea ),임용걸 ( Yong Gul Lim ),문세호 ( Se Ho Moon ),최봉철 ( Bong Chul Choi ),이병호 ( Byung Ho Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3

Background: During recent two decades of crucial revision of some cornerstone concepts has opened new horizons in neurosciences. Modern basic viewpoints include the idea of high CNS plasticity which means not only rearrangement of neurons and their interconnections, but also the formation of new neural cells in humans and animals during their whole life span. The purpose of this study is to harvest neural stem cell from the adult rat brain using the high speed centrifugation method and study the characteristics of these cell. Methods: 60 rats (Fisher 344, 150-160 g) brain were saved under inhalation anesthesia and dissect the subventricular zone under the microscope. The brain tissue was digested with enzyme to make a cell suspension. The cell suspension was processed high speed centrifugation to separate the neural stem/progenitor cells according to the buoyancy. After 2 weeks culture, immuno-staining (O4, GFAP, Nestin, beta-tubulin III and DAPI) were performed and replated the cultured cells. Results: The 2 weeks culture cells were positive 92.8% in Nestin, 91.5% in O4 and 87.6% in Gal-C. But only positive 1.4% in β-tubulin III and 5.5% in GFAP. And replated cell culture shows similar results compared to the primary culture. Conclusions: With this high speed centrifugation method, authors can harvest neural stem/progenitor cells from the adult rat brain. Although we have many limitations using these cell in clinical trial, but we can afford to next step on neural stem cell research. (Korean J Anesthesiol 2006; 51: 343~9)

36권6호 영문부록 : Fentanyl과 Ketorolac을 사용한 술 후 통증조절 환자에서 지속주입법 첨가에 대한 평가

김대우(Dae Woo Kim),강유진(Yoo Jin Kang),정동석(Dong Suk Chung),인장혁(Jang Hyeok In),이상수(Sang Su Lee),임용걸(Yong Gul Lim) 대한마취과학회 1999 영문부록 Vol.- No.-

서론 : 정맥내 자가통증조절법(PCA; Patient Controlled Analgesia)은 환자가 수술 후 통증을 느낄 때 주입 펌프를 이용하여 환자 스스로 투여되는 진통제의 용량을 조절하는 방법이다. 이러한 주입방법에 대하여 환자가 수면중이거나 예상치 못한 갑작스런 동작 등으로 통증을 유발하는 등의 경우에 대비하여, 이론적으로 약물의 평균 유효 진통농도 유지를 위한 지속적 주입법의 추가가 고려되어 왔다. 그러나 이 방법은 이론적인 면과 달리 약물의 부작용 증가 등의 이유로 그 사용 여부에 대하여 많은 논란이 있었다. 따라서 본 연구에서는 지속적 주입법이 부가되는 지속 주입 자가통증조절 방법과 자가통증조절 단독방법을 비교하여 fentanyl 총 사용량을 줄이고 ketorolac의 진통제 절감효과를 높여서 부작용을 최소화하고 술 후 진통과 환자의 만족을 향상시키고자 한다. 방 법: 미국 마취과 학회 분류상 전신상태 1급 및 2급에 해당되는 제왕절개술 환자 120명에서 잠금시간(lockout time) 6분, 기본 지속 주입 속도 0.5 ml/h, 자가통증조절 일회 주입량 0.5 ml인 Home pump (I-Flow ) PCA 기구를 이용하였다. 1군은 수술 종료 10∼15분전에 fentanyl 2μg/kg의 초회량 후, 환자의 요구에 따른 자가통증조절 일회 주입량은 fentanyl 10μg을 사용하였고, 2군은 1군 방법에 fentanyl 20μg/h의 지속 주입을 첨가하였다. 3군은 fentanyl 2μg/kg과 ketorolac 30 mg의 초회량 후, fentanyl 5μg와 ketorolac 1 mg의 자가통증조절 일회 주입량을 사용하였고, 4군은 3군 방법에 fentanyl 10μg/h와 ketorolac 2 mg/h의 지속주입을 첨가하였다. 각 군에서 visual analogue scale (VAS)에 의한 통증점수, 진정점수(sedation score), 환자의 만족도, fentanyl과 ketorolac의 총 사용량, 부작용의 정도 및 빈도 등에 대하여 비교 검토하였다. 결과: 전체적인 VAS에 의한 통증점수는 3군과 4군이 1군과 2군에 비하여 의의 있게 낮았으며, 2군과 4군에서는 다른 군에 비하여 통증점수상 향상이 없었다. Fentanyl의 총 사용량은 3군이 1군에 비해 64%, 4군이 2군에 비해 43% 감소하였고, 지속 주입의 추가가 없는 1군과 3군은 2군과 4군에 비하여 의의 있게 사용량이 적었다(P<0.05). 술 후 오심은 가장 흔한 부작용이었으며, 3군의 오심 발생빈도는 1군과 2군에 비하여 의의 있게 낮았다(P<0.05). 결론 : 술 후 환자 통증관리에서 자가통증조절 단독방법은 자가통증조절 방법에 부가적인 지속 주입법에 비하여 fentanyl의 사용량이 적었으면서도 통증점수상 별 차이가 없었으며 만족도도 거의 비슷하였다. 술 후 자가통증조절 단독방법의 사용과 ketorolac의 진통제 절감효과는 아편양제제의 사용량을 줄이고 부작용을 최소화할 수 있을 것으로 사료된다. (Korean J Anesthesiol 1999; 36: S 1∼S 8)

수술중 발생한 고열증

임용걸,김태관,윤준로 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2

The fulminant malignant hyperthermia(MH) is now encountered less frequently because of increased awareness of the condition by anesthesiologist and better use of mornitoring facilities. Thus there is also an increase in the number of aborted cases, in which anesthesia is stopped and treatment instituted as soon as MH is thought to be likely. We presented a case of an abortive MH in 18 years old male patient during the discectomy on the third and fourth lumbar intervertebral spaces. Anesthesia was induced with thiopental sodium and succinylcholine and then maintained with nitrous oxide, oxygen and enflurane. After induction, there were persistent tachycardia, elavation of end-tidal CO2 tension on capnography, spontaneous tachypnea, body temperature elevation up to 38.2oC, respiratory acidosis and highly level of CPK, myoglobulin in serum and urine. Under the suspicion of MH, all anesthetics were discontinued and vigorous emergency treatment was attempted including ventilation with high flow of 100% oxygen(8 l/min), changing all anesthetic circuits, and cooling measurements such as chilled intravenous solution infusion, gastric lavage with cold saline, alcohol and ice water pack over the body. Fourtunately, he recovered well and discharged without complications. (Korean J Anesthesiol 1998; 34: 464∼469)