경요도 절제술을 시행받는 환자에서 초음파기를 이용한 폐쇄신경 차단 - 서혜부 주름부위 접근법

길현주 ( Hyun Jue Gill ),전덕희 ( Duk Hee Chun ),백인찬 ( In Chan Baek ),장준흠 ( Jun Heum Jang ),신동욱 ( Dong Wook Shin ),강화자 ( Wha Ja Kang ) 경희대학교 경희의료원 2014 慶熙醫學 Vol.29 No.1

연구배경: 경요도절제술을 시행받을 환자 중에서 초음파기와 신경 자극기를 이용하여 폐쇄신경 차단 을 시행하는 것이 환자에게 안전하고 효과적인지 알 아보고자 한다. 방법: 척추 마취하 경요도절제술을 시행 받는 26 명의 환자들에게 초음파기와 신경 자극기를 사용하 여 폐쇄신경 차단을 시행하였다. 초음파로 해부학적 구조를 확인하고 근수축 확인 후 1% lidocaine 10 ml 를 폐쇄신경의 anterior와 posterior branch에 각각 투 여하였다. 초음파기를 이용하여 해부학적 위치감별 에 걸리는 시간, 전체 신경차단에 걸리는 시간, 바늘 깊이, 수술 중 근수축의 정도, 실패율, 합병증등을 평가하였다. 결과: 초음파기를 이용하여 fascial plane을 감별하 는 데 걸리는 시간은 21±14.9초, 폐쇄신경의 anterior branch와 posterior branch를 확인하는 데 걸리는 시간 은 각각 39.6±27.4와 24.3±11.7초였으며 전체 신경차 단에 걸리는 시간은 174±65.1초, 바늘 깊이는 anterior branch가 4.8±0.8 cm, posterior branch가 6.2±1.1 cm였 다. 실패율은 anterior branch가 2/26 (7.7%), posterior branch가 7/26 (26.9%)이었다. Grade 1의 근수축은 22/26 (84.7%)에서 나타났으며 폐쇄신경술의 성공률 은 23/26 (88.5%)이었다. 결론: 서혜부 위치에서 초음파로 신경의 위치를 확인하는 방법은 쉬우나 초음파와 신경 자극기를 사 용한 폐쇄신경 차단술의 성공률은 큰 차이가 없었다.

실험연구 : Methylmethacrylate Monomer의 흰쥐 기관 평활근 이완 효과

길현주 ( Hyun Jue Gill ),이정은 ( Jung Un Lee ),김윤희 ( Yoon Hee Kim ),양현정 ( Hyun Jung Yang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2

Background: Methylmethacrylate monomer (MN) bone cement is commonly employed in orthopedic procedures, particularly total hip and knee replacement, to anchor prosthetic devices to bone. Numerous cardiopulmonary complications can occur just after injection of MN. And MN produces direct relaxation of vascular smooth muscle in vitro. The purpose of this study was to determine if MN could have relaxation effect in tracheal smooth muscle too. Methods: Each ring of rat trachea was suspended on wire supports in a bath with Tris Tyrode solution. Dose response curves of MN were recorded after contraction of tracheal ring with acethylcholine (Ach) 10-5 M or cabachol (Cch) 10-8 M. MN was administered in denuded tracheal rings and compared it`s effect with intact tracheal rings to see the effect of epithelium for contraction. And MN dose response curves were recorded after pretreatment of nitric oxide synthase inactivator (L-NAME), muscarinic receptor blocker (atropine), beta-adrenaline receptor blocker (propranolol), adenylyl cyclase inhibitor (SQ22536) respectively. The effects of MN on cellular Ca2+ and K+ migration in rat tracheal preparations were studied. Results: MN significantly inhibited acetylcholine or carbachol induced contractions of tracheal rings dose-dependently (P < 0.05). This relaxation effect of MN was not recovered in denuded tracheal rings. And pretreatment with L-NAME, propranolol, atropine, SQ22536 or tetraethylammonium respectively did not recover the relaxation effect of MN. MN inhibited both intracellular calcium release and extracelluar calcium influx. Conclusions: The relaxation effects of MN on rat tracheal rings are not related with epithelium, nitric oxide, muscarinic, or beta-adrenergic receptor. Methylmethacrylate monomer inhibits both intracellular calcium release and extracelluar calcium influx. (Korean J Anesthesiol 2007; 52: 194~201)

임상연구 : 서혜부 탈장 환아에서 Sevoflurane 마취 후 각성 흥분: Thiopental Sodium, Propofol과 Ketamine 마취 유도의 비교

김욱종 ( Wook Jong Kim ),길현주 ( Hyun Jue Gill ),김용찬 ( Yong Chan Kim ),이종연 ( Jong Youn Lee ),정금희 ( Kum Hee Chung ),이상우 ( Sang Woo Lee ),손석우 ( Suk Woo Son ),신용섭 ( Yong Sup Shin ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6

Background: This study compared the incidence of emergence agitation and the recovery profile from sevoflurane anesthesia after thiopental sodium, propofol or ketamine induction in pediatric inguinal herniorrhaphy. Methods: Forty eight children aged 1-7 years undergoing high ligation due to an inguinal hernia were examined. All patients received a 0.004 mg/kg glycopyrrolate injection for premedication prior to induction and were randomly assigned to receive thiopental sodium 5 mg/kg (Group T, n = 16), propofol 2 mg/kg (Group P, n = 16) or ketamine 1 mg/kg (Group K, n = 16) for induction. The side effects during the induction time were checked. All patients received sevoflurane (2-2.5 vol%)-N2O (2 L/min)-O2 (2 L/min) for the maintenance of anesthesia. Ventilation was given to assist spontaneous ventilation using a facial mask. The agitation score, pain score, discharge score, incidence of emergence agitation and postoperative side effects in the three groups were assessed at the recovery room and compared. Results: The emergence time in Group T (7.5 ± 1.8 min) was significantly rapid. The agitation and pain scores were significantly low in Group P. The discharge score was more rapid in Groups P and K than in Group T. The incidence of emergence agitation was similar in all three groups. Conclusions: Although recovery was faster and emergence agitation was low in the propofol group, propofol induction was not smooth compared with thiopental or ketamine induction. The incidence of emergence agitation after sevoflurane anesthesia in pediatric inguinal herniorrhaphy was similar in the thiopental sodium, propofol or ketamine induction groups. (Korean J Anesthesiol 2006; 50: 616~22)

증례보고 : 베타 수용체 차단제와 칼슘 통로 차단제를 복용 중인 환자에서 상완신경총 차단 후 지연 발생한 심정지

이종연 ( Jong Yeon Lee ),이형석 ( Hyung Suk Lee ),박사현 ( Sa Hyun Park ),길현주 ( Hyun Jue Gill ),이상우 ( Sang Woo Lee ),김승호 ( Seung Ho Kim ),정금희 ( Kuem Hee Chung ),김민성 ( Min Sung Kim ),이헌락 ( Heon Rak Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6

A Bezold-Jarisch reflex (BJR) mediated vasovagal syncope is the most common neurally mediated reflex characterized by the sudden failure of the autonomic nervous system and have been reported in patients undergoing a peripheral nerve block. The concomitant administration of a β-adrenoreceptor antagonist and calcium channel blocker have a synergistic suppressant effect on the autonomic nervous system and interact with the anesthetics significantly. We report a case of a 57-year-old female patient with essential hypertension controlled with lercanidipine and carvedilol. Cardiac arrest developed with spontaneous respiration 50 min after the brachial plexus block to remove a plate in the humerus. Epinephrine was administered and the pulse immediately returned to a normal sinus rhythm. This event might be vasovagal syncope mediated by BJR, and realted to the antihypertensive medication used. (Korean J Anesthesiol 2006; 51: 752~5)

임상연구 : 사각근간 차단 시 찌름점에서 상완신경총과 6-7번 경추간공까지의 깊이 및 각도

권경석 ( Kyoung Seok Kweon ),양현정 ( Hyeon Jeong Yang ),길현주 ( Hyun Jue Gill ),설정호 ( Jung Ho Seol ),김지형 ( Ji Hyoung Kim ),이종연 ( Jong Yeon Lee ),김민구 ( Min Ku Kim ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5

Background: The angle and depth from the insertion point to the brachial plexus (BP) and C6-7 intervertebral foramen (IF) was examined to prevent critical complications of an interscalene brachial plexus block (ISBPB), such as an epidural or subdural injection of local anesthetics and spinal cord injury. Methods: Thirty patients (female=12, male=18), aged 20-64 years, undergoing shoulder or upper limb surgery were examined. ISBPB was performed at the interscalene groove intersecting the extended transverse line from the cricoid cartilage. A needle was then advanced towards the C6 transverse process (TP) and C6-7 IF under the C-arm fluoroscopic guidance. The depth and angle of the needle path intersecting the sagittal plane from the skin insertion point to BP, transverse process (TP) and IF were measured. Results: The mean depth of the needle from the insertion point to BP, TP and IF were 2.6±0.3 cm, 3.2±0.4 cm, 3.7±0.3 cm in the female patients, and 2.7±0.3 cm, 3.6±0.5 cm, 4.1±0.3 cm in the male patients. The mean angle of the needle path at the same point was 56.0±7.2° (range, 42.0-65.0°), 54.2±5.8°, 53.7±4.4° in the female patients, and 59.3±8.3° (45.0-75.0°), 54.0±6.3°, 54.9±4.2° in male patients. There were significant differences in the depth from the skinto the TP and IF between males and females. Conclusions: These findings are expected to provide a guideline for more accurate needle placement and successful block during ISBPB. (Korean J Anesthesiol 2008;55:570~4)

증례보고 : 마취 유도 중 발견된 호기밸브 오작동

양현정 ( Hyeon Jeong Yang ),송지은 ( Ji Eun Song ),이종연 ( Jong Yeon Lee ),김민구 ( Min Ku Kim ),길현주 ( Hyun Jue Gill ),박정현 ( Jung Hyun Park ),정금희 ( Kuem Hee Chung ),김승호 ( Seung Ho Kim ),이상우 ( Sang Woo Lee ),유찬기 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6

The malfunction of an expiratory unidirectional valve (EV) can cause rebreath of expired gas, barotraumas, or ventilatory failure during the general anesthesia. The following is a report on a case of ventilatoryfailure caused by an EV that failed to open during the induction of anesthesia. A 57-year-old man was scheduled for the biopsy of a vocal cord polyp. After intubation, we could not detect the evidence of ventilation through the endotracheal tube. Suspecting the esophageal intubation, we administered extubation. The patient was still having difficulty in ventilating even after a retrial of intubation. Then we discovered the EV was failing to open properly with ventilation and thus not able to function properly. The common cause of ventilatory failure immediately after intubation is malposition of an endotracheal tube, like esophageal intubation, and equipment failure also has reported. Accordingly, we should remember possible causes of ventilatory failure after intubations and routine conscientious inspection of the ventilator. (Korean J Anesthesiol 2007; 53: 774∼7)

Wolff-Parkinson-White 증후군 환자의 마취경험

박광원,김원옥,길현주 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.6

Since it was first described in 1930 by Wolff, Parkinson and White (W-P-W), the W-P-W syndrome, in its clinical significance, is the occurrence of tachyarrythmia by accessory conduction which may result in chest pain, hypotesion, congestive failure, syncope or sudden death. It still remains one of the most difficult cardiac arrythinias to treat. We experience the successful anesthetic management of 10 patients with W-P-W syndrome for non-cardiac and cardiac surgery from January, 1971 to April, 1987 at Severance hospital. With adequate preoperative management, in spite of their syndrome, all 10 patients tolerated general anesthesia fairly well, and we did not notice any significant changes in their vital signs during the perioperative period, Among the 10 patients, one recently experienced serious case is presented. In the selection of drugs for general anesthesia in cases of W-P-W syndrome, careful consideration should be given to all drugs which affect the conduction system of the heart.

소아 서혜부 탈장교정술시 미추마취와 전신마취의 임상고찰

김종우,정금희,길현주 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.2

Background : Caudal block has proved to be a satisfactory method of providing perioperative analgesia for pediatric surgery in the inguinal and perineal areas. The object of this study was to compare the general (n=55) with caudal anesthesia (n=41) in pediatric inguinal herniorrhaphy during surgery and postoperative 24 hours in their changes of behaviors in the recovery room, and other complications. Methods : Ninety six children who underwent to inguinal herniorrhaphy were devided into two groups. Group I was given general anesthesia as usual methods using endotracheal intubation. Group II was given caudal block using 1% lidocaine 1 ml/kg or 0.25% bupivacaine 1 ml/kg, or a mixture of both of them at the ratio of 1:1, 1 ml/kg. All caudal blocks were carried out in left lateral position after ketamine 1∼1.5 mg/kg intravenous injection. The side effects during and after operation and postoperative behavior in the recovery room, neurologic complications and postoperative fever incidence were observed and comped with the two groups. Results : In group I (n=55), 13 cases (23.6%) showed hoarseness after extubation. 78.2% of 55 patients were irritable and cryng in the recovery room. Postoperative fever incidence was over 69%. In group II (n=41), almost all patients were calm and stayed quiet in the recovery room. However there were 3 cases of bradycardia and 2 cases of hypotension during operation. Postoperative complications were rare and the mumber of patients with fever was 36.6% which was significantly low compared to group I. Conclusions : As the results of this study, we report that caudal anesthesia is a safe, simple practical method with few complications for inguinal herniorraphy in children compared with general anesthesia. We also recommend that the caudal block can be used safely in pediatric outpatient surgery. (Korean J Anesthesiol 1999; 36: 244∼249)

상하복부 암성통증에 대한 복강신경총 및 요부교감신경절 차단 : 7예 보고

오흥근,윤덕미,길현주,이예철 대한통증학회 1988 The Korean Journal of Pain Vol.1 No.2

It is well known that the celiac plexus block is specially useful for relieve intractable upper abdominal pain caused by upper abdominal visceral malignancy or upper abdominal metastasis from distant organs. But in cases of lower abdominal or pelvic metastasis from upper abdominal malig- nancy, the lower abdominal intractable pain is remained after the successful celiac plexus block. We have reported 7 cases of celiac plexus block combined with lumbar sympathetic ganglion block, among the 305 cases of the celiac plexus block from 1968 to Nov. 1987, performed in patients with lower abdominal or back pain due to carcinomatosis of lower abdominal metastatic malignancy, that their results were excellent for pain relief.

갑상선절제술 환자에서 Ondansetron, Droperidol 혹은 두 약제의 혼합 투여가 술후 오심, 구토에 미치는 영향

이숙영,김진수,이영석,길현주,최민협,한상건,소의영 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.5

Background : Thyroidectomy has been a surgical procedure associated with a high incidence of postoperative nausea and vomiting (PONV), and conventional antiemetics cannot prevent PONV effectively. In this study, we compared the efficacy and safety of ondansetron 70μg/kg, droperidol 10μg/kg and combination of both drugs to placebo in the prevention of PONV. Methods : Seventy-six patients undergoing thyroidectomy were randomized to receive placebo (Group I, n=20), ondansetron 70μg/kg (Group II, n=19), droperidol 10μg/kg (Group III, n=18) and combination of both drugs (Group IV, n=19). The effects of these regimens on the incidence and severity of PONV and adverse events were analyzed for the 0 to 1 hour and 1 to 24 hours postoperative periods. Results : In the 0 to 1 hour postoperative periods, the incidence of symptom free (no nausea and retching or vomiting) paients were 60% for placebo, 68.4% for ondansetron (p>0.05 versus placebo group), 88.9% for droperidol (p<0.05 versus placebo group), and 94.7% foination of both drugs (p<0.05 versus placebo and ondansetron group). In the 1 to 24 hours postoperative period, the incidence of symptom free patients were 35% for placebo, 52.6% for ondansetron (p>0.05 versus placebo group), 77.8% for droperidol (p<0.05 versus placebo group), and 78.9% for combination of both drugs (p<0.05 versus placebo group). Overall, during the first 24 hours postoperatively, the incidence of symptom free patients were 30% for placebo, 42.1% for ondansetron (p>0.05 versus placebo group), 77.8% for droperidol (p<0.05 versus placebo and ondansetron group), and 73.7% for combination of both drugs (p<0.05 versus placebo and ondansetron group). Also, there were no significant differences between the droperidol and droperidol plus ondansetron group. Among the side effects associated with antiemetics, headache and dizziness incidence was higher. Conclusions : Droperidol and combination of ondansetron plus droperidol was superior to placebo, and ondansetron for prevention of PONV during tt 24 hours postoperative period. (Korean J Anesthesiol 1999; 36: 834∼840)