임상연구 : 고농도 Desflurane 흡입에 의한 심혈관계 반응의 연령에 따른 차이

김은아 ( Eun Ah Kim ),김성규 ( Seong Kyu Kim ),임형선 ( Hyung Sun Lim ),고성훈 ( Seong Hoon Ko ),한영진 ( Young Jin Han ),송희선 ( He Sun Song ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4

Background: The inhalation of high concentrations of desflurane transiently increases the cardiovascular responses. This study examined the effects of age on the cardiovascular response to desflurane. Methods: Eighty two patients were divided into one of three groups: under 3 years (Group 1), 20-50 years (Group 2), and over 65 years (Group 3). In each group, the inspired concentration of desflurane was increased abruptly to 12.0 vol% 2 minutes after a thiopental injection. The heart rate, blood pressure (BP), cardiac index (CI), End-tidal concentration of desflurane (ETdesf), and end-tidal concentration of CO2 were measured at the baseline and every 30 seconds. Results: The heart rate, BP, and CI increased transiently in the three groups compared with the baseline. The ETdesf increased more rapidly in Groups 1 and 3 than in Group 2. The ETdesf to reach the maximal mean arterial pressure (MAP) was highest in Group 3 among three groups. The relative maximal HR to the baseline value was similar in the three groups, but the relative maximal MAP to baseline value was significantly highest in the elderly patient group. The times to reach the maximal HR and BP were shortest in Group 1 among three groups. There were no significant differences in the CI between three groups. Conclusions: The inhalation of a high concentration of desflurane increases the HR, BP and CI transiently in all age groups. In pediatric patients, HR and BP increases more rapidly than in young adults and elderly patients. The relative maximal MAP to the baseline value is higher in elderly patients. (Korean J Anesthesiol 2007; 53: 435~40)

증례보고 : 전신마취하 제왕절개술 중 발생한 뇌실내 출혈

구희완 ( Hui Wan Koo ),손지선 ( Ji Seon Son ),한영진 ( Young Jin Han ),고성훈 ( Seong Hoon Ko ),송희선 ( He Sun Song ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2

An intracranial hemorrhage is a fatal complication associated with general anesthesia. It can occur in patients with an intracranial aneurysm, hypertension, cerebral vascular malformation, and blood dyscrasia, etc. A sudden hemodynamic change during intubation and extubation in general anesthesia is dangerous, particularly in these patients. We encountered an intraventricular hemorrhage in a 42 year old pregnant woman after a cesarean section. The patient was induced with 300 mg of thiopental and 45 mg of rocuronium. The anesthesia was maintained with N2O/O2 and sevoflurane after endotracheal intubation. Five hours after surgery, the patient had a seizure at the ward. A MRI and CT scan of the brain showed a right intraventricular and basal ganglia hematoma. The CT 3-D brain angiography showed an unruptured small aneurysm on the right posterior communicating artery. (Korean J Anesthesiol 2006; 51: 257~60)

33권6호 영문부록 : 흰쥐의 적출 심장에서 허헐처리후 Ketanine 의 양성 변력성 효과의 기전

고성훈(Seong Hoon Ko),김동찬(Dong Chan Kim),이상귀(Sang Kyi Lee),최훈(Hun Choe),송희선(He Sun Song) 대한마취과학회 1997 영문부록 Vol.- No.-

서 론: Ketamine은 여러 실험동물의 적출 심장에서 양성 변력성 작용을 보인다. 이러한 작용의 기전은 K+ 이온통로 억제에 의한 세포막 전위의 탈분극에 의해, 전압 민감성 Ca2+ 이온통로를 경유한 Ca2+ 이온의 세포내 증가로 여겨지고 있다. 본 연구에서는 K+ 이온통로의 일종으로 심장에서 허혈이나 저산소증시 활성화되는 ATP-민감성 K+ (ATP-sensitive K+, KATP) 이온통로와 심근허혈시 ketamine의 양성 변력성 작용의 상호 관계를 알아보고자 하였다. 방 법: 흰쥐 적출심장을 Langendorff 장치에 현수한 후 Krebs-Henseleit (KH)용액을 55 mmHg의 압력으로 관상동맥으로 관류시키면서 관류량을 측정하여 이때 관류량의 절반을 일정한 속도로 관류시켜 심근의 허혈을 유발하였다. 수축력의 측정은 좌심실의 압력 변화를 측정하였으며, 세포내 Ca2+ 농도의 변화는 단일 심실근 세포를 분리후 Ca2+과 결합하는 형광색소인 fura-2를 이용하여 측정하였다. 결 과: Ketamine은 수축력의 지표인 좌심실압을 용량 의존성으로 증가 시켰으며, 이는 propranolol (10-6 M)의 영향을 받지 않았다. 100 M의 ketamine은 좌심실압을 대조치에 비해 31.2 4.6% 증가 시켰으나, KATP 이온통로의 길항제인 glibenclamide (10-5 M) 존재하에서는 10.5 3.3%만을 증가 시켰다. 또한, K+ 이온통로 활성제인 pinacidil (3x10-5 M)은 좌심실압을 34.7 4.9% 감소시켰으나, ketamine 존재하에서는 단지 21.2 4.4%만을 감소시켰다. 고농도의 ketamine은 세포내 Ca2+ 농도를 증가시켰다. 결 론: Ketamine은 좌심실압과 세포내 Ca2+ 농도를 용량의존성으로 증가시켰다. 이러한 결과는 흰쥐의 적출심장에서 허혈시 ketamine이 양성 변력성 작용을 나타내며, 이는 KATP 이온통로의 억제가 부분적으로 관여함을 시사한다. (Korean J Anesthesiol 1997; 33: S1∼S8)

증례보고 : 술중 발생한 폐동맥 색전증 진단에 있어서 일측폐환기의 응용 1예

박창현 ( Chang Hyun Park ),손지선 ( Ji Seon Son ),고성훈 ( Seong Hoon Ko ),김동찬 ( Dong Chan Kim ),이상귀 ( Sang Kyi Lee ),한영진 ( Young Jin Han ),송희선 ( He Sun Song ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.1

악 교정 수술후 기관내 삽관 곤란 1 례 보고

송희선,이준례 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.5

This 17 year-old male patient had an experience of a difficult intubation problem on miniplate removal operation after orthognathic surgery, but he didn't have the same problem on a previous orthognathic surgery 1 year before. He suffers from mental retardation and speaking disability due to congenital brain damage. I think difficult exposure of the larynx was caused by the imbalance of neck muscle force and jaw instability, as result from surgery. The preoperative airway evaluation is very important because findings may dictate choice of intubation technique. A flexible fiberoptic laryngoscope may be the most useful aid to awake intubation in the patient with a known difficult airway.

후두마스크 삽입 및 기관내삽관이 안압에 미치는 영향

송희선,이상귀,김재양 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7

Many studies have been performed in order to evaluate intraocular pressure changes during induction and maintenance of anesthesia in ocular surgery. Use of the laryngeal mask airway permits the maintenance of a clear airway without laryngoscopy. To evaluate the effect of laryngeal mask airway placement with/withaut laryngoscopy on intraocular pressure, sixty patients were randomly allocated to one of three groups; a tracheal intubation group with laryngoscopy (TI, n=20); a laryngeal mask airway placement group with laryngoscopy (LMA-L, n=20); a laryngeal mask airway placement group with blind technique (LMA, n=20). The authors compared the intraocular pressure and hemodynamic responses to the laryngeal mask airway insertion with (LMA-L group) and without (LMA group) laryngoscope to those of tracheal intubation (TI group) in 60 patients during a standardized anesthetic pratice. Baseline measurements of intrao- cular pressure, heart rate, and arterial blood pressures were recorded and repeated at one minute after insertion of the airway device in each group. Insertion of the laryngeal mask airway required significantly more time (LMA-L group, 15.5 sec; LMA group, 14.3 sec) in comparison with that for the tracheal intubation (9.1 sec). The laryngeal mask airway placement did not increase intraocular pressure, or arterial blood pressures except for heart rate above baseline values. However, tracheal intubation was associated with significant increases of intraocular pressure, heart rate, and arterial blood pressure at one minute compared to the baseline values. The mean intraocular pressures at one minute after airway instrumentation in TI group were significantly different from those of LMA or LMA-L group. The authors suggest that a laryngeal mask airway may be a good alternative to tracheal intubation in intraocular surgery if a laryngeal mask airway is not contraindicated.

제왕절개술을 위한 경막외 마취시 국소마취제 용량과 혈중농도의 비교

송희선,한영진,이준례,송정자 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7

Epidural anesthesia for cesarean section requires sensory blockade up to T4 level. 18 to 20 ml of 0.5% bupivacaine, 1.5 to 2.0% lidocaine, or 3.0% chloropmcaine usually produces an adequate sensory blockade to T4 level. However, when we used that amount of local anesthetics, most of the patients often complained of mild to moderate pain or discomfort during delivery of baby, manipulation of peritoneum or the uterus. So we feeled the need of increase in dosage of local anesthetics and we used 26 ml of local anesthetics or local anesthetic-fentanyl mixture. This study was undertaken to measure plasma concentration of lidocaine and observe the possible systemic toxicity of local anesthetics with the total dosage of beyond maximum recom-mended dose. Epidural anesthesia were performed with a 17 gauge Tuohy needle and local anesthetics were injected as follows. Group 1 (n;17): 0.5% bupivacaine 100 mg+2% lidocaine 80 mg+fentanyl 100 ㎍ (50 ㎍/ml) Group 2 (n; 15): 2% lidocaine 520 mg without epinephrine Group 3 (n; ll): 2% lidocaine 480 mg + fentanyl 100 ㎍ All groups were received 26 ml of local anesthetics or local anesthetic-fentanyl mixture. We checked the level of anesthesia, length of spinal column, cardiovascular changes, plasma concen- tration of lidocaine, toxic systemic reactions and patient's complaints. The plasma concentration of lidocaine were measured by immunofluorescence assay at 2, 5, 7, 10, 12 and 15 minutes after injection of local anesthetics. The results were as follows; 1) The peak plasma concentration of lidocaine were measured 12 minutes after administration of local anesthetics in the group 2 and 3. 2) Sensory blockade up to T4 level could be accomplished within 10 minutes after epidural anesthesia in the group l. 3) In the group 2 and 3, onset of action was more rapid. These groups had a tendency to fall in blood pressure than the group 1, but recovered soon with small dose of ephedrine. 4) In one patient, maximum peak plasma concentration of hdocaine was 6.8 ug/ml, but no adversereaction was observed. Above results suggested that 26 ml of local anesthetics in all groups could be used for appropriate anesthesia for cesarean section with minimal camplications and patient's satisfaction.

Epinephrine 과 Clonidine 에 의한 T-Cain 척수마취의 연장 효과

송희선,한영진,이상귀,최현규,신감진 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.3

Vasoconstrictors such as epinephrine or phenylephrine have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an areceptor agonist, has been proved to have analgesic effect and to prolong epidural and spinal anesthesia. We used 0.3mg of epinephrine, 75 μg and 150 μg of clonidine in spinal anesthesia with 12 mg of T-Cain respectively and compared hemodynamic and analgesic effects of each drug. Heart rate and blood pressure were checked before, during and after anesthesia. Sensory level was checked by pin-prick method and motor blockade was measured by Bromages scale. The results were as follows. 1) Heart rate changed little in the epinephrine group and decreased significantly in all other groups. 2) Systolic blood pressure decreased significantly in all groups except the epinephrine group. Both 75 μg and 150 μg of clonidine caused a significant fall in diastolic pressure. 3) The onset time for sensory and motor blockade varied little among all gro 4) Sensory blockade was significantly higher in the 150 μg of clonidine group than the control group. Time to achieve the maximum level of sensory blockade was significantly faster in control group than 150 μg of clonidine group. 5) The duration of sensory and motor blockade was significantly prolonged in epinephrine and clonidine group than control group. The results indicate that clonidine, when used as an adjunct to T-Cain spinal anesthesia, is as effective as epinephrine in prolongation of motor and sensory blockade.

전신 마취시 아산화질소 투여 중단후 중이 내압의 변동

송희선,이상귀,윤용주,홍기환,최현규,신감진,권삼현 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.6

N₂O can diffuse in and/or out the middle ear cavities and it may alter the middle ear pres-sure. This study was performed to investigate the effect of N₂O discontinuation on the changes in middle ear pressure during general endotracheal anesthesia. We measured middle ear pres-sures and end-tidal NO concentrations at preanesthesia, immediately after N₂O discontinuation and then at every five minutes for 60 minutes under either halothane or enflurane an- esthesia in two groups(group 1=50% administration of N₂O in O₂; group 2=60% administration of N₂O in O₂). The middle ear pressures after N₂O discontinuation decreased slowly but they did not returned to the preanesthetic value in both groups. The end-tidal N₂O concentrations decreased rapidly until five minutes and then they decresed slowly to the zero leve1 until 30 minutes after N₂O discontinuation in both groups. The expected time of the middle ear pres-sure of preanesthesia value was 89.4 minutes in group 1 and 80.9 minutes in group 2 respectively. The middle ear pressure do not return to the level of preanesthesia at 60 minutes after N₂O discontinuation while the end-tidal N₂O concentration decrease to the zero level via 30 minutes after its discontinuation. Thus it is recommended that N₂O administration should be discontinued at least 30 minutes before an application of tympanic membrane patch on the ear drum and N₂O is carefully administered in patients with middle ear and/or upper airway disesses.

기관튜브의 종류가 굴곡성 후두경을 이용한 경구 기관내삽관의 용이도에 미치는 영향

송희선,이상귀,이준례,김윤희 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2

Background : The spiral-wound tracheal tubes have the different flexibility, materials, and shape of bevel according to the manufacturers. Theses different tube characteristics may affect the ease of orotracheal intubation. So this study was designed to investigate the ease of fiberoptic orotracheal intubation with two different types of spiral-wound tracheal tube. Methods : Seventy-one adult female patients who undergo fiberoptic intubation were randomly divided into two groups. Fiberoptic orotracheal intubation with silicone made spiral-wound tracheal tubes(M group) or silicone-rubber made spiral-wound tracheal tubes(R group) was performed. In the first attempt, the tracheal tube was advanced into the trachea over the pediatric fiberoptic laryngoscope which was orotracheally placed with the bevel of the tracheal tube oriented anteriorly at 12 o'clock direction. If the insertion was hindered the tracheal tube was withdrawn about 4∼5cm backward and rotated 60o to the left(10 o'clock direction) and readvanced If the second attempt was unsuccessful the tracheal tube was rotated 60o to the right(2 o'clock direction) and readvanced. If the third attempt was unsuccessful it was considered that the fiberoptic intubation was failed. Results : Success rate of the first attempt was 23.7%(9/38) in group M and 72.7%(24/33)in group R(P$lt;0.05). Failure rate was 23.7%(9/38) in group M and 3.0%(1/33) in group R(P$lt;0.05). Conclusions : It should be considered that the ease of fiberoptic intubation is different according to different types of spiral-wound tracheal tube in the attempt of fiberoptic orotracheal intubation. (Korean J Anesthesiol 1997; 32: 214∼218)