어려운 기도를 가진 환자에서 Airwayscope, 직접 후두경, 광봉을 이용한 기관내 삽관에 따른 심혈관계 반응의 비교

전명숙 ( Myong Sook Jeon ),김종수 ( Chong Soo Kim ),허진 ( Jin Huh ),민성원 ( Seong Won Min ),노영진 ( Young Jin Ro ),김대욱 ( Dae Wook Kim ),김덕경 ( Duk Kyung Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3

Background: Airwayscope (AWS), which has been used successfully for difficult airway in general anesthesia, has been anticipated that hemodynamic response to tracheal intubation in the difficult airway may be attenuated. Also, there is a series of reports demonstrating the successful use of lightwand to open the difficult airway. Thus, we decided to conduct a survey to compare AWS to lightwand and to direct laryngoscopy of cardiovascular response to tracheal intubation. Methods: Of 64 healthy patients without cardiovascular disease, 22, 21, 21 patients were randomly assigned to AWS group, lightwand group and direct laryngoscope group. After induction of general anesthesia, intubation was performed with manual in-line neck stabilization. During laryngoscopy, a modified Cormack-Lehane grade was assessed and time to intubation was measured. Systolic arterial pressure (SAP) and heart rate (HR) were recorded at the following timepoints: baseline, just before intubation, 1 min, 2 min, 3 min, 4 min and 5 min after intubation. Results: There were no significant differences between the 3 groups in SAP, HR (P>0.05). However modified Cormack-Lehane grade of all patients in the AWS group was I, while that in direct laryngoscope group was IIB or III. In addition, the mean time to intubation of the direct laryngoscope group was significantly longer than that of the AWS and lightwand (P<0.05). Conclusions: In the difficult airway, AWS was very effective in improving laryngeal view and decreasing time to intubation compared to direct laryngoscopey. In addition, lightwand reduced the time to intubation. However we could not find any significant difference in hemodynamic response to tracheal intubation among the 3 groups. (Korean J Anesthesiol 2009;57:284∼9)

증례보고 : Risperidone을 복용 중인 환자에서 척추 마취 시 발생한 중증 저혈압 -증례보고-

고승지 ( Seung Ji Ko ),허진 ( Jin Huh ),민성원 ( Seong Won Min ),김종수 ( Jong Su Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5

Antipsychotic medications are often continued throughout the perioperative period and may have significant interactions with anesthetics. Risperidone is an atypical agent used to treat both positive and negative symptoms of psychosis while producing fewer extrapyramidal symptoms. It`s mode of action is related to dopaminergic and serotonergic antagonism. However, it also possesses a potent α- 1 adrenergic antagonistic property. Here, we report a case of a 46-year-old man with major depressive disorder, controlled with paroxetine, clonazepam and risperidone, undergoing spinal anesthesia for open reduction of femur fracture. Eight minutes after induction of anesthesia, the patient developed exaggerated hypotension, unresponsive to ephedrine and rapid intravenous fluid administration. Eventually, hypotension was corrected after using large doses of phenylephrine. When planning spinal anesthesia to a patient taking risperidone, an α- 1 agonist, such as phenylephrine, may be useful in treating possible exaggerated hypotension. (Korean J Anesthesiol 2006; 50: 585~7)

실험연구 : 토끼의 격리폐 모델에서 Pinacidil, Tetraethylammonium과 Glibenclamide가 저산소성 폐혈관 수축반응에 미치는 효과

노영진 ( Young Jin Ro ),윤원희 ( Won Hee Yun ),김종수 ( Chong Soo Kim ),민성원 ( Sung Won Min ),김성덕 ( Seong Deok Kim ),김용락 ( Yong Lak Kim ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.6

임상연구 : Sniffing Position은 비만도에 상관없이 후두경소견을 개선시킨다

정희진 ( Hee Jin Jeong ),허진 ( Jin Huh ),노영진 ( Young Jin Ro ),민성원 ( Seong Won Min ),김종수 ( Jong Su Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5

Background: Most anesthesiologists universally recommend the sniffing position and consider it to be essential for improving the performance of orotracheal intubation. However, a recent investigation reported that the sniffing position does not aid the laryngoscope except under specific circumstances (i.e., obesity). Therefore, this study examined the impact of the BMI (body mass index) on the effectiveness of the sniffing position in improving the laryngeal view. Methods: A video laryngoscopy imaging system and POGO (the percentage of glottic opening) scoring system were used to assess the laryngeal view in 79 adult patients undergoing a laryngoscopy. In each patient, the laryngeal view was videotaped continuously from simple head extension to the sniffing position by inflating a pressure bag as a pillow to obtain approximately 15˚ of flexion of the lower cervical spine on the chest. The variables assessed included the BMI, the POGO score in each position and the change in the POGO score. Results: The POGO scores improved with the sniffing position (18.1 ± 14.3%). However, the sniffing position did not improve the POGO score in 16/79 (20.3%) patients. The sniffing position did not worsen the POGO score in any patient. No significant correlation was found between the BMI and the change in the POGO score in the sniffing position (Pearson`s correlation coefficient r = 0.075). Conclusions: The sniffing position has the potential to improve the laryngeal view in all intubations without needing to consider the BMI. Therefore, the sniffing position appears to be advantageous for orotracheal intubation compared with a simple head extension. (Korean J Anesthesiol 2007; 52: 526~9)

선형 및 비선형역학적 방법에 의한 당뇨병 환자의 술전 심박수 변이도 분석

민성원 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.2

Analysis of Heart Rate Variability in Preoperative Diabetic Patients by Linear and Nonlinear Dynamics Seong-Won Min, M.D. Department of Anesthesiology, Seoul Municipal Boramae Hospital, Seoul, Korea Background: The aim of this study was to investigate the underlying changes in heart rate variability(HRV) of preoperative diabetic patients using five analytical methods; SDNN (standard deviation of normal to normal intervals), SDANN (standard deviation of the mean of normal RR intervals for each 5 min period of the entire electrocardiographic recording), RMSSD (root mean squate successive difference, the squre root of the mean of the sum of the squares of differences between adjacent normal RR intervals over the entire electrocardiographic recording), PNN50 (percent of difference between adjacent normal RR intervals that are greater than 50 ms computed over the entire electrocardiographic recording) for linear time domain analysis and approximate entropy for nonlinear complexity analysis. Methods: HRV values analyzed by five different measures were compared between a control group of ten nondiabetics without any significant systemic disease and a diabetic group of ten patients from the preperative ambulatory electrocardiographic recordings. Results: Approximate entropy, SDNN and SDANN values were significantly lower in the diabetic group than those of the control group (P < 0.01). Conclusions: Significantly decreased approximate entropy, SDNN and SDANN could provide information about decreased cardiovascular complexity and sympathetic output, suggesting the nature of dysfunction of the diabetic cardiovascular system. (Korean J Anesthesiol 2001; 41: 133~139)

술 후 심근허혈시 심박수 변이도의 선형 및 비선형 분석 : 시간변역 분석 및 Approximate Entropy Time Domain Analysis versus Approximate Entropy

민성원 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.2

Linear and Nonlinear Analysis of Heart Rate Variability in Postoperative Myocardial Ischemic Patients: Time Domain Analysis versus Approximate Entropy Seong0Won Min, M.D. Department of Anesthesiology, Seoul Municipal Boramae Hospital, Seoul, Korea Background: Postoperative myocardial ischemia has been regarded as one of the major predictors of adverse cardiac outcomes after noncardiac surgery in high risk patients. Many schemes have been proposed to stratify the potential risk of this patient group in more noninvasive and cost-effective ways and analysis of heart rate variability (HRV) is one of them. To uncover the underlying changes in HRV with postoperative myocardial ischemia five analytical methods were introduced; SDNN (standard deviation of normal to normal intervals), SDANN (standard deviation of the mean of normal RR intervals for each 5 min period of the entire electrocardiographic recording), RMSSD (root mean square successive difference, the squre root of the mean of the sum of the squares of differences between adjacent normal RR intervals over the entire electrocardiographic recording), PNN50 (percent of difference between adjacent normal RR intervals that are greater than 50 ms computed over the entire electrocardiographic recording) for linear time domain analysis and approximate entropy for nonlinear complexity analysis. Methods: Sixteen vascular surgical patients were monitored by an ambulatory electrocardiogram preoperatively and during the first postoperative day (PODI). HRV values analyzed by five different measures were compared between a control group (C group) of eight patients with no postoperative ischemia and a postoperative ischemic group (PI group) of eight with ischemia on PODI. Results: Approximate entropy was the only measure of HRV which was significantly lower in PI group than that of C group (P < 0.01) on PODI. Conclusions: Approximate entropy, a complexity measure could provide more sensitive information about the physiologic changes associated with postoperative ischemia which could not be obtained from the conventional HRV measures. Time domain analyses can be used as adjuvant measures providing information about the cardiac autonomic regulation. (Korean J Anesthesiol 2001; 41: 141~147)

Power Spectral Analysis 를 이용한 당뇨병성 자율신경병증의 술전 평가

민성원 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5

Background: The aim of this study is to investigate the changes in the patterns of power spectra of R-R interval variability of diabetic patients who are subject to autonomic neuropathy. Methods: The changes in power spectra of eight diabetic patients were compared with those of eight normal persons while changing positions from supine to Trendelenburg and from supine to standing each. Results: Low, high and total frequency power densities of diabetic patient group were significantly lower than those of control group in resting supine position. Low frequency power density and ratio of low frequency power to high frequency power of control group increased significantly while changing position from supine to standing compared with those of diabetic patient group. And low frequency power density of control group decreased significantly compared with that of diabetic patient group while changing position from supine to Trendelenburg. Conclusions: The decrease in power densities of low, high and total frequency suggest depressed overall autonomic activities in diabetic patient group and significantly decreased changes in low frequency power and ratio of low frequency power to high frequency power while changing positions from supine to standing suggest attenuated sympathetic activity in diabetic patient group, reflecting autonomic changes in diabetic group rapidly. (Korean J Anesthesiol 1998; 35: 895∼902)

소아 중환자의 TISS 에 관한 고찰

김동옥,김성덕,민성원,손주태 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.2

There are few reports analyzing the results of intensive care for children in Korea. A total of 40 critically ill pediatric patients were evaluated in terms of Therapeutic Intervention Scoring System (TISS), The group was composed of patients from 4 services: cardiothoracic surgery, pediatric surgery, pediatrics and other surgeries. We evaluated duration of stay and cost in pediatric intensive care unit (PICU), Seoul National University Hospital, and TISS related to departments. The patients with higher TISS showed longer duration of stay and higher cost in PICU than those with lower TISS. The duration of stay of the patients with high TISS more than 50 was 5.0 days, but it was 2.8 days in 40-49, 2.4 days in 30-39, 2.1 days in 20-29 and 1.9 days in 10-19 of TISS's, respectively. The postoperative first day cost of intensive care was approximately 2,210,000 Won in the patients with high TISS more than 50, but it was 1,060,000 Won in 40-49, 220,000 Won in 30-39, 460,000 Won in 20-29, 120,000 Won in 10-19 of TISS's, respectively. The patients in cardiothoracic surgery showed higher values in maximum, minimum and discharge TISS than other services. Maximum, minimum and discharge TISS of the patients in cardiothoracic surgery were 41, 28 and 23, respectively. TISS's of patients in pediatric surgery and neurosurgery were similar, but durations of stay in PICU were 3.5 days in pediatric surgery and 1.2 days in neurosurgery. In this study, we conclude that duration of stay in PICU and cost of intensive care might be proportional to TISS.

가토의 뇌손상 모델에서 만니톨과 고자성식염수가 뇌압 및 혈역학에 미치는 영향의 비교연구

오용석,민성원 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.4

There has recently been an increased interest in the use of hypertonic saline for the fluid resuscitation of trauma victims and to control intracranial hypertension. In this study, the cerebral and hemodynamic effects of a 3.2% hypertonic saline solution were compared with those of either a 0.9% saline or 20% mannitol solution in a rabbit model of brain injury. Forty-five minutes following the creation of a left hemispheric cryogenic brain lesion, equal volumes of hypertonic saline, 0.9% saline, or mannitol were infused over a 5 minute period. Monitored variables over the ensuing 120 minutes included mean arterial pressure, central venous pressure, intracranial pressure, hematocrit and serum osmolality. Upon conclusion of the two hour study period, regional cortical water content was determined by the specific gravity method. There were no significant differences in mean arterial pressure between the three groups at any point during the experiment. Plasma osmolality was signifieantly increased by 10-11 mOsm/kg in the mannitol and hypertonic groups. The infusion of either mannitol or hypertonic saline produced a transient decrease in intracranial pressure lasting approximately 60 minutes, whereas animals in the saline group demonstrated a continual increase in intracranial pressure. The lesioned hemisphere demonstrated a significantly greater water content than the non-lesioned hemisphere. There was no difference in regional cortical water content at any sampling site between the various groups.

고빈도제트환기시 호기배출로 단면적의 변화가 기도내압에 미치는 영향

오용석,민성원,노규정 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.2

High frequency ventilation considerably reduces the risk of barotrauma due to low peak airway pressure compared to conventional mechanical ventilation. This risk, however, is also preaent with high frequency jet ventilation (HFJV) if excessive driving preasure are used and, above all if expiration is impeded. We investigated the effects of outflow resistance, which was varied by connecting different size of tube (ID 8.0, 7.5, 7.0, 6.5, 5.5, 5.0, 4.5, 4.0 mm), which was cut in 10 cm length, to the proximal site of endotracheal tube (ID 8.0 mm), which was inserted into the trachea of anesthetized dogs with a attached airway pressure monitoring catheter externally, in different driving pressure (2 kg/㎠, 1 kg/㎠) and frequency (100beats/min, 200beats/min) on the intra-airway preesure during HFJV. HFJV was performed with a catheter (diameter 2.5 mm) which was inaerted through endotracheal tube and located 1 cm proximal to the tip of endotracheal tube. Intra-airway pressure was acutely increased with the tube sizef smaller than 5.5 mm in driving pressure 2 kg/㎠ and 5.0 mm in driving pressure 1 kg/㎠ compared to previous size of tube. 2 kg/㎠ of driving pressure showed significant higher airway pressure compared to 1 kg/cm in any size of tube. There was no difference in airway pressure by varing of frequency with same driving preasure. In summary, pulmonary barotrauma due to higher airway pressure may be occur if HFJV catheter occupied more than 25% of outflow tract area especially in higher driving pressure.