전신 마취 중 심박동변이도와 맥파전달시간 변화의 비교

백승완,김태균,김재형,전계록,예수영,Baik, Seong-Wan,Kim, Tae-Kyun,Kim, Jae-Hyung,Jeon, Gye-Rok,Ye, Soo-Young 한국전기전자재료학회 2008 전기전자재료학회논문지 Vol.21 No.8

Autonomic nervous system of the anesthetized patients can be influenced by the many kinds of stimulations such as intubation, surgical incision and so on. The changes of the heart rates and blood pressures are surrogates of responses of the autonomic system to the external stimulations. Recently, the power spectral analysis of the heart rate variability (HRV) made it easy to know the fractions and changes of sympathetic and parasympathetic autonomic systems. In this study, the changes of pulse transit time, one of the response of vessels to stimulations, was investigated in relation to the HRV. Ten patients were examined and average age is 22.5 $\pm$ 11.04, average weight is 63 $\pm$ 14.4 kg. The patients were anesthetized only by sevoflurane inhalation. Pulse transit time is determined by calculating the difference of the time between the R peak of ECG and the characteristic point of the plethysmography. Power spectral density (PSD) of the HRV was achieved in the frequency of 0.04-0.15 (LF) and 0.15-0.4 (HF). Compared to preanesthetic period the values of LF and LF/HF ratio of HRV were decreased (p<0.05). HF and PTT was increased in anesthetic state with sevoflurane. Otherwise, after intubation, the HF was decreased and LF, LF/HF ratio and PTT were increased. PSD of the HRV is well-known for the index of the autonomic nervous activity. Not only HRV but PTT analysis also is a useful index reflecting the autonomic responses to various stimulations. And this analysis is useful in bed side monitoring because the calculating method is simple and it takes shorter processing time compared to the HRV analysis.

전신 마취 중 전력스펙트럼 분석을 이용한 마취심도 파라미터 개발

백승완,예수영,박준모,전계록,Baik, Seong-Wan,Ye, Soo-Young,Park, Jun-Mo,Jeon, Gye-Rok 한국전기전자재료학회 2009 전기전자재료학회논문지 Vol.22 No.6

In this paper, new parameters were developed to estimate the depth of anesthesia during a general anesthesia using EEG. Power spectral density(PSD) analysis was used for these parameters because EEG became slow wave during anesthesia. The new parameters were DTR, ATR, TDR, ADR, BTR and BDR applied to PSD. These parameters were compared with SEF which is conventionally used at clinic and confirmed clinical value. As the results, DTR, ATR, TDR, ADR among parameters were not useful compared with SEF but BTR and BDR is valuable for clinic. 15 patents, at pre-operation BDR the value is $265.36{\pm}25.29$, at induction the value is $129.23{\pm}34.92$, at operation the value is $154.99{\pm}38.34$, at awaked the value is $283.83{\pm}39.80$ and at post-operation the value is $234.80{\pm}23.46$. Also at pre-operation BTR value is $183.38{\pm}13.59$, at induction the value is $104.09{\pm}25.11$, at operation the value is $115.38{\pm}23.42$, at awaked the value is $190.33{\pm}23.31$ and at post-operation the value is $172.38{\pm}19.08$. Trend of BDR and BTR is similar to change of SEF, so two parameters are useful. to estimate the depth of anesthesia.

주기별 맥동파형의 절흔점 위치변화 특성을 이용한 혈압 추정

백승완 ( Seong Wan Baik ),박성민 ( Sung Min Park ),손정만 ( Jung Man Shon ),박근철 ( Geun Chul Park ),이상훈 ( Sang Hoon Lee ),장우영 ( Woo Young Jang ),전아영 ( Ah Young Jeon ),전계록 ( Gyerok Jeon ) 한국센서학회 2013 센서학회지 Vol.22 No.2

In the study, novel blood pressure estimation method was proposed to improve the accuracy of oscillometric method. The proposed algorithm estimated the blood pressure by comparing and analyzing the point variation aspect of dicrotic notch on pulsating waveform during each cardiac cycle. The waveforms of each cardiac cycle were extracted by maximum points. The extracted pulsating waveforms were applied by re-sampling, end-matching, and normalization. The systolic and diastolic blood pressures were estimated by point variation aspect of dicrotic notch. The blood pressures, which were estimated from proposed algorithm, were compared and analyzed by blood pressures from oscillometric methods and auscultation. The systolic blood pressure from oscillometric methods were +0.88 mmHg more than proposed algorithm, and 1.875 less than the diastolic blood pressures from proposed algorithm. The systolic and diastolic blood pressures from auscultation were 2.89 mmHg and 3.44 mmHg less than the blood pressures from proposed algorithm. As the errors between blood pressures from proposed algorithm, oscillometric method and auscultation were less than 5 mmHg, the proposed algorithm was effective.

종설 : 마취심도의 측정

백승완 ( Seong Wan Baik ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3

마취 심도는 자극과 반응 및 마취제의 효과처 농도 등이 보정된 상태에서 일정한 자극에 대한 반응의 확률로 표현할 수 있다. 마취의 구성 요소는 여러 가지가 있으며 간략히 그 본질적인 면에서 본다면 최면과 진통으로 요약할 수 있다. 마취유지는 어느 한 쪽만으로는 이루어질 수 없다. 즉 깊은 최면상태만으로는 심한 자극에 대한 반응을 막을 수 없고, 다량의 진통제 단독으로 무의식을 보장할 수 없다. 따라서 마취는 동시에 둘을 만족시키며 두 요건의 충족 정도를 정량화하는 감시도 이루어져야 할 것이다. 현재까지는 하나의 방법으로 모든 마취 약제에 대하여 마취심도를 측정하는 것은 아직 불가능하다고 할 수 있다. 따라서 현재까지는 적어도 둘 이상의 감시 방법을 사용하는 것이 보다 정확한 마취심도를 측정하는 BIS나 엔트로피는 최면 진정상태와 관계가 있고 진통작용에 대한 유효한 전기 생리학적인 평가 방법으로 현재까지는 HRV 등이 알려져 있다. 그러나 이러한 감시 장치나 기법들은 엄밀히 말하면 의식과 통증을 직접 측정한 것이 아니라 그 부산물인 EEG나 생리적 신호를 보기 쉽게 가공 처리한 것이며 최면, 진통제 이외의 부가적인 마취제들이 마취심도에 미치는 영향에 대한 이해가 아직 부족하여 마취의 깊이를 정확히 측정한 다는 것은 쉬운 일이 아니다. 또한 자극에 대한 다양한 반응, 이를테면 염증성 반응, 호르몬성 반응, 신경 생리적 반응, 정신적 반응 등이 마취 심도에 미치는 영향에 대한 이해가 부족한 상태이다. 따라서 마취 심도를 정확히 평가하기 위해서는 분석 도구들의 발전과 보다 깊은 과학적인 이해가 필요하다.

암성통증환자의 통증완하법과 실태에 대한 연구

백승완(Seong Wan Baik),변병호(Byeung Ho Byeun),채 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.2

N/A Pain is one of the most frequent and disturbing symptom of cancer patients. And almost of cancer patients are afraid of a attacks of pain related to cancer. Caring for the cancer patient can be divided into two phases. The phase of active treatment involves various interventions-surgical, chemical or radiological- that are designed to prolong the patient's life. Terminal care is the period from the end of active treatment until the patient's death. But in the majority of clinical settings, cancer pain is not being managed adequately results from a lack of education about how to treat the cancer pain management in the safest and most effective way during terminal phase,. Althought organic factors represent the most important cause of their pain, it is also important to deal with the patient's psychological reactions and to take account of his or her social and family environment if treatment for chronic cancer pain is to prove adequate. Thus we try to evaluate a kinds of cancer related to pain, degree of pain, effectiveness of drugs, and patient's responses to management, In regard to the satisfaction for pain relief in pain clinics at Pusan National University Hospital(PNUH) are about 70% in patients and 90% in family. Average life expectancy in cancer patients are about 140 days (3 days- 5.7 years). Cancer patients are complained of several discomfortness (above 30 kinds) such as, pain associated with cancer (75%), nausea and vomitting (38%), sleeping disorder (38%), anorexia (38%), dyspnea (32%), constipation (31%), etc. Distributioas of cancer associated with pain are stomach cancer (21%), lung cancer (16%), cervix cancer (10%), anorectal and colon cancer (8.6%), hepatoma (8%), pancreatic cancer (3%). About 1/3 of patients are suffer from incident pain in 3-5 times in a day especially in moving, coughing, and exercise. Methods for drug delivering system before death are transdermal fentanyl patch (42%), intravenous PCA (21%), oral intake of opioid (17%), epidural PCA (14%), etc.

유비쿼터스 헬스 케어 적용을 위한 의자 부착형 무선 심전도 측정 시스템 구현

예수영,백승완,김지철,전계록,Ye, Soo-Young,Baik, Seong-Wan,Kim, Jee-Chul,Jeon, Gye-Rok 한국전기전자재료학회 2008 전기전자재료학회논문지 Vol.21 No.8

In this study, ubiquitous health care system attaching in chair to monitor ECG for health care was developed at the unconsciousness state. The system conveniently and simple measured ECG at non-consciousness. We measured the contact impedance to skin-electrode of metal mesh electrodes of the system. Contact impedance enable the electrode to use for ECG measurement. The results are that the impedance of the metal mesh electrodes according to sizes is low when the size is 4$cm^2$. As the result, when the size of the metal mesh electrode is 4$cm^2$, the electrode is fit for ECG measurement. We can acquired by positing the arm on the metal mesh electrode. The ECG signal was detected using a high-input-impedance bio-amplifier, and then passed filter circuitry. The measured signal transmitted to a PC through the bluetooth wireless communication and monitored. Data of the non-constrained ECG system attaching in chair is noise-data when comparing metal mesh electrode with the Ag/Agcl electrode but the data is significant to monitor ECG for check the body state.

HRV 신호의 선형 및 비선형 분석을 이용한 마취심도 평가

예수영,백승완,김혜진,김태균,전계록,Ye, Soo-Young,Baik, Seong-Wan,Kim, Hye-Jin,Kim, Tae-Kyun,Jeon, Gye-Rok 한국전기전자재료학회 2010 전기전자재료학회논문지 Vol.23 No.1

In general, anesthetic depth is evaluated by experience of anesthesiologist based on the changes of blood pressure and pulse rate. So it is difficult to guarantee the accuracy in evaluation of anesthetic depth. The efforts to develop the objective index for evaluation of anesthetic depth were continued but there was few progression in this area. Heart rate variability provides much information of autonomic activity of cardiovascular system and almost all anesthetics depress the autonomic activity. Novel monitoring system which can simply and exactly analyze the autonomic activity of cardiovascular system will provide important information for evaluation of anesthetic depth. We investigated the anesthetic depth as following 7 stages. These are pre-anesthesia, induction, skin incision, before extubation, after extubation, Post-anesthesia. In this study, temporal, frequency and chaos analysis method were used to analyze the HRV time series from electrocardiogram signal. There were NN10-NN50, mean, SDNN and RMS parameter in the temporal method. In the frequency method, there are LF and HF and LF/HF ratio, 1/f noise, alphal and alpha2 of DFA analysis parameter. In the chaos analysis, there are CD, entropy and LPE. Chaos analysis method was valuable to estimate the anesthetic depth compared with temporal and frequency method. Because human body was involved the choastic character.

백서에서 Gabapentin 전신투여가 Facial Formalin Test에 미치는 영향

김철홍,백승완,김해규,권재영,김경훈,최성환,Kim, Chul-Hong,Baik, Seong-Wan,Kim, Hae-Kyu,Kwon, Jae-Young,Kim, Kyoung-Hun,Choi, Sung-Hwan 대한치과마취과학회 2003 Journal of Dental Anesthesia and Pain Medicine Vol.3 No.2

Background: Gabapentin is a novel anti-epileptic drug, which is used in clinical practice to treat epilepsy. This drug is also used as an analgesic in pain patients. The antinociceptive effect of this drug was assessed using the formalin test in the rat. Methods: In order to investigate the effects of gabapentin on the trigeminal nerve territory, we injected 0.5% formalin into the upper lip. Adult, male, Sprague-Dawley rats received a $50{\mu}l$ subcutaneous injection of 5% formalin into one vibrissal pad and the consequent, facial grooming behavior was monitored. Consistent with previous investigations using tile formalin model, animals exhibited biphasic nocifensive grooming (phase 1, 0-12 min; phase 2, 12-60 min). Results: The intraperitoneal administration gabapentin 5 minutes prior to the formalin injection led to a significant, dose-dependent reduction in grooming time during phase 2. In high doses, gabapentin also reduced the time of grooming during phase 1. Conclusions: The Intraperitoneal injection of gabapentin has an analgesic effect in the facial formalin rat model and this analgesic effect increases dose-dependently.

The Penetration of n-Alkanols into Model Membranes of cholesterol Plus Phospholipids Extracted from Brain Membranes

김인세,백승완,정규섭,Kim, Inn-Se,Baik, Seong-Wan,Chung, Kyoo-Sub The Korean Journal of Pain 1993 The Korean Journal of Pain Vol.6 No.1

소의 신선한 대뇌피질로부터 synaptosomal plasma membrane vesicles(SPMV)를 분리한 후 이 SPMV로부터 추출한 모든 인지질들로서 제제한 인공세포막(SPMVPL)에서의 n-alkanols 침투 정도를 형광 probe를 이용한 형광 소광법을 통하여 검색하였다. n-alkanols는 SPMVPL 외부 단층(outer monolayer)의 표면에 주로 분포하되 그 탄소수에 비례하여 소수성 부위에 분포되는 양이 증가되는 경향을 나타내었다. methanol, ethanol, 1-propano, 1-butanol, 1-pentanol, 1-hexanol, 1-heptanol, 1-octanol, 1-nonanol 및 1-decanol은 SPMVPL 외부 단층의 표면(친수성 부위)에 분포되는 것이 소수성 부위에 분포되는 것에 비하여 각각 432.4, 208.9. 125.6, 88.2, 19.3, 7.9, 2.6, 1.0, 0.42, 1.36배가 되었다. 1-decanol은 $C_{10}$인데도 불구하고 $C_8$인 1-octanol에 비하여 적은 양이 소수성 부위에 침투 분포된다는 것이 확인되었다. n-alkanols의 침투에 대하여 저자등이 이미 보고한 바 있는 SPMV 및 SPMVTL(cholesterol+phospholipids)의 경우보다도 본 연구에서의 SPMVPL의 경우가 현저하게 많은 양이 소수성 부위로 침투 분포된다는 것도 확인되었다.

스테로이드 사용(使用)으로 인(因)한 고혈당증(高血糖症)을 동반(同伴)한 대상포진후(帶狀疱疹後) 신경통(神經痛) 환자(患者)의 치험(治驗)

김영추,김해규,백승완,김성수,김인세,정규섭,Kim, Young-Choo,Kim, Hae-Kyu,Baik, Seong-Wan,Kim, Sung-Soo,Kim, Inn-Se,Chung, Kyoo-Sub 대한통증학회 1990 The Korean Journal of Pain Vol.3 No.1

대상포진후 신경통의 치료를 위하여 사용하였던 스테로이드로 인한 고혈당증을 동반한 환자를 치료한 결과를 다음과 같이 요약한다. 첫째, 통증치료실에서 흔히 쓰이는 약물 중에는 고혈당증을 유발하는 것이 많으므로 처치전에 고혈당이 영향을 주는 다른 질환의 유무를 확인하도록 한다. 둘째, 스테로이드 사용으로 인하여 발생되는 일시적인 고혈당중의 경우에는 스테로이드 사용 중단으로 회복이 가능하나 잠재되어 있던 당뇨병의 발현시는 지속적인 당뇨병의 치료를 필요로 한다. 셋째, low level laser therapy는 혈당치에 영향을 미치지 않는 통증치료법으로 유용하게 사용될 수 있다. There are many methods for treatment of post-herpetic neuralgia (PHN) and of these, epidural steroid or intralesional steroid injection is one of the most effective treatments. But there are some problems in the use of steroids. One of which is steroid-induced hyperglycemia. In that case, the treatment of PHN is very difficult and not so effective. So we used the low level laser therapy (LLLT), He-Ne and IR, for the treatment of post-herpetic neuralgia without any changes of blood glucose level. It seemed that LLLT was a very effective method for PHN without any systemic changes.