경요도 절제술을 시행받는 환자에서 초음파기를 이용한 폐쇄신경 차단 - 서혜부 주름부위 접근법

길현주 ( Hyun Jue Gill ),전덕희 ( Duk Hee Chun ),백인찬 ( In Chan Baek ),장준흠 ( Jun Heum Jang ),신동욱 ( Dong Wook Shin ),강화자 ( Wha Ja Kang ) 경희대학교 경희의료원 2014 慶熙醫學 Vol.29 No.1

연구배경: 경요도절제술을 시행받을 환자 중에서 초음파기와 신경 자극기를 이용하여 폐쇄신경 차단 을 시행하는 것이 환자에게 안전하고 효과적인지 알 아보고자 한다. 방법: 척추 마취하 경요도절제술을 시행 받는 26 명의 환자들에게 초음파기와 신경 자극기를 사용하 여 폐쇄신경 차단을 시행하였다. 초음파로 해부학적 구조를 확인하고 근수축 확인 후 1% lidocaine 10 ml 를 폐쇄신경의 anterior와 posterior branch에 각각 투 여하였다. 초음파기를 이용하여 해부학적 위치감별 에 걸리는 시간, 전체 신경차단에 걸리는 시간, 바늘 깊이, 수술 중 근수축의 정도, 실패율, 합병증등을 평가하였다. 결과: 초음파기를 이용하여 fascial plane을 감별하 는 데 걸리는 시간은 21±14.9초, 폐쇄신경의 anterior branch와 posterior branch를 확인하는 데 걸리는 시간 은 각각 39.6±27.4와 24.3±11.7초였으며 전체 신경차 단에 걸리는 시간은 174±65.1초, 바늘 깊이는 anterior branch가 4.8±0.8 cm, posterior branch가 6.2±1.1 cm였 다. 실패율은 anterior branch가 2/26 (7.7%), posterior branch가 7/26 (26.9%)이었다. Grade 1의 근수축은 22/26 (84.7%)에서 나타났으며 폐쇄신경술의 성공률 은 23/26 (88.5%)이었다. 결론: 서혜부 위치에서 초음파로 신경의 위치를 확인하는 방법은 쉬우나 초음파와 신경 자극기를 사 용한 폐쇄신경 차단술의 성공률은 큰 차이가 없었다.

실험연구 : Methylmethacrylate Monomer의 흰쥐 기관 평활근 이완 효과

길현주 ( Hyun Jue Gill ),이정은 ( Jung Un Lee ),김윤희 ( Yoon Hee Kim ),양현정 ( Hyun Jung Yang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2

Background: Methylmethacrylate monomer (MN) bone cement is commonly employed in orthopedic procedures, particularly total hip and knee replacement, to anchor prosthetic devices to bone. Numerous cardiopulmonary complications can occur just after injection of MN. And MN produces direct relaxation of vascular smooth muscle in vitro. The purpose of this study was to determine if MN could have relaxation effect in tracheal smooth muscle too. Methods: Each ring of rat trachea was suspended on wire supports in a bath with Tris Tyrode solution. Dose response curves of MN were recorded after contraction of tracheal ring with acethylcholine (Ach) 10-5 M or cabachol (Cch) 10-8 M. MN was administered in denuded tracheal rings and compared it`s effect with intact tracheal rings to see the effect of epithelium for contraction. And MN dose response curves were recorded after pretreatment of nitric oxide synthase inactivator (L-NAME), muscarinic receptor blocker (atropine), beta-adrenaline receptor blocker (propranolol), adenylyl cyclase inhibitor (SQ22536) respectively. The effects of MN on cellular Ca2+ and K+ migration in rat tracheal preparations were studied. Results: MN significantly inhibited acetylcholine or carbachol induced contractions of tracheal rings dose-dependently (P < 0.05). This relaxation effect of MN was not recovered in denuded tracheal rings. And pretreatment with L-NAME, propranolol, atropine, SQ22536 or tetraethylammonium respectively did not recover the relaxation effect of MN. MN inhibited both intracellular calcium release and extracelluar calcium influx. Conclusions: The relaxation effects of MN on rat tracheal rings are not related with epithelium, nitric oxide, muscarinic, or beta-adrenergic receptor. Methylmethacrylate monomer inhibits both intracellular calcium release and extracelluar calcium influx. (Korean J Anesthesiol 2007; 52: 194~201)

Effectiveness of Left Infrascapular Skin Temperature Monitoring in the ICU

Young Joo Lee,Hyun Jue Gill,Kuem Hee Chung,Jeong Yeon Hong,Bong Ki Moon,Myoung Eun Kim,Min Hyup Choi,Young Seok Lee Korean Society of Critical Care Medicine 1998 Acute and Critical Care Vol.13 No.2

BACKGOUND: Many sites are used to measure the body temperature and each site has different physiologic and practical importance. Several types of skin temperature monitoring have been used as simple, inexpensive and viable alternatives in many settings. In the operating area, it is difficult to insert a temperature probe during operation. The object of this study was to compare the difference and the correlation between the temperature of the left infrascapular skin region and temperatures of axilla, nasopharynx and rectum, METHODS: Forty-two adult patients who were admitted at surgical ICU were studied. After covering the bed with insulator and sheets, patients were placed in supine position. Temperature monitoring was done at the same time using four temperature probes from two bedside patient monitors in the same patient. The temperatures were measured twice at 30 minutes after application of the temperature probe at 10 minute intervals and the average temperature was recorded. RESULTS: The differences between skin temperature and rectal, nasopharyngeal, and axillary temperatures were -0.64+/-0.21degrees C (p

The effect of remifentanil for reducing myoclonus during induction of anesthesia with etomidate

Sang Woo Lee,Hyun Jue Gill,Sung Chul Park,Jun Young Kim,Ji Hyung Kim,Jong Yeon Lee,Hyeon Jeong Yang,Min Ku Kim 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4

Background: Myoclonic movement is a common problem during induction of anesthesia with etomidate. We investigated the influences of pretreatment with remifentanil on etomidate induced myoclonus. Methods: Ninety ASA class I patients were divided randomly into three groups. Group NS received normal saline 2 ml as placebo (n=30), group R0.5 and group R1.0 were pretreated with remifentanil 0.5 μg/kg (n=30) or 1.0 μg/kg (n=30) 1 minute before induction with etomidate 0.3 mg/kg. Orotracheal intubation was performed after administration of rocuronium 0.5 mg/kg. We assessed the incidence, onset, duration and intensity of myoclonus. Mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS) were recorded during induction. Results: Twenty five patients developed myoclonus in group NS (83.3%), 3 patients in group R0.5 developed myoclonus (10%), as did 5 patients in group R1.0 (16.7%). Moderate to severe myoclonus of grade 3 and 4 were found 66.7% of patients in group NS, whereas no patients in both remifentanil pretreated groups developed this grade of myoclonus. The duration of myoclonus was reduced significantly in the remifentanil groups: 93.8±59.5 sec in group NS, 49.3±34.9 sec in group R0.5, 36.0±27.0 sec in group R1.0 (P<0.05). HR was decreased by pretreatment with remifentanil prior to induction, while MAP and HR were decreased after induction with etomidate (P<0.05). BIS changes were not different among the three groups. The dose dependent differences between the two remifentanil doses were not noticed. Conclusions: Pretreatment with remifentanil significantly reduced the incidence, duration and intensity of etomidate induced myoclonus. (Korean J Anesthesiol 2009;57:438∼43)

Wolff-Parkinson-White 증후군 환자의 마취경험

박광원,김원옥,길현주 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.6

Since it was first described in 1930 by Wolff, Parkinson and White (W-P-W), the W-P-W syndrome, in its clinical significance, is the occurrence of tachyarrythmia by accessory conduction which may result in chest pain, hypotesion, congestive failure, syncope or sudden death. It still remains one of the most difficult cardiac arrythinias to treat. We experience the successful anesthetic management of 10 patients with W-P-W syndrome for non-cardiac and cardiac surgery from January, 1971 to April, 1987 at Severance hospital. With adequate preoperative management, in spite of their syndrome, all 10 patients tolerated general anesthesia fairly well, and we did not notice any significant changes in their vital signs during the perioperative period, Among the 10 patients, one recently experienced serious case is presented. In the selection of drugs for general anesthesia in cases of W-P-W syndrome, careful consideration should be given to all drugs which affect the conduction system of the heart.

상하복부 암성통증에 대한 복강신경총 및 요부교감신경절 차단 : 7예 보고

오흥근,윤덕미,길현주,이예철 대한통증학회 1988 The Korean Journal of Pain Vol.1 No.2

It is well known that the celiac plexus block is specially useful for relieve intractable upper abdominal pain caused by upper abdominal visceral malignancy or upper abdominal metastasis from distant organs. But in cases of lower abdominal or pelvic metastasis from upper abdominal malig- nancy, the lower abdominal intractable pain is remained after the successful celiac plexus block. We have reported 7 cases of celiac plexus block combined with lumbar sympathetic ganglion block, among the 305 cases of the celiac plexus block from 1968 to Nov. 1987, performed in patients with lower abdominal or back pain due to carcinomatosis of lower abdominal metastatic malignancy, that their results were excellent for pain relief.

소아 서혜부 탈장교정술시 미추마취와 전신마취의 임상고찰

김종우,정금희,길현주 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.2

Background : Caudal block has proved to be a satisfactory method of providing perioperative analgesia for pediatric surgery in the inguinal and perineal areas. The object of this study was to compare the general (n=55) with caudal anesthesia (n=41) in pediatric inguinal herniorrhaphy during surgery and postoperative 24 hours in their changes of behaviors in the recovery room, and other complications. Methods : Ninety six children who underwent to inguinal herniorrhaphy were devided into two groups. Group I was given general anesthesia as usual methods using endotracheal intubation. Group II was given caudal block using 1% lidocaine 1 ml/kg or 0.25% bupivacaine 1 ml/kg, or a mixture of both of them at the ratio of 1:1, 1 ml/kg. All caudal blocks were carried out in left lateral position after ketamine 1∼1.5 mg/kg intravenous injection. The side effects during and after operation and postoperative behavior in the recovery room, neurologic complications and postoperative fever incidence were observed and comped with the two groups. Results : In group I (n=55), 13 cases (23.6%) showed hoarseness after extubation. 78.2% of 55 patients were irritable and cryng in the recovery room. Postoperative fever incidence was over 69%. In group II (n=41), almost all patients were calm and stayed quiet in the recovery room. However there were 3 cases of bradycardia and 2 cases of hypotension during operation. Postoperative complications were rare and the mumber of patients with fever was 36.6% which was significantly low compared to group I. Conclusions : As the results of this study, we report that caudal anesthesia is a safe, simple practical method with few complications for inguinal herniorraphy in children compared with general anesthesia. We also recommend that the caudal block can be used safely in pediatric outpatient surgery. (Korean J Anesthesiol 1999; 36: 244∼249)

임상연구 : 서혜부 탈장 환아에서 Sevoflurane 마취 후 각성 흥분: Thiopental Sodium, Propofol과 Ketamine 마취 유도의 비교

김욱종 ( Wook Jong Kim ),길현주 ( Hyun Jue Gill ),김용찬 ( Yong Chan Kim ),이종연 ( Jong Youn Lee ),정금희 ( Kum Hee Chung ),이상우 ( Sang Woo Lee ),손석우 ( Suk Woo Son ),신용섭 ( Yong Sup Shin ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6

Background: This study compared the incidence of emergence agitation and the recovery profile from sevoflurane anesthesia after thiopental sodium, propofol or ketamine induction in pediatric inguinal herniorrhaphy. Methods: Forty eight children aged 1-7 years undergoing high ligation due to an inguinal hernia were examined. All patients received a 0.004 mg/kg glycopyrrolate injection for premedication prior to induction and were randomly assigned to receive thiopental sodium 5 mg/kg (Group T, n = 16), propofol 2 mg/kg (Group P, n = 16) or ketamine 1 mg/kg (Group K, n = 16) for induction. The side effects during the induction time were checked. All patients received sevoflurane (2-2.5 vol%)-N2O (2 L/min)-O2 (2 L/min) for the maintenance of anesthesia. Ventilation was given to assist spontaneous ventilation using a facial mask. The agitation score, pain score, discharge score, incidence of emergence agitation and postoperative side effects in the three groups were assessed at the recovery room and compared. Results: The emergence time in Group T (7.5 ± 1.8 min) was significantly rapid. The agitation and pain scores were significantly low in Group P. The discharge score was more rapid in Groups P and K than in Group T. The incidence of emergence agitation was similar in all three groups. Conclusions: Although recovery was faster and emergence agitation was low in the propofol group, propofol induction was not smooth compared with thiopental or ketamine induction. The incidence of emergence agitation after sevoflurane anesthesia in pediatric inguinal herniorrhaphy was similar in the thiopental sodium, propofol or ketamine induction groups. (Korean J Anesthesiol 2006; 50: 616~22)

Statistical Analysis of the Patients in the ICU by Using the APACHE II Scoring System

Young Joo Lee,Keum Hee Chung,Hyun Jue Gill,Kyung Jin Lee,Sang Hyun Kim,Chang Whan Cho,Young Suk Lee Korean Society of Critical Care Medicine 1998 Acute and Critical Care Vol.13 No.1

Introduction: The APACHE II scoring system has been promulgated as a useful tool in the assessment of the severity of disease and prognosis for patients with acute-on-chronic medical conditions. The purpose of this study was to assess the statistical association of APACHE II score and multiple variables in ICU patients. METHODS: Prospective data on 803 ICU patients for validation of the APACHE II system were analysed. We evaluated the relationship between APACHE II scores within the first 24 hours of ICU admission and multiple variables that included days in the ICU, mortality rate and age. The patients were classified as operation and nonoperation, survival and nonsurvival groups. RESULT: 1) The APACHE II score was significantly higher in the 153 nonsurvivals (23.97+/-10.98) than in the 651 survivals (11.51+/-6.14) (p

외래마취시 전처치제로 사용한 Midazolam의 마취회복 및 회복실 퇴실 시간에 미치는 영향

이봉재,이종연,박정현,이병희,양현정,김민구,사해경,길현주,정금희 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.1

Background: Midazolam is often used as an anxiolytic premedication before surgery. But preoperatively administered midazolam may contribute to postopertive sedation and delayed recovery from general anesthesia. This study was undertaken to evaluate the effect of midazolam premedication on postoperative recovery and discharge-readiness after brief outpatient surgery. Methods: Sixty healthy ASA physical status I women scheduled for outpatient diagnostic laparoscopic surgery were considered for the study. They were randomly allocated to one of two groups. Group one received normal saline (N/S) 5 ml intravenously (IV), while group two received IV midazolam 0.04 mg/kg. The study drug was prepared in 5 ml of saline and administered 10 minutes before the induction of general anesthesia. General anesthesia was induced with fentanyl, propofol and vecuronium and was maintained with N2O and enflurane. Postanesthetic recovery (PAR) scores were recorded after the arrival of the patients in the postanesthetic recovery room. Sedation was quantified before and after premedication and 60, 120 minutes after arriving in the postanesthetic recovery room, using the symbol-digit-modalities test (SDMT) and trail-making test (TMT). Results: There were no significant differences between the two groups with respect to age, weight and anesthesia time. There were no significant differences in PAR scores or PAR-stay time between two groups. SDMT and TMT scores were significantly different 5 minutes after the study's drug administration, and 60 minutes after arrival in the postanesthetic recovery room between the two groups. The incidence of side effects was similar in both groups. Conclusions: Midazolam premedication proved effective in sedation and anxiolysis without prolonging postanesthetic recovery and discharge times for outpatient general anesthesia. (Korean J Anesthesiol 1999; 37: 1∼5)