가토에서 국소 마취제와 Epinephrine이 대퇴동맥의 혈류에 미치는 영향

오수원(Soo Won Oh),구길회(Gill Hoi Koo),이춘희(Cho 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1

N/A Many surgeons and anesthesiologists prefer using vasoconstrictor mixed with local anes- thetic agent to reduce the incidence of side effects and prolong the duration of analgesia because most local anesthetic agents, except cocaine, were believed to possess vasodilating effect. However, some investigators recently reported vasoconstricting effect of local anes- thetic agents. There is still controversy on the vasoactive effect of local anesthetic agents. So this study is aimed to clarify the vasoactive effect of local anesthetics in the animal model resembling clinical settings. Rabbits were anesthesized with ketamine and halothane, and respirations were controlled with Harvard animal ventilator. Lidocaine(0.5%, 1.0%, 1.5%) and bupivacaine(0.125%, 0.25% and 0.5%) with or without 1:100,000 epinephrine were subdermaly injected on the femoral areas of 24 rabbits. The concentration-dependent vasoactive effects of lidocaine and bupivacaine on the femoral artery were measured with Doppler flow meter in vivo. The mean arterial pressure, pulse rate, arterial blood gases, pH and level of serum electrolytes were measured at every 2 minute interval for 30 minutes. Results were as follows: l) There was no significant vasoconstriction with 0.5% lidocaine and 0.125% bupivacaine. 2) Statistically significant(p<0.05) vasodilations were observed with lidocaine(1.0-2.0%) and bupivacaine(0.25-0.5%). 3) There were no changes on the duration of vasodilation induced by local anesthetic a- gents of various concentrations. 4) Onset of vasodilation induced by local anesthetic agents of high concentrations were faster than that of lower concentrations. 5) In the mixed injection group of epinephrine and local anesthetic agent, the vasocon- striction induced by epinephrine was completely reversed by local anesthetics, approxi- mately 5 minutes later. In conclusion, local anesthetic agents at dose exceeding 1.0 % lidocaine and 0.25 bupivacaine increase local blood flow significantly in animal study in vivo which is appli- cable in human clinical settings. The increase blood flow may be due to dilatation of blood vessel. Further study on the analysis of association between amount of absorbed local an- esthetics in the blood vessels and dilatation of blood vessels is needed.

우측 성상 신경절 차단이 기관내 삽관에 따른 심혈관계 반응에 미치는 영향

오수원(Soo Won Oh),구길회(Gill Hoi Koo) 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1

N/A Back ground: Endotracbeal intubation is one of the methods most securely establishing airway. But accompanying hemodynamic responses ate harmful to coronary or cerebral vascular disease patients. These hemodynamic responses are regarded as the results of sympathetic stimulation due to pbaryn- golaryngeal stimulation, and sympathetic blocking method-stellate ganglian block- may be obtundate these hemodynamic respmees. Methods: 75 paticnts of ASA physical status I-II were selected. There were 40 patients normotensive (Group 0, 35 patients hypertensive (Group II) Group I, steliate ganglion block was performed on 20 patients (Group I-S) the remainder bad no procedure (Group I-O). Group II, 18 patients received SG3 (Group II-S), 17 patients had no procedure (Group II-O). SGB was performed with 1% lidocaine 8 ml on right stellate genglion after patients consent. Blood pressure 0IP) and pulse rate(PR) were first measured in the pre-anestbesia room. Follow up BP and PR are checked immediately following SGB and every 5 minutes far subsequent 20 minutes, then after arrival at operatig room, then immediately after intubation and at 3, 5, 10, 15 and 20 minutes after intubation. Results: All poup experienced significantly increased blood pressure and pulse rate upon arrival at the pre-anesthesetic and opeating rooms, as compared to when patients rates in the ward. After intubation and for subsequent 5 minutes, significant changes were measured. Patients then recovered to preblock value. In Group I, no statistical significance was recorded between subgroup I-S and I-O. However in Group II, there were significant differences between sub-group II-S and II-O. In evaluating pulse rate changes, there were no significant differences between Group I-S and I-O; nor II-S and II-O. Conclusion: The proper diagnosis of Stellate Ganglion Block had some measure of protective effect as hemodynamics following endotracheal intubation, especially in hypertensive patients.

임상연구 : 한국 성인에서 굴곡성 기관지경으로 측정한 이중관 기관지 튜브 사용시 안전역

박정원 ( Jung Won Park ),라은길 ( Eun Gil Rah ),이보령 ( Bo Ryoung Lee ),백종화 ( Chong Wha Baek ),정용훈 ( Young Hun Jung ),오수원 ( Soo Won Oh ),우영철 ( Young Cheol Woo ),김진윤 ( Jin Yun Kim ),구길회 ( Gill Hoi Koo ),박선규 ( 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.44 No.2

복강경 담낭절제술 환자에서 Propofol마취와 Enflurane 마취에 따른 수술후 간 기능 변화의 비교

오수원,우영철,구길회,김석주 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.2

Background : Recently, using propofol as intravenous anesthetic agent is increasing. And it is known that propofol has little effects on liver function even after long operation such as plastic surgery. But its effect on liver functon after hepatobilliary operation which may damage liver was not studied. Thus, authors carried out this study to evaluate the effect of propofol on liver function by comparing with enflurane in the patients who had laparoscopic cholecystectomy. Methods : Patients's anesthesia records and hospital charts from January 1994 to June 1996 were anlaysed retrospectively. Three hundred and thirty three patients who had normal liver function preoperatively and had no complications during and after operation were selected. They were divided into two groups ; propofol group (n=191) and enflurane group (n=142). The preoperative values of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were compared with those of 1 and 3 days after operation. Results : One day after operation, both propofol and enflurane group showed significant increase in AST and ALT (p<0.05) and decrease in ALP (p<0.05). But there was no difference between two groups. Conclusion : Concerned to liver function, propofol is as useful as enflurane to the patients who scheduled for laparoscopic cholecystectomy. (Korean J Anesthesiol 1999; 36: 279∼285)

Budd-Chiari 증후군 환자 수술의 마취관리

오수원,서재현 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.5

Budd-Chiari Syndrome is a rare disorder due to obstruction of hepatic venous outflow and generally follows a rapid fatal course. Hepatic vein thrombosis is a common complication with a high mortality rate and surgery for this condition is associated with a high perioperative mortality. Those who survive the acute phase almost invariably go on to develop cirrhosis of the liver and die within a few years from hepaic failure, bleeding esophageal varices or other complications of chronic liver disease. We have experienced the anesthetic management of three parients with Budd-Chiari syndrome who were treated with finger fracture and mesoatrial shunt. It is important that the anesthesiologist realizes that certain pathophysiological changes occur during the several surgical approaches to relieve the effect of hepatic vein obstruction, and perioper-ative hepatic dysfunction.

비특이적인 ST-T 분절 변화소견을 보인 환자들의 일반적 및 수술 중 특성 비교

오수원,정용훈,구길회,박정원 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.6

Background: ST changes that do not fulfill the criteria of specific one-ST changes greater or equal to 1 mm and lating over 1 minite-, are termed as "nonspecific". The term, "nonspecific ST-T change", has not had an important role as a guildeline of treatment. However, the incidence of "nonspecific ST-T changes" is estimated as not so negligible, and the relation to postoperative complications or the role as a coronary prognostic risk value has not been studied so fat, so the authors thought to examine the general characteristics and course during the perioperative period of "nonspecifics ST-T change" patients to conduct bettwe anesthesia services. Methods: From January 1st to June 30th in the year 2000, medical charts of patients who underwent an operation in one university hospital under general or regional anesthesia and whose preoperative electrocardiographic finding was "nonspecific ST-T changes" were reviewed. In the preoperative viewing of charts, demographic data, co-existing disease, findings in electrocardiography or echcardiography, and replies of a consultation to a cardiologist were reviewed. In the anesthesia records, nature of conducted anesthesia, agents, operation time and drugs acting on the cardiovascular system were reviewed. Results: Incidence of "nonspecific ST-T changes" patients is 8.24%. Mean age is 54±16 yrs and the ratio of M:F is about 1:2. The number of patients who had other medical diseases was 42, about 27%. The number was 65±7%. The number of patients who consulted a cardiologist preoperatively was 44, about 22% and the majority of them were OK'd as "no problem". Administration of drugs acting on the cardiovascular system was done in 49 cases, about 33%. General anesthesia was conducted in 131 cases, regional anesthesia in 23 cases. Conclusions: In all cases, operations were performed without specific events or major complications. However more attention and risk evluation is desirable in "nonspecific ST-T change" patients to conduct safer and more ideal anesthesia.

복강경하 질식 자궁 적출술에서 술 전 투여된 Clonidine의 효과

오수원 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5

Background: Laparoscopic surgery is a technique with cosmetic advantage, reduction of hospital days, postoperative pain and morbidity. However, in terms of anesthetic care, increase of airway pressure and blood pressure, decrease of ventilatory capacities, and hypercarbia have been pronblematic issues. The purpose of this study was to evaluate the effect of preoperative administration of clonidine for controlling blood pressure during laparoscopic surgery. Methods: Forty patients who underwent a laparoscopically-assisted vaginal hysterectomy were randomly allocated into clonidine administered group (group C) or a control group (group N) before the operation. Clonidine 0.15 mg was given intravenously for group C patients, then induction was started. Blood pressure and pulse rates were measured at times of entering the operating room, intubation, post-intubation 1, 3, and 5 minutes, post-insufflation 10 minutes, and postoperatively 1 hour. Blood sugar was checked at post-insuffalation 10 minutes and postoperatively 1 hour. Results: In both groups blood pressure and pulse rate increased significantly compared to the control value after intubation and this feature continued to post-intubation 1 minute in group N. There was significant increase of blood pressure in the postoperative 1 hour period only in group N. Blood sugar also increased significantly at post-insufflation 10 minutes in group N and 1 hour in both groups. Comparing the two groups, blood pressure values of group N at postintubation 1, 3, and 5 minutes were significantly higher than group C, and pulse rate at postinsuflation 1 hour was significantly higher than group C. In addition, the blood sugar in group N was significantly higher than group C at postinsufflation 10 minutes. Conclusions: Preoperative clonidine administration is an effective and convenient method to control hypertension and the blood sugar level during laparoscopic surgery. (Korean F Anesthesiol 2002; 43: 649~654)

복강경하 및 개복하 담낭절제술 후의 간 기능 변화 비교

오수원,이보령,정용훈,박정원 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.6

Propofol 과 Enflurane 이 혈중 당(glucose)농도에 미치는 영향 비교

오수원,구길회,정지섭 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2

Background : Even though surgery and anesthesia give stress to patients, adequate anesthesia could attenuate stress reactions and minimize side effects from these reactions. Abnormal glucose homeostasis is well documented side effect during anesthesia, especially when inhalational anesthetics are used. We planned this study to investigate and compare the effects of two popular anesthetics-between propofol, intravenous anesthetics, and enflurane, inhalational agents on blood glucose level. Methods : Adult patients free of diabetes mellitus and any other endocrine disease were randomly allocated into two groups. In both groups, anesthesia was induced with 2.5% pentothal sodium 5 mg/kg and succinylcholine 1 mg/kg. After intubation, propofol 6∼10 mg/kg with 50 % N2O-O2 mixture 4 liter were used for maintenance in one group(Group P). In other group, enflurane 1.5∼2% with 50% N2O-O2 mixture 4 liter were used(Group E). Hartmann's solutions were used for maintenance fluid in both groups. Blood glucose levels were measured at preintubation period, postintubation 5, 10, 15 minutes and just-preincision period. Blood glucose level at admission was regarded as control value and statistical analysis was done by Student's t-test. Results : In group E, there was significant increase of the blood glucose level about 23 minutes after induction but in group P, there was no significant increase of glucose level during entire experimental time. Blood glucose levels were higher from postintubation 5 minutes to just-preincision period with statistical significance in group E than group P. Conclusions : Propofol maintained stable blood glucose level compared to enflurane during general anesthesia. (Korean J Anesthesiol 1998; 34: 323∼328)

예정 수술 취소의 원인 분석

오수원 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.3

Background : Unexpected cancellation of the elective operation on scheduled day is stressful event to both of patients and doctors, especially when there is little explanation and understanding. Above all, it is against cost-saving policies in hospital management. Thus the author investigated the rate, distribution and causes of cancelled cases to get help to make plans to reduce the cancellation rates. Methods : From March 1st in 1996 to February 28th in 1997, all operation schedules were reviewed and cancelled cases on scheduled day were analyzed. All the elective operations except emergency operations under general, regional or local anesthesia were included in this analysis. Total cancellation rate was analyzed according to surgical departments, month, week day, age and causes. In statistical analysis, SAS program was used. Results : Total number of cancellation was 424 cases and mean cancellation rate was 8.47%. In analysis of cancellation rate by months, it was highest in October and lowest in November. In August, October and December the cancellation rates were higher than the other months. It was higher on Tuesday and Thursday. Most common causes of cancellation was the problems related patient's condition, especially related to co-existing diseases. Among these, cardiac disease was predominant. Non-medical causes were predominant than medical causes in most cancelled cases. Conclusion : Trying to reduce the cancellation rates is suggested as one of methods that will make the quality and quantity of medical services better. Careful preoperative evaluation of patient and consultation of abnormal findings or laboratory data before hospitalization, appropriate scheduling of operation, complete preparation of operation apparatus, through all these, firm establishment of doctor-patient rapport are core element of reducing of cancellation rate. So, attention and support by not only anesthesiologist but surgeons and hospital managers are needed to achieve these goals of reducing of cancellation rate. (Korean J Anesthesiol 1997; 33: 540∼547)