복강경 담낭절제술 시 공기배증 전에 주입한 복강 내 lidocaine의 공기배증 후 혈압상승 완화효과

송선옥 ( Sun Ok Song ),이혜미 ( Hae Mi Lee ),윤성수 ( Sung Soo Yun ),유화림 ( Hwarim Yu ),심수영 ( Soo Young Shim ),김흥대 ( Heung Dae Kim ) 영남대학교 의과대학 2016 Yeungnam University Journal of Medicine Vol.33 No.2

Background: We have previously found that intra-peritoneal lidocaine instillation before pneumoperitoneum attenuates pneumoperitoneum-induced hypertension. Whether this procedure alters patient`s hemodynamic status during operation should be determined for clinical application. This study elucidated the possible mechanism of the attenuation of the pneumoperitoneum-induced hypertension by intra-peritoneal lidocaine before pneumoperitoneum. Methods: Thirty-four patients underwent laparoscopic cholecystectomy (LC) were randomly allocated into two groups. After induction of general anesthesia, 200 mL of 0.2% lidocaine (lidocaine group, n=17), or normal saline (control group, n=17) were sub-diaphragmatically instilled 10 minutes before pneumoperitoneum. The changes in systolic blood pressure, heart rate, central venous pressure, stroke volume, cardiac output, and systemic vascular resistance were compared between the groups. The number of analgesics used during post-operative 24 h was compared. Results: Systolic blood pressure was elevated during pneumoperitoneum in both groups (p<0.01), but the degree of elevation was significantly reduced in the lidocaine group than in the control (p<0.01). However, stroke volume and cardiac output were decreased and systemic vascular resistance was increased after induction of pneumoperitoneum (p<0.05) without statistical difference between two groups. The number of analgesics used was significantly reduced in the lidocaine group (p<0.01). Conclusion: These data suggest that intra-peritoneal lidocaine before pneumoperitoneum does not alter patient`s hemodynamics, and attenuation of pneumoperitoneum-induced hypertension may be the consequence of reduced intra-abdominal pain rather than the decrease of cardiac output during pneumoperitoneum. Therefore, intra-peritoneal lidocaine instillation before pneumoperitoneum is a useful method to manage an intraoperative pneumoperitoneum-induced hypertension and to control postoperative pain without severe detrimental hemodynamic effects.

현장측정을 통한 분기기 망간 크로싱의 피로거동 평가

송선옥(Song Sun Ok),엄맥(Eom Mac),양신추(Yang Shin Chu),박용걸(Park Yong Gul) 한국철도학회 2006 한국철도학회 학술발표대회논문집 Vol.- No.-

The major objective of this study is to investigate the fatigue behavior evaluation of immovability crossing for railway turnout by the field test. In railway engineering, an appliance is necessary to allow a vehicle to move from one track to another. This appliance came to be known technically as turnout. So, turnout is required very complex railway technologies such as rolling stock, track. Due to the plan under the application of high speed train, turnout are needed more stable for fatigue behaviors. It analyzed the mechanical behaviors of turnout crossing with propose its advanced technical type on the field test and fatigue evaluation for the dynamic fatigue characteristics. As a result, the advanced type crossing are obviously effective for the fatigue damage ratio and dynamic response which is non-modified type. The analytical and experimental study are carried out to investigate the passing path of contact surface and fatigue damage trend decrease dynamic stresses and deflections on advanced crossing type. And the advanced type reduce dynamic fatigue damage ratio and increase fatigue life(about each 38%)more than non-modified type. From the field test results of the servicing turnout crossing, it is evaluated that the modification of contact angle, weight, material and sectional properties is very effective for ensure against fatigue risks.

성상신경절차단시 주입된 1% Lidocaine 양에 따른 형중 Lidocaine 농도 변화

송선옥(Sun Ok Song),서영호(Yung Ho Suh) 대한통증학회 2001 The Korean Journal of Pain Vol.14 No.1

N/A Background: Sympathetic blocks with local anesthetics are used to differentiate sympathetically- maintained pain (SMP) from sympathetically-independent pain (SIP). However, systemic lidocaine is also used in the management of neuropathic pain. Therefore, there may be possibility of a false positive response in relieving their pain by systemic absorption of lidocaine following a diagnostic sympathetic block in patients with SIP. In this study, we measured the plasma lidocaine concentrations after a stellate ganglion block (SGB) using three volumes of 1% lidocaine. Methods: This prospective, crossover study was performed in 3 patients who experience sudden hearing loss and in 4 volunteers. Each person received SGB three times using three different volumes (6 ml, 12 ml and 16 ml) of 1% lidocaine at one week intervals. SGB was performed using a 23 G butterfly needle via a paratracheal approach by two persons. Two ml of venous blood was obtained from a prepared contra-lateral sided venous route at 1, 3, 5, 7, 10, 20 and 60 min after SGB. Plasma lidocaine level was analyzed by immunoassay. Results: Mean plasma lidocaine concentrations correlated well with the volumes of 1% lidocaine used in SGB; larger volumes showed higher concentrations (P < 0.01). Mean peak plasma concentrations were 1.08 ± 0.18 in 6 ml, 1.90 ± 0.47 in the 12 ml and 2.74 ± 0.67 ㎍/ml in the 16 ml groups (P < 0.01). The mean time to reach peak plasma concentration was not significantly different between the three groups. Conclusions: The peak plasma lidocaine concentrations in SGB using large volume were found to be similar to that of IV lidocaine infusion in the management of neuropathic pain. These data suggest that diagnostic sympathetic block may result in many false positive responses for SMP. Part of its effect may be related to systemic local anesthetic absorption and not to a sympathetic block. Therefore, physicians may be required to use optimal volumes and minimal concentration of local anesthetic in diagnostic sympathetic block procedures and also make a careful assessment of the performance of a permanent sympathetic block.

정맥내 통증 자가조절법을 이용한 말기 암환자의 통증조절

송선옥(Sun Ok Song),여정은(Jung Eun Yeo),김흉대(He 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1

N/A Background: Nerve blocks, including epidural analgesia, can be risky for terminal cancer pain patients in generally poor conditions. We performed this study to evaluate the effica- cy of intravenous patient-controlled analgesia(PCA) to treat severe pain of terminally ill cancer patients during the last days of life. Methods: We explained the patient's poor general condition to relatives and received a written consent to administer PCA. The starting dose of opioid for PCA in cancer pain management was based on previous 24-hour dose. Previous 24-hour opioid dose was con- verted to intramuscular morphine equivalent. The concentration of opioid mixed into Basal Bolus Infusor® was controlled to allow for one half of the previous 24-hour equianalgesic dose to infuse continuously. Patients controlled their pain by pushing the PCA module themselves. Patients were observed by pain service team. Some discharged patients were treated at home until death. Results: Forty eight patients received PCA for last two years. The most common reason receiving a PCA was the patients poor general condition(52.0%). The mean starting dose of PCA was 20.6±16.2mg of morphine. Over eighty percents of the patients were in good or tolerable state of analgesia. Half of the patients expired within one week. The mean duration of PCA was 8.7±7.0 days. The problems during PCA were: difficulty in maintain- ing intravenous routes, early loss of mentality after starting PCA, hypotension and nausea. Conclusion: We concluded that PCA, if used correctly, is an effective, relatively safe and readily controllable method of pain management in terminally ill cancer patients dur- ing the last days of life. For future considerations, terminal patients may expire at the com- fort of their own homes after the resolution of legal problems regarding using opioid in home care.

천미골 접합부를 이용한 외톨이 신경절 차단법

송선옥(Sun Ok Song),권오득(Oh Deuk Kwon),김성기(Se 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2

Ganglion impar lies immediately anterior to the sacrococcygeal junction and blockade of the ganglion is used to treat anorectal and perineal pain. Although the technique introduced by Plancarte et al is widely practised, the bent needle is sometimes difficult to position precisely and patients find the procedure painful. We modified this approach of block of ganglion impar by positioning the needle into the sacro- coccygeal junction and using the loss of resistance technique. With the patient in the lateral position, a skin wheal was raised at 1-1.5cm below the sacral hiatus. Twenty-three gauge short needle was directly placed into the sacrococcygeal junction with aid of fluoroscopic guidance. From 1 cm behind the anterior margin of the vertebral body in lateral view, we used the loss of resistance technique to confirm the retroperitoneal space. We found this modified approach easier to perform during six blocks for three patients with anorectal or perineal pain. Our modified approach through the sacrococcygeal junction may provide opportunity for wider administration of this procedure because of its simple technique, reduced pain during procedure and decreased risk of infection.

성상신경절 차단후 발생한 반대측 호너 증후군

송선옥(Sun Ok Song),이덕희(Deok Hee Lee),박대팔(Da 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.1

Stellate ganglion block(SGB) is a widely used sympathetic block to diagnose or treat var- ious painful conditions. We experienced a rare case who exhihited a contralateral Horner's syndrome following SGB. A 64-year-old female patient suffering from postherpetic neuralgia on mandibular branch of trigeminal nerve visited our pain clinic. She complained of severe burning and shooting pain on right side lower lip, ear and temporal area. We modified her previous medications and performed repeated right SGB daily, in combination with mandibular or mental and auriculotemporal nerve blocks twice a week. Her symptoms were progressively improved. A contralateral Horner's syndrome occured after the thirteenth SGB, which was per- formed under several attqmpts in the same manner and the same physician. She had no evidence of subarachnoid or brachial plexus blocks. She did not need any special treat- ment and returned home 2 hours later. Subsquent blocks were followed on ipsilateral Horner's syndromes.

알코올성 간경변 환자에서 다량의 복수로 발현된 막증식성 사구체신염의 양상을 동반한 IgA 신병증

송선옥 ( Sun Ok Song ),이승원 ( Seung Won Lee ),이희우 ( Hee Woo Lee ),강버들 ( Beo Deul Kang ),동시헌 ( Shi Heon Dong ),최자성 ( Ja Sung Choi ),송지선 ( Ji Sun Dong ),윤수영 ( Soo Young Yoon ),이상철 ( Sang Choel Lee ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.2

IgA nephropathy can occur commonly in alcoholic liver cirrhosis and is the most common form of secondary IgA nephropathy. Defective clearance of IgA-containing complexes by liver is thought to contribute to the development of IgA nephropathy in alcoholic cirrhosis. Although IgA deposition is found up to 64% in autopsy cases of alcoholic cirrhosis, most patients have mild clinical symptoms, and nephrotic range proteinuria occurs rarely in these patients. We report a case of IgA nephropathy with a membranoproliferative pattern that is detected with unusual massive ascites in a patient with alcoholic liver disease. A 60-year-old male patient was referred to our hospital for evaluation and management of abdominal distension. Abdominal ultrasonographic findings were compatible with diffuse liver cirrhosis with splenomegaly and large amount of ascites. He had nephrotic range proteinuria, azotemia, hyperlipidemia, and hematuria in dipstick. Renal biopsy performed under the impression of acute nephritis revealed mesangial and endocapillary proliferative glomerulonephritis with double contour of capillary loop. Immunofluorescence findings showed mesangial IgA and C3 deposit, compatible with IgA nephropathy. He was treated with high dose steroid, and steroid was tapered during 2 months. Steroid treatment induced complete remission state, and ascites was resolved.

N-ethylmaleimide(NEM)가 개구리 피부의 Na⁺ 이동에 미치는 영향

송선옥(Song, Sun-Ok),정노팔(Jung, Noh-Pal),박양생(Park, Yang-Saeng) 대한생리학회 1979 대한생리학회지 Vol.13 No.1

Studies have been conducted using isolated surviving skin of Rana temporalia in an attempt to evaluate the effect of N-ethylmaleimide (NEM) on the epithelial Na⁺ transport. Active transport of Na⁺ across the skin was estimated by measuring short circuit current (SCC). NEM administered to the outside surface of the skin in concentration of 0.5 X 10^-4-2.5 X 10^-4M induced 20~40% increase during the first 30 mintues, followed by a gradual reduction in SCC. With NEM above 4 X 10^-4M, SCC was inhibited from the beginning. Qualitatively similar results were obtained when NEM was added to the inside bathing medium. However, the concentration of NEM for a similar effect was much higher with the drug in the inside bathing medium than in the outside bathing medium. The oxygen consumption of the skin was inhibited by NEM of above 10^-4M, the effect being of approximately the same magnitude as that on SCC. The activity of Na⁺-K⁺ ATPase of the skin was not inhibited by NEM below 10^-3M, but it was dramatically reduced with 1.2 X M NEM. The effects of NEM (10^-4M) on the SCC and oxygen consumption could be eliminated by adding cysteine (10^-4-10^-3M) in the medium, indicating that the SH group is involved in the action of NEM in the frog skin. On the basis of these results, the mode of action of NEM on the Na⁺ transport across the frog skin was discussed.

임상연구 : 술 후 통증 평가에 이용된 숫자등급과 시각등급 통증점수의 상관관계

송선옥 ( Sun Ok Song ),김세연 ( Sae Yeon Kim ),이선영 ( Seon Young Lee ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.2

정맥내 통증 자가조절법에 의한 술후 통증관리 1,590예에 대한 분석

송선옥(Sun Ok Song),지대림(Dae Lim Jee),구본업(Bon 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

N/A Background: We started postoperative pain management service using an intravenous patient-controlled analgesia(IV-PCA, PCA), which is known as convenient and effective an- algesic method. In this report, we describe the efficacy and safety of PCA and the experi- ence of developing an acute pain service to treat postoperative pain using a PCA. Methods: Practices of an acute pain service were started at a ward for general surgery after preparation of the standardized protocols for PCA. In each patient, PCA was con- nected following administration o;. initial loading doses of analgesics at recovery room after operation. All patients were checked by acute pain service team once or twice daily. The scope of acute pain service was gradually spread to other departments such as ortho- pedic, thoracic, obstetric and gynecologic departments by requests of patients or surgeons. We managed 1,590 patients during first 22 months. Among them, nine hundred seventy two cases were prospectively evaluated for their analgesic efficacy and side effects of PCA. Results: The number of patients was increased day by day. The most common type of operation was gastrectomy(21.6%). Cominonly used analgesics were nalbuphine(59%) and morphine(37%,). The mean duration of PCA attachment was 3.3 days. The degree of anal- gesia on operation day was good in 44.8#k and tolerable in 52.6% of patients. Only 3.9% of patients complained severe pain during their postoperative periods. One elderly patient ex- perienced respiratory depression(0.06%) owing to accidental misuse of PCA by his relatives. Overall patient's satisfaction was over 93%. Conclusions: According to our experiences, we conclude that PCA is an effective, relative- ly safe and highly satisfactory method for postoperative pain management. Because of these advantages of PCA, the creation of our acute pain service using a PCA was success- ful and expanded rapidly.