Adenosine 정주가 복강경 담낭절제술에서 시간 경과에 따라 술 중 혈압 변화와 술 후 통증에 미치는 영향

김혜경,성규완,박희진,임종범,김성수,김영기,이청 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.01

Background: Adenosine has been shown to exert an antinociceptive effect under experimental conditions in animals and humans. This study was performed to evaluate the effects of adenosine on postoperative pain and intraoperative blood pressure changes. Methods: We studied 30 patients, aged <65 years, who underwent laparoscopic cholecystectomy under N2O-O2-isoflurane general anesthesia. Patients were randomized into two groups: an adenosine group (adenosine was infused continuously at 100-150 μg/kg/min, n = 15) and a control group (normal saline infused at 4 ml/min, n = 15). Mean arterial blood pressure during the intraoperative period, and pain score at 30 minutes, 6 hours, 24 hours, and 48 hours after operation were checked. On patient request, meperidine was administrated intravenously. Results: Pain scores and the cumulative doses of meperidine were much lower in the adenosine group than in the control group. The elevation of mean arterial pressure during pnemoperiton-eum was significantly attenuated in the adenosine group. Conclusions: This data suggests that intravenous adenosine infusion is effective at post-operative pain control following a laparoscopic cholecystectomy and that it is also effective at attenuating blood pressure elevation during pneumoperitoneum.

인공 대동맥판막 기능부전을 일으킨 특발성 과호산구 증후군 -1예 보고-

박종빈,유동곤,성규완,정상식,강길현,김종욱 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.4

특발성 과호산구 증후군은 호산구 매개에 의한 조직 손상으로 인해 다발성 장기부전, 특히 심장을 침범하는 드문 전신성, 백혈구증식성 질환이다. 심장침범은 특발성 과호산구 증후군 환자의 75% 이상에서 일어난다. 심장증상은 심내막 하 섬유증, 제한성 심근병증, 판막부전, 그리고 말초동맥 혈전증을 유발하는 혈전이다. 이 질환은 남자에서 여자보다 9:1로 호발하고, 20∼50대에서 주로 발현하는 경향이 있으며 소아에서는 매우 드물다. 인공 대동맥판막부전을 나타낸 특발성 과호산구 증후군 환자(58세, 남자)를 인공판막 재치환 수술 후 부신피질호르몬제와 hydroxyurea 투여로 성공적으로 치료하였기에 보고하는 바이다.

심낭압전으로 발견된 원발성 심낭 섬유육종-1예 보고-

임주영,박종빈,성규완,강길현,유동곤,김종욱 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.8

심낭에서 발생한 원발성 섬유육종은 매우 드문 질환으로 주로 급격한 혈성 심낭 삼출을 유발한다. 평소에 간헐적인 흉부압박감을 느껴왔던 30세 남자 환자가 내원 하루 전 갑작스런 흉통과 심한 호흡곤란으로 근처 병원에서 협심증 진단 하에 전원되어 심초음파 검사, 흉부 전산화 단층촬영 및 자기공명검사 등 정밀검사를 시행받았고, 그 결과 심낭 기형종 파열에 의한 심낭압전의 진단하에 수술을 받았다. 수술소견 상 혈성 심낭 삼출액이 다량 있었고, 심낭 종괴는 완전 절제하였으나 동결절편검사 상 악성종양이 의심되었다. 수술 후 병리조직 검사상 심낭 종괴는 원발성 심낭 섬유육종으로 진단되었고 심낭 삼출액에서 암세포는 발견되지 않았다. 환자는 특별한 합병증 없이 퇴원 후 전원되어 추가적인 방사선치료를 받고 있다. 임상적으로 긴급을 요하는 심낭압전을 동반한 원발성 심낭 섬유육종 1예를 치험하였기에 보고하는 바이다.

Lidocaine이 Vecuronium의 작용 발현시간에 미치는 영향

김태엽,양홍석,성규완 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.5

Background : Local anesthetics have been shown to interact with neuromuscular blockers. Most local anesthetics decrease neuromuscular transmission and potentiate neuromuscular block from muscle relaxants. The purpose of this study was to examine the effectiveness of lidocaine on the onset time of vecuronium and to compare that with other method such as simply increasing the dose of vecuronium. Methods : Sixty patients of ASA physical status I or II were induced with thiopental (4-5 mg/kg) and maintained with O2-enflurane (2.5 vol%). They were randomly divided into four groups: Vecuronium (0.1 mg/kg) was administered intravenously in Group C (n = 15), additional lidocaine (1 mg/kg) was given intravenously 1 min prior to administration of vecuronium in Group L (n = 15), increased vecuronium (0.15 mg/kg) was given in Group V (n = 15) and succinylcholine was given in Group S (n = 15), respectively. Neuromuscular blockade was assessed by train-of-four (TOF) at the adductor pollicis muscle with supramaximal stimulation of ulnar nerve (2 Hz, 0.2 ms) every 12 sec. Endotracheal intubation was performed and intubating conditions were evaluated according to the standard scoring method after measuring the onset time (from the end of giving each muscle relaxants to the 90% suppression of the first twitch). Results : The onset time of Group L (122.0±11.0 sec) and that of Group V (98.0±16.9 sec) were shorter than that of Group C (135.2±16.0 sec) (P< 0.05), but these were not shorter than that of Group S (42.0±6.2 sec). There was no statistical difference between Group L and Group V. Intubating conditions were good or excellent in all groups. Conclusions : Additional lidocaine for attenuating sympathetic response could accelerate the onset of vecuronium. But the onset time of this method was not shorter than that of simply increasing the dose of vecuroium nor that of succinylcholine. (Korean J Anesthesiol 1999; 37: 763∼768)

흰쥐 횡격막 신경근 표본에서 Mivacurium 의 근이완 작용에 대한 Edrophonium 과 Pseudocholinesterase 의 반전 효과

김혜경,박동호,양홍석,성규완,정우영 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.2

Background : Mivacurium is a nondepolarizing neuromuscular blocking agent hydrolyzed by pseudocholinesterase. Anticholinesterase used in the reversal of mivacurium-induced muscle relaxation may also inhibit plasma pseudocholinesterase, and delay hydrolysis of mivacurium. In this study, the effects of edrophonium and/or bovine pseudocholinesterase (BpChE) in the reversal of mivacurium were investigated with the rat phrenic nerve-diaphragm preparation. Methods : Fifty Sprague-Dawley rats (150-200 g) were randomly allocated into 10 groups based on the dosage of edrophonium and BpChE. Each animal was anesthetized with thiopental sodium (40 ㎎/㎏ I.P.). The phrenic nerve-diaphragm was dissected and mounted in a bath containing an oxygenated Krebs' solution at 32℃. The phrenic nerve was stimulated at supramaximal intensity and the single twitch responses and train of four (TOF) ratio were measured. After stabilization of the twitch responese, mivacurium (1 ㎍/㎖) was administered incrementally to obtain more than 95% twitch inhibition. Reversal of the mivacurium-induced block by edrophonium (0.01, 0.1, 1, or 10 ㎍/㎖) and/or BpChE (0.1 u, or 1.0 u/㎖) were tested. A single twitch height more than 75% of the baseline value was considered an adequate reversal. Results : Mivacurium-induced paralysis was recovered more effectively by BpChE 1.0 u/㎖ than the other groups. Edrophonium improved a single twitch in a dose dependent manner. Conclusions : Mivacurium-induced paralysis can be more effectively reversed by BpChE than edrophonium. Inhibition of pseudocholinesterase was not observed by increasing the dose of edrophonium. (Korean J Anesthesiol 2002; 42: 213~220)

신경절단 간의 압력-혈류 관계 및 산소화에 관한 연구

안미영,이종현,최규택,박광민,성규완,김기훈,최동락 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.3

Background: Various pressor agents are used to raise systemic vascular resistance (SVR) during liver transplantation. The aim of this study was to investigate the effect of liver denervation on hepatic hemodynamic responses to vasopressors. Methods: This study was conducted in eight anesthetized dogs randomly assigned in to 4 groups [epinephrine-Low dose (L): 0,05 ㎍/kg/min, epinephrine-High dose (H): 0.5 ㎍/kg/min, ephedrine (D): 0.2 mg/kg, phenylephrine (P): 80 ㎍/min]. One hour after surgical denervation of the liver, cardiac output, blood gases and hepatic blood flow were measured before and after administration of vasopressors with an electromagnetic flow meter. Oxygen consumption rate (hepatic artery plus portal vein oxygen delivery-hepatic vein oxygen delivery) was calculated. The Wilcoxon signed rank test and Kruskal-Wallis test were used for statistical analysis; The level of significance was assumed at the P $lt; 0.05 level. Results are expressed as mean±SE. Results: The resulting hemodynamic valuese not significantly different between groups except for hepatic vascular resistance in the P group. Hepatic blood flow decreased significantly in the P and H groups, whereas it increased significantly in the L group. Hepatic oxygen consumption and Base Excess in hepatic venous blood after vasopressors were not significantly different between groups. These results mean there were no significant differences in hepatic oxygenation between groups. Conclusions: Various pressor agents can be used to raise SVR without jeopardizing hepatic oxygenation. However, phenylephrine and high dose of epinephrine are not recommended after liver trans- plantation because decreased hepatic blood flow might affect the intracellular oxygen environment adversely.

Adenosine 정주가 복강경 담낭절제술에서 시간 경과에 따라 술 중 혈압 변화와 술 후 통증에 미치는 영향

김성수 ( Seong Su Kim ),성규완 ( Kyu Wan Seong ),박희진 ( Hi Jin Park ),임종범 ( Jong Bum Lim ),김혜경 ( Hae Kyung Kim ),김영기 ( Young Ki Kim ),이청 ( Chung Lee ) 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.1

장기기증 뇌사자 분석

이유미,이승규,최규택,이동명,이청,서병태,성규완,하희선 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.1

Background : Since the first successful kidney transplantation from a brain death donor(BDD) was done in 1979, organ transplantations from BDD have steadily increased. The number of BDDs have been increasing year by year. The purpose of this study is to analyze clinical status of organ donor from BDDs. Methods : We analyzed retrospectively the status of BDDs registerd for organ transplant program in Asan Medical Center from January, 1992 to March, 1997. Results: The male to female ratio was 3 : 1, and the age distribution was the highest in twenties. The distribution of cause of brain death was the highest in motor vehicle accidents. The distribution of acquired organ was the highest in kidney, heart, liver in order. The distribution of days stayed in ICU before organ donation was the highest in 2 days. The choice of agent for inotropic support of the myocardium is dobutamine. The donors have been transfused with packed red blood cell(PRBC) to maintain the hematocrit between 25∼35%. Two units of PRBC should be readily available at all times for transfusion. The failure of organ donation was mainly very poor organ condition. Conclusions : We wish that these results were made use of bases of status of organ donation from BDDs. (Korean J Anesthesiol 1998; 34: 160∼166)

초음파를 활용한 회전근개 간격으로 접근한 견관절 주사법

임종범 ( Jong Bum Lim ),김영기 ( Young Ki Kim ),김성우 ( Sung Woo Kim ),성규완 ( Kyu Wan Sung ),정일 ( Il Jung ),이청 ( Chung Lee ) 대한통증학회 2008 The Korean Journal of Pain Vol.21 No.1

증례보고 : 선천성무통무한증 환아의 전 정맥마취관리

이석진 ( Seuk Jin Lee ),김영기 ( Young Ki Kim ),성규완 ( Kyu Wan Seong ),김성우 ( Seong Woo Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare hereditary sensory and autonomic neuropathy. CIPA is characterized by inability to sweat, insensitivity to pain, self-mutilation, recurrent episodes of hyperpyrexia, mental retardation, and autonomic nervous system abnormality. Patients with CIPA may undergo surgery because of susceptibility to trauma, bony fracture and osteomyelitis due to insensitivity to pain. We report a child who had undergone anesthesia with total intravenous anesthesia. The anesthetic management of this condition is discussed. (Korean J Anesthesiol 2007; 52: 367~70)