말기암 환자들의 의료이용행태

한태형(Tae Hyung Han),조병진(Byang Jin Cho),신백효 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1

N/A Background: In order to improve the quality of life of dying patients, they need to receive not only the physical, psychological, social, and spiritual care, but also systematic and continuous care to die with dignity. However, no adequate medical services are available for these terminal cancer patients. We studied their behavior patterns of health care utilization to understand more of their medical and social needs. Methods: We investigated 108 bereaved families through the telephone interview with structured questionnaires. They were randomly selected through the retrospective chart review of the terminal patients who passed away due to cancer. Results: Most of the terminal cancer patients received their care from proper medical services including admission to hospital (45.4%), outpatient clinic (22.2%), emergency room (16.7%), and oriental medicine (12.0%). But during the terminal phase of their illness, 32.4% of patients never received medical care including oriental medicine, and 28.7% received alternative natural care. 26 bereaved families (24.1%) pointed out the indifference of medical staff as a problem receiving proper hospital care, and 22 (20.4%) emphasized emotional strain of their helplessness with the patients suffering as a problem of caring at home. Over 90% suggested availability of continuous care, hospice care, home care, and 24 hour telephone service to be improved. Conclusions: Due to various reasons, adequate medical care is not delivered to the terminal cancer patients in our present medical system. These problems can be approached with the establishment of proper education and medical delivery system. The role of comprehensive medical specialty cannot be overly emphasized to accomplish this most effectively.

목재파티클과 재생폴리프로필렌을 이용한 복합패널 제조 및 물성에 관한 연구

한태형 ( Tae Hyung Han ),신랑호 ( Rang Ho Shin ),권진헌 ( Jin Heon Kwon ) 한국목재공학회 2005 목재공학 Vol.33 No.6

임상연구 : 비선형 혼합효과 모델을 이용한 Etomidate의 집단 약동학 및 약역학

한태형 ( Tae Hyung Han ),이수경 ( Soo Kyung Lee ),이현철 ( Hyun Chul Lee ),이진영 ( Jin Young Lee ),곽인숙 ( In Suk Kwak ),정미화 ( Mi Hwa Jung ),길호영 ( Ho Yeong Kil ),박경수 ( Kyung Soo Park ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3

Background: Etomidate is used as a fast-acting hypnotic with few cardiovascular effects to induce anesthesia in patients with a poor cardiovascular reserve. The bispectral index (BIS) has been suggested to be a measure of the depth of anesthesia and correlates well with the level of consciousness. This study examined the population pharmacokinetics and pharmacodynamics of etomidate using nonlinear mixed effect (NONMEM) modeling and sigmoid Emax modeling. Methods: Eighteen middle aged adults, with ASA physical status I or II, who were scheduled for elective surgery, were included. 0.2% etomidate was administerd at 150 ml/h until the patients lost consciousness. The patient recovered spontaneously until they regained consciousness, as determined by a verbal response. The BIS was determined and arterial blood samples were collected. The plasma concentrations were measured with high performance liquid chromatograhy (HPLC). NONMEM was used for population pharmacokinetic and sigmoid Emax model for pharmacodynamic analysis. Results: The induction dose for the loss of eyelid reflexes was 0.38 mg/kg. The induction time from drug infusion to the loss of eyelash reflexes was approximately 3.5 minutes. This study took approximately 8.5 minutes from the start of drug infusion to the recovery of consciousness. The pharmacokinetic parameters were t1/2α = 1.1 min, t1/2β = 1.9 min, t1/2γ = 106.5 min, k21 = 0.36 L/min, k31 = 0.009 L/min, V1 = 6.43 L, Varea = 426 L, Cl = 2.77 L/min. The pharmacodynamics were keo = 0.40 L/min, CE50 = 1.0 ug/mL, E0 = 94, Emax = 94 and γ = 1.2. The performance error for the etomidate concentration was 0.14 ± 0.99 (typical prediction) and -0.03 ± 0.40 (individual prediction) and -0.09 ± 1.00 and -0.001 ± 0.13 for the BIS score. Conclusions: When compared with other previously published data, our pharmacokinetic parameters demonstrated a shorter half lives, a larger volume of distribution, and an increased clearance with significant interindividual differences. The pharmacodynamics showed a large interindividual variability. The reason for discrepancy might be the relatively short sampling time. However, further study will be warranted to improve the model performance in the future. (Korean J Anesthesiol 2006; 51: 271~7)

암성 통증 관리에 사용된 부가적 진통제로서의 Propofol

한태형(Tae Hyung Han),황원균(Won Gyoon Hwang) 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1

Cancer is a devastating disease, and the treatment of related pain is an extremely challenging task. Providing adequate analgesia while avoiding unnecessary drug effects often requires a polypharmacologic approach in cancer pain management. A 36-year old woman with breast cancer metastatic to the axial skeleton and bilateral hip joints was admitted to hemato-oncology service with complaints of intractable abdominal and hip pain. Despite rapidly increasing doses of intravenous morphine up to 350 mg per day; transderma1 fentanyl; midazolam; ketorolac; lorazepam; dexamethasone, the patient continued to describe her pain as 10 of 10, refusing all surgical /diagnostic interventions not directly related to pain control. She did, however, consent to lumbar epidural catheter placement. The patient was sedated with titrating doses of propofol to assist with positioning. Even though the procedure was not successful due to significant thoracolumbar scoliosis, the patient admitted feeling better than she has in months during attempted placement. After continuous infusion of propofol was initiated at subhypnotic dose, the patients analgesic demand was drastically reduced and described her pain as 1 to 3 of l0. Approximately 96 hours after the propofol infusion was started, the patient expired comfortably. There had been no change in her medical regimen during final 48 hours. In the case described, propofol was extremely advantageous as an adjuvant in the management of cancer related pain.

치과 수술후의 통증 관리: Myprodol 대 Ibuprofen 대 Codeine

한태형(Tae Hyung Han),신병섭(Byung Seop Shin),김정 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1

N/A Background: Myprodol, a newly introduced combination analgesics with codeine, ibuprofen and paracetamol was evaluated in the dental surgery patients for its efficacy and side effects. Methods: Total 60 ASA I or II outpatients dental surgical patients were randomly assigned into three groups(n 20 each). After various oral procedures, one of three oral analgesics, myprodol, ibuprofen or codeine, was prescribed to each patients in double blind fashion for three days. Each patient was followed carefully by daily phone calls for verbal analog pain scale, side effects and patient's satisfaction level. Results: Demographic data and duration of surgery revealed no statistical differences in all three groups. Myprodol group showed better verbal analgesic scores consistently for the study period than ibuprofen or codeine group. Adverse effects were minimal. Patients' satisfaction level was high in all three groups. Conclusion: We conclude that myprodol is an excellent oral analgesic for day-surgery based dental procedure patients. This effect appears to be synergistic among different analgesics rather than additive.

37권6호 영문부록 : 프로포폴/아산화 질소 마취에 있어 펜타닐의 지속적 정주가 프로포폴의 요구량, 마취에서의 회복 및 수술 후 진통효과에 미치는 영향

한태형(Tae Hyung Han),강형만(Hyun Man Kang),길호영(Ho Yeong Kil) 대한마취과학회 1999 연수강좌 Vol.- No.-

Background : It is very important to understand the drug interaction in total intravenous anesthesia. We conducted this study to find the effects of plasma fentabyl concentrations on intraoperative propofol requirements, emergence from anesthesia and relief of postoperative pain. Methods : Total 60, ASA physical status I-II patients who underwent spine fusion were studied. The patients were randomly assigned to four study groups according to the expected intraoperative plasma fentanyl concentration. Group I received an infusion of saline and Groups II, III and IV received fentanyl infusions to maintain the blood level at 1.5, 3.0 and 4.5 ng/ml, respectively. An infusion rate of propofol was adjusted to keep the mean arterial pressure (MAP) within 15% of the control value. Inspired nitrous oxide concentration was maintained at 67% throughout the surgical procedure. The following items were investigated in each group: 1) an average propofol infusion rate, 2) time to spontaneous eye opening and recovery of orientation (name, date and place) and 3) total dosage of fentanyl used for 24 hr after admission to post-anesthetic care unit. Results : Average propofol infusion rates were 10.1±2.5 (mean±SD), 7.5±1.2, 5.7±1.1, and 4.9±1.2 mg/kg/h, in Group I, II, III and IV, respectively. Groups receiving fentanyl infusion had significantly less administration rates (P< 0.01) than the group receiving saline infusion. Among the three fentanyl infusion groups, Group II (P< 0.01) had more than Groups III and IV. Time to spontaneous eye opening and the recovery of orientation were prolonged in the order of plasma fentanyl concentration. There was no significant difference between Groupss III and IV of the plasma fentanyl level of 3 and 4.5 ng/ml. Total amount of IV-PCA fentanyl during postop 24 h increased significantly in the reversed order of plasma fentanyl concentrations: 913.1±58.4, 553.4± 129, 222.7±73.4 and 135.1±69.5 mcg in Groups I, II, III and IV, respectively. Conclusion : These results confirmed that the addition of fentanyl infusion had analgesic ceiling effects, which in turn reduced the average propofol infusion rate to plasma fentanyl concentration level of 3 4.5 ng/ml. This had an indirect influence on the recovery of consciousness after surgery, but it did not show similar ceiling effect in postoperative analgesia. (Korean J Anesthesiol 1999; 37: S 1∼S 9)

실험연구 : 일차 배양된 흰쥐 해마 신경세포에서 Fluoxetine의 생체 내 대사산물인 Norfluoxetine에 의한 전압의존성 K(+) 이온통로의 억제

한태형 ( Tae Hyung Han ),최진성 ( Jin Sung Choi ),곽인숙 ( In Suk Kwak ),최유준 ( You Jun Choi ),김명준 ( Myung Jun Kim ),민도식 ( Do Sik Min ),이덕주 ( Duck Joo Rhie ),윤신희 ( Shin Hee Yoon ),조양혁 ( Yang Hyeok Jo ),김명석 ( My 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.3

신경병증성 통증 증후군의 관리를 위한 부가적 진통제로서의 Paroxetine

한태형(Tae Hyung Han),은종신(Jong Shin Eun),이상민 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.2

N/A Background: Tricyclic antidepressants (TCA) have been used for various pain syndromes for their analgesic effects. They, however, often have anticholinergic side effects and therefore search for more selective drugs with fewer side effects is justified. Paroxetine, a selective serotonin reuptake inhibitor devoid of autonornic side effects, was evaluated for its role as an analgesic adjuvant in the management of neuropathic pain. Method: According to individual diagnostic group as diabetic neuropathy, postherpetic neuralgia, central pain syndrome and cancer related plexopathy, 10 patients per each group were equally accumu- lated. Patients have been stabilized in their analgesic regimen at least four weeks prior to enrollment into study. TCA, if taken, was discontinued for two weeks for wash out period. Baseline four point verbal pain intensity score was obtained and oral administration of paroxetine 20 mg was initiated. At two weeks follow-up visit, pain intensity scores, pain improvement scores judged by family, drug efficacy, tolerability and overall evaluation were assessed. The incidence of side effects were also obtained. Result: After two weeks of treatment, pain intensity scores decreased in 77.5% of patients and no patients experienced aggravation. These findings were objectively reflected in pain improvement scores judged by family members. But, the number of nonresponders was different among groups. In drug efficacy, tolerability and overall evaluation, the proportions of patients who scored as excellent or good were 75%, 80% and 80% respectively. Incidence of side effects was 27.5%, but the side effects sponta- neously disappeared after discontinuation of medication. Conclusion: Paroxetine, a selective serotonin reuptake inhibitor, appears to be effective as adjuvant analgesic for the management of various neuropathic pain syndromes.

지주막하강 수펜타닐과 뷰피바케인의 혼합 투여가 분만 제1기 산모의 진통 효과에 미치는 영향

한태형(Tae Hyung Han),조용상(Yong Sang Cho) 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1

N/A Background: Previous studies have proven beneficial in labor analgesia to use subarachnoid sufentanil(alone or with adjuvant) on parturients in early first stage of labor. We designed this prospective study to evaluate analgesic efficacy and side effects of subarachnoid sufentanil plus bupivacaine in women with cervical dilatation of 7 cm greater. Methods: This was an open-label, nonrandomized trial of 32 parturients in late first stage labor who requested labor analgesia. After signing the consent form each patient received subarachnoid sufentanil (l0μg) and bupivacaine (2.5 mg). Patients were asked to rate their verbal pain score (0-10 scale) before regional anesthesia and 5 minutes after subarachnoid injection, and every 20 minutes thereafter until delivery or request for additional analgesia. Blood pressure, pruritus, Bromage motor block score, mode of delivery and need for supplemental analgesics were recorded. Results: Thirty women were included in the study. Mean pain scores (mean±SD) were 8.7+1.0 pre-spinal, 0.7±1.5 5 minutes post-injection, and remained less than 5 for 130 minutes after spinal injection. Of 30 patients, 24 had unassisted vaginal delivery, 4 instrumental vaginal delivery (vacuum), and 2 cesarean delivery. Of 28 patients who delivered vaginally, 19 did not require supplemental analgesics and had a delivery pain score of 5 or #lower. Blood pressure decreased in three patients after spinal analgesia (p<0.05), which necessitated treatment.. The Bromage motor block score was 0 in 26 patients and 1 in 4 patients. Pruritus was noted in 22 patients. Conclusion: Subarachnoid sufentanil-bupivacaine provides rapid analgesia for an effective duration of approximately 130 minutes in parturients in late first stage of labor.

부인과 수술 후 통증 관리에 있어서 프로파세타몰의 모르핀 절감 및 내분비 대사에 대한 효과

한태형(Tae Hyung Han),서재완(Jae Wan Seo),신백효(B 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2

N/A Background: The analgesic efficacy and safety of propacetamol, an injectable prodrug of acetoam- inophen, in combination with intravenous morphine PCA were studied in 40 patients after gynecological surgery requiring lower abdominal incision. Methods: Using a double-blind, randomized, parallel-group design, the effects of four(every 6 hr) intravenous injections of 2 g propacelamol( 1 g acetoaminophen) were compared with four injections of placebo(PL) immediately after surgery. Efficacy of cumulative dose of morphine and number of boluses requested was assessed over 24 hours by automated recording on the PCA device. It was assessed on pain scores rated on a ten-point verbal scale along with vital signs, K', glucose, BUN, creatinine, FI' and PIT were measured along with stress hormones(epinephrine, norepinephrine and cortisol). Results: There were no differences in demographic data between two groups. Propacetamol group demonstrated approximately 21% morphine sparing effect compared to placebo group(33.1 ± 10.4 mg vs 41.4 ± 8.0 mg). No significant differences noted in K, glucose, BUN, Creatinine, FT and PTT levels. There were significant increases in norepinephrine and cortisol in placebo group postoperatively, compared to preoperative values. At the same time, propacetamol group also showed significant changes in these hormones. Both group revealed high degree of patient satisfaction. Conclusion: Propacetamol showed significant morphine sparing effect to some degree. Side effects were much less in propacetamol group with subsequently high patient satisfaction. The secretion of stress hormone were not blocked by postoperative propacetamol injections. Authors concluded that propacetamol should be considered as an excellent adjuvant analgesics in postoperative pain control in opioid patient controlled analgesia.