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수축제로 전수축된 백서 대동맥에서 Milrinone의 혈관이완 효과
권희욱 ( Hee Uk Kwon ),박종택 ( Jong Taek Park ),류승우 ( Sung Woo Ryoo ),박일환 ( Il Hwan Park ),이세희 ( Se Hee Lee ),김순열 ( Soon Yul Kim ),윤석화 ( Seok Hwa Yoon ),임현교 ( Hyun Kyo Lim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Background: Milrinone, phosphodiesterase III inhibitor, has been used effectively in patients with right heart failure, especially resulted from pulmonary hypertension. However, milrinone is often used with α- and β-adrenergic receptor agonist to prevent severe systemic vasodilation and unfavorable hypotension. Furthermore, structural and functional vasacular changes are associated with aging and are greatest in the aorta. We evaluated the vasodilatory effects of milrinone and sodium nitroprusside (SNP) on young and old rat aortic rings preconstricted with various catecholamines. Methods: Aortic rings of young and old rat were placed in 25 ml organ chamber and preconstricted with epinephrine (EPI, 10(-6) M), norepinephrine (NE, 10(-7) M) , phenylephrine 10(-7) M) , and U46619 (10(-8) M). Cummulative dose-responses to milrinone (10(-9)-10(-5) M) and SNP (10(-9)-10(-5) M) were obtained to characterize vasodilatory effects. Results: Relaxation response to milrinone was markedly enhanced in both young and old aortic rings preconstricted with U46619 compared with other vasoconstrictors. The maximal response of the young rat aortic rings preconstricted with NE is significantly reduced, compared with that of EPI. The maximal vasorelaxant response of SNP in young and old aortic rings are nearly identical. Conclusions: We conclude that combined use of milrinone and epinephrine may be more useful in prevention and treatment of systemic hypotension. (Korean J Anesthesiol 2009;57:615∼21)
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백서에서 척수의 허혈/재관류 손상시 neuronal Nitric Oxide Synthase(nNOS)의 발현
이광호,권희욱,강포순,조춘규,양춘우,양춘모,박종택 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.4
The aim of this experimental study was to investigate the expression of nNOS following ischemia/reperfusion injury in rat spinal cord. Methods: Spraque-Dawley rats (250-300 gm) were classified into two groups according to experimental methods. Control group (n = 5) received sham operation. Ischemia in experimental group (n = 5) was induced by clamping the abdominal aorta just below the left renal artery and the abdominal aorta just above the aortic bifurcation for 20 minutes followed by 20 minutes reperfusion. The spinal cord was obtained 7 days after operation. The expression of nNOS was examined in gray and white matter with confocal microscope and Image Analyzer. Results: There is no difference in nNOS expression of nNOS between gray and white matter in control group. Comparing to control group, experimental group showed higher levels of nNOS expression (P < 0.05). Conclusions: nNOS expression increased in the rat spinal cord after ischemia/reperfusion injury. We suggest that overproduction of NO may play a role in progressive nerve cell damage.
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적절한 기관내관 기낭 압력 유지를 위한 Loss of Resistance Syringe의 적용
조춘규,권희욱,박성수,정원준,이미진 대한응급의학회 2010 대한응급의학회지 Vol.21 No.2
Purpose: The management of cuffed endotracheal (ET)tubes is routine practice for emergency physicians. Although various cuff inflation techniques are used, there is no standard technique identified in the literature as the method for cuff inflation or intracuffed pressure (ICP). A loss of resistance (LOR) syringe has been used for years and this is located in the epidural space. The purpose of this study was to measure the actual ICP obtained by a new estimation technique. Methods: Using a manikin simulation model, we assessed how physicians inflated the cuff in 5.5, 6.5, 7.5 mm inner diameter ET tubes. We measured the inflated air volumes and the ICPs obtained by the conventional technique (A group), by the commercial 10-ml syringe + passive release technique (B group), and by a LOR syringe + PRT (C group). Subsequently, a manometer was used to measure the actual ICP (normal: 16 to 40 cmH2O). Results: We sampled 90 participants. They were classified into three groups: those who underwent the conventional inflation technique (A group, n=30), those who underwent the commercial syringe technique (B group, n=30) and those who underwent the Perifix LOR syringe technique (C group, n=30). In the control group, the mean recorded ICPs were 78.2±30.7 cmH2O (A group) and 56.1±16.0cmH2O (B group). The initial cuff pressures were greater than 40 cmH2O in 25 (83.3%) cases. For the experimental group, the mean recorded ICP was 19.1±1.8 cmH2O. With respect to the rate of optimal cuff inflation, the LOR syringe technique was significantly higher than the conventional method or the PRT + 10-ml syringe method (100% vs. 16.7and 23.3%, respectively, p<0.001). Conclusion: Using conventional syringe technique, most cuff pressures exceeded a safe pressure and they required correction. Ultimately, PRT using the Perifix LOR syringe is a useful alternative cuff inflation method when direct intracuff pressure measurement is not available.
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노인에서의 다른 3가지 방법의 척추 경막외 병용마취 및 척수마취 방법의 비교 연구
임영수,양춘우,권희욱 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.2
Background: Combined spinal epidural anesthesia (CSE) combines the rapid onset and intensity of a subarachnoid blockade with the flexibility of an epidural catheter, thereby allowing the intraoperative extension of anesthesia and postoperative epidural analgesia. This study investigated the effects of hyperbaric bupivacaine during CSE for lower limb orthopedic surgery in geriatric patients. Methods: Group 1 received a subarachnoid injection of 8 mg of bupivacaine and an epidural catheter. Group 2 received a subarachnoid injection of 5 mg of bupivacaine and fentanyl, 10μg and an epidural top-up with 3 ml saline. Group 3 received a subarachnoid injection of 5 mg of bupivacaine and fentanyl 10μg with an epidural top-up of 6 ml saline. Group 4 received a subarachnoid injection of 6 mg of bupivacaine and an epidural top-up with 6 ml saline. The maximal level of the sensory blockade, the time of onset to the maximal sensory blockade, the two segment regression time, the time for sensory regression to the tenth thoracic dermatome (T10) and the motor recovery to modified Bromage Scale 0 were compared. After recording the baseline systolic blood pressure and heart rate, the systolic blood pressure and heart rate were recorded at 5 min intervals. Results: There were significant differences in the two-segment regression times, the times to motor recovery between the groups. However, the intraoperative blood pressure and heart rate were similar. Conclusions: In terms of the peri-operative side effects and recovery from the blocks, CSE was better for lower limb orthopedic surgery in geriatric patients than spinal anesthesia. (Korean J Anesthesiol 2006; 50: 152~7)
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김영근,이경아,권희욱,이종욱 대한감염학회 2009 Infection and Chemotherapy Vol.41 No.2
Background : Deficiency of von Willebrand factor-cleaving protease, a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13), is thought to be responsible for platelet aggregation and microthrombi formation, which in turn cause typical thrombotic microangiopathies. This deficiency is found in patients with thrombocytopenia-associated multiple organ failure such as thrombocytopenic purpura and disseminated intravascular coagulation (DIC). We evaluated the clinical significance of ADAMTS13 deficiency in patients with sepsis-induced DIC. Materials and Methods : Nineteen patients with sepsis-induced DIC were enrolled. ADAMTS13 antigen levels were determined by Enzyme-Linked Immunosorbent Assay (ELISA) and activity levels were measured by fluorescence resonance energy transfer assay. Patients were categorized into two groups according to ADAMTS13 antigen level: less than 350 ng/mL or above. Clinical characteristics and survival were compared between the two groups. Results : ADAMTS13 antigen level was less than 350 ng/mL in 7 patients and was above 350 ng/mL in 12 patients. There were no significant differences between the groups for age, sex, severity of illness, and other clinical characteristics. In patients with ADAMTS13 antigen level less than 350 ng/mL, in-hospital mortality was much higher (100% versus 25%, P=0.003) and 7-day survival was much shorter (P=0.023). Conclusion : Deficiency of ADAMTS13 could be thought to be associated with unfavorable outcome in patients with sepsis-induced DIC. Background : Deficiency of von Willebrand factor-cleaving protease, a disintegrin-like and metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13), is thought to be responsible for platelet aggregation and microthrombi formation, which in turn cause typical thrombotic microangiopathies. This deficiency is found in patients with thrombocytopenia-associated multiple organ failure such as thrombocytopenic purpura and disseminated intravascular coagulation (DIC). We evaluated the clinical significance of ADAMTS13 deficiency in patients with sepsis-induced DIC. Materials and Methods : Nineteen patients with sepsis-induced DIC were enrolled. ADAMTS13 antigen levels were determined by Enzyme-Linked Immunosorbent Assay (ELISA) and activity levels were measured by fluorescence resonance energy transfer assay. Patients were categorized into two groups according to ADAMTS13 antigen level: less than 350 ng/mL or above. Clinical characteristics and survival were compared between the two groups. Results : ADAMTS13 antigen level was less than 350 ng/mL in 7 patients and was above 350 ng/mL in 12 patients. There were no significant differences between the groups for age, sex, severity of illness, and other clinical characteristics. In patients with ADAMTS13 antigen level less than 350 ng/mL, in-hospital mortality was much higher (100% versus 25%, P=0.003) and 7-day survival was much shorter (P=0.023). Conclusion : Deficiency of ADAMTS13 could be thought to be associated with unfavorable outcome in patients with sepsis-induced DIC.
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양춘우,조춘규,권희욱,노재영,허윤무,안성민 대한마취통증의학회 2010 Korean Journal of Anesthesiology Vol.59 No.-
Supraclavicular brachial plexus blocks are not common in pediatric patients due to the risk of pneumothorax. Ultrasonography is an important tool for identifying nerves during regional anesthesia. Directly visualizing the target nerves and monitoring the distribution of the local anesthetic are potentially significant. In addition, ultrasound monitoring helps avoid complications, such as inadvertent intravascular injection or pneumothorax. This paper reports four cases of pediatric patients who received ultrasound-guided supraclavicular brachial plexus block for upper limb surgery.
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