흰쥐의 술 후 통증모델에서 척수강내로 투여된 Gabapentin과 Non-NMDA 수용체 길항제인 CNQX의 항통각과민 효과

박혜진 ( Hae Jin Park ),송장호 ( Jang Ho Song ),송진만 ( Jin Man Song ),이홍식 ( Hong Sik Lee ),이춘수 ( Choon Soo Lee ),정춘근 ( Choon Kun Chung ),차영덕 ( Young Deog Cha ),김부성 ( Boo Seong Kim ),유중하 ( Joong Ha Ryu ) 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.2

마그네슘 투여에 의한 제왕절개술산모의 기관삽관에 따른 심혈관계 자극억제 효과

정춘근,배진성 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.6

Background; Tracheal intubation for cesarean section is usually performed with rapid sequence induction. Under this light stage of anesthesia, marked hypertensive changes of maternal hemodynamic responses following tracheal intubation may occur, which are the common cause of maternal and neonatal complications. We have studied the matemal cardiovascular blunting effect of magnesium sulfate following tracheal intubation in cesarean section. Methods; After obtaining the written informed consents, ninety ASA class I parturients scheduled for cesarean section were randomly allocated to one of three groups: group 1 received thiopental 4 mg/kg and succinylcholine 1.5 mg/kg, group 2 received fentanyl 1.5 ㎍/kg additionally, and group 3 received fentanyl 1.5 ㎍/kg and MgSO₄ 40 mg/kg additionally. Systolic, mean, diastolic blood pressure, and heart rate were measured before induction, immediately after intubation. Serum magnesium concentrations were measured before administering magnesium and near the end of surgery. Train of four ratio was monitored during whole period of anesthesia. Neonatal Apgar scores and neurologic and adaptive capacity scores (NACS) were checked. Results; Blood pressure changes were more stable in group 2 and group 3, especially group 3, than group 1 (p$lt;0.05). No statistical differences were found in heart rat;. changes in all groups. No significant differences were noted in neuromuscular recoveries, neonatal Apgar scores and NACS. Conclusions; Magnesium sulfate may be successfully used for blunting the cardiovascular response to tracheal intubation in parturients undergoing general anesthesia for cesarean section.

제왕절개술 마취중 Vecuronium(Norcuron)투여후에 발생한 서맥

정춘근 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.1

Ritodrine(Yutopar)투여 산모의 제왕절개술중에 발생한 급성패부종

정춘근 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.6

Two selective β_2-sympathonimetic drugs are presently used to arrest preterm labor ritodrine (Yutopar) and terbutaline. As the use of rltodrine becomes more widespread an increasing number of cases of pulmonary edema is 7eing observed Besides pulmonary edema many other complications such as myocardial ischemia, cardiac arrhythmias, hypotension, hypertension, cerebral vasospaun, hyperglycemia and miscellaneous metabolic alterations have been recongnized. We recently experienced a previously healthy parturient who suddenly develeped severe pulmonary edema during a cesarian section under epidural anesthesia. She had been treated wish ritodrine for 4 days in an attempt to arrest preterm labor which ultimately failed. Close, aggresaive patient care, mechanical ventilatory support with PEEP and diuretics could dramatically relieve poteotiatty fatal pulmonary edema within 24 hours. The anesthetist should be aware of the potential, life·threatening complications. It is necessry for the aneathetist to know how to screen, monitor and treat a patient with compllcatitions associated with tocolytic agents.

소량의 Fentanyl 투여에 의한 기관내 삽관시의 심혈관자극 억제효과

정춘근 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.1

The hemodynamic response evoked by tracheal intubation was observed in 20 adult normotensive patients undergoing elective surgery. Patients were randomly assigned to receive either thiopental 6 mg/kg(n=10) or fentanyl 6㎍/kg with thiopental 3 mg/kg (n=10), for induction of anesthesia. Systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP) and heart rate(HR) were measured at 1 min., 3 min. and 5 min. after intubation. In the thiopental group, intubation caused a significant rise in SBP, DBP, MAP, HR(p<0.05) but each parameter returned to normal within 5 min. In the fentanylthiopental group intubation caued little cardiovascular change, byt within 5 minutes MAP decreased significantly from 101 mmHg to 83 mmHg (p<0.05). It is concluded that a low-dose of fentanyl which may cause minimal postoperative respiratory depression, significantly prevents postintubation hypertension when used as an adjunct to thiopental for the induction of anesthesia.

심폐소생술

鄭春根 대한의학협회 1993 대한의학협회지 Vol.36 No.6

기관내 삽관시 Nicardipine 정주에 의한 심혈관계 자극 억제효과

정춘근,임정만,강기철 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2

Background : Direct laryngoscopy and tracheal intubation frequently induce transient hypertension, tachycardia and arrhythmia. This study was to evaluate the effect of nicardipine on the changes of the blood pressure and heart rate induced by direct laryngoscopy and tracheal intubation. Methods : Sixty patients were randomly divided into three groups: Group 1 (nicardipine 0.02 mg/kg, n=20), Group 2 (diltiazem 0.2 mg/kg, n=20), Group 3 (normal saline 3 cc, n=20). Two minutes after intravenous injection of 2 mcg/kg of fentanyl, thiopental 5 mg/kg and nicardipine or diltiazem or normal slaine was administered intravenously. Then succinylcholine 1.5 mg/kg was administered. One minute after succinylcholine injection, direct laryngoscopy and tracheal intubation was done and vecuronium 0.1 mg/kg was injected. Anesthesia was maintained with 50% nitrous oxide in oxygen and 2 vol % of enflurane. Blood pressure and heart rate were measured at the period of preintubation, immediately after intubation, 1, 3 and 5 minutes following intubation by noninvasive method. Results : After tracheal intubation, the increase of systolic blood pressure was supressed significantly in nicardipine and diltiazem group compared with control group (nicardipine group 11%, diltiazem group 13%, control group 24%). The increase of heart rate was greatest in nicardipine group (nicardipine group 38% diltiazem group 29%, control group 20%). Conclusions : Nicardipine was effective in attenuating pressor responses to laryngoscopy and intubation, but in nicardipine group, increase of heart rate was greater than control group. (Korean J Anesthesiol 1998; 34: 303∼307)

급성 B형 바이러스성 간염환자의 Isoflurane 마취후 간기능 장애의 회복

정춘근,최강,한용성 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.2

Elective operation should be postponed in patient with acute hepatitis because of the increased risk of morbidity and mortality. Especially, surgery carried out in the presence of acute viral hepatitis is associated with high incidence of major complications The authors have recently experienced a patient who was performed emergency craniotomy for epidural hematoma. At that time, the patient was in midst of acute viral hepatitis B. Major in-halational anesthetic was isoflurane and muscle relaxant was atracurium. Fortunately, the preoperative hepatic dysfunction was not exacerbated and recovered uneventfully. The choice of anesthetics and the proper pre-and intraoperative anesthetic managements are reviewed.

종격동 혈관종 환자의 시험적 개흉술후 마취회복시 발생한 기도폐쇄

정소영,박동호,이홍식,이미라,정춘근,한용성 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.5

Anesthesia for the patients with mediastinal mass may be associated with significant respiratory and cardiovaacular complications due to compression of traeheobronchial trees, the pulmonary artery, heart and superior vena cava The authors present a case of a 6-year-old girl with a large mediastinal tumor located in anterior and superior mediaetinum. Preoperatively, the patient was asymptomatic and anesthesia was induced and maintained uneventfully. Operative finding was that 8 x 14 cm sized hemangioma was extended superiorly over thoracic outlet, posteriorly aorta and SVC, medially pericardium and right hilum and inferiorly right upper lung and pleura. Because difficulties in removal of the hemangioma were expected, exploratory thoracotomy was discontinued. On emergence, as soon as the patient was extubated due to irritability, the patient became cyanotic and was noticed bulging mass on right supraclavicular area, Intubation was attempted and during direct laryngoscopy, anesthesiologist also noticed a bulging mass in right oral cavity. Postoperatively, the patients airway was kept with endotracheal tube, but cyanosis appeared on the face and skin over the chest, but not below the abdomen. Bulging mass on right supraclavicular area, distension of neck vein and conjunctival edema were noticed only when the patient was crying or suctioned. Symptoms improved by deep sedation. We assumed that enlargement of hemangioma due to increased central blood volume occasionally compressed tracheobronchial tree and sup. vena cava when patient was irritable, crying and coughing. On 11th postoperative day, patient was transferred to the another hospital for the better treatment with endotracheal intubation.

경막외 마취중 고관절전치환술시 발생한 심한 돌발성 서맥과 저혈압

정소영,정춘근 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.5

Epidural anesthesia is a popular regional anesthetic technique for total hip replacement (THR). It s benefits are reduced blood loss, less need for transfusion, and decreased chance of deep vein thrombosis, and if necessary, it provides longstanding postoperative analgesia with small dose of epidural narcotics through indwelling epidural catheter. The wellknown cardiovascular effects are bradycardia and hypotension according to the degree of sympathetic blockade. These occur usually early in the anesthetic period and the course is benign and are easily treated. We report a case of sudden extreme bradycardia and hypotension during THR under epidural anesthesia that was not associated with hypoxemia, obvious respiratory depression, or systemic toxic reaction. It is concluded that the most likely cause would be a sudden large increase in vagal activity which results from marked reduction in venous return and inadequate oxygenation of myocardium with the assumption of prolonged iatrogenic hemodilution and undercorrected hypovolemia. The patient who receives epidural anesthesia should require constant monitoring and vigilance throughout all procedure.