Propofol TCI마취시 Lidocaine 정주가 기관내삽관에 따른 BIS 및 혈역학적 변화에 미치는 영향

류태하,김시오,백운이,박진웅,전영훈 대한마취과학회 2004 Korean Journal of Anesthesiology Vol.47 No.6

전자식 안정기 시스템과 제어IC 관련 기술동향

류태하,조규형 전력전자학회 1999 전력전자학회지 Vol.4 No.3

Perioperative management of left ventricular diastolic dysfunction and heart failure: an anesthesiologist’s perspective

류태하,송석영 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.1

Anesthesiologists frequently see asymptomatic patients with diastolic dysfunction or heart failure for various surgeries. These patients typically show normal systolic function but abnormal diastolic parameters in their preoperative echocardiographic evaluations. The symptoms that are sometimes seen are similar to those of chronic obstructive pulmonary disease. Patients with diastolic dysfunction, and even with diastolic heart failure, have the potential to develop a hypertensive crisis or pulmonary congestion. Thus, in addition to conventional perioperative risk quantification, it may be important to consider the results of diastolic assessment for predicting the postoperative outcome and making better decisions. If anesthesiologists see female patients older than 70 years of age who have hypertension, diabetes, chronic renal disease, recent weight gain, or exercise intolerance, they should focus on the patient’s diastologic echocardiography indicators such as left atrial enlargement or left ventricular hypertrophy. In addition, there is a need for perioperative strategies to mitigate diastolic dysfunction-related morbidity. Specifically, hypertension should be controlled, keeping pulse pressure below diastolic blood pressure, maintaining a sinus rhythm and normovolemia, and avoiding tachycardia and myocardial ischemia. There is no need to classify these diastolic dysfunction, but it is important to manage this condition to avoid worsening outcomes.

Retrospective analysis of risk factors of hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene blockade in the sitting position

류태하,김백진,Woo Seong Jun,Lee So Young,임정아,곽상규,노운석 대한마취통증의학회 2020 Korean Journal of Anesthesiology Vol.73 No.6

Background: Hypotensive bradycardic events (HBEs) are a frequent adverse event in patients who underwent shoulder arthroscopic surgery under interscalene block (ISB) in the sitting position. This retrospective study was conducted to investigate the independent risk factors of HBEs in shoulder arthroscopic surgery under ISB in the sitting position. Methods: A total of 2549 patients who underwent shoulder arthroscopic surgery under ISB and had complete clinical data were included in the study. The 357 patients who developed HBEs were included in the HBEs group, and the remaining 2192 in the non-HBEs group. The potential risk factors for HBEs, such as age, sex, past medical history, anesthetic characteristics, and intraoperative medications were collected and compared between the groups. Statistically significant variables were included in a logistic regression model to further evaluate the independent risk factors for HBEs in shoulder arthroscopic surgery under ISB. Results: The incidence of HBEs was 14.0% (357/2549). Logistic regression analysis revealed that the intraoperative use of hydralazine (odds ratio [OR] 4.2; 95% confidence interval [CI] 2.9–6.3), propofol (OR 2.1; 95% CI 1.3–3.6), and dexmedetomidine (OR 3.9; 95% CI 1.9–7.8) before HBEs were independent risk factors for HBEs in patients who received shoulder arthroscopic surgery under ISB. Conclusions: The intraoperative use of antihypertensives such as hydralazine and sedatives such as propofol or dexmedetomidine leads to increased risk of HBEs during shoulder arthroscopic surgery under ISB in the sitting position.

Fluid management in patients undergoing neurosurgery

류태하 대한마취통증의학회 2021 Anesthesia and pain medicine Vol.16 No.3

Fluid management is an important component of perioperative care for patients undergoing neurosurgery. The primary goal of fluid management in neurosurgery is the maintenance of normovolemia and prevention of serum osmolarity reduction. To maintain normovolemia, it is important to administer fluids in appropriate amounts following appropriate methods, and to prevent a decrease in serum osmolarity, the choice of fluid is essential. There is considerable debate about the choice and optimal amounts of fluids administered in the perioperative period. However, there is little high-quality clinical research on fluid therapy for patients undergoing neurosurgery. This review will discuss the choice and optimal amounts of fluids in neurosurgical patients based on the literature, recent issues, and perioperative fluid management practices.

Superoxide and Nitric Oxide Involvement in Enhancing of N-methyl-D-aspartate Receptor-Mediated Central Sensitization in the Chronic Post-ischemia Pain Model

류태하,정경영,하미진,임동건,홍정길,곽경화 대한통증학회 2010 The Korean Journal of Pain Vol.23 No.1

Background:Recent studies indicate that reactive oxygen species (ROS) are involved in persistent pain, including neuropathic and inflammatory pain. Since the data suggest that ROS are involved in central sensitization, the present study examines the levels of activated N-methyl-D-aspartate (NMDA) receptors in the dorsal horn after an exogenous supply of three antioxidants in rats with chronic post-ischemia pain (CPIP). This serves as an animal model of complex regional pain syndrome type-I induced by hindpaw ischemia/reperfusion injury. Methods:The application of tight-fitting O-rings for a period of three hours produced CPIP in male Sprague-Dawley rats. Allopurinol 4 mg/kg, allopurinol 40 mg/kg, superoxide dismutase (SOD) 4,000 U/kg, N-nitro-L-arginine methyl ester (L-NAME) 10 mg/kg and SOD 4,000 U/kg plus L-NAME 10 mg/kg were administered intraperitoneally just after O-ring application and on the first and second days after reperfusion. Mechanical allodynia was measured, and activation of the NMDA receptor subunit 1 (pNR1) of the lumbar spinal cord (L4-L6) was analyzed by the Western blot three days after reperfusion. Results:Allopurinol reduced mechanical allodynia and attenuated the enhancement of spinal pNR1 expression in CPIP rats. SOD and L-NAME also blocked spinal pNR1 in accordance with the reduced mechanical allodynia in rats with CPIP. Conclusions:The present data suggest the contribution of superoxide, produced via xanthine oxidase, and the participation of superoxide and nitric oxide as a precursor of peroxynitrite in NMDA mediated central sensitization. Finally, the findings support a therapeutic potential for the manipulation of superoxide and nitric oxide in ischemia/ reperfusion related pain conditions. (Korean J Pain 2010; 23: 1-10)

전신마취와 병행한 상박신경총 사각근간 차단 후 발생한 호흡곤란 환자의 술 후 통증조절 증례 보고

류태하,임동건,전영훈 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.2

A 46 year old, ASA physical status I, 50 kg and 160 cm woman, with left shoulder calcific tendonitis, presented for surgical excision of calcium deposits. Preoperative examinations were within normal limits, with the exception of the 1st degree AV block on ECG. Interscalene brachial plexus block, with 20 ml of 0.75% ropivacaine, was carried out prior to general anesthesia. The intra-operative course was uneventful. She complained of dyspnea and chest discomfort in the recovery room, and her SpO2 dropped to 89%. A chest X-ray showed an upward displacement of the left hemidiaphragm and she could not maintain a head lift for 5 seconds. She was diagnosed with left ipsilateral hemidiaphragmatic paresis and residual neuromuscular blockade. She was treated with oxygen inhalation under deep breathing. The dyspnea recovered 3 hours after brachial plexus block and a continuous infusion of 0.2% ropivacaine, which were started for pain control. Three days later, she was discharged without any complications. It was concluded that the respiratory movement should be carefully observed following interscalene brachial plexus block with general anesthesia, especially during recovery of anesthesia.

Redundancy operation method for a distributed public address system

류태하,김승천 한국융합학회 2020 한국융합학회논문지 Vol.11 No.8

In the case of a failure due to equipment deterioration in the public address system or a worker's mistake during construction, broadcasting becomes impossible. In this situation, we have designed a more advanced management broadcast system that can broadcast. The broadcasting service is operated using main broadcasting device, and local broadcasting device operates separately only in the local area. If the main broadcasting device becomes inoperable, the procedure for transferring the control activates the device with the local broadcasting devices based on data backed up by the main controller. This paper proposes an improved method of the conventional emergency broadcasting device duplication method. The existing method could not use the standby equipment in the normal state, but in the proposed method, the standby equipment can be used as local broadcasting equipment in usually. This method enables stable system operation while minimizing resource waste due to redundant configuration of expensive devices.

공공데이터와 IoT 센싱 데이터를 활용한 경보방송 방법에 관한 연구

류태하,김승천 한국인터넷방송통신학회 2022 한국인터넷방송통신학회 논문지 Vol.22 No.1

As society develops and becomes more complex, new and diverse types of disasters such as fine dust and infectious diseases are occurring. However, in the past, there was no PA(Public Address) system that provided accurate information to prepare for such a disaster. In this paper, we propose a public address system that automatically broadcasts an alarm by analyzing polluted air quality data collected from public data and IoT sensors. The warning level varies depending on the air quality, and the information provided by public data may show a significantly different result from the guide area due to various factors such as the distance from the measuring station or the wind direction. To compensate for this, we are going to propose a method for broadcasting by comparing and analyzing data obtained from public data and data from on-site IoT sensors. 사회가 발전하고 복잡해짐에 따라 재난의 종류도 미세먼지, 전염병 등과 같이 새롭고 다양하게 발생하고 있다. 하지만 기존에는 이러한 재난에 대비할 수 있는 정확한 정보를 제공하는 전관방송 시스템이 없었다. 본 논문에서는 공공데이터와 IoT 센서로부터 수집된 오염된 대기질 데이터를 분석하여 자동으로 경보를 방송하는 전관방송 시스템을 제안한다. 대기질에 따라 경보의 단계가 달라지며, 공공데이터에서 제공하는 정보는 측정소로부터의 거리나 풍향 등 다양한요인으로 인해 안내 지역과 상당한 차이가 있는 결과를 나타내기도 한다. 이를 보완하기 위해 공공데이터에서 가져온데이터와 현장 IoT센서에서 얻은 데이터를 비교 분석하여 방송하는 방법을 제안하고자 한다.

뇌신경 마취영역에서 ketamine의 적용에 대한 재평가

류태하,정진용 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.4

Traditionally, Ketamine has been considered to be contraindicatedin neurosurgical patients due to the risk of intracranial hypertension. The evidence for this contraindication originated from early casereports and case-control studies which were inadequately designedand controlled. However, several recent articles indicate thatketamine can be safely used in traumatic brain injured patientstreated with mechanical ventilation and that there is no significantincrease in the intracranial pressure (ICP). Ketamine is an N-methyl-D-aspartate antagonist. It is believed to provide neuroprotectionthrough a reduction in the glutamate excitotoxicity. This evidenceis based on in vitro and animal studies. However, studies aboutits neuroprotective effects in humans are scarce. Data to recommendketamine as first-line anesthetics for neurosurgery are insufficient,but ketamine as an adjuvant anesthetic agent may havebenefits for neurosurgical patients, such as traumatic head injuredpatients with unstable hemodynamics. Therefore, ketamine shouldnot be considered as absolutely contraindicated for neurosurgicalpatients and adequately powered, high-quality randomizedcontrolled studies are needed to provide clinical evidences.