기관내 삽관이 어렵도록 모의된 환자에서 세 가지 기관내 튜브 유도침을 이용한 삽관 용이성의 비교

박재현,이평복,박상헌,정일영,김혜경,홍정은,박종국 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.2

심장수술 환자에서 아트라큐리움 투여 후 발생한 아나필락시스

김재광 ( Jae Kwang Kim ),전윤석 ( Yun Seok Jeon ),홍덕만 ( Deok Mann Hong ),임태완 ( Tae Wan Lim ),박재현 ( Jae Hyon Bahk ),안혁 ( Hyuk Ahn ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.3

고농도 산소 투여가 백서의 폐에 미치는 병태 생리학적 영향

김성덕,박재현 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.3

An animal model was used to study the effects of normobaric hyperoxia on pulmonary mechanics and histopathology. Thirty two rats (227±46gm) were divided into control (Group 1) in room air and 3 hyperoxic groups (n=8, each). Hyperoxic groups breathed F₁O₂ 0.98 for 24 hr(Group 2), 48 hr(Group 3), and 72 hr(Group 4), respectively. After hyperoxia, rats were intubated through tracheostomy, and inflation and deflation compliances of lung-thorax [CLT(I), CLT(D)] were calculated. Body weight(BW) was measured, and lungs were removed and weighed(LW). The lung specimens were examined microscopically. At the 3rd day of hyperoxia, 5 of 8 rats were died (63% mortality). CLT(I) of Group 4 was low (p$lt;0.05) compared with others, and CLT(D) of all hyperoxic groups were low (p$lt;0.05) compared with control. Mean LW/BW (lung weight divided by body weight) was elevated (p$lt;0.05) in Group 3 and Group 4. Pulmonary pathologic findings such as inflammation, congestion, alveolar and bronchial wall damage, pulmonary edema etc. became aparent (p$lt;0.05) at the 3rd day. We conclude that during hyperoxia pulmonary compliance might be decreased and lung weight might be increased progressively, and pulmonary pathological appearance of normobaric hyperoxia (F₁O₂ $gt; 0.98) resemble those of adult respiratory distress syndrome (ARDS).

유아 및 소아에서 후두마스크 크기의 선택 기준 : 체중과 나이의 비교 Comparison between Body Weight and Age

박종두,박재현 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.2

Background : In children, laryngeal mask airways (LMA) almost always show a tendency to come out of the mouth too much before and during inflating the cuff. We hypothesized that the selection criteria based on body weight seemed to be set too low or unappropriate in children. Methods : After IRB approval and informed consent from parents, pediatric patients (n = 63; 42 male, 21 female) weighing less than 20 ㎏, of ASA physical starus 1 or 2, and in whom the use of an LMA was not contraindicated, were studied. LMAs were inserted by an experienced investigator and connected to a volume ventilator, and positive pressure ventilantion was initiated. Inspiratory and expiratory tidal volume (V_T) were measured to calculate the fraction of leakage (F_L, %) as ([inspiratory V_T-expiratory V_T]/inspiratory V_T) × 100. The larynx was inspected with a fiberoscope (FOB) located just proximal to the aperture bar. For each size of LMA, we divided each group into two subgroups depending on the body weight (4, 7 or 12 ㎏) and age (2, 9 or 30 months) and compared the FOB finding and F_L between the two subgroups. In the other 16 patients, LMAs of two different sizes were applied successively to a patient, and its FOB grades were compared. Results : For size 1 LMAs (n = 22), the FOB finding and F_L were not different between the subgroups. For size 1.5 LMAs (n = 20), patients weighing 7 to 10 ㎏ or aged < 9 months had a better FOB finding (P = 0.007 and 0.0003) than patients weighing 5 to 7 ㎏ or aged > 9 months. For size 2 LMAs (n = 21), F_L was correlated with body weight (P<0.001, r^2 = 0.448) and age (P < 0.001, r^2 = 0.424). In 8 patients of 5 to 7 ㎏, use of size 1 LMAs had a better FOB grade than that of size 1.5 LMAs (P = 0.031). In the other 8 patients of 10 to 12 ㎏, there was no difference of FOB grades between the size 1.5 and 2 LMAs. Conclusions : For patients weighing 5 to 7 ㎏, the use of size 1 LMAs is recommended. Contrary to adults, a smaller LMA may have to be tried if an LMA size turns out to be inappropriate. (Korean J Anesthesiol 2002; 42: 148~153)

저산소혈증 유발시 산화질소의 흡입에 의한 심·폐혈역학 및 산소화에 관한 효과

김성덕,박재현 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.3

Introduction : One-lung ventilation(OLV), as a model for adult respiratory distress syndrome, was performed in 8 mongrel dogs, which were made a little hypoxemic by adjusting inspired fraction of oxygen(FIO2) in order to know the effect of nitric oxide(NO) on cardiopulmonary hemodynamics and oxygenation during OLV in lateral position. Methods : Double-lumen endobronchial tube was intubated through tracheostomy. OLV was performed in lateral position by turning to the side where Swan-Ganz catheter tip was located. FIO2 was adjusted to set SpO2 around 85∼90%. After stabilization, cardiopulmonary hemodynamic variables and various oxygenation-related parameters were measured respectively at 5 steps: 1) OLV, 2) OLV and 20 PPM of NO inhalation, 3) OLV, 4) OLV and 40 PPM of NO inhalation, 5) OLV. NO(titrated in N2 tank at concentration of 800 PPM) was administered through low-pressure inlet of ventilator and diluted by inspiratory fresh gas. FIO2 setting of ventilator was slightly increased during NO administration o compensate for FIO2 decrease due to NO titration gas(N2) mixing. NO and NO2 concentration was monitored at the inspiratory limb of breathing circuit by a electrochemical analyzer. Results : There were no difference about hemodynamic variables such as blood pressure(BP), pulmonary arterial pressure(PAP), heart rate(HR), central venous pressure(CVP), pulmonary capillary wedge pressure(PCWP). Neither were different calculated hemodynamic variables such as systemic vascular resistance(SVR), pulmonary vascular resistance(PVR), pulmonary perfusion pressure(PPP), cardiac index(CI), and right ventricular stroke work index(RVSWI). PaO2/FIO2, AaDO2, and S/T were significantly different between step 3 and step 4. But other oxygenation-related parameters such as O2, O2 flux, and O2 ER extraction ratio were not different. Conclusions : NO inhalation may have a potential for relieving hypoxemia during OLV of dogs in lateral position. (Korean J Anesthesiol 1998; 35: 423∼437)

Experimental Research Article : The diabetes-induced functional and distributional changes of the alpha 1-adrenoceptor of the abdominal aorta and distal mesenteric artery from streptozotocin-induced diabetic rats

( Jong Hwan Lee ),( Jae Hyon Bahk ),( Sang Hyun Park ),( Jin Huh ) 대한마취과학회 2011 Korean Journal of Anesthesiology Vol.60 No.4

Background: The aim of this study was to evaluate the effect of diabetes on the function and distribution of vascular α1-adrenoceptors in the abdominal aorta and distal mesenteric artery from streptozotocin (STZ)-induced diabetic rats at the level of the α1-adrenoceptor subtypes. Methods: Diabetes was induced by a single intravenous injection of STZ (60 mg/kg) in 8 week-old male Sprague-Dawley rats (n = 11). Age-matched normal rats (n = 14) were used as a control group. Four weeks after STZ injection, the tilting-induced change of the mean arterial pressure was recorded. The α1-adrenoceptor subtypes mediating the contractions of the distal mesenteric artery and abdominal aorta were investigated using the agonist phenylephrine and subtype-selective antagonists that included prazocin, 5-methylurapidil and BMY 7378. The expressions of the α1-adrenoceptor subtypes of each artery were examined by immunofluorescence staining using the subtype selective antibodies. Results: The recovery of the mean arterial pressure was delayed after positional change in the diabetic rats. Compared with that of the normal rats, the contractile response to phenylephrine was increased in the abdominal aortas and it was decreased in the distal mesenteric arteries in the diabetic rats. In addition, compared with the normal rats, the fluorescent intensity of all the α1-adrenoceptor subtypes was increased in the abdominal aortas and it was decreased in the mesenteric arteries of the diabetic rats. Conclusions: Diabetes increased the contractility of the abdominal aorta in response to phenylephrine, yet diabetes decreased that of the mesenteric arteries in the STZ-induced diabetic rats. Those results are mainly based on the overall change of the α1-adrenoceptor, and not on the change of the specific α1-adrenoceptor subtypes. (Korean J Anesthesiol 2011; 60: 272-281)

바늘의 종류, 삽입 깊이 또는 유도침 사용여부가 척추 및 경막외 마취용 바늘의 편향현상에 미치는 영향

안원식,박재현 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.6

3384001222 Background: This study was performed to discover how much needle deflection occurs during spinal or epidural block and how it can be reduced. Methods: A styrofoam block was used to simulate the paraspinal area of the back. A line was drawn perpendicular to the edge. Using the line as a guide, the needles were advanced through the block. Quincke-type needles of 22 and 25 gauge, penci1-type needles of 22 and 25 gauge or Tuohy needles of 17 and 18 gauge were used. Using a block of 6 cm thick spinal needle was advanced through the introducer with their apertures facing to the same or opposite direction, The deflection from the perpendicular line was measured in mm intervals. Results: Small-gauged and beveled spinal needles had more deflection depending on the block thickness (P < 0.05). However, the deflection of epidural needles was not consistent. When the bevel of the introducer and spinal needle was facing the same direction, the use of an introducer needle decreased the deflection in 22 and 25 G Quicke, and 25 G Whitacre needles (P < 0.05). When facing each other, the deflection was reduced in all the spinal needles (P < 0,05), and reduced more in the 25 G Quicke needles (P < 0.05). Conclusions: Considering the estimated depth of the spinal canal, needle type, bevel direction, its gauge and the use of an introducer needle, we can take advantage of the deflection phenomenon to reduce post-dural puncture headache and to increase the success rate of a spinal or epidural block. (Korean J Anesthesiol 2000; 39: 876∼881)

수술 중 체외막형산소섭취의 보조 하에 시행된 양측 순차적 폐이식술의 마취 경험 (증례보고)

이종환 ( Jong Hwan Lee ),김재헌 ( Jae Hun Kim ),최은수 ( Eun Su Choi ),전윤석 ( Yun Seok Jeon ),김영태 ( Young Tae Kim ),박재현 ( Jae Hyon Bahk ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.2

소아에서 쇄골하정맥 도자시 도관의 상대정맥내 거치율을 증가시키는 방법

고홍,김지연,박재현,정철우 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.6

Background : Subclavian cannulation is useful for the patients who need long-term maintenance of central venous catheters, but the inadequate location of catheters produces some complications. In pediatric populations, the abnormal placement of subclavian catheters in the internal jugular vein (IJV) is frequent because the angle farmed by the subclavian vein and IJV is much larger than in adults. We would therefore propose a technique which will increase the location ratio of subclavian catheters in the superior vena cava (SVC). Methods : One hundred twenty three patients who received elective or emergent operations were divided into 4 groups which consisted of the neck rotation away from the cannulation site' group (RA), neck rotation toward the cannulation site' group (RT), neck tilt away from the cannulation site' group(TA), 'neck tilt toward the carmulation site group (TT). We cannulated each group and verified the location of the catheter tip i#o chest PA for each group. Results : The calculatio#n for the ratio of SVC location to the total cannulation of each group (%SVC) was done and the x^2 test was done. Total %SVC was 73.2% and %SVC of each group wme 64,9% for the RA group, 77.3% for the RT group, 61.8% for the TA group, and 93.3% for the TT group. A considerable difference was found for total %SVC in the g test. The location ratio of the TT group was higher than the others nnd there was no difference found between the RA, RT, TA groups. Conclusions : We can conlude that tilting the neck toward the cannulation site would produce a higher ratio of SVC location of the subclavian catheter than other neck pasitions. (Korean J Anesthesiol 2000; 38: 102A~I028)

실험연구 : 흰쥐의 장간막 동맥에서 성별에 따른 Myoendothelial Gap Junction의 분포와 혈관 긴장도에 대한 영향

한선숙 ( Sun Sook Han ),박재현 ( Jae Hyon Bahk ),허진 ( Jin Huh ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6

Background: Besides prostacyclin and nitric oxide, the endothelium-derived hyperpolarizing factor (EDHF), which is another distinct endothelium-dependent vasodilator, is involved in relaxing the vascular smooth muscle cells. The myoendothelial gap junction (MEGJ) and female sex hormone play important roles in the EDHF-mediated responses. Therefore, this study was designed to determine the influence of gender on the gap junctional distribution and endothelium-dependent vasodilation in the rat mesenteric arteries. Methods: Male and female Sprague-Dawley rat were euthanized and the tertiary branch of the mesenteric artery was harvested. Immunohistochemistry and confocal microscopic examination of the arterial wall were performed after treating them with specific antibodies to delineate the distribution of connexin 43, a gap junctional protein. Segments of the mesenteric artery, 5 mm in length, were connected to two tungsten wires under isometric tension. The arterial segments were suspended in a modified Krebs solution (37℃) aerated with 95% O2 and 5% CO2 in a vertical water-jacketed temperature-controlled tissue bath. The standard dose-response curve for acetylcholine (10-9-10-5 M) was drawn in the presence of the NO synthase inhibitor, Nω-nitro-L-arginine methyl ester (L-NAME; 10-4 M) plus indomethacin (10-5 M) and/or gap junctional inhibitor, carbenoxolone (10-4 M). Results: In the female rat mesenteric artery, the gap junctional plagues were more prevalent particularly along the endothelial layer. The inhibition of the relaxation response to acetylcholine was depressed in the presence of L-NAME plus indomethacin and augmented in the presence of carbenoxolone when compared with the male rat mesenteric arteries (P < 0.05). Conclusions: Gender differences in the rat mensenteric arteries have an effect on the expression of connexin 43 and the release of EDHF through MEGJ may play a key role in controlling the female arterial tone. (Korean J Anesthesiol 2006; 51: 720~6)