Vanadate가 신피질 근위세뇨관 상피세표의 Na^+ -K^+ ATPase 활성 및 유기산(PHA) 이동에 미치는 영향

강용인 이화여자대학교 의과대학 1990 梨花醫學誌 Vol.- No.22

The results of the influence of the vanadate in the kidney are as follows; 1) Vanadate inhibits the activation of Na^+-K^+ ATPase. The inhibitory action takes place in both high and low affinity sites bringing about structural changes. 2) The inhibitory pump of vanadate gets stronger as the concentration of the K^+ increases in the extracellular fluid and as the concentration of the Na^+ decreases in the exracellular fluid. 3) Due to the inhibitory action of Na^+-K^+ATPase in the epithelial cells in the renal tubule causing urination and matriuresis. 4) The control of PAH is caused by the concentration of Na^+ in the Na^+-K^+ pump and cells and on the addition of vanadate PAH decreases. 5) The process of PAH includes both rapid and slow uptakes and in the case of slow uptake Na^+ is needed. 6) Vanadate does not directly influence the secretion of K^+, changes are caused by the change in concentration of Na^+ in the luminal fluid. 7) Vanadate decreases the secretion of renin. 8) Unlike experiments in the Gatto renal cortex of cats and dogs, the hematodynamic effect in systematic circulation and blood vessels of the kidney, has a direct influence in the amount of urea excreted and in the excretion of electrolyte. Vanadate is not synthesized but exists as an element in Nature. In the human body, it is expected to be the element controlling Na^+-K^+ATPase activation. As a result, it is found that the concentration of vanadate increases in the blood of patients suffering from chronic renal failure, Also, the abnormal physiological array of vanadium is explained to be the cause of neurosis and cardiovascular disease. It is clearly seen that vanadium is of great importance in the human body but due to the development of industry and the increased usage of metals and oil, one must be careful of the poisonous effects of vanadium in the human body.

초산부에게 시행한 경막외 진통이 제왕절개에 미치는 영향

강용인,김병국,방은치,김수연,이현숙,조경숙 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.1

Background: The effect of epidural analgesia for labor on obstetric outcome is controversial. The purpose of this study is evaluating the influence of epidural analgesia on cesarean section in nulliparous women. Methods: We retrospectively investigated 979 nulliparous women ASA graded I - II. EPI (n = 230) was received epidural analgesia with 0.2% ropivacaine and 75μg fentanyl. N-EPI (n = 749) was received no epidural analgesia but nalbuphine 10 mg intramuscularly. We compared the rate and causes of cesarean section,instrumental delivery rate and fetal outcomes between EPI and N-EPI. Results: Cesarean section rate was not different between the EPI (18%) and N-EPI (23%). Causes of cesarean section were progress failure (83% in EPI and 80% in N-EPI) and fetal distress (17% in EPI and 20% in N-EPI) and there were no differences between two groups. Instrumental delivery rate was higher in EPI (8%) than N-EPI (5%). Fetal outcome was not different between two groups. Conclusions: Epidural analgesia did not increase cesarean section rate and did not influence on causes of cesarean section. But epidural analgesia increased the vacuum delivery rate.

제왕절개술을 위한 척추마취 시 국소마취제 주입 속도가 저혈압에 미치는 영향

강용인,방은치,신동욱,권대은,김수연,이현숙,조경숙,이수연 이화여자대학교 의과학연구소 2012 EMJ (Ewha medical journal) Vol.35 No.2

Objectives: Maternal hypotension is a common problem during cesarean section under spinal anesthesia. We evaluated the influence of injection speed of local anesthetic to subarachnoid space on maternal hypotension and level of sensory block. Methods: Bupivacaine (0.5%) 9 mg with fentanyl 10 μg was injected to subarachnoid space either quickly (during 20 seconds, 0.1 mL/sec, n=20) or slowly (during 100 seconds, 0.02 mL/sec, n=20) in parturients scheduled for elective cesarean section. The onset and level of sensory block was checked and heart rate and blood pressure was checked by 2.5 minutes during 20 minutes. Hypotension (systolic blood pressure <100 mmHg or <70% of baseline) was treated with ephedrine. Results: Hypotension occurred 70% of parturients with spinal anesthesia. Slow injection didn’t influence on the onset and level of sensory block and didn’t reduce the incidence of hypotension. But onset of hypotension was delayed. Conclusion: Slow injection (during 100 seconds, 0.02 mL/sec) of local anesthetic delayed onset of hypotension and required less amount of ephedrine. Slow injection of local anesthetic was one of the effective methods for the cardiovascular stability during cesarean section under spinal anesthesia.

임상연구 : 불임 환자에게 시행되는 난자 채취 시 Fentanyl과 Alfentanil을 이용한 정맥 마취의 비교

강용인 ( Yong In Kang ),방은치 ( Eun Chi Bang ),이현숙 ( Hyun Sook Lee ),조경숙 ( Kyung Sook Cho ),김수연 ( Su Yeon Kim ),설정호 ( Jung Ho Sul ),김준영 ( Jun Young Kim ),윤태기 ( Tae Gi Yoon ),석현하 ( Hyun Ha Seok ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5

Background: This study was carried out to compare the effect of intravenous anesthesia with fentanyl or alfentanil on the hemodynamic profile, sedation, recovery and side effect in the patients undergoing oocyte retrieval. Methods: The patients were designed to receive alfentanil (group A, n=70) or fentanyl (group F, n=70) intravenous anesthesia. The patients were given midazolam 0.6 mg/kg and alfentanil 15 μg/kg in group A or fentanyl 1.5 μg/kg in group F. Propofol 0.7 mg/kg was given if patient was awaken during procedure. Hemodynamic changes, propofol used dosage and initial propofol injecting time, Ramsay Sedation Scales, cough reflex on opioid injection, recovery time, duration of apnea and postoperative nausea, vomiting at the recovery room were recorded. Results: Group A had rapid onset, deep sedation, less amount of propofol used, more frequent apnea than group F. There were no significant differences in postoperative nausea, vomiting and recovery time between the two groups. Conclusions: The intravenous anesthesia with fentanyl or alfentanil are suitable for oocyte retreival but apnea happened more frequent in alfentanil group, so the use of alfentanil needs to monitor ventilation and hemodynamic changes carefully. (Korean J Anesthesiol 2008;55:543~8)

편도 및 아데노이드절제술 후 발생한 종격동기종과 피하기종

이영석,허철령,강용인,이영주 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.6

The causes of pneumomediastinum during perioperative period are trauma to the airway from intubation or other manipulation, raised airway pressure during anesthesia, rupture of a bleb or other intrapulmonary lesion, upper airway damage during neck surgery, infiltration of the tonsillar fossa or adenoid bed with air under pressure, increased airway pressure after nausea and vomiting, and coughing during awakening. This paper is represents and discusses a case of pneumomediastinum, pneumothorax, extensive subcutaneous and retroperitoneal emphysema which occurred suddenly a few minute after several times of bucking and straining in the intubated state with oxygen catheter after tonsillectomy and adenoidectomy at recovery room. The complieation was thought to be a infiltration of air through tonsillar fossa under pressure or alveolar rupture due to increased airway pressure after coughing. The patient was treated with high concentration of oxygen and recoverd uneventfully.

고혈압을 동반한 산모의 제왕절개술 마취의 임상적 고찰 (10년간의 후향적 연구)

방은치,이현숙,강용인,조경숙,김수연,김준영 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.4

Background: There are many difficulties in anesthetic management for cesarean section of the patients with hypertension. The anesthetic management of hypertensive disorders in pregnancy has been controversial. Methods: We reviewed the medical records of the patients with hypertensive disorders in pregnancy from Jan., 1998 to Dec., 2007, and made clinical analysis of the anesthesia for cesarean section. Results: Of the total 775 parturients with hypertensive disorders, 638 (82.3%) was delivered by cesarean section. Indications for cesarean section were, in order of frequency, hypertensive disorders in pregnancy (36.9%), multiple pregnancy (13.8%), previous cesarean section (11.6%), etc. Of the total cesarean section, 468 (73.4%) were emergency cases. The majority of preoperative systolic blood pressures were 141−160 mmHg (36.2%) and 161− 180 mmHg (35.2%). The majority of preoperative diastolic blood pressures were 91−100 mmHg (28.6%) and 101−110 mmHg (25.0%). 350 (54.9%) had epidural anesthesia, 195 (30.5%) had general anesthesia, and 93 (14.6%) had spinal anesthesia. Estimated blood loss was significantly lower after regional anesthesia than after general anesthesia. In patients received magnesium sulfate (MgSO4), (40.0% of total) 83.5% had regional anesthesia and 16.5% had general anesthesia. In the cases with MgSO4 1 min Apgar score was lower and neonatal birth weight was smaller than in cases without MgSO4. Conclusions: Anesthesiologist must have much attention on the prevention, treatment and anesthetic management for cesarean section of patients with hypertensive disorders in pregnancy.

전신마취 유도제로서의 Midazolam 요량

김종래,이명희,강용인,민경태 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.2

Midazolam, a new water-soluble benzodiazepine, has a few important advantages over diazepam which are lack of vascular irritation and rapid onset and short duration of action. So it has been used for an induction agent for anesthesia. But there were many different reports about the effective dose of midazolam as an induction agent for anesthesia, and which showed intersubject variability. Therefore, this study was aimed to verify the effective induction dose of midazolam comparing with thiopental 5 mg/kg for general anesthesia. The patients were divided into 6 groups. The patients of group 1, 2, 3, 4, and 5 were injected midazolam 0.15, 0.20, 0.25, 0.30, and 0.35 mg/kg, respectively, and, of group 6, thiopental 5 mg/kg for induction of anesthesia. Induction of anesthesia was defined as complete with loss of eyealsh reflex and failure to verbal commands. Unless induction was attained within 3 minutes, it was considered as failure of induction, and further steps of study were discontinued. After anesthesia was induced, stimulus to trapezius muscle relevant to endotracheal intubation was applied. The blood pressure, heart rate and arterial oxygen saturation were recorded before induction, at induction, and 1, 2, and 3 minutes after a stimulus to trapezius muscle. The incidences of pain on injection, venous irritations and antegrade amnesia were evaluated. The results were as follows; 1) Induction fractions of group 1, 2, 3, 4, 5, and 6 were 21.5, 57.2, 81.9, 100, and 100%, respectively. Induction times of group 1 to 5(midazolam groups) were 74.7∼87.9 sec.(raanges, 40∼150 sec.) and, of group 6, 39.5 sec.(ranges, 33-55 sec.). But there was no relationship between midazolam doses and induction times. 2) At induction, systolic blood pressures of patients in group 3, 4, 5, and 6 decreased 6.1%, 5.8%, 10.5%, and 8.8%, respectively, and remained so after stimulus to trapezius muscle, but in group 6, which returned to preinduction value. Changes in sytoiic blood pressure were statistically insignificant among groups. 3) At induction, diastolic blood pressures of patients in group 5 and 6 decreased 11.0% and 11.3%, respectively, and, after stimulus to trapezius muscle, diastolic blood pressures did not change in group 3, 4, and 5, but, in group 6, returned to preinductuin value. Changes in diastolic blood pressure were statistically insignificant among groups. 4) At induction, heart rates of patients in group 3, 4, 5, and 6 increased 10.0%, 13.8%, 7.5%, and 25.8%, respectively. Changes in heart rate were significantly different between group 6 and other groups. 5) Arterial oxygen saturations decreased 0.25%, 0.3%, and 0.35% in group 3, 4, and 5 at induction, respectively, but, in group 6, decreased 3.4% after stimulus to trapezius muscle. Changes in arterial oxygen saturation were statistically insignificant among groups. 6) There were no differences in incidences of pain on injection, venous irritations, and antegrade amnesia among groups. In summary, midazolam can be used to induce general anesthesia safely with dose of 0.25 mg/ kg to 0.35 mg/kg, although there remains intersubject variability.

복강경하 자궁근종제거술 및 보조질식자궁절제술시 자궁과 자궁경관 주위조직으로 투여된 vasopressin에 의해 발생된 폐부종 -증례 보고-

김수연,이정향,방은치,이현숙,강용인,조경숙,권태희 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.4

Vasopressin is often used locally to reduce blood loss in gynecologic surgery. The use of local infiltration of low concentration vasopressin (0.05−0.3 units/ml) has been considered to be safe. However, serious side effects such as bradycardia, hypertension, arrhythmia, pulmonary edema, coronary vasospasm, myocardial infarction and even cardiac arrest were reported during low-dose vasopressin. In 2 healthy women with myoma and multiple myoma combined with adenomyosis, we experienced pulmonary edema after intramyometrial injection and paracervical infiltration of vasopressin. After diuretics and oxygen therapy, the patients were recovered without any complications.

무통분만을 위한 경막외 진통에서 Fentanyl의 용량에 따른 0.2% Ropivacaine의 작용발현시간과 작용지속시간

방은치,신지현,이현숙,강용인,조경숙,김수연 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.3

Background:The purpose of this study was to identify the effect of fentanyl dose on the onset and duration of 0.2% ropivacaine. Methods:Sixty-one nulliparous women with singleton vertex pregnancy who requested epidural labor analgesia were enrolled.Patients were administered randomly 0, 50, 100μg of fentanyl with 10 ml of 0.2% ropivacaine (Group F0, F50 and F100, respectively).VAS pain scores were recorded 0, 5, 10, 15 min after epidural injection, after which they were recorded every 15 min.The onset and duration of analgesia were measured.Side effects such as, pruritus, motor blockade, and hypotension were recorded.Satisfaction scores, type of delivery, and neonatal outcomes were recorded. Results:The onset of analgesia was at 8.5 ± 3.4 min in Group F100, compared with 13.7 ± 7.2 min in Group F0 and 13.6 ± 5.3 min in Group F50 (P = 0.009).The duration of analgesia was 122.6 ± 20 min in Group F100, compared with 72.3 ± 21.2 min in Group F0 and 97.8 ± 22.4 min in Group F50 (P = 0.000).There were significant differences in VAS pain scores and satisfaction scores among the three groups. There were no differences in the incidences of maternal side effects and operative delivery or neonatal outcomes. Conclusion:Fentanyl 100μg was the most appropriate dose when combined with 0.2% ropivacaine due to the rapid onset and long duration of epidural labor analgesia.

복강경술과 자궁경술시 발생한 심혈관계 허탈

이현숙,김수연,박광원,조경숙,강용인,정춘근,김명희 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.1

Hysteroscopy is an established gynecologic procedure that has been used for the past 20 years as a diagnostic technique. It is also used therapeutically. Hysteroscopy is commonly performed with CO₂insufflation and its complications are rare. The sudden decrease of end-tidal partial pressure of carbon dioxide, associated with mill-wheel murmur, loss of cardiac output and sinus tachycardia on the ECG are highly suggestive of massive gas embolism during laparoscopy and hysteroscopy. We report 2 cases of cardiac arrest and severe bradycardia. The second patient's expired CO2 concentration fell rapidly to 7 mmHg and blood pressure and heart rate dropped suddenly after resection of the uterine septum and adhesiolysis. We performed cardiac resuscitation with cardiotonic drugs, cardiac compression, defibrillator and resulted in good recovery. At the time of discharge 10 days and 2 days later, the patients had recovered almost completely. (Korean J Anesthesiol 1998; 34: 208∼212)