임상연구 : 두개전기자극(Cranial Electrotherapy Stimulation) 전처치가 수술 전 불안감 및 혈역학적 반응에 미치는 영향

김현정 ( Hyun Jung Kim ),김운영 ( Woon Young Kim ),이윤숙 ( Yoon Sook Lee ),장문석 ( Moon Seok Chang ),김재환 ( Jae Hwan Kim ),박영철 ( Young Cheol Park ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.6

Background: Cranial electrotherapy stimulation is used as a treatment for depression, anxiety, insomnia, and adjunctive intervention for pain management. The aim of this study is to evaluate the effect of cranial electrotherapy stimulation pretreatment on the level of preoperative anxiety and the hemodynamic responses. Methods: Sixty patients undergoing general anesthesia were randomly assigned into two groups to receive either no pretreatment (Control group, n = 30) or cranial electrotherapy stimulation pretreatment (CES group, n = 30). Anxiety score, systolic and diastolic blood pressure, and heart rate were measured in the preoperative holding area and the operating room. Results: The anxiety score in the operating room compared with the preoperative holding area decreased in the CES group, but increased in the Control group. Systolic blood pressure and heart rate in the operating room were lower in the CES group compared with the Control group. Conclusions: Cranial electrotherapy stimulation pretreatment reduced the level of the preoperative anxiety and the hemodynamic responses. (Korean J Anesthesiol 2008; 55: 657~61)

계란의 유통구조 개선

김정주,김운영 ( Jung Joo Kim,Woon Young Kim ) 한국축산경영학회 1994 韓國畜産經營學會誌 Vol.10 No.1

부분조절내사시 환자에서 발생한 악성고열증 1예

권성욱,김균형,김운영,김승현,Sung Wook Kwon,Kyun Hyung Kim,Woon Young Kim,Seung Hyun Kim 대한안과학회 2008 대한안과학회지 Vol.49 No.8

Purpose: Malignant hyperthermia is hypermetabolic disorder of skeletal muscle that manifests during general anesthesia. Strabismus and ptosis are important risk factors in ophthalmology field for malignant hyperthermia. We report a case of malignant hyperthermia in patient with partially accommodative esotropia. Case summary: A 6-year-old patient was supposed to undergo a surgical correction for 20 prism diopters of right esotropia after correction of hypermetropia. Because the patient showed tachycardia and hyperthermia just after inhalation of sevoflurane, we interrupted general anesthesia and cancelled the surgery. The patient was transferred to the intensive care unit. In this case, no significant familial and past histories were found. Intractable tachycardia and hyperthermia that had not responded to conservative management improved after two administration of dantrolene sodium. The patient was returned to the ward three days later. As the patient showed no other complication, he was discharged. Conclusions: In malignant hyperthermia, early diagnosis, appropriate management, and prompt administration of dantrolene sodium are important factors for better prognosis. Preoperatively, full explanation of possible complication and history taking are needed. Careful observation is necessary during anesthesia and surgery. J Korean Ophthalmol Soc 49(8):1356-1359, 2008

Joubert 증후군 환아의 마취관리 -증례보고

이윤숙 ( Yoon Sook Lee ),김운영 ( Woon Young Kim ),김경근 ( Kyoung Gun Kim ),장문석 ( Moon Seok Chang ),김재환 ( Jae Hwan Kim ),박영철 ( Young Cheol Park ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1

Joubert syndrome is a rare autosomal recessive condition in which there is complete or partial agenesis of the cerebellar vermis. The clinical features are hypotonia, ataxia, mental retardation, abnormal ocular movements, typical facial features and episodic tachypnea with alternating apnea. The abnormal respiratory pattern and hypotonia may be exacerbated by anesthetics, and especially, the apneic episodes may be prolonged by administering opioids. Joubert syndrome has been associated with various airway abnormalities such as a high and arched palate, a large or protruding tongue, laryngomalacia, a variable epiglottis and micrognathia. These abnormalities may cause difficulty with tracheal intubation. In this present case, direct laryngoscope-assisted, fiberscopic guided intubation was performed. This case is the first report of anesthetic management in a patient with Joubert syndrome and who underwent palatoplasty in Korea. (Korean J Anesthesiol 2009; 57: 96~9)

무릎 관절경 수술 시 Fentanyl 투여가 압박띠 사용에 따른 혈역학적 변화에 미치는 영향

이윤숙 ( Yoon Sook Lee ),김재환 ( Jae Hwan Kim ),차문호 ( Moon Ho Cha ),민두재 ( Doo Jae Min ),김운영 ( Woon Young Kim ),장문석 ( Moon Seok Chang ),박영철 ( Young Cheol Park ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1

Background: The use of a tourniquet can produce pain and increase in blood pressure. It is known that fentanyl reduces central sensitization, however its effect on blood pressure increase due to tourniquet is unknown. So we investigated the effect of fentanyl on tourniquet-induced changes of mean arterial blood pressure (MBP), heart rate (HR), and cardiac index (CI). Methods: ASA physical status I and II, who were scheduled for knee arthroscopic surgery using a tourniquet, were assigned into control (n=30) and fentanyl group (n=30). Anesthesia was maintained with enflurane, N2O and O2. Fentanyl was injected 1.5 ug/kg at 10 min before inflation of the tourniquet in the fentanyl group. Changes of the MBP, HR, CI were measured before and 10, 20, 30, 40, 50, 60 min after inflation of the tourniquet. Results: There were no differences in the baseline values. MBP was increased at 40, 50, 60 min in the control group. At 60 min, MBP was lower in the fentanyl than the control group. HR was decreased at 10 min in the fentanyl group. CI was decreased in all groups after tourniquet inflation. At 60 min, CI was more decreased in the control than the fentanyl group. Conclusions: Fentanyl injection prior to tourniquet inflation can attenuate the tourniquet induced hemodynamic changes in the knee arthroscopic surgery patients. (Korean J Anesthesiol 2009;56:6~10)

Angelman 증후군 환아에서의 마취 경험 -증례보고-

옥세진 ( Se Jin Ok ),김재환 ( Jae Hwan Kim ),손주형 ( Joo Hyung Son ),김운영 ( Woon Young Kim ),박영철 ( Young Cheol Park ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6

The Angelman syndrome is characterized by an abnormality of chromosome 15, where a subunit of the gamma amino-butyric acid receptor is coded. The clinical features are developmental delay, microcephaly, wide mouth, prognathia which usually do not have problem with intubation. But, muscular atrophy may induce delayed recovery from neuromuscular blockade. Moreover, there are case reports that vagal hypertonia such as severe bardycardia or asystole occurred during anesthesia. We present a 5-year-9-month-old male Angelman syndrome patient who underwent a left and right rectus ophthalmicus muscle recession. We gave him prophylactic glycopyrrolate before anesthetic induction and induced and maintained anesthesia with sevoflurane and oxygen. After that we monitored train-of-four ratio for evaluation of neuromuscular blockade. There is no complication during operation and recovery from anesthesia. (Korean J Anesthesiol 2009; 57: 785∼8)

원저(原著) : 자가면역용혈성빈혈에 의한 ABO불일치 결과의 해석 (한냉응집증후군의 예)

유승국 ( Seung Gug Yoo ),김미정 ( Mi Jung Kim ),김운영 ( Woon Young Kim ),이명권 ( Myoung Kwon Lee ),남정현 ( Jeong Hyun Nam ) 대한임상병리사협회 1997 임상수혈검사학회 발표자료집 Vol.4 No.1

54세의 자가면역용혈성빈혈 환자에서 발생한 ABO 불일치를 한냉자가항체에 의한 원인으로의심하였고 DAT, IAT 검사, 자가항체검사, 한냉응집소역가검사, 특이항체검사 등을 실시하여 ABO 불일치현상을 해결하였기에 보고하는 바이다. An ABO discrepancy was observed in a 54-year-old patient with cold agglutinin syndrome, classification of autoimmune hemolytic anemia(AIHA) and with liver disease, renal disease. The patient`s red cells was typed AB and his serum had both anti-A and anti-B. An autocontrol positive and the DAT(direct antiglobulin test) is strongly positive. The patient`s we obtained the following results : 1. DAT is strongly positive(complement is the only protein detected on RECs) 2. Type of hemolytic anemia associated with cold-reactive autoantibodies. 3. Cold-reactive autoagglutinin titer is above 1,000. 4. Anti-I is seen. 5. Spherocytes, target cells and anisocytosis are seen on the red blood cell morphology. 6. Mycoplasma Ab is positive(1 : 80) 7. Additional test : each laboratory test. 8. Cell typed was "AB" and serum typed "O" but the result proved to group "A" In pretransfusion tests on patients with autoantibodies, cold-reactive autoantibodies, resulting in erroneous determinations of ABO and Rh type. CAS(cold agglutinin syndrome) is the most common type hemolytic anemia associated with cold-reactive autoantibodies, and accounts for approximately 16~32% of all cases of immune hemolysis. It is only necessary to maintain the blood sample at 37℃ immediately after collection and to wash the red blood cells with warm saline before testing.

실험연구 : Sufentanil 투여가 흰쥐적출심장에서 허혈시 심근기능 및 관상동맥혈류에 미치는 영향

서경원 ( Kyung Won Seo ),신명강 ( Myoung Gang Shin ),이윤숙 ( Yoon Sook Lee ),장문석 ( Moon Seok Chang ),김운영 ( Woon Young Kim ),김재환 ( Jae Hwan Kim ),박영철 ( Young Cheol Park ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2

Background: Some opioids have been shown to attenuate an ischemia-reperfusion injury in an isolated-heart model. The aim of this study was to evaluate the effect of sufentanil on the cardiac function in isolated-heart models when given before and after prolonged periods of low flow ischemia. Methods: Isolated rat hearts were stabilized for 30 minutes and subdivided into four groups (each n = 7). The control group was subjected to low flow ischemia (LFI 0.3 ml/min) of 5% dextrose water for 30 minutes, followed by perfusion with a modified Krebs solution at a constant pressure for 60 minutes. In the sufentanil groups, different sufentanil (12.5 mg/L, 25 mg/L, 50 mg/L) doses were administered with the modified Krebs solution after 30 minutes of stabilization until the end of the experiment with the exception of the LFI group. The left ventricular end systolic pressure (LVESP), dP/dt max, heart rate and coronary flow were measured. After reperfusion, the infarct size of all groups was measured. Results: The control and the sufentanil groups had a lower LVESP, dP/dt max, coronary effluent flow and arrhythmia duration after ischemia and reperfusion than those before ischemia. The infarct sizes in the sufentanil groups were smaller than those in the control group. However the infarct sizes of the sufentanil groups were similar. Conclusion: Sufentanil reduces the infarct size but does not improve the post-ischemic functional dysfunction. (Korean J Anesthesiol 2006; 51: 216~21)

척추 경막외 병용마취하 제왕절개술 환자에서 술후 통증관리를 위한 경막외 Buprenorphine의 효과

김운영 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.6

Background : Combined spinal epidural anesthesia has become the technique of anesthesia for cesarean section because of the reliability of spinal block with the flexibility of epidural block. Buprenorphine, a new synthetic thebaine derivative is a partial agonist of the opioid μ-receptor with high receptor affinity, great lipid solubility, and slow rate of opiate receptor association and dissociation. Continous epidural infusion of opioid can possibly produced undesirable effects, such as respiratory depression, pruritus, etc. Methods : The present study was undertaken to compare the analgesic properties and side effects of continous epidural infusion of buprenorphine and morphine combined with bupivacaine in 60 patients following elective cesarean section in combined spinal epidural anesthesia. At the clothing of peritoneum, the initial bolus doses were 3 mg morphine (M group), 0.15 mg buprenorphine (0.15B group), 0.3 mg buprenorphine (0.3B Group) combined with 0.15% bupivacaine 10 ml and subsequent contious infusion doses were 6 mg morphine plus 0.125% bupivacaine 100 ml (M Group) and 0.6 mg buprenorphine plus 0.125% bupivacaine 100 ml (0.15B, 0.3B Group) during 48 hours. The assessment of analgesic efficacy and side effects were made at arrival of recovery room,postoperative 1, 4, 8, 24, 36, and 48 hours. Results : The pain score during 48 hours was significantly higher in the 0.15B group than in the M group and 0.3B group except the pain score of recovery room. (p<0.05) and the number of patients requiring additional analgesics was higher in 0.15B group than in the M group and 0.3B group but, it was not significant. The incidence of pruritus and urinary retention was significantly higher in M group than in the 0.15B and 0.3B group, and the incidence of sedation, nausea and vomiting was similar in three group. The subjective rating of satisfaction was better in the 0.3B group and M group than in the 0.15B group. Conclusions : The above results suggest that continous epidural infusion of 0.6 mg buprenorphin after 0.3 mg buprenorphine initial bolus dose combined with low dose bupivacaine is an advisable method of postoperative pain control in combined spinal epidural anesthesia for cesarean section. (Korean J Anesthesiol 1999; 36: 1026∼1032)

Propofol과 Thiopental이 기절상태의 적출쥐 심장기능에 미치는 영향

김운영,서규석,박영철 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.2

Background : Propofol(2,6-diisopropyl phenol) is an intravenous anesthetic agent, which was first introduced in 1986. It has 178.27 molecular weight and 1.8 fold stronger action of induction than that of thiopental. The effect of propofol, lowering blood pressure by depressing the cardiovascular system, has been mentioned in many papers, but its effect on myocardium is still in controversy and differs according to the method and interpretation of experiments used. This animal experiment was conducted to compare the effects of propofol and thiopental on myocardial contractility and coronary flow in isolated stunned rat hearts. Method : The hearts were isolated from twenty-four Sprague-Dawley rats and were perfused with modified Krebs solution. After isolation, the hearts were left in stabilizing period for 30 minutes. Then, myocardial stunning was induced by global ischemia for 15 minutes. In Group I, propofol was added to modified Krebs solution, which was used to perfuse the hearts at 40, 80, 120, 160, and 200 M concentration. In Group II, thiopental was added to perfusate at same concentration. Between each perfusion with anesthetic-added solution, the hearts in both groups were perfused with normal Krebs solution for 30 minutes to eliminate cumulative effect of anesthetics added. Left ventricular pressure, rate of ventricular pressure generation(dP/dt), and coronary flow were measured. Result : In both groups, anesthetics reduced left ventricular pressure and dP/dt in a dose dependent fashion. These changes were not statistically significant between two groups. However, at the 40 and 80 M concentration, the increment of coronary flow by propofol was significantly larger than that by thiopental. At the 120, 160, and 200 M concentration of propofol, coronary flow was gradually decreased with increasing concentration, and these decrease in coronary flow were not statistically significant between two groups. Conclusion : The effects of propofol on myocardial function were similar to those of thiopental in isolated stunned rat hearts and the increment of coronary flow might develop the coronary steal phenomenon. So, propofol may not have the benefit compare to thiopental for cardiac function. (Korean J Anesthesiol 1998; 35: 204∼214)