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The Effects of Systemic Morphine to Analgesic Level in Spinal Anesthesia
이강창,김태요,윤재승,이의상,Lee, Kang-Chang,Kim, Tai-Yo,Yun, Jae-Seung,Lee, Eui-Sang The Korean Journal of Pain 1995 The Korean Journal of Pain Vol.8 No.1
척추마취는 국소마취제를 지주막하강에 주입하여 척수신경 전근과 후근을 차단하는 방법으로 하복부나 하지 수술 뿐 아니라 만성 통증과 암성 통증의 치료에도 이용되고 있는데 마취시간이나 제통시간의 연장 및 적절한 피부분절의 마취나 진통의 달성은 척추마취에서 중요한 사항이다. 본 연구에서는 morphine정주가 척추마취에 어떤 영향을 주는지 알아보기 위해 척추마취하에서 하지 수술을 받은 40명의 환자를 대상으로 척추마취를 시행한 80분에 척추마취 레벨, 수축기 및 이완기 혈압, 맥박 그리고 호흡수를 조사한후 morphine 10 mg을 정맥내로 주사후 20분후에 척추마취 레벨과 혈압, 맥박, 호흡수를 조사하여 다음과 같은 결과를 얻었다. 1) 척추마취 레벨은 morphine 투여진 $T_{7.5{\pm}0.32}$에 비해 morphine 투여 20분후에 $T_{6.0{\pm}0.31}$로 의의있게 상승하였다 (p<0.005). 2) 수축기 및 이완기 혈압과 맥박수는 morphine투여전과 투여후에 의의있는 변화가 없었다. 3) 호흡수는 morphine 투여전에 비해 투여후 감소가 있었다(p<0.005). 이상의 결과로 척추마취하에서 수술을 시행할 때나 통증치료시 전신적으로 morphne을 투여하여 마취와 진통부위를 넓일 수 있을 것으로 사료된다.
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뇌성마비와 소아마비 환자에서 succinylcholie 사용후 혈중 전해질 농도의 변화
이강창,이환봉 圓光大學校 醫科學硏究所 1999 圓光醫科學 Vol.15 No.1
Background: Succinylcholine(Sch)-induced hyperkalemia occurs in patients with burn, severe trauma, uremia and neuromuscular diseases. Cerebral palsy and poliomyelitis are categorized into these neuromuscular diseases. This study was to exam the change of serum electrolyte after the administration of Sch in patients with cerebral palsy and poliomyelitis. Materials and Methods: 60 patients were devided into three groups. Group 1 (n=20) was composed of cerebral palsy patients with age range 1-4years. Group 2 (n=20) was composed of cerebral palsy patients over 4 years. Group 3(n=20) was composed of patients with poliomyelitis. To establish the effect of Sch in patients with cerebral palsy and poliomyelitis, serum potassium, sodium, calcium and chloride were measured prior to administration of Sch, and 2, 5, 10 and 30 minutes after injection of it. Results: Fine fasciculation on the hand (grade 1 by Cullen's grading) occurred 4, 6, 13 in Group 1, 2 and 3, respectively. In Group 3, 2 patients showed minimal contraction of the trunk and extremities. There was no significant increase in the concentrations of potassium after the administration of Sch. Conclusion: Succinylcholine seems to have no relation to hyperkalemia in patients with cerebral palsy and poliomyelitis over 1 year.
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국소마취제가 말초신경에 미치는 영향에 대한 실험적 연구
이강창,윤재승,김태요,송윤강,임홍섭 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.3
Injury to a peripheral nerve due to a drug injection is of particular concern, because of both its clinical and medicolegal implications. Among numerous agents, local anesthetic solutions are most frequently injected near the main nerve trunks. In spite of the low incidence of nerve fiber injury associated with these local anesthetic agents, there are several clinical reports of injury. The author experimentally induced injection injury into the rat sciatic nerve with 2% lidocaine HCL and 0.5% bupivacaine. The neurotoxicity of these agents to the peripheral nerve was observed by light and electron microscope. The results are as follows: 1) Some inflammatory round cells and vasodilation were observed in the surrounding loose areolar tissues immediately after injection. No fibroblast or fibrosis was observed on light and electron microscopic examinations. 2) Immediately after injection, the axons were seperated by the splitting of the collagen fibers between the axons. But within one week, the collagen fibers were reunited and compacted. 3) Most cytoplasmic organelles of the axon, including the microtubules and micro filaments, were quite normal and were not altered by injection injury. But the shape of the axon was changed and shrinked to create a large space from the myelin sheath. The above change returned to normal within one week. 4) The Schwann cells, maintained the normal structure of their cytoplasm and nucleus, but some Schwann cells were seperated from the axons, and floated in the collagen tissue. They were reunited with the axons within one week. 5) There were no significant histologic differences between lidocaine and bupivacaine. 6) The above changes were easily reversible and not severe enough to interfere with nerve function permanently. In conclusion, local injection of these agents is very safe to the peripheral nerve.
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이강창 圓光大學校 醫科學硏究所 1987 圓光醫科學 Vol.3 No.2
Ten healthy patients were studied to evaluate the effect of vecuronium on intraocular pressure(IOP) and to search its cause. The mean decrease in CVP at 5 and 10 minutes following the administration of vecuronium were 11.82% and 15.46%, respectively, and the mean decrease in IOP were 13.6% and 17.72%. The fluid was administered after decrease in IOP and CVP, afterthen IOP and CVP were increased to control value coincidently. This increasing effect on IOP appeared to be the result of a secondary action possibly via an effect on CVP. Vecuronium would be a suitable neuromuscular blocker for patient undergoing eye surgery inwhom increase in IOP would be undesirable.
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Bupivacaine을 이용한 미추마취후 전신반응 증례보고
이강창,김태요 圓光大學校 醫科學硏究所 1987 圓光醫科學 Vol.3 No.1
The authors had an experience of a severe convulsion and hypoxic patient who had caudal block with 20ml of 0.5% bupivacaine ( total 100 ㎎) in order to have operation for the anal fistula. These complications were developed just after injection of 0.5% bupivacaine in to the sacral hiatus. This patient was treated completely without sequale . Nextday, operation had done under the general anesthesia.
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술전 식수 섭취가 환자의 위 내용물 및 정서 상태에 미치는 영향
이강창,윤재승,김태요,송윤강,권승안 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.3
Because the most impcetant goal of anesthetic management is patient safety, it is accepted practice that pre-operative patients take nothing by mouth for at least 6 to 8 hours before surgery. However, recent studies have questioned this conventional pre-operative fasting, showing that a fixed volume of water at various time pre-operatively may either improve the characteristics of gastric contents, or else have no effect. The present study was designed to investigate the effect of aUowing patients unlimited access to oral water drinks regardless of time. Fifty-eight fit adult patients scheduled for elective surgery normally requiring endotracheal intubation were recruited. They were randomly allocated to two groups; $quot;Fasters$quot; and $quot;Drinkers$quot;, and the effects on plasma osmolality, gastric contents and patient comfort were compared, respectively. This protocol was associated with a reduction in pre-operative anxiety, although the mechanism of this is not clear. No effects were found on plasma osmolality or on the volume or acidity of the gastric contents. No regurgitation occurred during induction and/or emergence in $quot;Drinkers$quot;.
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