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심장수술 시 농축적혈구, 자가수혈기 혈액, 체외 순환기 혈액에서의 유리 혈색소 농도 비교
송장호,구승우,백종화,정용보,이정순,최인철 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5
Background: Intraoperative autotransfusion or residual blood in a cardiopulmonaty bypass (CPB) circuit has been used to reduce the need for an homologous blood transfutsion during cardiac surgery. However, it may contain some free hemoglobin released from damaged cells. The load of blood containing free hemoglobin may cause renal dysfunction. We measured the amount of free hemoglobin in backed blood, cell saver blood and CPB blood to evaluate what is the least hemolytic blood transfused in cardiac surgery. Methods: This study was performed in 20 patients undergoing cardiac surgery. In each patient, the banked blood, intraoperative salvaged blood with a cell saver and CPB residual blood were sampled at the end of the operation. The concentration of free hemoglobin, hemoglobin and platelet counts were measured in these blood samples and percent of hemolysis was calculated (%hemolysis = [free hemoglobin] / .free hemogloben + hemoglobin]) Results: In salvaged blood with a cell saver, CPB residual blood and banked blood, hemoglobin concentrations were 20.1 ± 2.7 g/dl, 8.0 ± 1.1 g/dl, and 22.2 ± 2.7 g/dl, respectively. Free hemoglobin concentrations were 336.6 ± 239.5 mg/dl, 49.2 ± 26.8 mg/dl, and 279.5 ± 167.5 mg/dl respectively. Platelet counts were 26.1 ± 22.2 × 10^3/mm^3, 116.8 ± 56.5 × 10^3/mm^3, and 94.9 ± 43.6 × 10^3/mm^3 respectively. % Hemolysis were 1.6 ± 1.1%, 0.6 ± 0.4%, and 1.2 ± 0.7% respectively. In the comparison between the salvaged blood with a cell saver and CPB residual blood, free hemoglobin concentration, % hemolysis, and platelet counts had positive correlations (r = 0.8, 0.7, and 0.6). Conclusions: In twenty cardiac surgeries, CPB residual blood had a lower free hemoglobin level than the other two blood groups. The platelet counts in CPB residual blood were higher than those in cell saver blood but did not differ from those in banked blood. Therefore, CPB residual blood was the least hemolytic blood among the three blood groups when a transfusion was performed in cardiac surgery. (Korean J Acesthesiol 2002; 43: 588~593)
실험연구 : 흰쥐 횡격막 신경근 표본에서 Ondansetron과 Granisetron이 Rocuronium의 근 이완 작용에 미치는 효과
백종화 ( Chong Wha Baek ),강현 ( Hyun Kang ),정용훈 ( Yong Hun Jung ),박정원 ( Jung Won Park ),정화성 ( Hwa Sung Jung ),이윤경 ( Yoon Kyung Lee ),양홍석 ( Hong Seuk Yang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: Both ondansetron and granisetron exert their antiemetic effects via a blockade of the 5-hydroxytryptamine 3 receptor (5-HT3R). Because the 5-HT3R is a member of a superfamily of ligand-gated ion channels and has structural similarities to the nicotinic acetylcholine receptor (nAChR), a 5-HT3R antagonist may also inhibit the nAChR. This study examined the effects of 5-HT3R antagonists, ondansetron and granisetron, on rocuronium-induced neuromuscular blockade in vitro. Methods: Rat phrenic nerve-hemidiaphragm preparations were isolated and allocated randomly into seven groups (control, 1, 10, 100μg/ml of ondansetron, 0.1, 1, 10μg/ml of granisetron). Two studies were carried out using single twitch responses. In the cumulative dose-response study, rocuronium 1μg/ml and each doses of ondansetron or granisetron were administered simultaneously, and incremental 0.5μg/ml doses of rocuronium were added to obtain more than 95% neuromuscular twitch inhibition. ED5, ED50, ED90, and ED95 of rocuronium in each group were calculated using a logistic model. In the partial curarization study, the twitch heights were measured after administering ondansetron or granisetron (10 minutes after administering 3μg/ml rocuronium) and were measured 10 minutes later. The 2 twitch heights were then compared. Results: In the cumulative dose-response study, ondansetron 100μg/ml and granisetron 10μg/ml significantly reduced the ED50 of rocuronium (P < 0.05). There were no intergroup differences in the partial curarization study. Conclusions: High concentration of ondansetron and granisetron enhanced the neuromuscular blockade of rocuronium. Granisetron enhanced the neuromuscular blockade of rocuronium more potently than ondansetron. (Korean J Anesthesiol 2006; 51: 94~100)
임상연구 : 슬관절 전치환술을 받는 노인환자에서 혈역학적 변화를 최소화하기 위해 지속 정주한 Remifentanil과 Esmolol, Nicardipine의 비교
백종화 ( Chong Wha Baek ),곽미정 ( Mi Jeung Gwak ),고나영 ( Na Young Ko ),강현 ( Hyun Kang ),박정원 ( Jung Won Park ),정용훈 ( Yong Hun Jung ),우영철 ( Young Cheol Woo ),김진윤 ( Jin Yun Kim ),구길회 ( Gill Hoi Koo ),박선규 ( Sun 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Background: The use of tourniquet is associated with severe hemodynamic changes, particularly in elderly patients. This study examined the effects of continuously infused remifentanil or nicardipine with esmolol on the attenuation of the hemodynamic changes with enflurane inhalation during total knee arthroplasty in elderly patients. Methods: Thirty elderly female patients undergoing total knee arthroplasty were enrolled into this randomized, prospective study. Remifentanil (group R) or nicardipine with esmolol (group EN) was infused using a titration method to maintain a mean arterial pressure (MAP) of 90 mmHg to 70 mmHg during tourniquet inflation. In addition, the inhalation of enflurane was adjusted to guarantee a hypnotic state based on entropy. The hemodynamic variables, inhaled concentration of enflurane, recovery time, and postoperative pain characteristics were measured and compared. Results: Following tourniquet inflation, the MAP was increased and maintained in the target since 20 min after that in both group. Following tourniquet deflation the MAP was decreased significantly in both groups and more patients in group R required a vasopressor. Group R inhaled a lower enflurane concentration and showed more rapid recovery than group EN. There were no significant differences in the level of postoperative pain between the two groups. Conclusions: These results suggest that remifentanil is more likely to be associated with hypotension after tourniquet deflation and require more attention than nicardipine with esmolol. (Korean J Anesthesiol 2007; 53: 463~9)
복강경하 담낭절제술 중 발생한 고혈압 치료시 Nifedipine 비강 투여의 효과
박정원,백종화 중앙대학교 의과대학 의과학연구소 2003 中央醫大誌 Vol.28 No.2-3
Intranasal drug administration has been suggested as a useful method to treat various systemic cardiovascular disorders such as systemic hypertension and angina pectoris. Nifedipine is usually administered sublingually. We tried to see the efficacy of intranasal nifedipine for treatment of hypertension during laparoscopic cholesystectomy. After CO₂ insufflation, we selected the patients who had increased values of 25% more than the previous blood pressure. Eight patients were received nifedipine intranasally. Blood pressure and heart rate were recorded at 0, 1, 2, 3, 5, 10, 15 minutes after intranasal nifedipine. Significant decreases in blood pressure and increases in heart rate occurred from 2 minute to 15 minute after intranasal nifedipine. And then there were not any changes of blood pressure and heart rate during the observation period. Our results suggest that administration of intranasal nifedipine was effective and safe in immediate control of hypertension associated with CO₂ insufflation during laparoscopic cholesystectomy .
고양이에서 출혈성 쇽후 수액소생시 수액 종류가 소화관 점막 산소화에 미치는 효과
박평환,백종화,최종무 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.6
Recently, much attention has been paid to the gut mucosal oxygenation in shock resuscitation, because many studies has been reported that the ultimate etiologies of death due to shock are mainly due to multiple organ failure caused by translocation of endotoxins and microorganisms from the ischemic gut mucosa. As there has been persistent controvesies over the relative merits of various kinds of resuscitation fluids in regard to the tissue oxygenation during management of shock, we studied the effects of various kinds of resuscitation fluids on the gut mucosal oxygenation with cats which were in hemorrhagic shcok 24 anesthetized cats were subjected to ge to decrease the mean arterial blood pressure to 40∼45 mmHg and this pressure was maintained for 120 minutes (oligemic period). After this period, normal saline, hydroxyethyl starch and hypertonic saline/dextran mixture were administered respectively to raise systolic blood pressure up to 85 mmHg over 30 minutes and this level was maintained for another 120 minutes (post-oligemic period). Mesenteric venous oxygen tension, mesenteric venous-arterial lactate difference, carbon dioxide tension difference and arterial-venous pH difference were measured far evaluating the effects of three groups of resucitation fluids in regard to the gut mucosal oxygenation. There were no statistical significances among three groups by measuring the venous oxygen tension, venous-arterial carbon dioxide difference, arterial-venous pH difference. But venousarterial lactate difference in normal saline resuscitation group was significantly elevated from 5.0 ±l.l mg/dl immediately after fluid resuscitation to 8.4±1.8 mg/dl 1 hour after fluid resuscitation (p$lt;0.05). The difference in normal saline group was significantly high compared to the hydroxyethyl starch group which was 4.4±0.5 mg/dl and also compared to the hypertonic saline/dextran mixture group which was 4.1±0.9 mg/dl (p$lt;0.05). Hydroxyethly starch and hypertonic saline/dextran mixture are more effective than normal saline in rd to the gut mucosal oxygenation in shock resuscitation, based on changes in venous-arterial lactate difference in each group. Further clinical studies may be needad
( Jin Suk Park ),( Chong Wha Baek ),( Hyun Kang ),( Su Man Cha ),( Jung Won Park ),( Yong Hun Jung ),( Young Cheol Woo ) 대한마취과학회 2010 Korean Journal of Anesthesiology Vol.58 No.4
A 23-year-old woman with MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) underwent a laparoscopy-assisted appendectomy. MELAS syndrome is a multisystemic disease caused by mitochondrial dysfunction. General anesthesia has several potential hazards to patients with MELAS syndrome, such as malignant hyperthermia, hypothermia, and metabolic acidosis. In this case, anesthesia was performed with propofol, remifentanil TCI, and atracurium without any surgical or anesthetic complications. We discuss the anesthetic effects of MELAS syndrome. (Korean J Anesthesiol 2010; 58: 409-412)