임상연구 : 부위마취 시 Alprazolam에 의한 수술 전 스트레스 반응의 감소

최재찬 ( Jae Chan Choi ),박상규 ( Sang Kyu Park ),김순열 ( Soon Yul Kim ),윤여승 ( Yeo Seung Yoon ),이광호 ( Kwang Ho Lee ),이영복 ( Young Bok Lee ),임현교 ( Hyun Kyo Lim ),박종태 ( Jong Taek Park ),이지연 ( Ji Yeon Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2

Background: Preoperative anxiety activates the hypothalamo-pituitary-adrenal axis and the sympathetic nervous system, and also affects immune responses. Therefore, there is a need to reduce the anxiety. Methods: Forty-eight healthy patients scheduled for elective knee arthroscopic and reconstructive surgery under spinal anesthesia (SA) were randomly allocated into the control (CG, n = 24) and the alprazolam group (AG, n = 24). Oral 0.25 mg alprazolam in the evening before SA and 0.5 mg alprazolam 90 min before SA were administered to patients of the AG. Visual analogue scale (VAS) scores of anxiety were measured in the operating room before SA (ORSA) and operating room during operation and discharge day (DD). Serum ACTH and cortisol in the ORSA and DD, systolic and diastolic blood pressure and heart rate in the ward and ORSA, sleep time and number of night awakenings in the night before SA were measured. Results: Age (31.9 ± 10.8 yr), sex, height, weight, and sleep time were not significantly different between the two groups. The number of night awakenings in the AG were significantly lower than in the CG. VAS scores of anxiety in the ORSA were significantly higher in the CG than in the AG. ACTH and cortisol levels in the CG were significantly higher in the ORSA than in the DD. ACTH and cortisol levels in the AG were not significantly different between the ORSA and the DD. Cortisol level in the ORSA were significantly lower in the AG than in the CG. Diastolic blood pressure and heart rate in the ORSA were significantly lower in the AG than in the CG. Conclusions: These indicate that oral alprazolam attenuates preoperative stress responses to regional anesthesia. (Korean J Anesthesiol 2007; 52: 132~7)

실험연구 : 생쥐(Mice)에서 하지무부하가 심혈관계 기능에 미치는 영향

이영복 ( Young Bok Lee ),박종택 ( Jong Taek Park ),임현교 ( Hyun Kyo Lim ),최재찬 ( Jae Chan Choi ),김순열 ( Soon Yul Kim ),조준현 ( Jun Hyun Cho ),이광호 ( Kwang Ho Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2

Background: Orthostatic intolerance is a debilitating problem that can occur after prolonged bed-rest, exposure to microgravity, and in the elderly. This study examined the integrated cardiovascular response to baroreceptor activation in a hind-limb unweighing (HLU) mouse model of microgravity to test the hypothesis that both the pressor and contractility response are attenuated in HLU mice. Methods: C57BL/6 mice (25-30 g body wt, 8-10 wk old) were exposed to HLU for 2 weeks. A bilateral carotid artery occlusion and open-loop baroreceptor stimulus was performed to measure the myocardial contractile responses using a left ventricular micromanometer-conductance catheter in the mice. In isolated myocytes simultaneous sarcomere shortening and calcium transient were measured in response to increasing concentrations of the β-agonist isoproterenol. Results: In the controls, bilateral carotid artery occlusion increased the heart rate and mean arterial pressure. These responses were markedly attenuated in the HLU mice. A bilateral carotid artery occlusion also increased the slope of the end-systolic pressure volume relationship (Ees) by 70 ± 11% and the slope was markedly attenuated to 10 ± 8% in the HLU mice. Isoproterenol increased the sarcomere shortening in both control and HLU mice in a dose-dependent manner. However the contractile response to isoproterenol was significantly attenuated in the HLU mice than the controls. Conclusions: Both the pressor and myocardial contractile responses appear to be impaired in a mouse model of microgravity. (Korean J Anesthesiol 2007; 53: 222~8)

Doxapram Hydrochloride가 Desflurane 마취 후 각성과 Bispectral (BIS) Index에 미치는 영향

박종택 ( Jong Taek Park ),이영복 ( Young Bok Lee ),임현교 ( Hyun Kyo Lim ),최재찬 ( Jae Chan Choi ),김순열 ( Soon Yul Kim ),전자연 ( Ja Youn Jeon ),이광호 ( Kwang Ho Lee ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.54 No.1

실험연구 : 백서에서 심폐우회로 후 Nitric Oxide에 대한 대동맥의 반응

최재찬 ( Jae Chan Choi ),이영복 ( Young Bok Lee ),임현교 ( Hyun Kyo Lim ),박종택 ( Jong Taek Park ),이광호 ( Kwang Ho Lee ),김재명 ( Jae Myoung Kim ),김순열 ( Soon Yul Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4

Background: We evaluated whether vessel reactivity to nitric oxide changed after cardiopulmonary bypass, which would play an inportant role in temporary vital organ perfusion. Methods: We used the distal aortas of five rats weighing 400-500 g after cardiopulmonary bypass in experimental group. We also used the distal aortas of five rats before cardiopulmonary bypass under sham operation in control group. All cumulative concentration-effect curves were performed in the aortic rings and EC50 and maximal response (Emax) were calculated by using nonlineal logistic regression analysis with the software PRISM (Graphpad, Mountain View, CA). Results: CPB inhibited acetylcholine induced relaxation in aortic rings and also inhibited sodium nitroprusside (SNP) induced relaxation in ones. It was similar to depression of acetylcholine induced relaxation. Conclusions: The depression of aortic rings relaxation after CPB may be associated with attenuated sensitivity of them to NO in rats. (Korean J Anesthesiol 2006; 51: 463~7)

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)

고양이에서 Galactosamine 에 의한 급성간부전이 Mivacurium의 근이완 작용에 미치는 영향

김순열,임현교,윤경봉,김천경 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2

Background: Though the mivacurium is the short acting nondepolarizing neuromuscular blocking agent, the action duration of it is not prospected in condition of hepatic failure owing to its being metabolized by serum cholinesterase and other esterase produced in liver. The purpose of this study is to evaluate neuromuscular effect of the mivacurium in cats with acute hepatic failure. Methods: Six cats administrated only mivacurium are the control group, and six cats with acute hepatic failure by galactosamine hydrochloride are the experimental group. The force of the anterior tibialis muscle in response to supramaximal common peroneal nerve stimulations were recorded, the time intervals from mivacurium administration to attain 100% twitch depression (onset time), from mivacurium administration to recovery of 25% twitch tension(duration) and from 25% to 75% of twitch recovery (recovery index) were compared between the control group and the experimental group. Results: In experimental group, SGOT and SGPT prior to administration of galatosamine were 28.8±5.6(IU/L) and 43.0±7.9(IU/L), respectively, SGOT and SGPT in acute hepatic failure were 5004.0±8113.2(IU/L) and 3763.0±5416.4(IU/L), respectively, and there were significant differences between the control group and the experimental group. The action duration{47.6±18.0(min)} and the recovery time{7.7±3.7(min)} of mivacurium in the experimental group were more prolonged than the action duration{21.9±5.0(min)} and the recovery time{4.4±0.7(min)} of mivacurium in the control group. Conclusions: These results indicate that the hepatic failure can prolong the action duration and the recovery index of mivacurium, but the other factors affecting the action of mivacurium must be studied. (Korean J Anesthesiol 1998; 34: 266∼272)

일측폐 환기시 고빈도 제트환기와 호기말양압이 동맥혈 산소화에 미치는 효과

이영복,김순열,임현교,박정심 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.1

Background : Hypoxemia during one lung ventilation(OLV) may occur in spite of high inspired oxygen concentration. The purpose of this study was to evaluate the effect of highfrequency jet ventilation(HFJV) alone to the non-ventilated lung or in combination with 5 cmH2O of positive end expiratory pressure(PEEP) to the ventilated lung on arterial oxygenation(PaO2) during OLV for thoracic surgery. Methods : After endotracheal intubation with double lumen tube, arterial blood gases were measured 20 minutes after stabilization had occurred following onset of OLV, HFJV, and HFJV with 5 cmH2O of PEEP. Result : The mean PaO2 during OLV was 257.5±81.7 mmHg, and application of HFJV alone or with PEEP resulted in a significant increase in PaO2 to 356.6±79.1 mmHg and 354.9±66.6 mmHg, respectively(P<0.001). Alveolar-arterial oxygen differences were significantly decreased as compared to OLV. Conclusion : Both HFJV alone or in combination with 5cmH2O of PEEP are effective to improve oxygenation during OLV. (Korean J Anesthesiol 1998; 34: 103∼107)

한국인에서 신장(Height)과 제 6 경추 횡돌기에서 성상신경절 및 제 2 흉부교감신경절 간격과의 상관관계에 관한 고찰

이영복,김순열,윤경봉,우혜용 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.5

Background: To obtain optimal results with stellate ganglion block, it is necessary to have a precise knowledge of the exact location of the stellate ganglion and its relationship to the upper thoracic and lower cervical ganglia, in the procedure, the landmark is C6 transverse process, and the drugs for sympathetic block is injected into it. Methods: We attempted to show the correlation between the height and the distance from C6 transverse process to stellate ganglion and T2 sympathetic ganglion, and respective means and standard deviations in 10 cadavers to estimate whether the height can be used as one of the factors to decide injection dosage for stellate ganglion block, or not. Results: The mean of height was 161.20 5.89 cm and the mean of the distance from left C6 transverse process to T2 sympathetic ganglion was 44.88 6.76, the mean of the distance from right C6 transverse process to stellate ganglion was 40.73 7.47 mm, and the correlation coefficient and regression equation were 0.29 and y=0.38 20.55, respectively, the mean of the distance from left C6 transverse process to T2 sympathetic ganglion was 65.02 11.12 mm, and the correlation coefficient and regression equation were 0.75 and y=1.42 164.01, respectively, the mean of the distance from right C6 transverse process to T2 sympathetic ganglion was 61.38 9.20 mm, and the correlation coefficient and regression equation were 0.74 and y=1.16 125.88, respectively. Conclusions: It is concluded that we can used the height as one of effective factors to decide drug dosage for stellate ganglion block in Korean. (Korean J Anesthesiol 1997; 32: 693∼700)

기관지식도루 수술 중 발견된 이중관 기관지 튜브에 의한 기관 파열

임공빈,김순열,윤경봉,채윤정,임현교 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.3

Tracheobronchial rupture following tracheal intubation with double-lumen endobronchial tube (DLT) is a rare complication, but may result in a massive air leakage with resultant pneumothorax, mediastinal emphysema and extensive subcutaneous emphysema in the postoperative period. We report a case of sustained laceration of the posterior membranous part of the trachea possibly due to overinflation of the double-lumen endobronchial tube. A 76-year-old, 45 kg, female was scheduled for a repair of her bronchopleural fistula. Following induction of anesthesia, intubation was performed with Robertshaw's DLT, and a tracheal cuff was inflated with 6 ml of air, but the sound of an air leak was heard coming from the patient's mouth during controlled ventilation. A further 5 ml of air was added 1 ml at a time into the tracheal cuff but the air leak sound continued. At that point, the sound was considered to originate from the bronchopleural fistula rather than from lack of sufficient air. After a thorough deflation of the tracheal cuff, 6 ml of air was reinjected and the operation was resumed. A 4 cm split was unexpectedly noticed in the posterior wall of the trachea during the operation and was repaired without complication. (Korean J Anesthesiol 1999; 37: 527∼529)

소아 일반외과 외래환자 마취(小兒 一般外科 外來患者 麻醉)의 임상적 평가(臨床的 評價)

신양식,김종래,홍정,심재선,김순열,남용택,황의호 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.4

This retrospecitve review covers our experience with outpatient anesthesia for pediatric general surgery in 2404 children, including both sexes up the age of 15 years over five years from Jan.1. 1986 to Dec.31. 1990. Except in 1990(27.1%), there was no significant difference in outpatients showing an annual average of 11.7% with the respect to the total pediatric ageneral surgical patients. Seventy-four percent of the patients including the youngest at 3 months were under 10 years of age. As anticholinergics, glycopyrrolate or atropine were injected intramuscularly into the children, 47 and 9 percent, respectively. Thiopental, ketamine or diazepam (42,15 or 1.8 percent respectively) were adminstered intravenously for sedation only at the immediate preanesthetic period. No sedative was given to forty-two percent of the children. In ninty-eight percent of the patients, general anesthesia was done and the most common inhalation anesthetic was halothane(65%). Succinylcholine ws administered to facilitate the endotracheal intubation to 97% of the patients, but vecuronium or pancuronium. were given to one or three percent of the patients, respectively, strictly for surgical manupulation. Excision of neck mass, incision & drainage of abscess and inguinal hernioplasty were indicated in 75% of the patients. In 1990 eighty-seven patients of the 141 total outpatient pediatric general surgery patients involved inguinal hernioplasty. The duration of operation and stay in the recovery room were about one hour. No complication was found. We believe that, from both medical and patient-parent viewpoints, the aims of ambulatory anesthesia in pediatrics are achieved by the standardization. and organization. Patients safety in anesthetic techniques of outpatient anesthesia is not only possible but also desirable in modern anesthesia.