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이은호 ( Eun Ho Lee ),신균 ( Kyoon Shin ),김종욱 ( Joung Uk Kim ),박종연 ( Jong Yeon Park ),박룡철 ( Long Zhe Piao ),황규삼 ( Gyu Sam Hwang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
Background: Marked changes in systemic hemodynamics during liver transplantation may lead to changes in cerebral hemodynamics and metabolism. Therefore, continuous monitoring of the jugular venous oxygen saturation (SjvO2) may help the anesthetic management of liver transplantation. Methods: We observed changes in SjvO2 using a double lumen oximetry catheter for continuous monitoring and analyzed the correlation between SjvO2 and hemodynamic measurements in thirty patients undergoing liver transplantation. Results: There were no significant changes in SjvO2 compared to initial SjvO2 during liver transplantation. SjvO2, however, increased from 72.5 to 79.6 % (P < 0.05), before and after reperfusion. There was a weak correlation between changes in SjvO2 and cardiac output (r = 0.38, P < 0.05), whereas no correlation was found among changes in SjvO2 and arterial carbon dioxide tension, mean arterial pressure, central venous pressure, or mixed venous oxygen saturation before and after reperfusion. Conclusions: SjvO2 that reflects changes in cerebral oxygen demand-supply balance was well maintained during liver transplantation except the reperfusion period. Continuous monitoring of changes in SjvO2 at this period may provide further insight to understand physiology of cerebral oxygenation during liver transplantation and merits further studies. (Korean J Anesthesiol 2006; 51: 578~83)
Hydrogen Peroxide로 유도된 산화성 간세포 손상에 대한 Propofol과 Etomidate의 효과
이은호 ( Eun Ho Lee ),신진우 ( Jin Woo Shin ),윤선경 ( Sun Kyung Yoon ),손효정 ( Hyo Jung Son ),이지연 ( Ji Yeon Lee ),구승우 ( Seung Woo Ku ),김종욱 ( Joung Uk Kim ),이유미 ( Yu Mi Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
Background: The present investigation was undertaken to evaluate the protective effect of propofol and etomidate against hydrogen peroxide (H2O2) induced oxidative damage in human hepatic SNU761 cells by measuring lactate dehydrogenase (LDH). Methods: The cell line of human hepatocellular carcinoma was grown for 24 hours in dissociated cell culture. They were divided into eight groups: negative control (NC) group with no drug administration, positive control (PC) group with H2O2 250 μM and other groups pretreated with propofol (P; 1, 10, 50 μM) or etomidate (ET; 1, 10, 50 μM) followed H2O2 administration. After 7 hours, cell death was assessed by morphology under the light microscope and quantified by measuring the LDH in the culture media. Results: In the light microscopic findings, the intact cells were increased in all three propofol groups compared to group PC. H2O2-induced LDH production was also significantly suppressed in all three propofol groups compared to group PC (P<0.001). There were no significant differences in the microscopic findings and LDH production between the etomidate groups and group PC. Conclusions: These results suggest that the propofol has protective effect on the hepatocyte against H2O2-induced oxidative stress. (Korean J Anesthesiol 2009;57:331∼6)
개흉술후 통증 조절을 위한 Fentanyl 의 요부 및 흉부 경막외 주입시 진통 효과의 비교
김종욱,이청,심지연,임정길,정진미,최인철 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2
Background : Epidural analgesia, via either a thoracic or lumbar route, is commonly used to provide postoperative analgesia following thoracotomy for pulmonary resection, but little data indicate which location is better in terms of postoperative analgesia, side effects, or associated complications. Methods : 54 patients, who undergo a lateral thoracotomy, were randomized to receive a mixture of fentanyl and 0.15% bupivacaine at 0.5 g/kg/hr of fentanyl via either a thoracic (Group T) or a lumbar (Group L) catheter. Postoperative pain was assessed 6hrs after the operation and everyday for 5 days on a visual analog scale (VAS). Postoperative side effects and patients satisfaction of epidural analgesia were assessed by 4 grades system. Results : The VAS scores during coughing were higher than those of resting state without intergroup differences. The incidences and severity of side effects (nausea, vomiting, pruritus, sedation) were not different between group T and group L, but the incidence of urinary retention attributable to use of the lumbar epidural route was significantly higher than with the thoracic route (p<0.05). Conclusions : The authors conclude that there is no clinical advantage of thoracic over lumbar epidural fentanyl in the thoracotomy patients with respect to analgesia and incidences of most side effects except urinary retention. (Korean J Anesthesiol 1998; 34: 353∼358)
Epinephrine 의 우발적 과용량 투여 후 발생한 가역적인 심근병증
박평환,김종욱,임민성 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.4
There is increasing tendency to use epinephrine injection or topical application to obtain clear operative field and hemostasis under general anesthesia. But excessive catecholamines due to inadvertent administration are known to cause a wide spectrum of cardiotoxicity. The authors have experienced a case of reversible cardiomyopathy due to accidental epinephrine overdose during mastoidectomy. This report is the first recorded case of the nearly fatal conseguences of inadvertent administration of a very large dose of epinephrine, with the subsequent development of a severe catecholamine induced $quot;cardiomyopathy$quot;. After the initial phase of massive catecholamine excess, this patient required exogenous catecholamines to support the injured, dysfunctional myocardium and maintain adequate perfusion pressure to vital organs. These abnormalities are also transient in nature with complete recovery documented. The case suggests the need for aggressive support of patients received accidental epinephrine overdose with the expectation that, while cardiar. function may be extremely impaired early in the course of the illness, recovery is virtually complete over time.
김남중,장성호,임혜자,채병국,공명훈,김종욱 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.4
Emergency surgical patients are more frequently in critical state than elective patients and they have not enough time for physical and laboratory examinations. The evaluation of perio-perative data will improve the outcome of emergency operation. We analyzed 1053 anesthesias for emergency operation which were performed at the department of anesthesiology, Anam Hospital from September 1992 to August 1993 clinically and statistically according to age, sex, physical status, department, anesthetic duration, method and agent, types of trauma, amount of transfusion, etc. The results were as follows; 1) The percent of emergency surgery cases was 13.6 of total surgical patients. 2) The ratio of male to female was 1.15:1. 3) About 61.1% of all emergency patients were in the 21-40 years age group. 4) According to the ASA classification of physical status, the percent of patients in emergency class 1 and 2 was 86.2 of the total patients. 5) The most common operation was Cesarean section (19.9%), and appendectomy (13.8%) the next. 6) The most common anesthetic method for emergency operation was general anesthesia with enflurane. 7) The obstetric cases were most common and the general surgery cases were the next. 8) The percent of the cases which took less than 2 hours duration was 82.4 of total operation. 9) The transfusion was done in 108 cases (10.3%) and less than 2 units was transfused most frequently. 10) The transference to ICU was done in 144 (13.7%) cases and the patients of general surgery were transfered to ICU most frequently. 11) The majority of injuries were classified as blunt trauma (86.6%) while 13.4% were classified as penetrating trauma. 12) The lagest number of injuries involved the upper extremity (47.8%) and the next was the head & neck (31.9%).
Vecuronium 의 근이완 작용에 대한 Neostigmine 과 Pyridostigmine 의 조기 투여 효과에 대한 비교
이일옥,윤석민,김종욱 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.3
To compare the time course of neostigmine and pyridostigmine antagonism of profound neuromuscular blockade (no-twitch: when no response to peripheral nerve stimulation could be elicited) induced by vecuronium, the authors studied 30 patients who were ASA Physical Status I or II undergoing minor surgery, free from neuromuscular, renal or hepatic dieases. Train-of Four[TOF] stimulation was applied to the ulnar nerve every ISseconds and the force of contraction of adductor pollicis muscle was recorded. In all patients, anesthesia was induced with thiopental sodium(5 mg/kg) and vecuronium (0.1 mg/kg), endotracheal intubation was performed at 100% depression of the T₁(the first response in the train-of-four sequence). Patients were randomly assigned to one of two groups Five minutes after intubation, when there was no detectable twitch response, each patient received either neostigmine(0.03 mg/kg) with atropine sulfate(0.02 mg/kg). Neuromuscular fuction in another ten subjects were allowed to recover spontaneously. The results were as follows; 1) Profound neuromuscular blockade was not rapidly antagonized by either neostigmine or pyridostigmine but the use of anticholinesterase was effeetive for recovery. 2) The results demonstrated that there were no difference in antagonism of vecuronium induced profound neuromuscular block between neostigmine and pyridostigmine. 3) The time to 100% depression of T₁ after vecuronium injection was 190.5±38.7 sec. 4) After anticholinesterase administration, in all groups, the changes of mean arterial pressure and heart rate were within ±10% of control after anticholinesterase dministration were observed.
고양이에서 출혈성 쇽 및 수액소생시 소화관내 산소투여가 소화관 점막 산소화에 미치는 효과
이유미,박평환,김종욱,조삼순 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.4
Background: This study was purposed to study the therapeutic value of intraluminal oxygen insufflation on the oxygenation of gut mucosa in a feline model subjected to a hemorrhagic shock followed by reperfusion. Methods: Eighteen cats were divided into three groups: For group 1, 6 cats were subjected to sham operation as a control group; for group 2, 6 cats were subjected to a hemorrhagic shock for 2 hours prior to reperfusion as a hemorrhagic shock(HS) group; for group 3, 6 cats were subjected to a simultaneous insufflation of intraluminal oxygen, continued during the shock and reperfusion periods as a oxygenated hemorrhagic shock(OHS) group. Mesenteric PvO₂, mesenteric venous arterial(v-a) lactate difference, mesenteric P(v-a)CO₂ and mesenteric pH(a-v) were measured for every 30 minutes during the shock and reperfusion. Results: The lactate(v-a) was increased during the shock. For group OHS, the lactate(v-a) returned to the baseline value after reperfusion, but for group HS, it did not return. The values pH(v-a) and P(v-a)CO. were increased during the shock and returned to the baseline value for group OHS, but for group HS, the increase was greater than group OHS(p$lt;0.05), but not returned to the baseline value after reperfusion. For both pH(v-a) and P(v-a)CO₂, there were statistically significant differences(p$lt;0.05) between group HS and group OHS during the shock and reperfusion. Conclusions: We conclude that the insufflation of intraluminal oxygen improves the oxygenation of gut mucosa in the feline model undergone a hemorrhagic shock followed by reperfusion.