제대동정맥 ECMO를 적용한 염소태아의 혈액가스 및 혈류역학 변화

송창훈(Chang Hun Song),소금영(Geum Young So),이국현(Kook Hyun Lee),박석천(Sok Cheon Pak) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.9

N/A Objectives : The purpose of this study is to establish animal model of extracorporeal membrane oxygenation (ECMO) system that uses membreane type oxygenator and circulation circuit of umbilical artery and vein. Blood gas and hemodynamic changes in the fetal goat undergoing ECMO were also evaluated. Methods : Total 15 pregnant goat had been used to perform extrauterine fetal incubation using ECMO through umbilical artery and vein. Cesarean-section was performed to pregnant goat (35 kg) of 120-130 days of gestation to insert catheters (8 Fr) into the umbilical artery and vein. The tip of inserted catheter's the other end was connected with the circuit system including membrane type oxygenator (Polystan) and roller pump. A total of 300 ml of blood was drawn from donor nonpregnant goat and primed into circuit on the day of surgery. The goat fetus was immersed in a chamber filled with artificial amniotic fluid to monitor blood flow dynamics and blood gas was analyzed. Results : The ECMO system using umbilical cord in the extrauterine incubation of fetal goat was developed and maximum survival of goat fetus was 34.5 hrs (mean survival was 856.6±688 min). Oxygen tension (PO2) in umbilical artery and vein were 20.53±2.54 mmHg, 31.03±13.03 mmHg and oxygen saturation (SO2) in umbilical artery and vein were 46.61±18.14 mmHg, 71.56±15.39 mmHg. Mean blood flow was 176±62 ml/min/kg. Conclusion : We suggest that our experimental model as an extrauterine fetal research could be a reasonable method in future advanced studies. However, longterm survival of extrauterine fetus needs more suitable hemodynamic and blood gas condition supported by further researches.

하지 수술을 위한 척추마취 시 척수강내로 주입한 Fentanyl의 효과

이상진 ( Sang Jin Lee ),김상훈 ( Sang Hun Kim ),정종달 ( Jong Dal Jung ),유병식 ( Byung Sik Yoo ),임경준 ( Kyung Joon Lim ),소금영 ( Geum Young So ),안태훈 ( Tae Hun An ),이여진 ( Yeo Jin Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3

Background: Intrathecal opioids in combination with bupivacaine has been shown to provide adequate sensory blockade and early recovery from spinal anesthesia. This study was investigated the added effects of intrathecal fentanyl 10 μg to bupivacaine for spinal anesthesia. Methods: Sixty patients undergoing lower extremity surgery were into three groups. Group I received bupivacaine 10 mg (0.5%), gruop II received bupivacaine 5 mg with normal saline 1 ml, and group III received bupivacaine 5 mg with fentanyl 10 μg and normal saline 0.8 ml. Results: There was no significant difference between group I and group III in the peak level and duration of sensory block. But the intensity of motor blockade was decreased in group III compared with group I and side effects of spinal anesthesia with local anesthetics was decreased in group III compared with group I. In Group II, 7 patients were complained the pain during surgery. Conclusions: Intrathecal fentanyl 10 μg with bupivacaine 5 mg on spinal blockade provide reliable anesthesia for lower extremity surgery. (Korean J Anesthesiol 2009; 56: 280∼3)

비탈분극성 근육이완의 길항시 Atropine, Pyridostigmine과 Glycopyrrolate, Pyridostigmine의 혼합정주가 심박수에 미치는 영향

소금영,채종한,조남수,정종달,김용일 朝鮮大學校 附設 醫學硏究所 1991 The Medical Journal of Chosun University Vol.16 No.1

Changes in heart rate during reversal of neuromuscular block have been a subject of clinical investigation for many years. A number of studies, have compared the effect used anticholinergics and anticholinesterase. In most studies, the drugs were administered simultaneously. Atropine and glycopyrrolate were studied in dose of 15㎕/㎏, 20㎕/㎏ and 7㎕㎕/㎏, lO㎕/㎏, given intravenously in a mixture with pyridostigmine 200㎕/㎏ at the end of operation. 15 ASA Class Ⅰ, Ⅱ patients, aged between 16 to 65, were selected in each group. Anesthesia was maintained with halothane(1.0 vol%), N20(3L/ min), O2(3L/min) and vecronium bromide 0.07㎎/㎏ was used as a muscle relaxant. The results were as follows ; 1) Atropine 15㎕/㎏, 20㎕/㎏, showed significant initial increase in pulse rate, atropine ZO㎕㎕/㎏ showed more initial increase than atropine 15㎕/㎏ Atropine 15㎕/㎏ showed more rate decrease than atropine 20㎕/㎏. 2) Gylcopyrrolate 7㎕/㎏ 10㎕/㎏ showed significant initial increase in pulse rate gylcopyrrolate 7㎕/㎏, 10㎕/㎏ showed less initial increase than atropine 15㎕/㎏, 20㎕/㎏. Atropine 20㎕/㎏ showed more late decrease than glycopyrrolate 10㎕/㎏.

응급 수술에 대한 기술통계학적 고찰 : 한 종합병원의 1개년을 중심으로 This statistical data derived from our hospital for one year

조남수,김용배,소금영 조선의대 1995 The Medical Journal of Chosun University Vol.20 No.2

기관내 삽관시 Fentanyl, Propofol이 심혈관계에 미치는 영향

김용일,소금영 최신의학사 1992 最新醫學 Vol.35 No.12

전신마취시 경막외강에 Bupivacaine과 함께 투여한 Neostigmine의 술호 진통 효과

안태훈,소금영,정종달,김길범,유병식,임경준,김훈정 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.3

Background: Intrathecal injection of analgesic agents such as opioids, clonidine, ketamine and nalbuphine with a local anesthetic produces analgesia in patients. Recently, the analgesic effect of intrathecal neostigmine has been investigated; however, the use of epidural neostigmine has not been investigated. The purpose of this study was to define the analgesic effectiveness and the side effects of epidural neostigmine. Methods: Forty patients undergoing a total abdominal hysterectomy were divided into 4 groups. After intramuscular 0.1 mg/kg midazolam premedication, patients were randomized to receive epidural bupivacaine with saline (control group), 1 ㎍/kg epidural neostigmine (Group I), 2 ㎍/kg epidural neostigmine (Group II), or 3 ㎍/kg epidural neostigmine (Group III) postoperatively. The concept of the visual analog scale, which consisted of a 10-cm line with 0 equaling $quot;no pain at all$quot; and 10 equaling $quot;the worst possible pain$quot; was introduced. Pain was assessed by using the visual analog scale at 1, 6, 9, 12, and 24 h postoperatively, and intramuscular 90 mg diclofenac was available at the patient's request. Results: The visual analog scale score at first rescue analgesic and the incidence of adverse effects were similar among neostigmine groups. The analgesic consumption in 24 hours and the pain visual analog scale score at 3 h, 12 h, and 24 h were significantly decreased in neostigmine groups compared with control groups. Conclusions: Epidural neostigmine coadministered with bupivacaine produces a dose-independent analgesic effect compared to the control group and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects.

전자궁적출술후 경막외 Bupivacaine, Fentanyl 과 Epinephrine 의 혼합액에 Clonidine 첨가시 진통효과

최성수,소금영,정종달 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.5

Epidurally administered clonidine, a selective α2-adrenergic agonist, has been reported to produce postoperative analgesia. The aim of this study was to see if the addition of a small dose of clonidine to a mixture of bupivacaine, fentanyl and epinephrine prolonged the duration of analgesia and reduce the number of injections or the total bupivacaine requirement and the incidence of side effects. Forty patients presenting for TAH in ASA physical status 1 or 2, were randomly divided into two groups group 1 was given a 10 ml epidural solution of bupivacaine 12.5 mg combined with fentanyl 50 pg and epinephrine 50㎍ ; group 2 was given the same solution with clonidine 75 ㎍. Changes in the systolic and diastolic blood pressure and the pulse rate were recorded at 5, 10, 20, 30, 45, 60, 75, 90, 105 and 120 minutes after drug administration, and the analgesic effects were assessed by measuring pain score (Prince Henry Score), analgesic duration, total bupivacaine requirement for 24 hours and side effect. The ress were as follows; 1) Heart rate changed little in group 1 and decreased significantly in group 2. 2) Systolic and diastolic blood pressure decreased significantly in all groups (earlier in group 2 than in group 1). 3) The mean duration of analgesia was significantly prolonged in group 2, compared with group 1 (437 min in group 2; 229 min in group 1). For 24 hours after the first injection, numbers of injections (6 in group 1; 3.15 in group 2) and total bupivacaine requirements (75.0 mg in group 1 ; 39.1 mg in group 2) were significantly reduced. 5) The side effects including hypotension, nausea and vomiting, pruritus, and respiratory depression were not significantly different from each other. These results show that epidurally administered clonidine helps to prolong analgesic duration, and decreased need for supplemental bupivacaine, after lower abdominal surgery.

하지수술시 사용한 척추경막외 병용마취의 효과

기삼서,소금영,정종달 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.4

Background: Spinal anesthesia is a simple technique requiring a small dose of local anesthetic to provide intense and reliable block. And epidural anesthesia with the catheter technique gives a better control of the level of analgesia and a good postoperative pain relief using opioids, local anestheties or both. Therefore, the combined spinal epidural (CSE) anesthesia was evaluated to provide rapid onse of action, good muscle relaxation, prolonged duration of the block and postoperative pain relief. Methods: All patients were placed in a lateral position. Using a midline approach at L interspace, a 18G Tuohy needle was introduced into the epidural space. A 27G Whitacre spinal needle was passed through the Tuohy needle until free flow cerebrospinal fluid, and than 0.5% heavy bupivacaine 3ml(15mg) was injected. The spinal needle was withdrawn and the epidural catheter was inserted. The dermatome level and time of sensory block was evaluated using loss of sensation of pinprick test every 1 minute for 30 minutes, until the maximum sensory block was established. Motor block was assessed using the Bromage scale. And postoperatively we interviewed the patients for opinioes on the blockade and complication. Results: The mean values of maximum sensory block level were T8 (T8.0±1.7 dermatome) and at that time was 8min 30sec (8.5±1.2min). The motor blockade of lower extremity was Bromage 3 in all patients. Prolonged anesthesia over 2 hours of operation was accomplished by adding 0.5% bupivacaine through epidural catheter. Subjective evaluation by the patients about postoperative pain control was excellent. Conclusions: CSE anesthesia appears to combine the reliabiIity and rapid onset of spinal block, and the ability to extend the block and postoperative analgesia by using the epidural catheter while minimizing their drawbacks.

소아 전신마취중에 발생한 심정지 1예 보고

조남수,김용일,소금영,정종달,채종한 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.4

It is a well known that cardiac arrest can occur during general anesthesia. We had experienced of a cardiac arrest during anesthsia in a child with halothane just after the use of a thiopental sodium and vecuronium bromide. When the cardiac asystole was noted by E.C.G., immediate treatment was performed. In this case, We think that Cardiac arrest being related to several factors, anxiety about operation, rough sugical maniplation, light anesthesia and drugs.

마취유도제로서 사용한 Midazolam 에 대한 심혈관계의 변화

조남수,김용일,유병식,소금영,정종달,임경준,송성용 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.8

The cardiovaseular response evoked by tracheal intubation was observed in 69 patients undergoing elective surgery in whom anesthesia was induced with group A, B and C induction agents. Sixty nine ASA class 1 or 2 surgical patients were divided into three groups. Group A: thiopental 5 mg/kg (control) Group B: thiopental 2 mg/kg with midazolam 0.1 mg/kg Group C: midazolam 0.2 mg/kg Systolic and diastolic blood pressure, mean arterial pressure, heart rate and loss of eyelid reflex were measured in each group. There was a little difference in the cardiovascular changes between group A and C. But there was not a significant difference between group A and B and also between group B and C. The measured time until loss of eyelid reflex of the group C (55±30 sec) was considerably longer than other groups (Group A: 10±3 sec, Group B: 37±13 sec). The incidence of venous complication in three groups was low. Pain on injection and posto- perative nausea and vomiting was noted in one patient of the group A and B respectly, but no patient in the group C. There was no significant difference in the incidence of the postoperative local venous complication. On the whole, these results suggest that the difference between midazolam and thiopental had no apparent hemodynamic change. From the above results, both midazolam alone and midazolam combined with thiopental may be useful agents for induction of anesthesia.