Verapamil 전투약이 Isoflurane-N2O 마취중 Sodium Nitroprusside 의 혈역학과 폐내가스 교환효과에 미치는 영향

유경연,하인호,지재술,권갑수 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.2

Controlled hypotension induced with sodium nitroprusside (SNP) has been most widely used to facilitate the surgical procedure and to reduce blood loss. However, major problem with its clinical use is cyanide toxicity, which is dose related. And resitance and tachyphylaxis, probably being mediated by sympathoadrenal response to lowered blood pressure, is known to increase dose requirements. Accordingly, several attempts have been made to attenuate sympathetic activity and therefore to reduce dose requirement of SNP. Verapamil, a representative calcium channel blocker, exerts inotropic and chronotropic effect, as well as vasodilation. And it is, also, known to impair pulmonary gas exchange. The purpose of these experiments was to evaluate hemodynamic and gas exchange effects of verapamil, and also its efficacy for reducing the amount of SNP during induced hypotension in patients anesthetized with isoflurane and N2O. Twenty five patients, scheduled to undergo general anesthesia with hypotension, were randomly assigned to two groups. Twelve patients were pretreated with verapamil (160mg, SOD: verapamil group) and the other thirteen were not (control group). The results were as follows: 1) Cardiac index remained unchanged in both groups and did not differ significantly between groups at all times. 2) Heart rate was significatly lower in verapamil group than in control group in the hypotensive period. (113± 3.3 vs 103± 2.7, p $lt; 0.05) 3) Hypotension induced by SNP resulted from a marked decrease in systemic vascular resistance in both groups. 4) MPAP, PCWP, CVP, SVR and PVR significantly decreased after SNP infusion in both groups, but they did not differ significantly between the groups at all times. 5) SNP dose requirements to attain the same MAP reduction did not differ significantly between groups. (5.5±0.8vs 4.1±0.8mcg/kg/min, NS) 6) Verapamil pretreatment produced no significant change in intrapulmonary shunt fraction at all times. 7) SNP caused a signficant decrease in arterial oxygen tension in both group, bhere were no significant difference between groups at all times. From the above results, it might be concluded 1) that verapamil, in clinical doses, does not blunt a reflex increase in sympathetic activity in response to SNP induced vasodilation, since it produced only a minor influence on SNP induced hemodynamics and the SNP dose requirements, and that verapamil does not inhibit hypoxic pulmonary vasoconstriction during isoflurane-N2O anesthesia. Thus, verapamil could not be a valuable adjunct of SNP in enhancing the hypotensive effect in spite of preserved arterial oxygenation.

제휴시설 100배 즐기기 : 원광디지털대 2012학년도 1학기 신,편입생 모집

유경연 대한지방행정공제회 2011 地方行政 Vol.60 No.697

100억 출자 삼익오토텍 100%매출 신장 눈길

유경연 대한지방행정공제회 2008 地方行政 Vol.57 No.655

이연법인세의 유동 / 비유동 구분 기준과 기업 가치관련성 분석

유경연(Kyeong-Yoeon You),조성권(Sung-Kwon Cho),김대훈(Dae-Hun Kim) 한국국제회계학회 2008 국제회계연구 Vol.0 No.24

우리나라에서 이연법인세회계가 1998년4월1일부터 시작되었는데 기업회계의 수익비용 인식기준과 법인세법의 과세소득산정기준의 차이 때문에 나타나는 회계정보의 왜곡을 바로 잡고, 두 기준의 차이를 합리적으로 조정하는 것이 법인세 기간배분회계이다. 이러한 이연법인세회계는 일시적 차이의 효과를 차기 이후의 기간에 배분하는 것으로 자산과 부채의 적정표시를 목적으로 한다. 따라서, 본 연구는 이언법인세 자산/부채를 유동/비유동으로 구분 표시할 경우, 구운 적용전후의(2004년 6월) 그 가치관련성의 정도가 어떻게 평가되는가를 살펴보았다 검정을 위한 기본적인 모형으로는 기업가치 평가와 관련된 Ohlson(1995) 모형을 사용하였다. 기준상 이연법인세 자산과 부채를 유동/비유동으로 구분하여 표시하기 전에는 모두 비유동으로 분류했으므로 연도별로 자산과 부채를 유동과 비유동으로 각각 분해하여 회귀분석한 결과의 R2를 살펴봄으로써 처음 감사보고서에 나타난 2005년도분 이연법인세 재무자료에서 유동과 비유동으로 구분하는 효과를 평가하였다. 연구 결과는 이연법인세 자산과 부채에 대해 유동과 비유동으로 구분하여 회계처리하고 표시하므로서 기업의 가치관련성이 증대될 것이라는 가설을 실증분석을 통해 지지하고 있다. 또 한 추가분석으로 기업규모(기초자산의 로그값의 중위수를 기준으로 더미변수)에 따른 구분기준과 기업 가치관련성과 제조업내에서 산업별로 분류해서 구분한 기준의 의미를 살펴보았으나 역시 가설을 지지하고 있다. 따라서 본 연구는 국제회계기준에 초점을 둔 기준의 수정 및 시행에 대한 효과를 실증 분석한 것으로 기존의 연구를 확장했다는 의미를 지니고 있다. Deferred tax was introduced in Korea on April 1st. 1998. The liquidity-classification of deferred tax is to correct and reasonably mediate the distortions of accounting information. coming from the differences of the standards between Net Income of KGAAP and Taxable income. This deferred tax accounting which distributes the impact of temporary difference to the next year is to indicate proper assets and liabilities. As a result, this study allows people to recognize how the evaluating correlation of corporation valuation deferred tax front and rear (June. 2004). in case assets and liabilities are represented. divided into liquid and non-liquid accounts. Ohlson model related to evaluation of corporation valuation is used for the basic model of verification. Assets and liabilities had been represented as non-liquid things in all cases before KGAAP divided them into either liquid or non-liquid. Consequently. it was possible to estimate the effects of the accounting analysis in 2005. divided into liquid and non-liquid accounts on deferred tax by checking R2 of regression analysis of each year. The result of demonstrative analysis supports the hypothesis that the value-relevance of corporation is to be increasing when the accounting method of firms classifies assets and liabilities associated with deferred tax into liquid and non-liquid. To add to this. it is still in favor of the hypothesis. although considered with meaning of actual analysis in terms of scale of firms and industrial categories(A dummy variable of median for basic asset's log) again. In conclusion, this research has an expanded meaning than former case studies by showing actual proof which shows the effect of change of standards and implementation focused on IFRS.

Propranolol 이 Succinylcholine 에 의한 혈청 K+ 치 변동에 미치는 영향

유경연,정창영,임웅모,신성식 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.1

Succinylcholine induces a small increase in serum K^+(0.3∼0.5 mEq/l) in normal patients, but it may produce fatal increases in sensitive conditions, including severs burn, massive trauma, tetanus and neuromuscular disorders. Recently, interest has been focussed on the role of the adrenergic system in extrarenal potassium homeostasis. Accordin to this concept, beta-adrenergic stimulation enhances and conversely a blockade impairs celluar uptake of potassium. Meanwhile propranolol, a beta-adrenergic blocker, is an increasingly, common drug among surgical patients. Therefore, the present experiment was carried out on 66 patients in order to determine whether propranolol augments or prolongs the increases in serum K^+ following succinylcholine injection(2 mg/kg, I.V.). Serum K^+ and NaA^+ levels were measured just prior to induction and at 3,5,10,30,60,90 minutes following succinylcholine administration. The patients were divided into three groups: Group 1; 26 patients without propranolol treatment. Group 2; 20 patients pretreat with divided doses of propranolol(320 mg b.i.d. p.o.). and Group 3: 20 patients on chronic propranolol therapy. The results were as follows. 1) Baseline K^+ values were significantly higher in propranolol treated patients(Groups 2 and 3) than in non-treadted patients(Group 1). 2) The magnitude of maximum increases in serum K^+ following succinylcholine was 0.19 mEq/l, 0.16 mEq/l and 0.21 mEq/l in Groups 1, 2 and 3, respectively. 3) The time to peak increases in K^+ was 30 min, 5 min and 3 min following succiny lcholine in Groups 1, 2 and 3, respectively. 4) Serum Na^+ decreased singificantly following succinylcholine administration in all groups, but there was no significant difference among the groups at other ives. These results indicate that propranolol neither augments nor prolongs increases in serum K^+ following succinylcholine injection. Thus succiny lcholine can be used safely in the presence of a beta-adrengic blockade.

급만성 척수손상환자에서 기관내 삽관이 심혈관계에 미치는 영향

유경연,배홍범,김석재,이형곤,최정일,정성욱,윤명하,임병도 대한마취과학회 2005 Korean Journal of Anesthesiology Vol.49 No.3

소기와 Desflurane 이 기관내삽관에 의한 혈역학반응에 미치는 영향

유경연,박남기,정창영,정성수,윤명하,곽상현,최정일,배홍범 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.6

Background: Endotracheal intubation often results in hypertension and tachycardia. Desflurane and nitrous oxide (N2O) are known to augment the sympathetic nervous activity. We examined whether N2O and desflurane affect the cardiovascular responses to the intubation. Methods: One hundred-fifty patients were assigned randomly to receive one of six treatment regimens (n = 25 each): 2% sevoflurane (control), 6% desflurane or 12% desflurane with and without 75% N2O, respectively. General anesthesia was induced with intravenous thiopental (5-7 mg/kg), and tracheal intubation was facilitated with intravenous vecuronium (0.12 mg/kg). N2O was started 3 min before and desflurane soon after the intubation. Systolic arterial blood pressure (SAP), heart rate (HR), and plasma catecholamine concentrations were determined. Results: The intubation increased SAP and HR in all groups within 1 min. A second increase was noted with 12% desflurane at 3 to 5 min after the intubation. N2O did not affect the tachycardiac response, but attenuated the pressor response to both intubation and 12% desflurane. The plasma concentrations of norepinephrine increased significantly at 1 min after the intubation in all groups with more pronounced rise in N2O groups, and increased further at 5 min in the 12% desflurane groups. Conclusions:A biphasic increase of SAP and HR was noted with 12% desflurane. The first increase may be related with the mechanical stimulus of the tracheal intubation and the second with the desflurane itself. Although N2O did not affect the tachycardiac responses and augmented norepinephrine release, it suppressed the pressor responses. Background: Endotracheal intubation often results in hypertension and tachycardia. Desflurane and nitrous oxide (N2O) are known to augment the sympathetic nervous activity. We examined whether N2O and desflurane affect the cardiovascular responses to the intubation. Methods: One hundred-fifty patients were assigned randomly to receive one of six treatment regimens (n = 25 each): 2% sevoflurane (control), 6% desflurane or 12% desflurane with and without 75% N2O, respectively. General anesthesia was induced with intravenous thiopental (5-7 mg/kg), and tracheal intubation was facilitated with intravenous vecuronium (0.12 mg/kg). N2O was started 3 min before and desflurane soon after the intubation. Systolic arterial blood pressure (SAP), heart rate (HR), and plasma catecholamine concentrations were determined. Results: The intubation increased SAP and HR in all groups within 1 min. A second increase was noted with 12% desflurane at 3 to 5 min after the intubation. N2O did not affect the tachycardiac response, but attenuated the pressor response to both intubation and 12% desflurane. The plasma concentrations of norepinephrine increased significantly at 1 min after the intubation in all groups with more pronounced rise in N2O groups, and increased further at 5 min in the 12% desflurane groups. Conclusions:A biphasic increase of SAP and HR was noted with 12% desflurane. The first increase may be related with the mechanical stimulus of the tracheal intubation and the second with the desflurane itself. Although N2O did not affect the tachycardiac responses and augmented norepinephrine release, it suppressed the pressor responses.

Remifentanil 과 Alfentanil이 후두경을 이용한 이중관 기관지내관 삽관시 동반되는 심혈관 반응에 미치는 영향니다.

유경연,박수현,김창모,정성태,김석재,배홍범,곽상현 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.6

Background: This study examined the cardiovascular responses to double-lumen endobronchial intubation during rapid sequence induction of anesthesia, and compared the effect of remifentanil and alfentanil in a randomized, double-blind, placebo-controlled study in three groups of 20 elderly patients each. Methods: Anesthesia was induced with intravenous thiopental (4-6 mg/kg) immediately followed by either remifentanil 2 μg/kg, alfentanil 30μg/kg, or saline (placebo) given over 30 sec. Succinylcholine 1.5 mg/kg was given for neuromuscular block. The laryngoscopy and intubation were performed 60 sec later. Results: The intubation significantly increased systolic arterial pressure (SAP) and heart rate (HR) in all groups. The maximum pressure changes in the remifentanil and alfentanil groups (36 ± 26 and 33 ± 30 mmHg, respectively) were significantly lower than the 83 ± 35 mmHg in the control group. The maximum HR in the remifentanil (77 ± 13 bpm) and alfentanil (80 ± 13 bpm) groups was lower when compared to controls (93 ± 11 bpm). The norepinephrine and epinephrine concentrations increased after intubation in the control group but remained unaltered in both the alfentanil and remifentanil groups. There were no significant differences between the remifentanil and alfentanil groups in HR, SAP or catecholamines at any time. Five patients in the remifentanil group and three in the alfentanil group received ephedrine for hypotension. Conclusions: Endobronchial intubation elicited a significant pressor response, and that both remifentanil and alfentanil similarly attenuated the pressor response. However, the incidence of hypotension confirms that both drugs should be used with caution in elderly patients.

하지마비 환자에서 후두경에 의한 기관내 삽관 시 혈역학 및 카테콜라민반응 : 발생시기와 손상부위에 따른 비교

유경연 ( Kyung Yeon Yoo ),김웅모 ( Woong Mo Kim ),정철원 ( Cheol Won Jeong ),홍진욱 ( Jin Wook Hong ),김석재 ( Seok Jai Kim ),정성태 ( Sung Tae Chung ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.54 No.2

종설 : 허혈 재관류 손상과 마취

유경연 ( Kyung Yeon Yoo ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5