CLINICAL OBSERVATION OF THE STRUCTURE OF DISSOCIATIVE ANESTHESIA IN 212 PATIENTS< Ketamine Hydrochloride의 임상적 고찰 >

원임수,견일수 국군의무사령부 1974 대한군진의학학술지 Vol.5 No.1

선천성 횡격막 탈장증 전신마취 2 례 보고

이정웅,견일수,박무길 대한마취과학회 1973 Korean Journal of Anesthesiology Vol.6 No.2

The authors have experienced two cases of general anesthesia for repair of congenital diaphragmatic hernia. Both patients were female (1 year 5 months and 8 months of age) and had left sided Bochdalek hernia. Anesthesia was maintained with halothane-oxygen using nonrebreathing system with Ruben valve, and the patients tolerated the whole procedure very well. The importance of maintaining adequate ventilation with high concentrations of oxygen and avoiding abdominal distension has been stressed.

쥐 뇌의 Postsynaptic density분획에 존재하는 phosphotyrosine함유 단백질들의 검출

고복현,견일수,문일수 東國大學校醫學硏究所 1994 東國醫學 Vol.2 No.-

정보를 얻어 과정을 학습이라하고, 얻은 정보를 저항는 과정을 기억이라고 한다. 학습과 기억에 대한 생물학적 이해는 아직 미미하지만, 현재 알려진 바로는 사용빈도 및 사용형태에 따른 연접강도의 변화 즉 연접가소성에 의하여 정보가 저장된다. 기억형성과 관련된 연접가소성의 일종인 long-term potentiation (LTP)은 연접효율이 증가된 상태가 장기간 지속되는 현상으로서 장기기억의 연접기전으로 알려져있다. LTP의 형성에는 CaMKII, tyrosine kinase등의 효소가 필수적이다. 본 연구에서는 연접에서 가장 현저한 구조인 postsynaptic density (PSD)에 존재하는 phosphotyrosine 함유 단백질들의 분포를 조사하였다. PSD는 후신경세포막에 존재하는 고전자밀도소기관으로서 세포골격의 특수형태이며, 연접신호전달효율을 조절하는 역학을 한다. 쥐 뇌의 PSD분획 단백질들의 전기영동하여 분리하고, phosphotyrosine특히성 항체를 이용하여 immunoblot분석한 결과 PSD분획에서 15개의 phosphotyrosine함유 peptide를 확인할 수 있었다. 이들중 특히 180kD 크기의 peptide는 상대적으로 많은 phosphotyrosine을 함유하였다. 이 peptide는 NMDA수용체 2B (NR2B)의 항체에 의하여 면역침강되었다. 이러한 결과들은 PSD문획에는 여러 가지 단백질들이 tyrosine kinase에 의하여 인산화되면, 특히 180kD의 peptide는 주요 phosphotyrosine함유 단백질로서 NR2B임을 시사하며, tyroisne인산화에 의하여 그 기능이 조절됨을 시사한다. It is believed that information is stored as usage-dependent changes in the synaptic strength. One model of such synaptic plasticity is long-term potentiation (LTP), a persistent increase in synaptic efficacy. LTP is believed to be a synpatic mechanism underlying the long-term memory. The ?? influx through NMDA receptors, a subtype of glutamate receptors, is essential for induction of LTP. Although some kinases such as CaMKII nd tyrosine kinase are known to be essential for induction of LTP, the detailed understanding of signal transduction pathways downstream of ?? influx is far from completion. In this study we searched for phosphotyrosine-containing proteins in rat postsynaptic density (PSD) fractions. PSD is a dynamic, protein-rich cytosketal specialization tightly apposed to the postsynaptic membrane. PSD is thought to be involved in synaptic regulation. Phosphotyrosines provide binding sites for SH2 domains. Binding of SH2 domain-containing proteins trigger the next step of signal cascades. Westen blot analyses revealed that the PSD fraction contained many proteins recognized by phosphotyrosine-specific antibodies. This result implies that the signaling through tyrosine-phosphorylation may play important roles in synaptic regulation such as LTP formation.

수술후 통증관리 방법에 따른 심박수, 혈압, 맥압승치 및 시각적 아날로그 눈금의 비교

소은희,지대림,견일수 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.6

Previous studies have shown that patient-controlled analgesia(PCA) provides effective pain control in the postoperative patient. To compare the effect of pain relief on postoperative sympathetic responses and myocardial oxygen consumption, 40 healthy female patients undergoing abdominal hysterectomy were chosen randomly. They underwent pain management with either intravenous patient-controlled analgesia(IV PCA) or intermittent intramuscular opioid(IM P.R.N) regimen. Pain intensity(VAS), heart rate, blood pressure, and rate pressure product(RPP) were measured at predetermined time intervals for postoperative 72 hours after measurement of preoperative baseline values. Comparisons were then made between the two groups and among individuals within each group. IV-PCA improved postoperative pain relief(P$lt;0.05), but did not suppress efficiently the heart rate, blood pressure, and RPP indicating sympathetic responses and myocardial oxygen consumption when compared with M P.R.N regimen. These variables were increased immediately and/or 30 minutes following the operation in both groups when compared with preoperative baseline value (P$lt;0.05). These results suggest that improved pain relief per se by IV PCA had no mjor influence on the suppression of sympathetic responses and myocardial oxygen consumption and these responses were exaggerated during first 30 minutes after abdominal hysterectomy.

악성 고열증 1 예

김태우,정흥관,견일수 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.6

Malignant hyperthermia is a genetically transmitted, catastrophic, hypermetabolic syndrome that is induced by potent volatile anesthetics and/or depolarizing muscle relaxants. It is now well established that the pathophysiology is related to a malfunction of the intracellular calcium homeostasis in skeletal muscle. Morbidity has been correlated to the duration of symptoms. Dantrolene decreased release of calcium from the sarcoplasmic reticulum. We recently encountered a fulminant case during halothane anesthesia. Anesthesia was induced with thiopental and succinylcholine without jaw tightness or stiffness. After induction, tachycardia, arrhythmias, increased end-tidal CO₂, and high body temperature were noted. Arterial blood gas analysis showed a severe, mixed acidosis. Intensive treatment with body cooling was immediately initiated. But dantolene could not be available. The patient died of renal failure and disseminated intravascular coagulation 41 hours after induction of anesthesia.

원발성 Aldosteronism 환자의 마취관리

최경혜,정흥관,견일수 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.11

Increased and inappropriate production of aldosterone from the adrenal gland is known as primary aldosteronism and leads to sodium retention with hypertension, suppression of plasma renin, and hypokalemia and its manifestations. It is due mainly to a solitary adenoma, bilateral hyperplasia, or rarely an adrenal carcinoms. Primary aldosteronism due to an adenoma is usually treated by surgical excision. Preoper-ative managements include the correction of hypokalemia, volume derangement, and metabolic alkalosis with spironolactone and the trestment of existing hypertension. The authors report a case of unilateral adrenalectomy and anesthetic considerations during perioperative periods.

전신마취중 발생한 Tension Pneumothorax 1례 보고

김병권,최현만,견일수 대한마취과학회 1973 Korean Journal of Anesthesiology Vol.6 No.2

Tension pneumothorax occurred in a 42 year old man with pulmonary tuberculosis during induction of general anesthesia for left lobectomy. Rupture of emphysematous bullae, presumably due to positive pressure ventilation employed during induction, was identified by immediate thoracotomy. The patient made an uneventful recovery.

신적출술 후 발생한 종격동기종, 피하기종, 복강기종 및 후복막기종

김태우,소은희,김인정,견일수 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.6

Pneumomediastinum, air within the planes of the mediastinum, occurs in a wide variety of clinical settings. In the perioperative period, pneumomediastinum is caused by various anesthetic and surgical complications, but may appear spontaneously. When pneumomediastinum occurs with no apparent cause, it is referred to as a spontaneous pneumomediastinum. The suggested mechanism of spontaneous pneumomediastinum is rupture of marginal alveoli due to increased intraalveolar pressure and dissection of air along the bronchovascular sheath into the mediastinum. Predisposing factors include raised intrathoracic pressure, as with coughing, vomiting, and Valsalva maneuvers. The auther's case is presented of pneumomediastinum, with subcutaneous emphysema, pneumoperitoneum, and pneumoretroperitoneum, oecurring one day postoperatively, in a 26-year-old female patient who underwent nephrectomy under general anesthesia. The patient was treated conservatively with oxygen and had an uneventful recovery. The authors discuss the possible causes and its management with a review of the relevant literature.

경부 및 종격동내 수활액낭종 절제술을 위한 기관내 삽관직후 발생한 상기도 폐쇄

김진모,이주영,김인정,견일수,유한목 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.2

Abrupt increase in the size of cervico-mediastinal tumor due to infection or spontaneous hemorrhage into cyst can induce severe tracheal compression and therefore sudden death. A 5 year old boy, who had a history of URI, had an enlarging cystic hygroma on the right side of the neck and anterior mediastinum. Under diagnosis of the cervico-mediastinal cystic hygroma, surgical removal was scheduled. After induction of anesthesia, intubation was done without any difficulty. A few minutes later, signs of partial airway obstruction were appeared. And within a very short period, total airway occlusion occurred. The tracheal tube was removed and manual ventilation was performed with positive airway pressure, but ineffective. We attempted to puncture cricothyroid membrane with 14 Gauge needle in order to ventilate manually. As soon as we puncture cricothyroid membrane, straw-colored fluid, not air, gushed out through a needle. After aspiration of about 200ml of cystic fluid, the obstructive signs disappeared and the patency of the airway was maintained. Intraoperatively, no more airway problems occured and vital signs were stable. And postoperatively, patient had no specific complications and discharged on the 7th day after operation. (Korean J Anesthesiol 1997; 33: 371∼375)

성상 신경절 차단에 의한 Adult Onset Still`s Disease의 치료 경험

서영배,천범수,정흥관,견일수,정재혁 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.1

A 31-year-old woman was referred to our pain clinic department under the diagnosis of an adult onset Still's disease. She had been suffering from high fever, skin rash, multiple arthralgia, morning stiffness and lymph node enlargement for 16 months. She had taken conventional medication with steroid and NSAIDs, but the symptoms were a remittent nature. And also, she complained of systemic side effects of corticosteroids. Stellate ganglion block with 0.25% bupivacaine was performed 67 times for the treatment of adult onset Still's disease and then, her symptoms were improved eventually. We could discontinue steroid and NSAIDs, laboratory data were satisfactory. As we experienced an adult onset still's disease improved with stellate ganglion block, we report this case with a review of the literature. (Korean J Anesthesiol 1998; 35: 186∼189)