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임상연구 : 마취 중 H1-수용체 길항제 투여에 의한 혈역학적 변화에 대한 고찰
함태수 ( Tae Soo Hahm ),김정수 ( Chung Soo Kim ),구명신 ( Myong Shin Koo ),신병섭 ( Byung Seop Shin ),황희윤 ( Hee Youn Hwang ),이상민 ( Sang Min Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Background: Antihistamine agents are one of the most common drugs used during perioperative periods. As histamine can cause various hemodynamic reactions, administration of antihistamine can also result in unexpected responses. Therefore, we investigated what kind of hemodynamic changes might occur after the administration of antihistamine. Methods: We prospectively performed this study on 12 patients who underwent lung surgery. After induction of anesthesia, Swan-Ganz catheter was introduced and continuous arterial blood pressure was checked via radial arterial catheterization. Initial hemodynamic parameters were checked. Based on these parameters, we calculated systemic vascular resistance (SVR), pulmonary vascular resistance (PVR). After administration of chlorpheniramine maleate 8 mg, hemodynamic parameters were checked and calculated at 2, 4, 6, 8, 10, 12, and 15 minute. Then, we made comparisons of these values with initial values. It is commonly recommended to maintain hemodynamic values within 20% of baseline for safe use of a drug. Results: SVR and PVR failed to show statistically significant changes. Heart rates were increased only at 2 minute after administration of chlorpheniramine maleate. Blood pressures were increased but returned to basal level within 4 minutes. Cardiac output showed statistically significant increase until 8 minutes. However, the changes of hemodynamic values were maintained within 20% of basal levels. Conclusions: Chlorpheniramine maleate is observed to cause statistically significant hemodynamic change after intravenous administration during anesthesia. But the changes were within 20% of basal levels, and we can safely use chlorpheniramine maleate 8 mg IV in the view of hemodynamic changes. (Korean J Anesthesiol 2006; 51: 395~9)
전정맥 전신마취下 복강경 수술환자의 부위별 심부체온의 변화 평가
함태수(Hahm Tae Soo),김원호(Kim Won Ho),김남초(Kim, Nam Cho),유제복(Yoo, Je Bog) 기본간호학회 2015 기본간호학회지 Vol.22 No.4
The trend of body temperature change during laparoscopic surgery and the most adequate site for monitoring temperature measurements have not been investigated thoroughly. In this study body temperature change during laparoscopic surgery was measured and measurements of the tympanic, esophageal, and nasopharyngeal core temperatures in surgical patients with total intravenous anesthesia were compared. Methods: From February to October 2013, 28 laparoscopic surgical patients were recruited from a tertiary hospital in Seoul. The patients’ core temperature was measured 12 times at ten minute intervals from ten minutes after the beginning of endotracheal intubation. Results: Repeated measure of core temperatures indicated a significant difference according to body part (p=.033), time of measure (p<.001) and the reciprocal interaction between body part and time of measure (p<.027). The core temperatures were highest at tympany location, lowest at nasopharynx. The amount of temperature change was least for the esophagus (36.10~36.33℃), followed by nasopharynx and tympany. Conclusion: The esophageal core temperature showed the highest stability followed by nasopharyngeal and tympanic temperature. Therefore, close observations are required between 10~20minutes after the beginning of the operation.
함태수 ( Tae Soo Hahm ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
Electrical stimulation of acupoint (EA), a form of electrotherapy, involves passing an electrical current via pairs of acupuncture needles attached to a device that generates an electrical pulse. This electrical generator is used to control and adjust the stimulus parameters. EA is quite similar to traditional acupuncture in that the same points are stimulated. However, EA stimulates a larger area than a specific point. In addition, greater control of stimulus parameters is possible with EA, which results in its being reproducible and objective. EA has been used to treat in various conditions, including musculoskeletal disorders and as a form of anesthesia. Additionally, EA reportedly relieve pain and inflammation, and reduce nausea and vomiting. Although the mechanism by which EA functions has not yet fully elucidated, some of its action on the endogenous opioids system through multiple neuronal pathways has been indentified. It has also been shown that the released neurotransmitters are dependent on stimulation frequencies, although there is considerably overlap. Although EA is increasingly used to treat various clinical conditions, there are insufficient scientific evidences available regarding its efficacy. There is no established optimal protocol of EA treatment (optimal parameter, frequency of treatment, duration of a treatment session). Moreover, the exact mechanism by which EA treats underlying conditions. Therefore, for EA to be recognized as an established mode of treatment, further studies are warranted to assess its scientific and systematic efficacy and to clarify the mechanism underlying its effects. (Korean J Anesthesiol 2009; 57: 3~7)
실험연구 : 잡견에서 Bupivacaine의 주입에 의한 심장 독성 발생 시 시행한 심폐소생술에서 인슐린 부가 효과의 연구
함태수 ( Tae Soo Hahm ),신병섭 ( Byung Seop Shin ),김정수 ( Chung Su Kim ),이상민 ( Sang Min Lee ),여진석 ( Jin Seok Yeo ),황희윤 ( Hee Youn Hwang ),이국현 ( Kook Hyun Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: Because of the difficulty of resuscitation caused by bupivacaine-induced cardiotoxicity, the choice of resuscitation medication is still unclear. We investigated whether insulin can improve outcomes of resuscitation by epinephrine from bupivacaine-induced cardiovascular collapse. Methods: Twenty-four mongrel dogs were randomly allocated to one of the two groups: an EPI group (n = 12), and an EPI + RI group (n = 12). Sixty minutes after induction of general anesthesia, baseline measurement of hemodynamic parameters and arterial blood gas tension was performed. Bupivacaine infusion was started at a rate of 0.5 mg/kg/min and kept until mean arterial blood pressure fell below 40 mmHg and heart rate 40 beats per minute. At this point, bupivacaine infusion was stopped and resuscitation was started, with epinephrine in EPI group and epinephrine combined with regular insulin in EPI + RI group. Results: Bupivacaine infusion caused significant decreases in mean arterial blood pressure, heart rate, cardiac output, and systemic vascular resistance and increases in mean pulmonary blood pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, and central venous pressure. The recovery rate of EPI + RI group (8/12) was higher than that of EPI group (2/12). Conclusions: Combined administration of epinephrine and regular insulin improves outcomes of resuscitation of bupivacaine-induced cardiovascular collapse. Therefore, we believe that prompt administration of insulin should be strongly considered in case of bupivacaine-induced cardiotoxicity. (Korean J Anesthesiol 2006; 50: 579~84)
임상연구 : 두부 하강, 외회전 자세에서의 내경정맥과 경동맥의 관찰
정익수 ( Ik Soo Chung ),권민아 ( Min A Kwon ),황희윤 ( Hee Youn Hwang ),박정헌 ( Jeong Heon Park ),여진석 ( Jin Seok Yeo ),김정수 ( Chung Su Kim ),함태수 ( Tae Soo Hahm ),이상민 ( Sang Min Lee ),조현성 ( Hyun Sung Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: This study evaluated the position and relationship between the right internal jugular vein (IJV) and the surrounding external landmarks using ultrasonography. Methods: Fifty-four patients undergoing central vein access for cardiac surgery were enrolled in this study. The IJV, carotid artery (CA) and sternocleidomastoid muscle (SCM) at the cricoid cartilage level in 15˚ trendelenburg position with 30˚ head rotation were examined using a two dimensional ultrasound transducer of a TEE machine. Images of the vessels and the demographic data of the patients were recorded and analysed. Results: At the level of the cricoid cartilage, the position of the right IJV was medial to middle of the clavicular head of the SCM muscle in 26 cases (48.2%), lateral in 11 cases (20.4%) and just above the middle of clavicular head of the SCM muscle in 17 cases (31.5%). In 43 patients (79.6%), the IJV overlapped the CA anterolaterlly < 5 mm, and these cases were regarded as normal. Ten patients (18.5%) had a medially positioned IJV overlapping the CA more than 5 mm and the IJV was positioned lateral to CA in 1 (2%) patient. The mean ratio of the overlapped diameter and the diameter of the CA was 33.6% and the overlapping ratios were greater than 50% in 10 patients (31.4%). The mean skin-to-vein distance at the angle of 30˚ was 1.82 cm. Conclusions: In 18.5% of patients positioned in the 15˚ Trendelenburg position, with their head turned to the left 30˚, the IJV overlapped the CA medially more than 5 mm, which increased the risk of a carotid puncture using the blind technique. (Korean J Anesthesiol 2006; 51: 11~6)
증례보고 : 성문상 종양에 의한 성문 폐쇄 환자에서의 기관 내 삽관
이숙영 ( Suk Young Lee ),함태수 ( Tae Soo Hahm ),진현승 ( Hyun Seung Jin ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Intubation in patients with an obstruction of the glottis due to a large mass may present great challenge to most anesthesiologists. If tracheostomy is not available, flexible fiberscope guided endotracheal intubation is now the part of the standard management in these cases, but difficulty in advancing the tracheal tube over the fiberscope and into the trachea may be encountered. In this case, a 60-year-old male with a huge supraglottic mass was given general anesthesia for laryngomicroscopic surgery and debulking of the mass lesion. We planned an awake flexible fiberoptic intubation but failed to railroad the tube over the fiberscope even after successfully placing the scope inside the trachea. During various attempts to pass the tracheal entrance, the patient coughed and the tube slid into the trachea as mass moved aside and we could successfully secure the airway. (Korean J Anesthesiol 2009;56:87~91)
추간판 탈출증 환자에서 미추 접근법으로 일측 경막외 카테터를 통한 스테로이드 주입 시 유효 용량에 관한 연구
신영희 ( Young Hee Shin ),김태형 ( Tae Hyeong Kim ),이석진 ( Seok Jin Lee ),이철중 ( Chul Joong Lee ),심우석 ( Woo Seok Sim ),곽미숙 ( Mi Sook Gwak ),김정수 ( Chung Soo Kim ),함태수 ( Tae Soo Hahm ),김명희 ( Myung Hee Kim ),조현성 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.54 No.4
실험연구 : 백서의 족관절 염좌모델에서 전기침구에 효과적인 침구점
조현성 ( Hyun Sung Cho ),양미경 ( Mi Kyung Yang ),유래근 ( Rae Geun Yoo ),함태수 ( Tae Soo Hahm ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: The stimulation and selection of an effective acupoint is important for producing effective analgesia in electraoacupuncture. This study examined the effect of electroacupuncture to different acupoints and investigated the effective acupoint for ankle-sprained pain in rats. Methods: A Sprain was produced by manually overextending the lateral ligament of the right ankle in rats. Electrical stimulation was delivered individually to five acupoints: bilateral Yangno (SI6s), contralateral Zusanli (ST36), Hapko (LI4) and Sanyinjiao (SP6). The level of pain evoked by ankle sprain was measured by the stepping force of the sprained paw during walking at pre-sprain and 24 hrs after the sprain. The effect of electroacupuncture was evaluated by the % full recovery of the stepping force at 1, 2, 4 hr after terminating electroacupuncture. Results: Electrical stimulation to SI6 and ST36 among the five acupoints produced a significant increase in the % full recovery of the stepping force of the ankle-sprained paw during walking. Conclusions: The effective acupoints for electroacupuncture on ankle-sprained pain in rats is SI6 and ST36. These points are relatively specific to ankle-sprain. It is important to select the appropriate acupoint for effective electroacupuncture-induced analgesia. (Korean J Anesthesiol 2006; 51: 354~8)