실험연구 : Thiopental Sodium, Propofol, Midazolam과 Ketamine의 흰쥐 동맥내피인자에 대한 효과

강봉진 ( Bong Jin Kang ),이정은 ( Jung Un Lee ),손수창 ( Soo Chang Son ),강포순 ( Po Sun Kang ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.44 No.5

임상연구 : 슬관절 전치환술 시 경막외강, 슬관절강 및 슬관절 주위 조직에 병용 투여한 Bupivacaine과 Morphine이 술 후 통증에 미치는 영향

최현기 ( Hyun Gee Choi ),김성기 ( Seong Gee Kim ),권성범 ( Seong Bum Kwon ),김종선 ( Jong Sun Kim ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5

Background: Epidural opioids and local anesthetics provide excellent postoperative analgesia. In addition, soft tissue and intra-articular injection of bupivacaine and morphine may have a beneficial analgesic effects after total knee arthroplasty (TKA). This study was designed to assess the additional analgesic effect of combined soft tissue, and intra-articular injection of morphine and bupivacaine in patients undergoing TKA under spinal anesthesia with continuous epidural morphine and bupivacaine injection. Methods: Forty patients aged 55 to 75 years for a TKA under spinal anesthesia were randomly divided into 2 groups. The both group of patients received a continuous epidural infusion using a two-day infusor containing morphine 5 mg in 100 ml of 0.125% bupivacaine. The experimental group of patients (n = 20) received soft tissue, and intra-articular injection containing 10 mg morphine in 100 ml bupivacaine 0.125%. The control group of patients (n = 20) received soft tissue, and intra-articular injection of 100 ml normal saline. Postoperative pain was assessed using the visual analog scale (VAS) at 1, 2, 4, 8, 12, 24, and 48 h postoperatively and side effects, such as hypotension, nausea, vomiting, pruritus, and respiratory distress were recorded. Whenever patients demanded supplemental analgesia, diclofenac sodium 75 mg was injected intramuscularly and the need for additional analgesic requirement was recorded. Results: The experimental group of patients had significantly lower pain score and analgesic requirements than the control group for 2 days. There was no difference in the incidence of side effects between groups. Conclusions: Combined soft tissue, and intra-articular injection of morphine and bupivacaine with continuous epidural morphine and bupivacaine infusion reduces postoperative pain and supplementary analgesic requirements than continuous epidural morphine and bupivacaine infusion only in patients undergoing TKA. (Korean J Anesthesiol 2006; 50: 546~51)

도관 거치 후 발생한 족배동맥 가성동맥류

강포순,이규창,선금태,이예철 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.3

Pseudoaneurysm occurs rarely after percutaneous cannulation of a peripheral artery. A 90 years old male patient with cholangiocarcinoma of distal common bile duct was underwent palliative surgery. Arterial cannulation of a dorsalis pedis artery was done for continuous arterial blood pressure monitoring and blood sampling, and it was removed 7 days after cannulation. Pseudoaneurysm was developed 25 days after cannulation. We report the pseudoaneurysm of dorsalis pedis artery and describe the related mechanisms and predisposing factors. (Korean J Anesthesiol 1998; 35: 558∼561)

Rifampicin을 투여받은 흰쥐에서 Cimetidine이 Halothane 대사 및 Halothane 마취후 간에 미치는 영향에 관한 연구

강포순,장성호 고려대학교 의과대학 1993 고려대 의대 잡지 Vol.30 No.1

The H2-receptor antagonist, cimetidine, through binding of its imidazole ring to cytochrome P-450, has been known to inhibit drug metabolism, and the antituberculous drug, rifampicin, through microsomal enzyme induction, has been known to increase drug metabolism. The intermediate metabolites of halothane appear to be involved in the etiology of halothane-induced hepatotoxicity. This study was done to determine the effect of cimetidine on halothane hepatotoxicity in rats pretreated with rifampicin. Ninty six Sprague-Dawley rats were divided into three groups. Saline was administered orally daily for 7 days in group Ⅰ (N=31). Rifampicin (100mg/kg) was administered orally daily for 7 days in group Ⅱ (N=33) and group Ⅲ (N=32). Cimetidine (180mg/kg) was injected intraperitoneally one hour before halothane anesthesia in group Ⅲ. All of the three groups were exposed to halothane-N_(2)O-O_(2) (l%-3L/min-3L/min) for two hours 24 hours after the last treatment with saline or rifampicin. Blood sampling was done before any treatment as control. Blood sampling and hepatectomy for light microscopic examination 24 hours after halothane anesthesia were done in one half of the rats from each group and the remaining were examined 96 hours after halothane anesthesia. The measurements we examined were values of liver function test (alanine aminotransferase : ALT) and aspartate aminotranferase : AST), metabolites of halothane (bromide and fluoride) and the histologic scores of light microscopic findings of liver tissue 24 hours or 96 hours after halothane anesthesia. The results were as follows ; 1. The values of liver function test 24 hours after halothane anesthesia showed increasing tendency in all three groups, but there were no statistical significance in all three group except the value of AST in group Ⅲ. 2. The values of ALT and AST 96 hours after halothane anestheisa decreased and showed significant statistical difference from those of 24 hours after anesthesia in group Ⅱ. 3. Serum concentrations of bromide and fluoride 24 hours or 96 hours after halothane anesthesia showed no significant statistical differences among three groups. But bromide concentration 96 hours after halothane anesthesia was less than the values 24 hours after halothane anesthesia (p<0.05). 4. The histologic evidences of hepatic changes were not shown in all groups 24 hours and 96 hours after anesthesia. The above results concluded that neither cimetidine nor rifampicin does affect halothane metabolism and hepatic changes after halothane anesthesia.

수술후 제통을 위한 경막외 마취후 발생한 심폐 정지

이규창,강포순,우남식,임정애,박영주,이예철 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.4

The continuous epidural anesthesia is an effective method for postoperative pain control and improvement of pulmonary function. A 39-year-old man was scheduled for postoperative intestinal obstruction. After adhesiolysis under the general anesthesia, epidural anesthesia was done for postoperative pain control. Because an accidental dural puncture was noticed, the adjacent interspace of epidural anesthesia was tried and catheter was inserted. Respiratory depression, hypotension, loss of consciousness and cardiac arrest were developed about 20 minutes after the first injection of 1% lidocain 10ml. Endotracheal intubation was performed and the respiration was controlled using 100% oxygen. Self respiration and alert mentality returned after 180 minutes. No CSF leakage, delayed onset time, severe hypotension, complete recovery may be the result of subdural anesthesia and postoperative hypoxia. But radiological examination was not performed.

찬송가와 독경이 수술실에서 마취전 환자의 불안에 미치는 영향

김성곤,강포순,이예철,임정애 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.6

Background: Most surgical patients experience preoperative anxiety. This anxiety can effect the amount of preanesthetic medication and anesthetic agents needed, and contribute to postoperative pain. Music has been recognized as a way to reduce anxiety and fear. The effect of hymn and sutra-chanting on the preanesthetic patient's anxiety in the operating room were studied. Methods: 98 patients were divided into two groups according to the religionist or atheism. Group I(n=50, religionist) and Group II(n=48, atheism) listened to hymn or sutra-chanting according to the patients religion and choice. At ward, hemodynamic variables including systolic and diastolic blood pressure and pulse rate were measured as control values. Hemodynamic variables and measurements of anxiety score with Hamilton anxiety rating scale were made at pre-music and post-music in the operating room. Also, patients response to the music was measured on the postoperative 5-6th day. Results: There were no difference between ward, pre-music, and post-music in terms of systolic pressure, diastolic pressure and pulse rate except the systolic pressure at pre-music that is grater than that of controls in both groups. Both group, anxiety score at post-music was significantly lower than that of pre-music (10.2±3.4 vs 4.4±2.9, 11.0±3.2 vs 5.7±3.1). At post-musie, anxiety score in Group I showed significant reduced compaired with Group II (p$lt;0.05). Patients showed relatively good satisfaction with music in both groups. Conclusion: The results suggest that music with hymn and Sutra-chanting were effective to reduce preanesthetic anxiety in both religionist group and atheism group.

Metocurine Iodide 와 Vecuronium Bromide 의 분할 투여방법이 안압에 미치는 영향

최영석,강포순 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.1

We measured the intraocular pressure changes in forty female patients (aged from 20 to 50) without a history of ocular or cardiovascular disease who were classified physical status 1 and 2, and scheduled for elective surgery. They were divided into 4 groups. Group l (n=10); metocurime 0.03 mg/kg as a priming dose and metocurine 0.27 mg/ kg as a intubating dose. Group 2 (n= 10); vecuronium 0.008 mg/kg as a priming dose and vecuronium 0.072 mg as a intubating dose. Group 3 (n=10); vecuronium 0.008mg/kg as a priming dose and metocurine 0.27 mg/kg as a intubating dose. Group 4 (n=10); metocurine 0.03mg/kg as a priming dose and vecuronium 0.072 mg/kg as a intubating dose. In this study, metocurine and vecuronium were used with the priming principle. We also measured changes in blood pressure, pulse rate and T1% of Train of four stimulation and evaluated the discomfort after the administration of the priming dose and the difficulties of intubation. The results were as follows, 1) Compared with the control value, there was no increse in intraocular pressure following intubation in all four groups and intraocular pressure of 2 and 4 minutes following intubation decreased significantly in all four groups. The greatest decrease was seen in group 3, but it was not significant when compared to the other three groups. 2) While a transient increase in blood pressure was seen in all four groups, the lowest increase was seen in group 3 as compared to the control value. Blood pressure 4 minutes following intubation decreased significantly in grop 3. 3) A significant decrease in the T1% of the Train of four stimuli at one minute after administration of the intubating dose was seen in group 3 compared to the other three groups. 4) Group 3 showed the lowest number of difficult intubation. In conclusion, the combination of vecuronium and metoeurine with the priming principle provide optimal conditions for smooth and rapid intubation with no elevation of intraocular pressure, blood pressure and heart rate changes for ocular surgery.

제왕절개술시 기관내삽관을 위한 Atracurium Besylate 의 사용에 대한 연구

윤석민,임혜자,강포순,김종욱 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.5

The need for a short-acting non-depolarizing neuromuscular blocking agent to replace succinylcholine chloride(succinylcholine) is recognized widely and attempts to find such a drug have been numerous. Atracurium besylate(atracurium) is one of the new series of neuromuscular blocking agents with little cardiovascular effect and is not dependent on hepatic and renal function for terminating its action because of its self-destroying mechanism. Because succinylchline may occasionally be contraindieated for intubation in parturients we studied the use of atracurium in 23 patients having cesarean section. All patients received 0. 5 mg/kg atracurium for intubation and neuromuscular relaxation. Hemodynamic changes, the time from the injection of atracurium to maximal twitch suppression, the time between atracurium administration and the return to 10% of control twitch height were recorded and observed the degree of vocal cord relaxation and conditions of intubation and evaluated the Apgar scores. 1) Mean arterial pressure and heart rate increased significantly after intubation compared with that of control and just before intubation but there were no significant changes in 5 minutes after intubation. 2) The 90% twitch suppression following atracurium administration was 75.6±20.9 seconds. 3) The return of 10% of control twitch height was 2449.3±1114.0 seconds. 4) Intubation conditions were excellent for 19 patients. 5) The Apgar scores of 20 neonates were high. These data suggest that the use of atracurium may be a useful alternative for induction for Cesarean section when succinylcholine is contraindicated.

Halothane 마취중인 소아에서 Glycopyrrolate 의 투여량에 따른 심박수 변동에 관한 연구

박영철,윤석민,강포순,손지영 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.2

The dose-response for glycopyrrolate and heart rate in anesthetized children has not heen defined. We determined the dose-response for glyeopyrrolate and heart rate in 50 children, ASA physical status l and 2, anesthetized with halothane and nitrous oxide. Anesthesia was induced with 60-70% nitrous oxide in oxygen and halothane(1.5∼2.0 vo1%). After induction of aneethesia, glycopyrrolate in a dose of 4, 6, 8, 12 or 16㎍·kg^(-1) was administered by rapid infusion to each subject. The effects of glycopyrrolate on heart rate, heart rhythm and systolic blood pressure were compared among dosage groups, and dose-response curve for peak heart rate was constructed, Glycopyrrolate increased the heart rate in a dose-related manner upto 12㎍·kg^(-1) except 16㎍·kg^(-1). Fifty percent maximal response corresponded to 6.1 μg x kg(-1), and 95% maximal response corresponded to 11.1㎍·kg^(-1). None of the patients had nonsinus rhythm after glycopyrrolate injection. Except for glycopyrrolate given at 4㎍·kg^(-1) systolic blood pressure increased significantly after all other doses. Glycopyrrolate in doses greater than or equal to 6㎍·kg^(-1) increased the heart rate and systolic blood pressure in children anesthetized with halothane and nitrous oxide.

지주막하 Morphine과 근주 Caroverine과 Tiaprofenate의 경요도 전립선 절제술후 진통효과

김윤수,이규창,강포순,김정성,선금태,이예철 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.1

Background: Intrathecal injection of morphine is widely used in the management of postoperative pain because it provides long-lasting analgesia. Intramuscular caroverine and tiaprofenate are used to produce postoperative pain relief. This study was designed to evaluate the analgesic efficacy and quality of sleep achieved with intrathecal morphine and those of intramuscular caroverine and tiaprofenate in transurethral resection of the prostate (TURP). Methods: Forty patients undergoing elective TURP were randomly allocated into 2 groups as follows: Group M (n=20); 0.25 mg of morphine hydrochloride mixed in 7.5 mg of 0.5% hyperbaric bupivacaine was administered at the time of induction of spinal anesthesia. Group S (n=20); 7.5 mg of 0.5% hyperbaric bupivacaine was administered intrathecally and caroverine and tiaprofenate intramuscularly at every 8 hr and 12hr postoperatively for management of postoperative pain. We evaluated the analgesic efficacy with visual analog scale (VAS), quality of sleep, and side effects. Results: VAS at 6, 12 and 24 hours after operation were significantly less (p$lt;0.01) in the group M than in the group S. Group M was superior to group S with respect to quality of sleep (p$lt;0.01). In the group M, the incidence of nausea was 30% (6/20) and that of pruritus was 35% (7/20) and clinical respiratory depression did not occur. Conclusions: Intrathecal 0.25 mg morphine provides good postoperative analgesic effect. but intramuscular caroverine and tiaprofenate does not.