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Clonidine 경구 전투약이 기관내 삽관 후 호흡기계 역학의 변화에 미치는 효과
전희정,박평환,석은하,황규삼,강지영,천성관 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.4
Background : The aim of this study was to evaluate the influence of oral clonidine premedication on respiratory mechanics by tracheal intubation in smokers. Methods : Thirty male smoker patients were randomly divided into 3 groups. For group 1 (n = 10), l μg/kg of clonidine was premedicated. For group 2 (n = 10), 2 μg/kg of clonidine was premedicated. Group 3 (n = 10, control group) was the no premedication group. After anesthetic induction, CMV was applied with a Siemens Servo 900C ventilator, and anesthetic gases were supplied via the low pressure inlet of the ventilator. Tidal volume (10 ml/kg) was fixed during measurements for each patient. End-inspiratory occlusion was applied for at least 3 seconds and tracheal pressure was measured at the distal end of the endotracheal tube. Pressure, flow and volume were monitored and recorded with a Bicore CP-100 pulmonary monitor. Data were measured after 2 (100% O2) and 5 (1.5 vol% enflurane with 50% N2O) minutes of tracheal intubation. Data were transferr to PC and analyzed by processing software (ANADAT). Total respiratory (Rrs), airway (Raw) and tissue (Rve) resistances, along with static (Cstat), dynamic (Cdyn) compliances were calculated. Results : There were no significant differences for Rrs, Raw, Rve, Cstat and Cdyn in the three groups. Conclusions : Oral clonidine premedication in dosages up to 2 μg/kg do not affect the changes of respiratory mechanics caused by tracheal intubation in smokers. (Korean J Anesthesiol 1999; 37: 545∼550)
이정희,박평환,석은하,임근호,임태환 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.2
Background : The effects of the inhibitor of nitric oxide synthase (NOS) in cerebral ischemia have been debated. Recently, it has been suggested that it depends on the amount of the inhibitor used. Therefore, this study was carried out to evaluate the effects of the NOS in the acute ischemia-reperfusion of the cat model using variable amounts of the inhibitor. Methods : Nineteen cats were divided into 3 groups: group 1 (n = 6), 10 mg/kg of N-nitro-L-arginine methyl ester (I.-NAME); group 2 (n = 7), 0.5 mg/kg; group 3 (n = 6), control group. Incomplete global cerebral ischemia was induced by ligation of both carotid arteries with arterial hypotension (―40 mmHg) for 30 minutes followed by 3 hours of reperfusion. The NOS inhibitor (L-NAME), was injected intra peritoneally 5 minutes before reperfusion. $quot;P and 'H MR spectroscopy were performed. A series of spectra was acquired in the time intervals before ligation, during ischemia, and after reperfusion Results: Phosphocreatine/inorganic phosphate (PCr/Pi) atios for group 1 were significantly lower than for groups 2 and 3 (P $lt; 0.05), and there was no significant difference between groups 2 and 3. Lactate/N-acetyl aspartate (Lac/NAA) and lactate/creatine (Lac/Cr) ratios at 180 minutes after reperfusion were higher for group l than for groups 2 and 3 (P $lt; 0.05). There were no significant differences in pH and lactate/choline (Lac/Cho) ratios among the 3 groups. Conclusions : It is demonstrated that the effect of the NOS inhibitor is dosage dependent. A high dose (10 mg/kg) of L-NAME seems to have an adverse effect on recovery of the ischemia, but a low dose (0.5 mg/kg) seenm to have no effect. (Korean J Anesthesiol 2000; 38: 340~347)
Enflurane 마취중 젊은 환자와 노인환자에서 호흡기계 역학의 비교
정성문,박평환,석은하,황규삼,심지연,강지영,이병옥 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.4
Background : The aim of this study was to compare the respiratory mechanics between young and elderly during enflurane anesthesia using flow-interruption technique. Methods : Fourteen patients were divided into 2 groups; for young aged group (Group Y)(24.9±4.9 years) and old aged group (Group O)(73.4±5.6 years). After anesthetic induction, endotracheal intubation was performed with Univent tube, and then tracheal pressure was measured at the distal end of the tube. 1.5 vol% of enflurane and 0.15 mg/kg of vecuronium were administered to maintain anesthesia. IMV (intermittent mandatory ventilation) was applied with Siemens Servo 900C ventilator and anesthetic gases were supplied via low pressure inlet of the ventilator. Tidal volume (10 ml/kg) was fixed during measurements for each patient. After stabilization of vital signs, respiratory parameters were measured before surgery. End-inspiratory occlusion was applied at least 3 seconds. Pressure, flow and volume were monitored and recorded with Bicore CP100 pmonary monitor. The data were transfered to a PC and analyzed by a processing software. Total respiratory (Rrs), airway (Raw) and tissue (Rve) resistances, and dynamic (Cdyn) and static (Csta) compliances were calculated. Mann-Whitney U test was used for statistical analysis. Results : There were no statistically significant differences for the Cdyn and Csta values between the two groups. But the values of Rrs, Raw and Rve were higher in the Group O than the Group Y. Conclusion : During enflurane anesthesia, the values of Rrs, Raw and Rve were higher in the Group O than the Group Y. To elucidate the exact causes of the above results, further studies are needed. (Korean J Anesthesiol 1998; 35: 669∼673)
근무력증 환자의 마취관리에서 Mivacurium의 사용 경험
조명원,최인철,양홍석,석은하,심지연 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.6
We have used mivacurium in two myasthenic patients, a generalized myasthenia gravis (MG) patient presenting for thymectomy and a Lambert-Eaton myasthenic (LEM) patient for mediastinoscopic lymph node biopsy. Both of them received nitrous oxide/oxygen (1:1)-narcotic-enflurane anesthesia with mivacurium as a muscle relaxant and the neuromuscular blocking effect of mivacurium was monitored continuously through the operation as well as before the induction of anesthesia. The dose of mivacurium for MG patient was 5.5 mg and LEM patient was 12 mg, because MG patient showed more severe clinical symptoms. The response to train-of-four (TOF) ulnar nerve stimulation was recorded using accelography. The onset times to maximal block in MG and LEM patients were 30 and 120 sec, respectively after injection and the recovery times to 25% from maximal block were 117 and 76 min, respectively. Mivacrium would be safe and appropriate for use in myasthenic patients, with relatively small dose under the neuromuscular monitoring. Korean J Anesthesiol 1999; 36: 1075∼1080)
Poly(ADP-ribose)Polymerase 억제제가 신생백서의 저산소성 허혈성 뇌손상에 미치는 영향/1H 자기공명분광법을 이용한 연구
황현숙,이정희,박평환,석은하,임근호,곽미정 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.2
Background : Poly (ADP-ribose) polymerase (PARP) has been described as an important candidate for mediation of neurotoxicity after brain ischemia. This study was purposed to evaluate the effects of a PARP inhibitor on hypoxic-ischemic injury in the neonatal rat brain. In this study, a highly potent inhibitor of PARP, 3, 4-Dihydro-5-[4-(1-piperidinyl) butoxy]-1 (2H)-isoquinolinone (DPQ) was investigated. Methods : Seven-day old Sprague-Dawley rat pups were used. The right common carotid artery was ligated under halothane anesthesia. After a recovery period of 3 hours, they were exposed to 8% oxygen at 37℃ for about 120 minutes. The animals were divided into four groups: the pre-treatment group (n = 13) and post-treatment group (n = 21) were given DPQ 10 ㎎/㎏ and the pre-control group (n = 7) and post-control group (n = 14) were given a vehicle for controls. Pre-treatment and pre-control groups were injected 30 minutes prior to the hypoxic injury while post-treatment and post-control groups were injected 30 minutes after the hypoxic period intraperitoneally. The right cerebral hemisphere of the rats were examined with localized ^1H magnetic resonance spectroscopy on day 1 and 7 after the hypoxic insult. Lipid/N-acetyl aspartate (Lip/NAA) and lipid/creatine (Lip/Cr) ratios were used as apoptotic markers. On day 14, the degree of brain injury was scored by morphological changes. Results : In the DPQ treated groups, the Lip/NAA and Lip/Cr ratios were lower than those of the control groups on day 1 after the hypoxic-ischemic injury (P < 0.05). However on day 7, only the ratios of the pre-treatment group were lower than those of the control group (P < 0.05). The degree of morphological changes of the brain injury on day 14 were lower in the DPQ treated groups (P < 0.05). Conclusions : These results suggest that DPQ exerts a neuroprotective effect in cerebral hypoxicischemic injury probably by inhibiting apoptosis especially in the early stage after an insult. Acute inhibiton of PARP can have a therapeutic value in preventing ischemic brain injury. (Korean J Anesthesiol 2002; 42: 228~240)
조인숙,최윤,최규택,석은하,황규삼 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.5
Hepatopulmonary syndrome is essentially the triad of liver disease, pulmonary vascular dilations and abnormal arterial oxygenation, which can result in severe hypoxia. We managed two cases of 9 and 49-year-old males for liver transplantation with hepatopulmonary syndrome. Preoperative evaluation showed decreased diffusion capacity of carbon monoxide and severe hypoxemia, while breathing room air (PaO_2 < 60 mmHg) but they responded to oxygen therapy. The pulmonary vascular resistance was low, consistent with an intrapulmonary vascular shunt but the pulmonary artery pressure was normal, reflecting a high cardiac output. Intraoperative oxygenation was satisfactory (PaO_2 of 100-200 mmHg) in spite of a high shunt fraction (Qs/Qt 18.5±9.2%). This means that the impairment in gas exchange is not the result of a true shunt, suggesting the presence of a functional shunt, which is characterized by diffusion-perfusion impairment. The intraoperative course was uneventful in the two patients and they are in a successful postoperative course. In case 1, the hypoxemia was resolved promptly, but in case 2, it was persistent for sixteen months after transplantation.The hypoxemia itself in hepatopulmonary syndrome is not regarded as a contraindication to liver transplantation.