응급의료 헬리콥터를 이용한 환자이송에 대한 고찰

송형곤,김병철,송근정,정연권,신백효 大韓應急醫學會 1998 대한응급의학회지 Vol.9 No.4

Background: The first EMS helicopter was introduced to Korea in 1996 and from Dec. 1. 1997, it was used for transporting emergent patients. Authors, here upon, report the transporting experiences. Methods: From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data prospectively analyzed. Result: A total of 65 patients were transported. Male to female ratio was 1.95:1. The mean transport time was 64.1 min(10 - 160 min). Majority of the evacuated patients was surgical patients (General Surgery : 16, Orthopedic surgery : 10, Neurosurgery : 6, Internal medicine : 13, Pediatrics : 3, and others : 3). Twenty-one of the 65 patients transported were admitted to ICU and 31 did not require ICU care. During the air evacuation, one physician and one nurse trained for air evacuation attended the patients. No medical problems or deaths developed during the air evacuation period. Conclusion: The first EMS helicopter was introduced to Korea in 1996. From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data reported.

신경교 세포에서 에너지 고갈과 재관류 동안에 생기는 세포내 칼슘 이온 변화에 대한 Lidocaine 의 효과

김명희,신백효,이수련 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.5

서 론: 국소 마취제로서 lidocaine은 전압 감수성의 칼슘 통로와 소디움 통로를 차단하여 세포막을 안정시킴으로써 세포내의 칼슘 이온 변동을 감소시킨다고 알려져왔다. 이에 본 실험에서는 단 세포(single cell)를 이용한 in vitro 실험에서 허혈성 변화로 인한 세포내 에너지 고갈 및 재판류로 인한 손상 (소위, 칼슘 파라톡스 현상)을 유도하여 lidocaine의 효과를 알아보고자 하였다. 방 법: 실험 재료로서는 인간의 성상세포종양의 세포를 이용하였다. 세포내 에너지 감소를 유도하기 위해 미토콘드리아 호흡쇄 (respiratory chain) 차단제인 amytal/CCCP를 사용하였고, 재관류를 모사하기 위해 일정시간의 저농도 칼슘 완충용액 관류 후 표준 칼슘용액으로 재관류 하였다. 실험 세포내의 칼슘이온 변화를 측정하기 위해서 칼슘 지정 염료인 fura-2를 사용하여 microspectrometry로 측정하였다. 결 과: 세포내 에너지 저하시 생기는 칼슘이온의 증가는 주로 세포내 세포소기관(organelles)으로부터 유리된 것이었고, 세포 소기관으로부터의 칼슘유리는 세포질 내의 소디움 농도에 의존적이었다. 세포내의 에너지 감소시 0.5 mM lidocainc 첨가로 세포내 칼슘이온 증가를 막았다. 또한 0.5 mM lidocaine은 재관류시 칼슘이온 증가의 주된 길인 소디움/칼슘 교환체 작용을 억제하여 세포내 칼슘 농도의 증가를 억제하였다. 결 론: 국소 마취제 lidocainc은 소디움/칼슘 교환체에 작용하여, 허혈 및 허혈 후 재관류시 세포내 칼슘 이온 증가를 막는데 효과적이었다. (Korean J Anesthesiol 1996; 30; 516∼522)

저온배양이 탈분극 및 대사 장해로 인한 성상세포의 손상에 미치는 영향

김명희,신백효 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.6

Background : There are evidences that cytotoxic cell death occurs first by intracellular sodium entry and then followed by calcium accumulation during ischemic damage. To investigate the protective effect of hypothermia on the sodium induced or energy depletion induced cell death, we studied the relationship of incubation temperature with viability of the cultured astrocytoma cells. Methods : The survival rate of astrocytoma cells under veratridine and/or iodoacetate(IAA)/carbonylcyanide m-chlorophenylhydrazone (CCCP) treatments was assessed. To measure the cell viability by veratridine or IAA/CCCP, 3-[4,5-dimethylthiazol-2yl]-2,5, diphenyl tetrazolium bromide (MTT) test using ELISA was utilized. Incubation temperature was varied to 27, 30, 37oC. Results : Veratridine (30, 15, 3 M) known to increase intracellular sodium caused cell death. The survival rate was 88.8 1.3, 100.04 3.8, 105 4.5% of control, respectively at 1hr and 80.0 1.72, 90.9 1.68, 97.5 0.9%, of control respectively at 3 hrs after treatment. The survival rate with IAA/CCCP 1.5 mM/20 M or 150 M/2 M was 12.75 0.99, 32.85 2.93, respectively at 1 hr, and 3.1 0.36%, 15.48 1.11, respectively at 3 hrs. Veratridine addition to IAA/CCCP exacerbated cell death as compared with IAA/CCCP alone (6.6 0.43 vs 15.48 1.11). Lowering incubation temperature decreased cell death by veratridine or IAA/CCCP significantly: veratridine treated group revealed 80.0 1.72 % survival rate at 37oC and 94.1 4.0% at 27oC after 3 hrs incubation. IAA/CCCP (150 M/2 M) treated group showed 15.48 1.11% survival rate at 37oC and 39.96 5.20% survival rate at 27oC after 3 hrs incubation. Conclusions : Cell death caused by veratridine or IAA/CCCP was ameliorated by hypothermic incubation. (Korean J Anesthesiol 1997; 32: 895∼901)

분만진통 관리를 위해 척수강내로 투여한 수펜타닐의 용량에 따른 효과 및 부작용의 비교

한태형,신백효,이육노 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.2

혈액희석 정도에 따른 혈액응고 양상의 변화

최영순,신백효,김갑수,함태수,김정수,전우재 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.5

Background: Hemodilution reduces the concentration of clotting factors in blood and this may induce some degree of impairment of coagulation. But there are some evidence that hemodilution may induce a hypercoagulable state. The goal of this study is to investigate the changes of coagulation status during progressive hemodilution. Methods : Whole Blood was diluted by 10% increment to 80% with 0.9% normal saline. At each 10% dilution blood coagulation status was analysed using thrombelastography(TEG) and was compared with that of an undiluted control specimen obtained concurrently from the same patients. Results : Hemodilutions up to 40% decrease r and K times and increase values of MA and angle. Hemodilutions more than 70% increase r and K times and decrease values of MA and angle. Conclusions : Hemodilutions up to 40% increase coagulability and hemodilutions more than 70% decrease coagulability of whole blood in vitro.(Korean J Anesthesiol 1997; 33: 918∼922)

사각근간 차단 후에 발생한 좌측 어깨의 감각 이상과 운동 장애

한태형,신백효,이정진 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.6

Nerve injury can arise as a complication of peripheral nerve block Three factors are of special etiologic interest: nerve lesion due to the needle injury or intraneural injection; toxic effects of drugs injected overall when epinephrine is used; ischemic trauma. The symptoms of such nerve lesions are dysesthesia, motor weakness or paralysis. We report a case of severe neurologic symptoms of left shoulder after interscalene nerve block in a 23-year-old ASA I male patient. Interscalene block utilizing nerve stimulator and elicitation of paresthesia was performed smoothly for incision and drainage of 2nd finger mass. Total 30 cc of 2% lidocaine with epinephrine was used. After the procedure, the patient developed a severe dysesthesia and motor weakness of left shoulder which gradually improved over the next 6 months through the extensive rehabilitation program. The block should be handled with care: rough paresthesia seeking techniques and intraneural injections should be avoided; short bevel needles and plain solutions should be used to avoid complications.

척추마취에 따른 폐기능의 변화 : 부피바카인과 테트라카인의 비교

한태형,신백효,김갑수,함태수,이정진,김정수,전우재,조현성 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.6

Background : Although degree of motor blockade during high thoracic spinal anesthesia is difficult to determine, pulmonary function may reflect the level of motor blockade. So we checked pulmonary function during spinal anesthesia with two different local anesthetic agents. Methods : 50 patients, ASA PS 1-2, were randomly divided into two groups. After basal pulmonary function test(FVC: forced vital capacity, FEV1: forced expiratory volume in one second, PEFR: peak expiratory flow rate, PEP: peak expiratory pressure, PIP: peak inspiratory pressure.), the patients received spinal anesthesia with either 0.5% hyperbaric bupivacaine or 0.5% hyperbaric tetracaine. Thirty minutes after injection, level of sensory blockade was checked by pinprick test and pulmonary function test was performed. Results : Almost all the values of pulmonary function reduced after spinal anesthesia, but the degrees of reduction were not differ in two groups except PEP, which reduced more profoundly in tetracaine group than bupivacaine group. Conclusions : It is more desirable that we use bupivacaine rather than tetracaine as spinal anesthetic agent in the patient with poor pulmonary function. (Korean J Anesthesiol 1997; 33: 1109∼1115)

전이성 전립성 암의 골성 통증에 대한 Dexamethasone 의 진통 효과

한태형,신백효,이수련 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2

Background : Steroid therapy has been considered as co-analgesic for palliative treatment of metastatic bone pain in terminal cancer. We designed prospective study to observe analgesic efficacy of dexamethasone, to evaluate different analgesic assessment methods and its correlation to actual improvement of quality of life. Methods : Thirty seven men with symptomatic bone pain of prostate cancer were treated with dexamethasone infusions (10mg twice a day) for 2 weeks. Response to treatment was assessed by daily analgesic intake, by the McGill-Melzack pain questionnaire(MPQ), and by a series of 17 linear analog self-assessment scales(LASA) relating to pain and to various aspects of quality of life. Biochemical and radiological markers were measured. Results : Fourteen patients (38%) had improvement in indices used to assess pain at 2 weeks after starting dexamethasone. Reduction in pain indices was associated with improvement in other dimensions of quality of life and in the scale for overall well-being. Even though radiological and biochemical markers showed no correlation, symptomatic relief of pain was associated with a decrease in serum concentration of adrenal androgens. Conclusion : We conclude that 1) dexamethasone treatment may cause useful relief of pain in some of patients with bone pain of prostate cancer; 2) this relief of pain is associated with suppression of adrenal androgens; 3) measures of pain and quality of life can be used to assess benefits of systemic therapy with dexamethasone; and 4) this effects of dexamethasone should be further investigated in bone pain of other metastatic cancer. (Korean J Anesthesiol 1998; 34: 394∼402)

부인과 수술후 뷰톨파놀과 모르핀의 통증 자가관리에 관한 비교

한태형,신백효,이정진,강진원 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.2

Background: Intravenous patient controlled analgesia(IV-PCA) is a very popular and relatively safe technique due to its innate negative feedback mechanism. Morphine, the most commonly used analgesic, however, has its own drawbacks due to troublesome side effects. Narcotic agonist-antagonists are known to have ceiling effects not only to their analgesic potency, but also to their side effects. The authors studied the efficacy and incidence of side effects of Butorphanol IV-PCA for postoperative analgesia and compared these to morphine. Methods: 38 ASA class I or II patients, undergoing gynecological surgery were randomly assigned into two groups, respectively Butorphanol and Morphine and examined hemodynamic changes, overall pain relief, patients satisfaction and the frequency of side effects. After general anesthesia, each patient randomly received loading dose of butorphanol or morphine in the recovery room and discharged to the floor with the PCA module. Upon arrival, individual patient was evaluated at predetermined time interval for 24 hours. Results: The percentage of patient satisfaction was very high in both groups. The incidence of nausea was less in butorphanol group. The incidence of other side effects was statistically insignificant. Conclusion: Butorphanol has less incidence of side effects and comparable level of analgesia when compared to morphine. We conclude that butorphanol may be considered as a part of routine IV-PCA regimen, in postoperative pain management.

신경교 세포의 재관류 손상:칼슘 파라독스 현상과 그 기전

이병달,김명희,신백효,김유홍 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.4

Background: Mechanisms of secondary injury (post-ischemic injury) in the central nervous system have recently reported in a vast of a mount of experiments. Among many factors which give rise to post-ischemic neuronal darnage, glial deterioration probably mediated by calcium paradox, could be another of the aggravation deleterious factors to the already ischemic neurophil. Methods: Here we have designed experiment to investigate calcium paradox in astroglial cell line, human astrocytoma U1242MG. Intracellular calcium alterations in experimental cells were monitored by using calcium indicating dye fura-2 and epifluorescent photometry system. Results: Intracellular free calcium changes during reperfusion phase after exposure to low calcium led to ptrompt increase in intracellular calcium level after 10 and 30 minutes. The was of calcium cntry during the reperfusion phasc was mediated by the reverse mode of Na^+/Ca^2+ exchanger. Cells that had a reduction of reperfusate calcium to 10 uM increased cell viability. Also we observed an inverse relationship between major enzymatic activity in the astrocy toma cells (i.e., glutamine synthetase activity) and the duration of reperfusion in the the same protocols. Conclusion: A relatively small amount of intracellular calcium increase by the reverse mode of Na^+/Ca^2+ exchanger during the reperfusion period is related to limitation of enzyme activity and viability 24 hours later. (Korean J Anesthesiol 1996; 30; 384∼391).