증례보고 : 자발성 두개내 저압 환자에서 전산화 단층촬영 유도하에 시행된 경추 경막외 혈액봉합술에 의한 치료

민진혜 ( Jin Hye Min ),최영순 ( Young Soon Choi ),김용호 ( Yong Ho Kim ),이우경 ( Woo Kyung Lee ),이용경 ( Yong Kyung Lee ),채홍석 ( Hong Seok Chai ),채영근 ( Young Keun Chae ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1

Spontaneous intracranial hypotension due to spinal cerebrospinal fluid leakage is uncommon, relatively benign and usually self-limiting. However it is being increasingly recognized as a cause of postural headaches. The treatment options range from conservative supportive measures to an pidural blood patch. We report a 40-year-old woman who developed intracranial hypotention without any preceding events such as lumbar puncture, back trauma, surgical procedures or medical illnesses. The site of the cerebrospinal fluid leakage was identified at between the C1 to C2 level using computerized tomographic myelography. Consequently, the patient underwent a CT-guided autologous epidural blood patch at the C3-C4 level. Her symptoms were relieved immediately without recurrence. (Korean J Anesthesiol 2007; 52: 115~8)

요관경하 배석술 환자에서 Propofol 마취에 보조적으로 투여한 Remifentanil과 Fentanyl 비교

민진혜 ( Jin Hye Min ),김용호 ( Young Ho Kim ),채영근 ( Young Keun Chae ),이우경 ( Woo Kyung Lee ),최선순 ( Sun Soon Choi ),채홍석 ( Hong Seok Chai ),최영순 ( Young Soon Choi ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.54 No.3

임상연구 : 근이완제 투여 없이 Remifentanil을 사용한 기관 삽관 시 마취 유도제로 사용된 Thiopental, Propofol, Etomidate가 기관 삽관 환경 및 혈역학적 변화에 미치는 영향

김용호 ( Yong Ho Kim ),민진혜 ( Jin Hye Min ),최영순 ( Young Soon Choi ),이우경 ( Woo Kyung Lee ),이용경 ( Yong Kyung Lee ),이현민 ( Hyun Min Lee ),채영근 ( Young Keun Chae ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1

Background: Many studies have suggested that propofol in combination with remifentanil may provide adequate conditions for tracheal intubation without the use of muscle relaxants. Other hypnotic drugs have not been thoroughly investigated in this regard. The goal of our study was to evaluate the effect of thiopental, propofol or etomidate on tracheal intubating conditions and hemodynamic changes using remifentanil in the absence of muscle relaxants. Methods: A total of 45 healthy adults were divided randomly into three groups. After iv lidocaine 1.5 mg/kg, thiopental 5 mg/kg (thiopental group) or propofol 2.5 mg/kg (propofol group), or etomidate 0.4 mg/kg (etomidate group) were injected. After the injection of study drugs, remifentanil 2 mcg/kg was administered. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubating conditions were assessed and the mean arterial pressure and the heart rate was measured. Results: There were no significant differences in intubating conditions between patients in the three groups. The heart rate was significantly lower in the propofol and etomidate group patients when compared to the thiopental group patients after anesthetic induction. The mean arterial pressure was significantly lower in the propofol group patients when compared to the thiopental and etomidate group patients. Both heart rate and mean arterial pressure after tracheal intubation were significantly elevated in etomidate group patinets when compared to their preintubation value. Conclusions: The use of thiopental 5 mg/kg, propofol 2.5 mg/kg, and etomidate 0.4 mg/kg did not differ in effect under intubating conditions for tracheal intubation using remifentanil in the absence of muscle relaxants. Thiopental provided the best hemodynamic conditions. (Korean J Anesthesiol 2007; 53: 61~6)

Desflurane 흡입 마취 유도 시 기도 과민성에 대한 Lidocaine과 Fentanyl의 효과

최인규 ( In Gyu Choi ),최영순 ( Young Soon Choi ),민진혜 ( Jin Hye Min ),김용호 ( Yong Ho Kim ),채영근 ( Young Keun Chae ),이우경 ( Woo Kyung Lee ),이용경 ( Yong Kyung Lee ),이애리나 ( Ae Re Na Lee ),조형래 ( Hyong Rae Cho ),채홍석 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6

Background: Inhalation induction with desflurane can cause airway irritability and sympathetic stimulation. The aim of this study was to investigate whether lidocaine and fentanyl could reduce these unwanted reactions. Methods: Seventy-five patients who had premedication with midazolam were randomly allocated to one of three groups to receive intravenous saline (S group), lidocaine 1.5 mg/kg (L group), fentanyl 1 μg/kg (F group), respectively, before tidal volume induction with desflurane in oxygen and nitrous oxide. We recorded airway irritability such as cough, apnea, laryngospasm and excitatory movement and hemodynamic changes. Results: Airway irritability was not significantly different between the groups. In F group, mean blood pressure at LOC ver and LOC BIS and heart rate at LOC ver, LOC BIS and just before intubation were lower than those of S group (P<0.05). Other results were not significantly different. Conclusions: The results of the study showed that intravenous fentanyl and lidocaine had no beneficial effects to reduce airway irritability, but intravenous fentanyl could significantly reduce hemodynamic stimulation during inhalation induction with desflurane in the patients who were premedicated with midazolam. (Korean J Anesthesiol 2009; 57: 693∼7)

소아 갈색세포종 환자의 마취

민진혜,강유진 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.4

Pheochromocytoma is an unusual tumor in pediatric age group and there are several different aspects from adult counterparts. Children have fewer malignant, more extra-adrenal, and greater bilaterality and multiplicity of tumor. We present a case of 14-year old boy with pheochromocytoma who has symptoms such as episodic headaches, vomiting, seizure and paroxysmal hypertension which is less common in children. Although the duration of preoperative preparation was not long enough, we decided to remove the tumor because symptoms were disappeared rather rapidly after alpha and beta adrenergic blocker treatment. The patient was managed with continuous epidural block and light general anesthesia but extra use of adrenergic receptor blocker and vasodilator were demanded during tumor manipulation. The patient has remained well postoperatively but long-term follow up is essential because of the possibilities of recurrence. (Korean J Anesthesiol 1999; 37: 721∼725)

척추수술환자에서 급성 동량성 혈액희석 및 유도저혈압을 병용한 마취관리

이규탁,민진혜,정창우 관동대학교 의과학연구소 2000 關東醫大學術誌 Vol.4 No.1

Due to the discovery that blood transfusion can evoked several side effects, there has been increased interest in technologies that reduce the amount of homologous blood used during and after surgery. Acute normovolemic hemodilution is known as a convinient and effective blood conservation method, and drug-induced hypotension can reduce the amount of intraoperative bleeding with better operative field. Combination of these two techniques was suggested to reduce homologous blood requirements in various surgeries. Therefore, to minimize homologous blood transfusion, we conducted general anesthesia using acute normovolemic hemodilution combined with induced hypotension in patient undergoing spinal fusion surgery. We think that the routine careful combination of these techniques can be carried out safely in many surgeries.

경유돌공 부위에서 전기신경자극기를 이용한 안면경련 환자의 치료

정창우,민진혜,이규탁 관동대학교 의과학연구소 2000 關東醫大學術誌 Vol.4 No.1

Facial spasm is the most common in middle aged women, which is a distressing condition characterized by involuntary, intermittent, unilateral twitching of the muscles innervated by the facial nerve. There are various treatments for facial spam, such as neurovascular decompression, local injection of botulinum, facial nerve compression at stylomastoid foramen and facial nerve block with O'Brien method. There are the same clinical problems associated with the reported procedure in pain clinic, such as severe pain and recurrence of spasm. In this paper, we report the modified facial nerve block using electric nerve stimulator at the stylomastoid foramen. This new technique will be able to reduce the pain and the discomfort during facial nerve block, and reduced the recurrence of facial spasm.

회복실 환자의 고찰

채영근,이용경,최영순,김용호,이우경,민진혜 관동대학교 의과대학 의과학연구소 2005 關東醫大學術誌 Vol.9 No.1

We have analyzed 1158 patients managed in PACU(Postanesthesia care unit) after completion of general anesthesia between January 1, 2005 to June 30, 2005 to obtain better guidance and management in the PACU. The results of analysis were as follows 1) Total number of PACU patients was 1694, but only 1158 patients were analyzed because 478 patients were taken regional anesthesia, 17 patients' records were incomplete and 2 patients went to ICU for close observation. 2) Age distribution was relatively even in each decades except extreme age and mean age was 34.5 years. 3) The number of patients by operation sites was 429 in lower abdomen & pelvis surgery group, 349 in extremities and 199 in head & neck surgery group and 181 in the other group each. 4) Overall PAR(Postanesthetia recovery) score was 8.8±0.7, highest in 30-39age group and in extremities surgery group, least in over 80 group and in thoracic surgery group. 5) Overall PACU staying time was 41.3±19.0min, shortest in 30-39age group and neurosurgery, longest in over 80 and in back surgery group. 6) The overall incidence of complications; 230(19.9%) was cardiovascular, 56(4.8%) was respiratory, 52(4.5%) was postoperative nausea and vomiting(PONV), 17(1.5%) was agitation and 16(1.4%) was shivering.

노인환자에서 마취방법에 따른 비교 : 회복실에서 Post Anesthesia Care Unit

김용호,최영순,채영근,이우경,이용경,민진혜 관동대학교 의과대학 의과학연구소 2005 關東醫大學術誌 Vol.9 No.1

Background: It is difficult to care for elderly patients during perioperative period because they have lots of medical problems. Although there is no difference in overall morbidity and mortality between anesthetic methods, regional anesthesia is better than general anesthesia because it is less necessary to take care of elderly patients. Method: We divided 163 elderly patients (over 65 years) into two groups; general anesthesia group(GA, total;43) and regional anesthesia (RA, total;120) group according to their anesthetic service during lower abdominal& pelvis and orthopedic surgeries. In PACU, we compared to their postanesthetic recovery score(PAR), recovery time and incidences of complications-pulmonary, cardiaovascular and PONV(postoperative nausea and vomiting) in both group. Results: The PAR scores of RA group was higher than that of GA group (9.5±0.5 vs 8.5±0.7) and recovery time of RA groups was shorter than that of GA group(42.8±19.1min vs 52.6±21.8min). The incidence of pulmonary and cardiac complication in RA group were significantly lower than those of GA group except the incidence of PONV (p<0.05). Conclusion; For old age patients, RA is better anesthetic method in aspect of PACU care.

신경변증성 통증모델 흰쥐의 뇌에서 Fos 의 발현

김경현,박종민,문동언,김성년,민진혜,정창우 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.2

Fos Expression in the Brain of Neuropathic Pain Rats Jin Hye Min, M.D.^*, Chong Min par, M.D., Dong Eon Moon, M.D. Sung Nyeun KIm, M.D., Chang Woo Chung, M.D.^*, and Kyung Hyun Kim, M.D.^* Department of Anesthesiology, School of Medicine, The Catholic University of Korea, Seoul and ??Kwandong University, Gangneung, Korea background: There have been some investigations regarding expression of c-fos, as a marker of altered neuronal expression in the spinal cord of neuropathic rats. However, the expression of c-fos in the brain of a neuropathic pain model has not yet been investigated. The purpose of this study was to evaluate the time course of c-fos expression in the brain of neuropathic pain rats. Methods: The experimental rats were divided into two group; neuropathic pain (n = 16) and control (n = 16) groups. The left L_5-L_6 spinal nerves of the neuropathic pain group were ligated but those of the control group not ligated (sham operation). Two hours, 1st day, 3rd day and 7th day after the operation, we examined the expression of Fos in the cerebral cortex, the amygdala, the thalamus and the hypothalamus of the coronary sectioned brains of the rats. Results: C-fos expressions in the cerebral cortex and the amygdala of the neuropathic pain group were greater at 2 hours, the 3rd and the 7th day than the control group, but those of the thalamus and hypothalamus of the neuropathic pain group were greater on the 3rd and 7th day than the control group (P < 0.05). In the neuropathic pain group, c-fos expressions of four brain regions were greater on the 3rd and 7th day than those at 2 hours and day 1, but there was no difference between the 3rd and 7th day's (P < 0.05). Conclusions: There were sgnificant expressions of Fos protein in the brain of the neuropathic pain group at 2 hours, the 3rd day and 7th day of the operation, but the meaning of each expression was different. The expression of Fos at postoperative 2 hours resulted from acute pain but that at the 3rd and 7th day of the operation resulted from neuropathic pain. (Korean J Anesthesiol 2001; 41: 229~237)