고주파열응고술을 이용한 오부교감신경절제술에서 수술기주위의 온도변화

이기헌(Kee Heon Lee),신근만(Keun Man Shin),정배희(Bae Hee Jung),김현주(Hyun Ju Kim),김태성(Tae Sung Kim),홍순용(Soon Yong Hong),최영룡(Young Ryong Choi) 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.2

N/A Background: Currently, minimally invasive operations are preferred to open surgery whenever possible. Lumbar sympathectomy using RF (radiofrequency) thermocoagulation is both safe and minimally invasive. The problem with the technique is that it cannot be performed successfully in a significant number of cases. If the temperature change in the sole is monitored immediately after the procedure then it can be determined if the procedure needs to be repeated. Methods: A curved tip cannula, 150 mm long with a 10 mm active tip, was used for RF lumbar sympathectomy. The temperature of the soles of both the foot on the affected side and the foot on the control side was monitored immediately before the procedure, immediately after making the L2 lesion, immediately after making the L3 lesion and at 5, 10, and 15 minutes after the procedure. Results: No statistically significant difference was observed in the temperature of the two soles before making the lesions. In the 24 of the 27 patients, there were prominent differences in temperature between the two soles at 10 minutes after the procedures. 11 of the 24 patients showed a significant temperature change after the first trial. But the remaining 13 required a second lesion on L2 and L3. Conclusions: We judged the success of the operation in the operating room by monitoring the temperature difference in the soles of the feet. When no increase in the temperature difference is observed, we can move the electrode and make another lesion. With this procedure, we can drastically increase the success rate of the procedure.

지속적 성상 신경절 차단에 의한 슬상 신경통 (Geniculate Neuralgia) 환자의 치료

이기헌 ( Kee Heon Lee ),양선주 ( Sun Ju Yang ),김욱종 ( Wook Jong Kim ),김현주 ( Hyun Ju Kim ),이병상 ( Byung Sang Lee ) 대한통증학회 2003 The Korean Journal of Pain Vol.16 No.2

백서 좌골신경에 시행한 박동성 고주파술 ( Pulsed Radiofrequency )이 급성 통증과 신경조직에 미치는 영향

이기헌(Kee Heon Lee),신근만(Keun Man Shin),권경석(Kyoung Seok Kweon),정배희(Bae Hee Jung),임소영(So Young Lim),홍순영(Soon Yong Hong),최영희(Young Hee Choi),박영의(Young Euy Park) 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.2

N/A Background: Pulsed radiofrequency (RF) lesioning is a painless procedure and causes no neurodestruction and neuritis-like reaction are common following conventional RF lesioning. There is little data about the effect of pulsed RF especially with regard to its suitability for the treatment of acute pain. The possibility of a placebo effect cannot be ruled out because a double-blind study was not performed in previous studies. There is also no neuropathologic study about pulsed RF. Methods: The rats were anesthetized with sodium pentobarbital (40 mg/kg, i.p.; supplemented as necessary). The common sciatic nerve was exposed by blunt dissection through biceps femoris. Pulsed RF was administered to the common sciatic nerve using a 30 ms/s pulse with for 120 seconds. The temperature reached was no more than 42℃. Analgesia was determined using hot-plate assay shortly and, 3 days and 1 week before, and 2 weeks after operation. Lesions were examined with LM (light microscope) and EM (electron microscope) 2 weeks later. Results: There were no differences in response latencies between the control and experimental group. There were many vacuoles with hyaline bodies in the Schwann cell cytoplasm rather than axon in LM and larger electron dense bodies. No changes were found in the axon or unmyelinated fibers. Only small changes were found in the sheaths of myelinated fibers and Schwann cells. Conclusions: We therefore do think that any analgesic effect of pulsed RF is not a result of block of neural conduction. But rather than it can be attributed to others factors. It was also ineffective as a treatment for acute pain such as that caused by the hot-plate test.

행위자기반모형(Agent-Based Modeling)을 이용한 신기술과 지식 확산 연구

이상엽(Sang Yup Lee),이기헌(Kee Heon Lee) 과학기술정책연구원 2015 조사연구 Vol.- No.-

고주파열응고술에서 병소의 크기 및 형태학적 변화

이기헌,김근숙,임소영,홍순용,원임수,신근만 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.3

Propofol의 주입속도 변화가 동맥압반사 민감도에 미치는 영향

이승준,길호영,이기헌,오완수,양정화 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.2

Background : Induction of anesthesia with propofol caused a decrease in arterial blood pressure and systemic vascular resistance. This effects of propofol on the circulation can be more clarified by studying cardiovascular control mechanism such as baroreflex sensitivity during variable rate infusion of propofol. Methods : The effects of three infusion rates of propofol (3, 6, 12 mg/kg/hr) to supplement 66% nitrous oxide in oxygen anesthesia on baroreflex sensitivity were studied and compared with awake value in 80 ASA I or II patients (20∼55 years old, n=20 in each group). Baroreflex control of heat rate was studied by pertubing the patients' arterial pressure with 100 μg of phenylephrine in each three infusion rates of propofol which was maintained at least 30 min without any surgical stimulation. Results : Baroreflex slope representing baroreflex sensitivity among three infusion rates of propofol did not show any significant differences. The slope of each infusion rate was 8.4±0.7 at awake, 8.9± 1. 3 mg/kg/hr, 8.0±1.3 at 6 mg/kg/hr, 7.2±1.0 at 12 mg/kg/hr, respectively. But, resetting of the reflex occured at low heart rates. Conclusions : Usual propofol-nitrous oxide-oxygen anesthesia was not associated with impairment of baroreflex sensitivity, but showed reflex resetting at low heart rates. (Korean J Anesthesiol 1999; 36: 202∼207)

상부위장관 내시경을 위한 Propofol 의 지속정주

길호영,이기헌,박영주 대한정맥마취학회 1999 정맥마취 Vol.3 No.2

서론: 내시경 검사를 위한 진정은 단기간의 깊은 수면, 부작용의 최소화 등이 요구된다. Propofol은 빠른 작용 발현과 회복으로 내시경 검사를 위한 진정방법에 사용될 수 있으며 특히 저속 지속 주입 시 활력 징후의 변화가 적고 무호흡의 빈도가 현저히 감소된다는 보고가 있다. 저자들은 상부위장관 내시경의 진정을 위해 propofol을 저속으로 지속 정주하여 이 방법의 유용성을 알아보고자 하였다. 방법: 비국 마취과학회 신체 분류 등급상 1 및 2급에 속하는 30명의 환자를 대상으로 하였다. 1% Propofol 정주의 방식은 처음 정맥로를 통하여 150㎖/h 의 저속으로 속눈썹반사가 소실될 때까지 지속 정주 후 내시경을 되물릴 때까지 modified OAA/S scale을 2점으로 유지시키도록 propofol을 적정주입 하였다. 비강 케뉼라를 통하여 분당 3L의 산소를 투여하고, 진정 전, 진정 후 3분, 내시경 시행 중, 의식 회복 후 5분에 각각 활력 징후, 산소포화도, 합병증을 관찰하였다. 결과: 96.6%(29/30명)의 환자에서 완전 기억소실을, 3.5%(1/30명)에서는 부분 기억소실을 관찰하였다. 총 propofol 주입 시간은 6.2±1.8분, 약물 중단 후 음성 접촉에 눈을 뜨는 시간은 3.7±2.1분이었다. 수축기, 이완기 혈압의 변동은 propofol 진정 전 대조치와 비교하여, 11∼12% 감소하였으나 임상적 의의는 없었다. 내시경 시술자와 환자 모두 진정의 결과에 대하여 100% 만족함을 관찰하였다. 결론: Propofol 지속 정주를 이용한 내시경 검사는 적절한 진정 상태, 완전한 기억 소실, 의식의 조기 회복, 적은 합병증으로 인하여 시술자와 환자 모두 만족스러운 진정 방법임을 알수 있었다. Background: Endoscopy requires reliable sedation of short duration and must be devoid of side effects. Propofol has been found to be an ideal anesthetic for sedation during endoscopy with advantage of rapid onset of action and recovery. The aim of this study was to evaluate the usefulness of continuous infusion of propofol as a sedation method during upper gastrointestinal endoscopy. Methods: Thirty ASA Ⅰ or Ⅱ patients requesting sedation at diagnostic upper gastrointestional endoscopy received propofol. Propofol was infused continuously through an intravenous line at the rate of 150 ml/h until loss of eyelash reflex occurred and titrated to 6~10 ㎎/㎏/h according to estimated depth of sedation. Estimated depth of sedation was set to 2 of modified OAA/S seale. 3 L/min of oxygen was inhaled through nasal cannula to minimize possible hypoxemia. Vita signs, peripheral oxygen saturation, and complications were checked. Results: 96.6% (29/30) of patients showed complete amnesia and one patient showed partial amnesia during endoscopy. Average propofol infusion time, average endoscopy time, and eye opening time after cessation of propofol infusion was 6.2±1.8, 2±1.5 and 3.7±2.1 min, respectively. Systolic, diastolic blood pressure and pulse rate decreased by 11~12% compared with the control values, but those changes were not clinically significant. Endoscopists and patients were satisfied with this type of sedation method in all cases. Conclusions: Sedation using continuous infusion of propofol was a useful method during upper gastrointestinal endoscopy in terms of reliable depth of sedation, perfect amnesia, early recovery, and few complications.

Propofol 의 주입속도 변화가 동맥압반사 민감도에 미치는 영향

길호영,이기헌,양정화,이승준,오완수,박영주 대한정맥마취학회 1999 정맥마취 Vol.3 No.4

서론: Propofol 마취유도는 혈압하강을 보이며 이의 기전으로 심근 억제, 후부하 감소, 전부하의 감소, 전신혈관저항의 감소 등이 있다. 본 연구는 propofol을 3, 6, 12 ㎎/㎏/hr로 주입하면서 각성시와 propofol 주입 30분 후에 phenylephrine 정주에 의한 혈압변화에 따른 R-R 간격의 변화를 관찰함으로써 propofol 주입 속도에 따른 압반사 민감도의 변화를 관찰하였다. 방법: 20-55세, 체중 50-80 ㎏의 미국마취과학회 신체분류 등급상 1 및 2에 해당되는 남녀환자 80명을 대상으로 심전도, 맥박산소계측기, 지속적 동맥압을 측정하였고 propofol을 투여하지 않은군은 1군, propofol 3, 6, 12 ㎎/㎏/hr로 투여한 군을 각각 2, 3, 4군으로 분류하였다. 안정 상태에서 수축기 및 이완기 혈압, 맥박, 말초산소포화도를 3분 간격으로 3회 측정하여 평균치를 phenylephrine 100 ㎍을 정주한 후 혈압 및 맥박수(R-R 간격)을 20초 간격으로 기록하였다. 결과: 수축기 혈압에 대한 R-R 간격의 비율로 나타낸 압반사의 기울기는 1군 8.4 ± 0.7, 2군 8.9 ± 1.7, 3군 8.0 ± 1.3, 4군 7.2 ± 1.0으로 유의한 차이를 보이지 않아 propofol 주입속도 3-12 ㎎/㎏/hr에서 각 군간에 압반사 민감도의 차이는 없었다. 또한 2, 3, 4군에서 propofol 주입속도 증가에 따른 혈압하강에 따라 동시에 맥박이 증가하는 대신 감소된 상태를 유지함으로서 반사의 재조정 현상을 보여주었다. 결론: Propofol을 이용한 마취시 3, 6 및 12 ㎎/㎏/hr의 주입속도의 변화는 압반사 활성도에 유의한 변화를 보이지 않았고 압반사의 재조정 현상이 나타남을 알 수 있었다. Background: Induction of anesthesia with propofol caused a decrease in arterial blood pressure and systemic vascular resistance. This effects of propofol on the circulation can be more clarified by studying cardiovascular control mechanism such as baroreflex sensitivity during variable rate infusion of propofol. Methods: The effects of three infusion rates of propofol (3, 6, 12 ㎎/㎏/hr) to supplement 66% nitrous oxide in oxygen anesthesia on baroreflex sensitivity were studied and compared with awake value in 80 ASA Ⅰ or Ⅱ patients (20-55 years old, n=20 in each group). Batoreflex control of heat rate was studied by pertubing the patients' arterial pressure with 100 ㎍ of phenylephrine in each three infusion rates of propofol which was maintained at least 30 min without any surgical stimulation. Results: Baroreflex slope representing baroreflex sensitivity among three infusion rates of propofol did not show any significant differences. The slope of each infusion rate was 8.4 ± 0.7 at awake, 8.9 ± 1.7 at 3 ㎎/㎏/hr, 8.0 ± 1.3 at 6 ㎎/㎏/hr, 7.2 ± 1.0 at 12 ㎎/㎏/hr, respectively. But, resetting of the reflex occured at low heart rates. Conclusions: Usual propofol-nitrous oxide-oxygen anesthesia was not associated with impairment of baroreflex sensitivity, but showed reflex resetting at low heart rates.

난소가 적출된 임신성 융모성 질환에서 고원정체를 보인 p-hCG의 완전관해에 관한 증례

김태진,현우영,심재욱,이기헌,정환욱,강옥림,함경렬,이문섭,임경택,박종택,박인서 대한부인종양 콜포스코피학회 1998 Journal of Gynecologic Oncology Vol.9 No.2

Although chemotherapy remains to be the mainstay of treatment of trophoblastic disease, hysterectomy has been performed as the primary management of nonmetastatic trophoblastic disease who desire sterilization and for uterine disease resistant to chemotherapy. Clinically, the documentation of disease regression is provided by serial quantitative serum β-hCG assays and the persistent disease may be indicated when the serum β-hCG values rise for 2 weeks or plateau for 3 weeks or more. Because of similarity in molecular structure, the confounding effect of an elevated LH on β-hCG assessment in castrated women after treatment for trophoblastic disease has been documented. This LH cross-reactivity may be suspected in women with bilateral oophorectomy demonstrating persistent low levels of β-hCG. It is particularly true when the assay is perfo-rmed by conventional polyclonal radioimmunoassay. We have experienced two cases of nonmetastatic trophoblastic disease whose serum β-hCG assay plateaued at a low level atotal abdominal hysterectomy with bilateral salpingo-oophorectomy and chemotherapy. Clinical and radiologic work-ups were done for metastatic lesion in dose patients, but the results were negative. The quantitative LH assays (Serono LH MAIAclone kit, Roma, Italy) were performed with the sera obtained from the patients; the results were 37 and 31 mIU/ml (1st IRP) with β-hCG of 14 and 13 mIU/ml (1st IRP), respec-tively. With the initiation of oral estrogen replacement thrapy to those patients, the quantitative β-hCG values fell below 5 mIU/ml (1st IRP) and they remained in complete chemical remission without any additional chemotherapy for one year. The persistant low titers of β-hCG in those patients were considered to be result of LH cross-reactivity on β-hCG assessment. It is concluded that whenever the assay of β-hCG shows persistent low titers in the oophorectomized patient for treatment of trophoblastic disease, LH cross-reactivity should be suspected.

고주파열응고술을 이용한 척수신경 후내측지 신경절제술에서 후내측지를 확인하는 새로운 기준

임소영,최상은,홍순용,이기헌,신근만,윤선혜,최영룡,정배희 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.2

Radiofrequency medial branch neurotomy is an effective way of controlling pain in the posterior compartment of the spine such as the facet joint, and the interspinous ligament. However, it is difficult to determine the exact location of the medial branch. Up until now we have relied on sensory response provoked by 50 Hz stimulation. The responses elicited using this method are quite subjective and can originate from sources other than the medial branch such as the periosteum, the intermediate or lateral branch. We need a confirmed indicator to locate the medial branch reliably. We applied 2 Hz stimulation under 0.4 volts to locate the medial branch and elicited a motor response. Twitching of multifidus and muscles around the SI joint was observed. The observation of these muscles provides a much more reliable method for confirmation of the medial branch. We have treated 45 chronic nonspecific low back pain patients using radiofrequency medial branch neurotomy with this method of confirming the medial branch.