혈액회수법을 사용한 슬관절 전치환술시 교질액 사용이 술 후 출혈에 미치는 영향: Hextend와 Voluven의 비교

김종엽,김진수,한상건,박관식,황지훈,박성용 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.4

Background:Total knee arthroplasty (TKR) is associated with a significant loss of blood. Fluid substitution with crystalloid or colloid solutions to correct perioperative hypovolemia is essential. Colloid solutions, and especially hydroxyethyl starches (HES), are used to treat hypovolemia, but they may affect blood coagulation. The purpose of this study was to test the efficacy and the safety of colloid solutions in patients undergoing TKR. Methods:The patients undergoing TKR were divided into a group that underwent fluid management with VoluvenⓇ (n = 22) and a group that was managed with HextendⓇ (n = 24). The blood loss, the autotransfused blood volume, the hemoglobin level, the allogenic blood requirement, the urine output and the complications were assessed. Results:There were no significant differences in the amount of blood loss, the autotransfused blood volume, the allogenic requirement, the urine output and the complications between the two groups. Conclusions:VoluvenⓇ and HextendⓇ are equally efficacious plasma volume substitutes when performing TKR with an autotransfusion of drained blood.

갑상선절제술시 술후 오심, 구토 예방을 위한 Tropisetron 단독 혹은 Dexamethasone 과의 병합 투여 효과

이숙영,김진수,원종진,정성미,한상건,서창국,유은숙 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.4

제왕절개술을 위한 척추-경막외 병용마취시 지주막하 Fentanyl 투여의 효과

김동원,이영석,문봉기,한상건,이영주 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.4

Background : Combined spinal-epidural anesthesia (CSEA) for cesarean section has gained an increasing interest as it combines a reliability of spinal anesthesia and the flexibility of epidural anesthesia. The aim of this study is to compare the surgical analgesia and the frequency of side effects for cesarean section produced by CSEA using subarachnoid fentanyl or placbo. Methods : The study was performed in a randomized, double-blined fashion in 40 (20 per group) healthy, full-term parturients presenting for elective cesarean section. We compared the effects of intrathecal fentanyl (20μg), and placebo when administered together with 0.5% hyperbaric bupivacaine 7 mg in combined spinal-epidural anesthesia (CSEA) for cesarean section. Patients' anesthetic levels, vital signs and intraoperative pain were recorded. If anesthetic level achieved by intrathecal injection was not sufficient for cesarean section (T4), additional 2% lidocaine 2 ml per segment was administered epidurally. Patients were asked to ratetheir severity of pain on a visual analog scale (VAS) score intraoperatively and intravenous fentanyl was administered if the patient experienced intraoperative discomfort. The quality and side effects of anesthsia and neonatal Apgar scores were compared between two groups. Results : The number (percent) of patients achieved sensory block level above T4 by subarachnoid injection alone was significantly higher in the fentanyl group (17/18, 94.4%) than the control grop (10/16, 62.5%). The dose of epidural lidocaine was significantly less in the fentanyl group (p<0.05). The frequency of intraoperative pain was significantly less in the fentanyl group (17%) than in the control group (50%). Conclusion : We conclude that adding fentanyl into subarachnoid injection in CSEA for cesarean section significantly decreases the additional epidural local anesthetics and intraoperative pain. (Korean J Anesthesiol 1999; 36: 619∼624)

제왕절개술시 목표농도주입를 이용한 전정맥마취유지를 위한 Propofol과 Fentanyl의 적절한 목표농도

김상현,민상기,김진수,유은숙,한상건 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.6

Background : Propofol has been used for the induction and maintenance of obstetric anesthesia for its potential benefit of rapid recovery and less post-anesthetic complications. In order to determine the safe application of target-controlled infusion of propofol and fentanyl during Cesarean section under general anesthesia, we have investigated the adequate target concentrations of each drug using the bispectral index and hemodynamic parameters. Methods : Ninety-two pregnant women who received Cesarean section under general anesthesia were enrolled in this study. After preoxygenation, anesthesia was induced with thiopental 4 mg/kg and succinylcholine 1 mg/kg, and intubation was done. Vecuronium 0.1mg/kg I.V. was applied for muscle relaxation, and mechanical ventilation was maintained with N2O/O2 (2 L/2 L)-enflurane. EtCO2 was maintained between 30 35 mmHg. After delivery of the fetus, propofol and fentanyl was infused by a computer-assisted continuous infusion system with air/O2 (2 L/2 L). The bispectral index was monitored perioperatively. This study proceeded in three stages. In the first stage, thirty women were studied for titration of the target effect-site concentration of propofol that could maintain a bispectral index between 40 60 while maintaining the target concentration of fentanyl at 1.5 ng/ml. In the second stage, forty-two women were randomly assigned into the four different groups (F25, F50, F75, F100) at target fentanyl concentrations of fentanyl of 0.25, 0.50, 0.75 and 1.0 ng/ml for each group respectively. The adequate target concentration of fentanyl was titrated. In the third stage, twenty women were studied for assessment of the adequacy of target concentrations of propofol and fentanyl prospectively. Results : The target effect-site concentrations (Ce, 95% confidence interval) that could maintain 50% and 95% of patients hemodynamically stable with the bispectral index within 40-60 were 2.41 (2.27-2.55) μg/ml and 3.15 (2.95-3.50) μg/ml for propofol, 0.32 (0.13-0.46) ng/ml and 0.84 (0.61.29) ng/ml for fentanyl. The pre-anesthetic bispectral index was 97.1±1.2 and it decreased maximally to 39.5±6.47 after thiopental injection and increased maximally to 83.6±6.3 before delivery and it was 80.6±6.9 for eye-open to verbal command during recovery. Conclusions : The adequate target effect-site concentrations of propofol and fentanyl for the maintenance of total intravenous anesthesia during Cesarean section were determined and these concentrations were validated prospectively. (Korean J Anesthesiol 1999; 37: 986∼994)

부종양성 천포창 환자의 마취 관리

신양식,이동철,최미영,이기영,한상건 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.2

Paraneoplastic pemphigus is a distinct and rare autoimmune disease characterized by extensive and painful mucosal ulcerations and polymorphic desquamated skin lesions in the setting of an underlying neoplasm, typically of lymphoreticular origin. Thus difficulties in the management of anesthesia can be expected. A 66-years-old man was scheduled for removal of intraabdominal sarcoma associated with paraneoplastic pemphigus. Physical examination showed multiple erythematous bullae, crusts, plaques and target-like lesions on the whole body and desquamated erythematous skin lesions on the back and extremities. In the operating room, his right femoral artery was cannulated with a 20 G, 12.7 cm CVP catheter and left femoral and subclavian veins with 14 G, 20 cm CVP catheters, respectively. After application of 4 % lidocaine spray, his oropharynx and supraglottic area were evaluated under direct laryngoscopy and revealed multiple ulcerations on oral mucosa, but no distinct lesion on supraglottic area. Anesthesia was induced by rapid-sequence method with fentanyl, thiopental sodium and succinylcholine followed by endotracheal intubation. The endotracheal tube was held by a roll gauze around the neck and its cuff was minimally inflated to avoid overpressure against his tracheal wall. After the end of surgery, his oral cavity was suctioned with no remarkable bleeding, and tracheal wall including cuff-contacted area was evaluated under fiberoptic bronchoscopy, revealed intact wall without any bulla or ulceration. The patient was transferred to intensive care unit for proper postoperative management after extubation of endotracheal tube. (Korean J Anesthesiol 1997; 33: 385∼389)

腦血流및 血管에 미치는 옻나무의 效果

김종천,이계복,최병화,한상건,한종현 한국전통의학연구소 2004 한국전통의학지 Vol.14 No.1

The purpose of this present study is to measure the changes of regional cerebral blood flow(rCBF) was continually monitored by laser-doppler flowmeter (Transonic Instrument, USA) through the data acquisition system composed of MacLab and Macintosh computer. Contractile force was measured with force displacement transducer under 1.5 g loading tension. Rhus verniciflua stokes increased the changes of rCBF in rats, significantly. The rCBF of Rhus verniciflua stokes was decreased by pretreated propranolol, l-NNA and methylene blue. But atropine indomethacin did not change the rCBF. Contractions evoked by PE 0.1μM were significantly inecreased by Rhus verniciflua stokes. Propranolol significantly altered the effect of Rhus verniciflua stokes, but l-NNA, ODQ and indomethacin did not change the relaxation of Rhus verniciflua stokes. These results suggest that Rhus verniciflua stokes can increase the rCBF and relax EP induced contraction of isolated rat aorta, and that is related to sympathetics and nitric oxide.

Clonidine 과 Meperidine 의 마취후 전율에 대한 약물학적 예방효과:메타분석(Meta-analysis)

민상기,이영석,김원옥,이성중,한상건,남용택 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.1

Background: Post-operative shivering is one of the potential complications for any surgical patient. Its incidence varies from 5% to 65%, and many preventive and treatment modalities have been reported. For the effective prevention of post-anesthetic shivering by using intravenous clonidine or meperidine, randomized controlled studies were reviewed. The overall incidence of shivering after clonidine or meperidine administration, and the anti-shivering effect of clonidine and meperidine were evaluated. Methods: DATA SOURCES: Medline search from 1978 to March 1998. DATA SELECTION: We selected studies that had investigated the preventive anti-shivering effect of intravenous clonidine or meperidine by randomized controlled trials. Ten clinical trials were evaluated. Results: The pooled odd ratio of the patients who received clonidine was 0.32 (95% confidence interval, 0.22∼0.47) and it seemed to be effective. But these studies showed little evidence of significant homogeneity (P=0.01). In the subgroup analysi, the pooled odd ratio of group A (early administration or intra-operative infusion group) was 0.47 (95% CI 0.31∼0.72) evidenced effectiveness but failed to prove homogeneity (P=0.047). But group B (the late intra-operative administration group) had a pooled odd ratio of 0.10 (95% CI 0.05∼0.22) and showed homogeneity (P=0.98). In meperidine trials, the pooled odd ratio was 0.20 (95% CI 0.07∼0.55). Conclusion: We present quantitative evidence based on a meta-analysis of pooled effect size from randomized trials that clonidine is more beneficial for the prevention of post-anesthetic shivering and more effective than meperidine when it is administrated during later period of surgery. (Korean J Anesthesiol 1999; 37: 63∼72)

피부절제술로 치료한 대상포진후 신경통

이경진(Kyung Jin Lee),한상건(Sang Gun Han),김진수( 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.2

Postherpetic neuralgia (PHN) is defined as the persistence of pain after recovery from herpes zoster (HZ), when the rash has healed, usually after about 4 weeks. PHN is the most feared complication of herpes zoster and remains one of the most common and intractable chronic pain disorders, Recent evidence has shed some light on the possible mechanism of pain, and on the prophylactic and treatment approaches to PHN, but there is no secure therapy. This report is a case of a 70-year-old male with PHN, affecting the 8th to 10th thoracic dermatomes. Patient complains of allodynia and hyperalgesia on the affected skins. After sympathectomy, antidepressant, anticonvulsant, and capsaicin ointment application, much pain relief was achieved, but allodynia remained at the subcostal area about 7 X 3 cm2 in size. We decided to remove the painful area. Skin excision was done under local anesthesia. After skin excision, the pain was decreased and patient did not complain of pain for 10 months.

Failed Back Surgery Syndrome ( FBSS ) 환자에서 Hyaluronidase 를 사용한 신경근차단술의 효과

이경진(Kyung Jin Lee),한상건(Sang Gun Han),윤석환( 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.2

N/A Background: Millions of patients with chronic sciatica are still treated with epidural corticosteroids. The efficacy of epidural corticosteroids remains questionable, especially in the failed back surgery syndrome (FBSS). We studied to evaluate outcome for 10 patients with failed back surgery syndrome treated with spinal nerve root block using corticosteroids, hyaluronidase, and local anesthetics. Methods: The affected nerve roots are localized with the help of fluoroscopy and contrast dye. Local anesthetic diluted in 1,500 U hyaluronidase and 40 mg methylprednisolone is injected. A small retrospective pilot group of 10 patients with FBSS was treated. The success rate is evaluated using a visual analogue scale at 1 week and 3 month interval after the last injection. Results: Initially, 7 patients experienced good pain relief; 5 patients suspained pain relief for 3 months. No complications were observed. Conclusions: This technique is worthwhile for patients with FBSS and where epidural fibrosis is suspected to be the pain origin.

유소아 개심술 환아에서 대동맥 캐뉼러의 이상위치에 의한 요골·대퇴동맥압간 차이의 발생

유은숙,이영석,박원선,한동우,방서욱,남상범,곽영란,한상건 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.6

Background : Appropriate placement of aortic and venous cannulas is important to ensure effective systemic perfusion. The malposition of the aortic cannula may promote preferential flow down the aorta or induce flow to aortic arch vessels causing pressure gradient between mean radial arterial pressure (RAP) and femoral arterial pressure (FAP). In this study we compared mean radial to femoral artery pressure gradient before and immediately after aortic cannulation and during cardiopulmonary bypass (CPB). Methods : Ninety two pediatric patients undergoing open heart surgery were examined. After induction of anesthesia RAP and FAP were measured. The pressure gradient was measured before and after aortic cannulation, 15, 30 and 60 minutes after aortic cross clamping (ACC). When the pressure gradient of more than 10 mmHg developed, the surgeon was recommended to manipulate position of the aortic cannula. If the pressure gradient returned to pre-CPB level after manipulation, the pressure gradient was considered to develop due to aortic cannula. The age, presence of cyanosis, adjustment of shape of aortic cannula tip before cannulation and side of radial artery cannulation as factors developing pressure gradient were examined. Results : Fifteen patients (16.3%) developed pressure gradient due to position of aortic cannula. Two patients (2.2%) developed immediately after aortic cannulation and fourteen patients (15.2%) during CPB. There was no statistically significant factor developing pressure gradient except non-cyanotic disease. Conclusions : The pediatric patient could develop pressure gradient due to malposition of aortic cannula frequently during CPB. Therefore, the simultaneous monitoring of RAP and FAP may be beneficial for managing CPB in pediatric cardiac surgery. (Korean J Anesthesiol 1998; 35: 1124∼1128)