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경피 신경 척극이 통증역치와 혈장 Beta-endorphin치에 미치는 영향
길호영(Ho Yeong Kil),이두익(Doo Ik Lee),김철호(Chu 대한통증학회 1989 The Korean Journal of Pain Vol.2 No.2
N/A Pain is a common and important clinical symptom, and treatments aimed at relieving pain have a central position in medical practice. Recently Transcutaneous Electrical Nerve Stimulation (TENS) has been effectively used to control acute and chronic conditions that produce pain. But the mechanism of analgesia resu1ting from TENS remains obscure. In order to investigate the analgesic effect of TENS and it's action mechanism, TENS was applied in 40 rabbits with different frequencies, low frequency (2Hz) and high frequency (100Hz), for 20 minutes. And the pain threshold was measured by the temperature before and after stimulation, and an attempt was made to antagonize the stimulation effect with naloxone pretreatment (0.4 mg/kg). The results are as follows: 1) Both low frequency and high frequency TENS resulted in increasing the pain threshold signifi- cantly (Both p<0.01). 2) Naloxone pretreatment could antagonize the effect of increasing the pain threshold with low frequency TENS significantly (p<0.01), but not with high frequency TENS. Plasma beta-endorphin was measured by radioimmunoassay using an Beta-Endorphin Kit (Im- munonuclear Corporation, Stillwater, Minnesota, USA) and Automatic Gamma Scintillation Counter (Micromedic System 4/2000) before and after stimulation. An attempt was made to reverse the stimulation effect with naloxone pretreatment (0.4 mg/kg). The results are as follows: 1) Low frequency TENS resulted in increasing the level of plasma beta-endorphin significantly (p < 0.01), but high frequency TENS did not. 2) Naloxone pretreatment could reverse the effect of increasing the plasma beta-endorphin level with low frequency TENS significantly (p<0.01).
36권6호 영문부록 : 한국인에서 Propofol 목표혈중농도주입후 개안과 지남력 회복시의 농도
길호영(Ho Yeong Kil),김대우(Dae Woo Kim),인장혁(Jang Hyeok In) 대한마취과학회 1999 영문부록 Vol.- No.-
서론 : 목표농도조절주입(target controlled infusion)시 Diprifusor™를 사용하여 상황민감성 감소기(context sensitive decrement time)에 의한 회복시간을 예상할 수 있는 것은 propofol 사용의 또 다른 하나의 장점이 될 수 있다. 현재 Diprifusor™의 상황민감성 감소기 표준값은 1.2 μg/ml로 정해져 있으나 한국인에서 적합한지는 아직 연구되지 않았다. 현재 혈중 propofol농도의 측정은 국내에서 쉽게 할 수 없는 실정이다. 그러나 성인에서 Diprifusor™의 약동학적 모형을 이용하여 개안과 지남력의 최적의 회복농도를 후향적으로 평가하여 한국인에서 Diprifusor™를 마취로부터 회복시간을 예상하는 유용한 도구로 사용하고자 본 연구를 시행하였다. 방법 : 대상환자는 계획수술이 예정된 미국 마취과학회 신체상태 분류 1 및 2급에 해당하는 남녀환자 119 명을 대상으로 하였다. 마취유도는 propofol 목표농도를 6 μg/ml로 하였고, 유지는 O2(33%)-N2O (67%), propofol 목표농도 4 μg/ml로 하였다. 환자는 나이에 따라 성인에서 1군(39명): 18∼29세, 2군(41 명): 30∼39세, 3군(39명): 40∼54세로 구분하였다. 개안과 지남력 회복때까지의 농도를 구하였고, 이들 구해진 값으로 새로운 46명의 환자들에서 실제로 표준값으로 설정하여 각 환자마다 표준값에 의한 예상 시간과 이들의 실제 개안과 지남력 회복때까지의 시간들과의 상관관계(correlation coefficient)를 비교하였다. 결과: 수술 종료후 개안과 지남력회복때의 농도는 1군에서 각각 1.6 0.2 μg/ml 와 1.5 0.2 μg/ml, 2군에서 각각 1.6 0.1 μg/ml 와 1.5 0.1 μg/ml, 3군에서 각각 1.5 0.1 μg/ml와 1.4 0.1 μg/ml이였다. 3군에서 개안농도는 1군과 2군에 비하여 의의있게 낮았으며, 3군에서 지남력 회복농도는 1군에 비하여 낮았다(p<0.05). 표준값에 의한 각각 개안과 지남력 회복때 까지의 예상시간과 실제 개안과 지남력 회복때 까지의 시간과의 상관관계는 1 군에서는 지남력회복농도(r=0.67)와 3 군에서는 개안(r=0.72)과 지남력 회복농도(r=0.57) 모두에서 뚜렷한 상관관계를 보였다(p<0.05). 마취시간에 따르는 1시간 이전과 1시간 이후간의 개안과 지남력회복 때의 농도 비교 시에는 의의있는 차이가 없었다. 결론 : 성인에서 Diprifusor™의 약동학적 모형을 사용하여 구한 수술 종료후 개안과 지남력회복때의 평균 농도는 1.4∼1.6 μg/ml이었으므로 Diprifusor™의 상황민감성 감소기 표준값인 1.2μg/ml는 최소한 한국인에게 더 이상 적합하지 않은 것으로 사료된다. Diprifusor™를 사용한 목표농도 조절주입 후 회복농도는 나이에 따라 상당한 차이를 보였으나 마취시간에는 별다른 차이를 보이지 않았다. (Korean J Anesthesiol 1999; 36: S 9∼S 15)
말기암 환자의 통증 양상과 통증관리에 영향을 미치는 요소들
이수련(Soo Ryun Lee),길호영(Ho Yeong Kil),한태형(T 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.2
N/A Background: Validity of WHO guideline of cancer pain management has been proven and many trials have been done to derive solutions for inadequate cancer pain management. We assessed the severity of pain of terminal cancer patients in a few different ways and patients'characteristics influencing inadequate pain management. Methods: This study was based on 100 adult oncological patients who were confirmed as terminal stage in our institution from 3/1998 to 11/1998. Medical records were reviewed and individual patients were interviewed to obtain demographic information and medical characteristics such as; daily activity performance, metastasis, and drug-adjusted pain severity. Adequacy of prescribed analgesics in accordance with WHO guidelines of pain management and patients characteristics influencing adequacy of pain management were assessed. Results: Among those cancer patients diagnosed as terminal stage, 85% complained of pain, and 68% of those patients reported pain above moderate severity. 38% of those patients received inadequate pain management resulting in greater severity of pain; the less adequate pain relief was(p<0.01). Sex, age, primary cancer site metastasis, symptoms such as depression and anxiety, and daily activity performance were not significantly related. Conclusions: Despite WHO guidelines for pain management, majority of the terminal cancer patients received inadequate pain management. There is a necessity for education on proper pain evaluation and strict implimentation for WHO guidelines of pain management.
37권6호 영문부록 : 프로포폴/아산화 질소 마취에 있어 펜타닐의 지속적 정주가 프로포폴의 요구량, 마취에서의 회복 및 수술 후 진통효과에 미치는 영향
한태형(Tae Hyung Han),강형만(Hyun Man Kang),길호영(Ho Yeong Kil) 대한마취과학회 1999 연수강좌 Vol.- No.-
Background : It is very important to understand the drug interaction in total intravenous anesthesia. We conducted this study to find the effects of plasma fentabyl concentrations on intraoperative propofol requirements, emergence from anesthesia and relief of postoperative pain. Methods : Total 60, ASA physical status I-II patients who underwent spine fusion were studied. The patients were randomly assigned to four study groups according to the expected intraoperative plasma fentanyl concentration. Group I received an infusion of saline and Groups II, III and IV received fentanyl infusions to maintain the blood level at 1.5, 3.0 and 4.5 ng/ml, respectively. An infusion rate of propofol was adjusted to keep the mean arterial pressure (MAP) within 15% of the control value. Inspired nitrous oxide concentration was maintained at 67% throughout the surgical procedure. The following items were investigated in each group: 1) an average propofol infusion rate, 2) time to spontaneous eye opening and recovery of orientation (name, date and place) and 3) total dosage of fentanyl used for 24 hr after admission to post-anesthetic care unit. Results : Average propofol infusion rates were 10.1±2.5 (mean±SD), 7.5±1.2, 5.7±1.1, and 4.9±1.2 mg/kg/h, in Group I, II, III and IV, respectively. Groups receiving fentanyl infusion had significantly less administration rates (P< 0.01) than the group receiving saline infusion. Among the three fentanyl infusion groups, Group II (P< 0.01) had more than Groups III and IV. Time to spontaneous eye opening and the recovery of orientation were prolonged in the order of plasma fentanyl concentration. There was no significant difference between Groupss III and IV of the plasma fentanyl level of 3 and 4.5 ng/ml. Total amount of IV-PCA fentanyl during postop 24 h increased significantly in the reversed order of plasma fentanyl concentrations: 913.1±58.4, 553.4± 129, 222.7±73.4 and 135.1±69.5 mcg in Groups I, II, III and IV, respectively. Conclusion : These results confirmed that the addition of fentanyl infusion had analgesic ceiling effects, which in turn reduced the average propofol infusion rate to plasma fentanyl concentration level of 3 4.5 ng/ml. This had an indirect influence on the recovery of consciousness after surgery, but it did not show similar ceiling effect in postoperative analgesia. (Korean J Anesthesiol 1999; 37: S 1∼S 9)
임상연구 : 비선형 혼합효과 모델을 이용한 Etomidate의 집단 약동학 및 약역학
한태형 ( Tae Hyung Han ),이수경 ( Soo Kyung Lee ),이현철 ( Hyun Chul Lee ),이진영 ( Jin Young Lee ),곽인숙 ( In Suk Kwak ),정미화 ( Mi Hwa Jung ),길호영 ( Ho Yeong Kil ),박경수 ( Kyung Soo Park ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: Etomidate is used as a fast-acting hypnotic with few cardiovascular effects to induce anesthesia in patients with a poor cardiovascular reserve. The bispectral index (BIS) has been suggested to be a measure of the depth of anesthesia and correlates well with the level of consciousness. This study examined the population pharmacokinetics and pharmacodynamics of etomidate using nonlinear mixed effect (NONMEM) modeling and sigmoid Emax modeling. Methods: Eighteen middle aged adults, with ASA physical status I or II, who were scheduled for elective surgery, were included. 0.2% etomidate was administerd at 150 ml/h until the patients lost consciousness. The patient recovered spontaneously until they regained consciousness, as determined by a verbal response. The BIS was determined and arterial blood samples were collected. The plasma concentrations were measured with high performance liquid chromatograhy (HPLC). NONMEM was used for population pharmacokinetic and sigmoid Emax model for pharmacodynamic analysis. Results: The induction dose for the loss of eyelid reflexes was 0.38 mg/kg. The induction time from drug infusion to the loss of eyelash reflexes was approximately 3.5 minutes. This study took approximately 8.5 minutes from the start of drug infusion to the recovery of consciousness. The pharmacokinetic parameters were t1/2α = 1.1 min, t1/2β = 1.9 min, t1/2γ = 106.5 min, k21 = 0.36 L/min, k31 = 0.009 L/min, V1 = 6.43 L, Varea = 426 L, Cl = 2.77 L/min. The pharmacodynamics were keo = 0.40 L/min, CE50 = 1.0 ug/mL, E0 = 94, Emax = 94 and γ = 1.2. The performance error for the etomidate concentration was 0.14 ± 0.99 (typical prediction) and -0.03 ± 0.40 (individual prediction) and -0.09 ± 1.00 and -0.001 ± 0.13 for the BIS score. Conclusions: When compared with other previously published data, our pharmacokinetic parameters demonstrated a shorter half lives, a larger volume of distribution, and an increased clearance with significant interindividual differences. The pharmacodynamics showed a large interindividual variability. The reason for discrepancy might be the relatively short sampling time. However, further study will be warranted to improve the model performance in the future. (Korean J Anesthesiol 2006; 51: 271~7)