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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)
허리뼈 가시돌기 세로크기 차이를 이용한 4-5 허리뼈 가시사이 공간 확인법
김현우 ( Hyun Woo Kim ),진경욱 ( Gyong Uk Jin ),임영수 ( Young Su Lim ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),조춘규 ( Choon Kyu Cho ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Background: The appropriate landmark of spinal puncture is important for preventing spinal cord injury. L4 spinous process (SP) is the largest in size and L5 is the smallest. In this study `height of SP` is the longitudinal length of SP on lumbar AP view. The purpose of this study was to identify the L4-5 interspinous space (ISS) using difference between L4, 5 SP heights. Methods: Sixty-six patients scheduled for spine surgery were enrolled. After induction of general anesthesia, patients were changed to a prone position. The lumbar vertebrae were palpated from the lowest point of the lumbar spine and cranially. We palpated the difference in spinous process heights and marked the point of step-off from L4 SP to L5 SP. The level was radio-logically confirmed. Direction of estimation error and the effects of spondylolisthesis, sex, and obesity were also analyzed. Results: The number of accurate identification of the L4-5 ISS in males was 36 (85.7%), in females was 17 (70.8%), and in total 53 (80.3%). The difference between L4 and L5 SP heights (DL4-5SPHs) and sex affect the results. DL4-5SPHs were larger in concordant patients than in discordant patients (7.2±4.9 mm: 5.0±1.6 mm, P<0.05). Among errors, there were more cephalad identified cases compared to caudad identified ones (12.1%: 7.6%). Conclusions: The identification of L4-5 ISS using SP height difference was considerably accurate. So, we considered this might be a useful method for spinal anesthesia. (Korean J Anesthesiol 2009; 56: 652~7)
중환자실 입원 환자의 비강 도말에서 메티실린 내성 황색포도알균의 분자역학, 항생제 내성 연구
곽엄섭 ( Om Sub Kwak ),권미혜 ( Mee Hye Kwon ),정지현 ( Ji Hyun Jeong ),강미일 ( Mi Il Kang ),천지영 ( Ji Young Cheun ),이고은 ( Go Eun Lee ),김영근 ( Young Keun Kim ),최유진 ( Eu Gene Choi ),나문준 ( Moon Jun Na ),권희욱 ( Hee Uk 대한결핵 및 호흡기학회 2008 Tuberculosis and Respiratory Diseases Vol.65 No.2
연구배경: 메티실린 내성 황색포도알균은 의료기관 관련 감염 뿐 아니라 지역사회 감염에서도 나타나 이에 저자들은 한 대학병원 중환자실에 입원한 환자의 비강 도말 배양을 통해 MRSA의 의료기관 관련 감염 및 지역사회 감염의 빈도와 분자 역학 및 항생제 내성을 연구하였다. 방법: 2006년 6월에서 9월까지 건양대학교 병원 중환자실 환자 353명을 대상으로 입실 첫날 비강 도말 배양을 시행하여 MRSA 획득 위험인자에 따라 HA-MRSA와CA-MRSA로 나누어 Pulsed-Field Gel Electrophorosis(PFGE)로 분류하여 각각의 항생제 내성 검사를 시행하였다. 결과: 353명 중 비강 도말 배양에서 동정된 MRSA는 42명(11.9%)이며, 동정된 MRSA 중 HA-MRSA는 33명(78.6%), CA-MRSA는 9명(21.4%)이다. PFGE에서 type A에서 type K까지 11형으로 구분하였고 HA-MRSA는 type A (n=9), B (n=7)가, CA-MRSA는 type A (n=2), B (n=2)가 주로 나타났다. 항생제 내성률은 erythromycin, ciprofloxacin에서 HA-MRSA가 CA-MRSA보다 높게 나타났다. 결론: MRSA의 집락률은 11.9%이며 HA-MRSA의 균주가 CA-MRSA보다 많고, CA-MRSA는 9예로 적은 예지만 PFGE type에서 대부분의 type이 HA-MRSA에서 동정된 type과 같은 경향을 보여 지역사회전파를 시사한다. Background: Methicillin-resistant Staphylococcus aureus (MRSA) is the most common organism associated with nosocomial infections. MRSA infections are becoming increasing important because they have emerged no only as healthcare-associated (HA) infections but also as community-associated (CA) ones. This study examined the moleculo-epidemiology of MRSA, which was isolated from nasal swabs in the intensive care unit (ICU) at Konyang University Hospital. MRSA are classified into HA-MRSA and CA-MRSA. Methods: From June to September 2006, 353 patients who were admitted to the ICU in Konyang University Hospital were enrolled in this study. Single nasal swabs were obtained for culture in the ICU on the 1st day. Pulsed-field gel electrophoresis and the antimicrobial resistant patterns were analyzed between HA- and CA-MRSA. An antimicrobial sensitivity test was also performed. Results: Forty two strains of MRSA were isolated from 353 patients (11.9%). Among the 42 isolates, HA-MRSA and CA-MRSA were found in 33 (78.6%), and 9 (21.4%), respectively. Eleven different PFGE types (type A to K) were identified. Types A (n=9) and B (n=7) were the most common for HA-MRSA, and types A (n=2) and B (n=2) were identified in CA-MRSA. The proportion of types A and B in CA-MRSA (44.4%) was similar to that in HA-MRSA (48.5%). The rates of resistance rates to erythromycin and ciprofloxacin were higher in HA-MRSA than in CA-MRSA. Conclusion: The rate of isolation of MRSA in an ICU setting was 11.9%. HA-MRSA was isolated more frequently than CA-MRSA. The rate of resistance of HA-MRSA to erythromycin and ciprofloxacin was higher than that of CA-MRSA. Despite the small number of subjects, the main isolates (type A and B) of CA-MRSA were similar to those of HA-MRSA. (Tuberc Respir Dis 2008;65:91-98)
정중법을 이용한 빗장 아래 상완 신경총 차단 환자에서의 0.5% Levobupivacaine과 0.5% Ropivacaine의 비교
조춘규 ( Choon Kyu Cho ),김중연 ( Joong Yeoun Kim ),정성미 ( Sung Mee Jung ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),김철웅 ( Chul Woung Kim ),한정욱 ( Jeong Uk Han ),양춘우 ( Chun Woo Yang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.2
임상연구 : 제왕절개술을 위한 경막외 마취 시 0.5% Levobupivacaine과 0.5% Ropivacaine 비교
양춘우 ( Chun Woo Yang ),정성미 ( Sung Mee Jung ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),류승훈 ( Seung Hun Ryu ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3
Background: Ropivacaine and levobupivacaine, both single S-enantiomers, show less toxicity on the central nervous and cardiovascular system than racemic bupivacaine. Earlier studies have shown that levobupivacaine and bupivacaine are almost equipotent while ropivaciane was 60% less potent than bupivacaine. The aim of this prospective, double blinded study was to compare the clinical efficacy and safety of epidural anesthesia produced by 0.5% levobupivacaine and 0.5% ropivacaine for a cesarean section. Methods: Sixty-two parturients undergoing an elective cesarean section were randomized to receive either epidural levobupivacaine 0.5% 20 ml (n = 31) or epidural ropivacaine 0.5% 20 ml (n = 31). Surgery was commenced when the sensory block had reached the dermatome level, T6. The onset, duration, quality of the sensory and motor block and abdominal muscle relaxation were evaluated. The blood pressure and heart rate of the mother and neonatal outcome, as assessed by the Apgar score and umbilical pH, were also recorded. Results: There was no difference in the onset time, the segmental spread of sensory block and analgesic supplement between the two groups. However, levobupivacaine produced a longer duration of sensory block than ropivacaine (levobupivacaine 224.1 ± 66.6 min, ropivacaine 176.5 ± 32.8 min, P < 0.05). The onset time (except Bromage scale 2), intensity and duration of the motor block and muscle relaxation were similar in both groups. There was no difference in the maternal and neonatal outcomes between the two groups. Conclusions: 0.5% levobupivacaine and 0.5% ropivacaine produced equivalent efficacy and safety in epidural anesthesia for a cesarean section, but levobupivacaine resulted in a longer duration of sensory block. (Korean J Anesthesiol 2007; 52: 284~90)
임상연구 : 슬관절 전치환술 시 경막외강, 슬관절강 및 슬관절 주위 조직에 병용 투여한 Bupivacaine과 Morphine이 술 후 통증에 미치는 영향
최현기 ( Hyun Gee Choi ),김성기 ( Seong Gee Kim ),권성범 ( Seong Bum Kwon ),김종선 ( Jong Sun Kim ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: Epidural opioids and local anesthetics provide excellent postoperative analgesia. In addition, soft tissue and intra-articular injection of bupivacaine and morphine may have a beneficial analgesic effects after total knee arthroplasty (TKA). This study was designed to assess the additional analgesic effect of combined soft tissue, and intra-articular injection of morphine and bupivacaine in patients undergoing TKA under spinal anesthesia with continuous epidural morphine and bupivacaine injection. Methods: Forty patients aged 55 to 75 years for a TKA under spinal anesthesia were randomly divided into 2 groups. The both group of patients received a continuous epidural infusion using a two-day infusor containing morphine 5 mg in 100 ml of 0.125% bupivacaine. The experimental group of patients (n = 20) received soft tissue, and intra-articular injection containing 10 mg morphine in 100 ml bupivacaine 0.125%. The control group of patients (n = 20) received soft tissue, and intra-articular injection of 100 ml normal saline. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 4, 8, 12, 24, and 48 h postoperatively and side effects, such as hypotension, nausea, vomiting, pruritus, and respiratory distress were recorded. Whenever patients demanded supplemental analgesia, diclofenac sodium 75 mg was injected intramuscularly and the need for additional analgesic requirement was recorded. Results: The experimental group of patients had significantly lower pain score and analgesic requirements than the control group for 2 days. There was no difference in the incidence of side effects between groups. Conclusions: Combined soft tissue, and intra-articular injection of morphine and bupivacaine with continuous epidural morphine and bupivacaine infusion reduces postoperative pain and supplementary analgesic requirements than continuous epidural morphine and bupivacaine infusion only in patients undergoing TKA. (Korean J Anesthesiol 2006; 50: 546~51)
슬관절 전치환술 후 슬관절 주위주입과 병용한 지속적 정맥 진통과 지속적 경막외 진통의 비교
박정민 ( Jeong Min Park ),임영수 ( Young Su Lim ),이우석 ( Woo Suk Lee ),구자현 ( Ja Hyun Ku ),강포순 ( Po Soon Kang ),권희욱 ( Hee Uk Kwon ),조춘규 ( Choon Kyu Cho ),정성미 ( Sung Mee Jung ),양춘우 ( Chun Woo Yang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Background: Postoperative continuous intravenous analgesia may not provide effective postoperative analgesia following total knee arthroplasty. This study was conducted to determine if combined continuous intravenous analgesia and peri-articular infiltration provided a better quality of analgesia following total knee arthroplasty than epidural analgesia. Methods: A prospective, double-blind study involving 50 patients who had undergone total knee arthroplasty was conducted. Patients were divided into control group and an experimental group. Patients in the control group (n=25) received peri-articular infiltration with 47 mL normal saline prior to closure of the wound and postoperative epidural analgesia for 48 hours. Patients in the experimental group (n=25) received a mixture of peri-articular infiltration of 16 mL of 0.75% ropivacaine, 6 mg morphine, 0.2 mg of epinephrine and 25 mL normal saline prior to closure of the wound and postoperative continuous intravenous analgesia for 48 hours. The analgesic efficacy was then evaluated using the verbal numeric rating scale at 1, 2, 6, 12, 24, and 48 hours postoperatively. The side effects and the dosage of rescue analgesics were then recorded. Results: The experimental group showed a significantly higher pain score than the control group 2 and, 6 hours postoperatively at rest and 2 hours postoperatively following passive knee movement (P<0.05). In addition, the rescue analgesic requirement was higher for the experimental group during the first 24 hours following surgery than for the control group (P<0.05). Conclusions: We found that combined continuous intravenous analgesia and peri-articular infiltration of a mixture of ropivacaine and, morphine injected into the peri-articular tissue provided minimal benefits for pain control during the early postoperative period when compared to epidural analgesia after total knee arthroplasty. (Korean J Anesthesiol 2009;56:47~53)