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)

복강경하 미세 난관복원술시 발생한 피하기종과 기종격증 2예(윗첨자확인)

김정환 ( Kim Jeong Hwan ),김지향 ( Kim Ji Hyang ),한지은 ( Han Ji Eun ),강용인 ( Kang Yong In ),권태희 ( Kwon Tae Hui ),김수연 ( Kim Su Yeon ),윤태기 ( Yun Tae Gi ) 대한산부인과학회 2003 Obstetrics & Gynecology Science Vol.46 No.12

Over the last few decades, laparoscopy has evolved from a useful diagnostic tool to a complex surgical method. With its increasing popularity, the complications associated with laparoscopy are also increasing in number and variety. Subcutaneous emphysema,

증례보고 : 경막외마취 중 발생한 심정지

방은치 ( Eun Chi Bang ),이현숙 ( Hyun Sook Lee ),강용인 ( Yong In Kang ),조경숙 ( Kyoung Sook Cho ),김수연 ( Su Yeon Kim ),김상진 ( Sang Jin Kim ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.2

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.

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.

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.

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.

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)

지속적 경막외제통이 분만에 미치는 영향

이현숙,김수연,김명희,방은치,강용인,조경숙 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.2

Background: The effect of epidural analgesia on the progress of labor is controversial. The objective of this study is to determine the effect of analgesia on the outcomes of labor, especially the cesarean delivery rate in the epidural and non-epidural (intramuscular nalbuphine) groups, prospectively. Methods: All the nulliparous women were divided into two groups, group 1 (epidural group, n = 35) and group 2 (non-epidural group, intramuscular nalbuphine, n = 43) randomly. Epidural analgesia was maintained with a continuous epidural injection of 0.0625% bupivacaine with 0.2 pg/ml fentanyl in group 1 and nalbuphine 10 mg was intramuscularly injected in group 2 when the cervix was dilated to at least 3 - 5 cm. The duration of the first and second stages of labor, cesatean delivery rate, Apgar score and body weight of infant were recorded and the pain score of parturient was recorded by 0 - 100 mm visual analogue scale. Results: The duration of first and second stage were prolonged in the group 1 (epidural group). But there were no significant differences in the duration of first and second stage, Apgar score and body weight of infant between the two groups. Cesarean delivery rate was 16% (n = 7/35) in group 1 and 17% (n = 6/43) in group 2, so there was no significant difference between the two groups. Pain score was significantly lower in group 1 than in group 2. Conclusions: Epidural analgesia was not associated with increased cesarean delivery rate and provided safe and effective intrapartum pain control. Matemal-fetal factors and obstetric management, not epidural analgesia, are the most important determinants of the cesarean delivery rate.

산과 경막외마취가 분만에 미치는 영향

이현숙,김수연,김명희,김정환,방은치,강용인,조경숙,김수연 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.12

목적 : 무통분만을 위해 시행한 지속적 경막외제통이 분만에 미치는 영향을 살펴보고자 하였다. 연구방법 : 분만시 통증경감을 원하는 산모를 두군으로 나누어 자궁경부가 3-5cm 개대시 1군 산모 35명은 0.0625% bupivacaine과 0.2㎍/㎖ fentanyl을 혼합하여 지속적 경막외제통을 시행하였고, 2군 산모 43명은 nalbuphine 10mg을 근주하였다. 1군과 2군에서 분만 1기와 2기의 진행시 소요된 시간, 제왕절개술의 빈도, 신생아의 Apgar score 및 체중을 기록하였고 통증 정도는 0-100mm의 시각통증등급에따라 측정하였다. 통계는 모수검정에는 independent t-test, 비모수검정에는 chi-square test를 이용하여 p〈0.05인 경우 통계적 의의를 두었다. 결과 : 1. 1군에서 분만 1기와 2기가 연장되었지만 통계적 차이는 없었다. 2. 신생아의 체중 및 Apgar score는 두 군간에 차이가 없었다. 3. 제왕절개술의 빈도는 1군이 16%(7/35), 2군이 14%(6/43)로 두 군간에 유의한 차이는 없었다. 4. 통증정도는 1군에서 유의하게 낮았다. 결론 : 분만진통시 시행하는 경막외제통은 분만의 진행과정에 지장을 주지 않았고 제왕절개술의 빈도도 높이지 않았다. 경막외제통은 태아나 산모에게 안전하게 시행될 수 있으나 산모선택이나 마취방법, 산과적 수기에 세심한 주의가 필요하다고 사료된다. Background : The effect of epidural analgesia on the progress of labor is controversial. The objective of this study is to determine the effect of analgesia on the outcome of labor, especially cesarean delivery rate in the epidural group and non-epidural group, prospectively. Methods : All the parturients were divided into two groups, group 1(epidural group, n=35) and group 2(non-epidural group, intramuscular nalbuphine, n=43) randomly. Epidural analgesia was maintained with a continuous epidural injection of 0.0625% bupivacaine with 0.2 ㎍/㎖ fentanyl in the group 1 and nalbuphine 10 ㎎ was intramuscular injected in the group 2 when the cervix was dilated to at least 3-5 ㎝. The duration of first and second stage of labor, cesarean delivery rate, Apgar score and body weight of baby were recorded and pain score of parturient was recorded by 0-100 ㎜ visual analog scale. Results : The duration of first and second stage labor were prolonged in the group 1. But there were no significant differences in the duration of first and second stage labor, Apgar score and body weight of baby between the two groups. Cesarean delivery rate was 16%(n= 7/35) in the group 1 and 14%(n= 6/43) in the group 2, so there was no significant difference between the two groups. Pain score was significantly lower in the group 1 than the group 2. Conclusion : Epidural analgesia was not associated with increased cesarean delivery rate and provided safe and effective intrapartum pain control. Maternal-fetal factors and obstetric management, not epidural analgesia, are the most important determinants of the cesarean delivery rate.