고유량과 최소유량마취시 Carboxyhemoglobin치의 변화

이상하,유한목,장현수,전소영 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.5

Background : Minimal flow anesthesia preserves the moisture content of CO2 absorbents and seems to be a factor inhibiting carbon monoxide generation. In order to assess the safety of minimal flow anesthesia, we studied carboxyhemoglobin (COHb) level in minimal flow anesthesia. Methods : Forty women, ASA physical status I or II, undergoing total abdominal hysterectomy were randomly allocated to one of two groups with N2O-enflurane anesthesia. Anesthesia was maintained with O2 2 l/min and N2O 2 l/min (group 1) or O2 0.3 l/min and N2O 0.2 l/min (group 2). The arterial COHb levels were measured immediately after induction (T1), 45 min after induction (T2), 75 min after induction (T3), and after recovery from anesthesia (T4). Results : Although there was no statistically significant change in both groups, the COHb level at T3 and T4 increased more than that at T1 in group 1, and that at T3 and T4 decreased more than that at T1 in group 2. There was a significant difference in the COHb level at T4 between group 1 (0.93 0.31%) and 2 (0.68 0.36%) (P < 0.05). Conclusions : These results show that minimal flow anesthesia does not increase the COHb level and may be performed safely. (Korean J Anesthesiol 1999; 37: 776∼780)

전자궁적출술시 전신마취와 경막외마취가 혈역학에 미치는 영향의 비교

김애라,전재규,유한목 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.5

Background : The purpose of the study was to evaluate the effect of postural change on hemodynamics using thoracic eletrical bioimpedance (TEB) device during general anesthesia with enflurane-N2O-O2 and lumbar epidural anesthesia. The TEB device is safe, reliable and non-invasive way to measure hemodynmic values continuously. Methods : General anesthesia (twenty patients) was induced by administration of pentotal sodium 5 mg/kg and succinylcholine 1 mg/kg intravenously, and was maintained with 1 vol% of enflurane, N2O- O2 (2 l/min-2 l/min) and vecuronium 0.1 mg/kg. Epidural anesthesia (twenty patients) was performed at the level of L3-4 epidural space using 20 ml of 2% xylocaine mixed with epinephrine (5 μg/ml). Hemodynamic changes were measured before induction, 1 and 5 minutes after intubation or epidural injection, 1, 5, 10, 20, 30 minutes after head- down tilt and 1, 5, 10 minutes after returning to the supine position. Results : HR and LVSWI were minimaly affected in group E with epidural anesthesia comared to group G with general anesthesia. BP (SBP, DBP, MAP) and SVRI were remarkably increased in group G compared to group E. BP and SVRI showed rapid increse 1 minutes after head-down tilt in group G (p<0.01) and decreased gradually thereafter. SI and CI were decreased significantly in group G compared to group E (p<0.001). SI was unchanged but CI was decreasd significantly after head-down tilt in group E (p<0.05). EDI and ACI showed lower values decreased in general significantly in group G compared to group E (p<0.05). Conclusions : All hemodynamic changes were more predictable, gradual, less variable, and stable in the group with epidural anesthesia compared to the group with general anesthesia for hysterectomy. (Korean J Anesthesiol 1999; 36: 808∼817)

대수술시 목표농도조절주입법의 Propofol과 전신마취의 비용-효과의 비교

이상하,장현수,유한목,문상준 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.4

Background: The purpose of this study was to compare the cost-effectiveness of propofol using a target-controlled infusion (TCI) with two currently used anesthetic regimens during major operations. Methods: Forty-two patients undergoing major gynecological smgery were divided into three groups according to the period during which the surgeries were performed. Group propofol/TCI (n = 16) received 1% propofol using TCI-50% N20, Group isoflurane (n = 14) received thiopental 5 mg/kg-isoflurane-50% N20, and Group enflurane (n = 12) received thiopental 5 mg/kg-enflurane-50% N20. All patients also received 2 ㎍/kg of fentanyl before induction. Concentrations of propofol and volatile anesthetics were varied according to the patients hemodynamic responses. Consumption of volatile anesthetics was measured by weighing the vaporizers by a ptecision weighing machine. Results: Biometric data, duration of surgery and of anesthesia were similar in the three groups. Recovery from anesthesia was significantly shorter in the prpofol/TCI group. Episodes of postoperative nausea and vomiting in the recovery room were less common in propofol/TCI group. Patient satisfaction was similar in all three groups. Total (intra- and postoperative) costs were significantly higher in the propofol/TCI group. Conclusions: When compared with the standard anesthetic regimens, the use of propofol using TCI anesthesia during major operations was associated with higher costs, but did not offer any clinically significant advantages in cost-effectiveness over the standard anesthesia regimens.

술후 통증 조절을 위한 늑간신경 차단시 Bupivacaine에 첨가된 Clonidine의 효과

이상하,유우종,장현수,유한목 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.2

Baekground: The addition of clonidine to local anesthetics for regional block has been shown to increase the duration of anesthesia and analgesia. This study was designed to determine whether the addition of clonidine to bupivacaine would produce an extension of the analgesic effect after intercostal nerve block (ICNB). Methods: After informed consent, 30 ASA 1 or 2 patients undergoing appendectomy under general anesthesia were randomly divided into two groups, Before induction of anesthesia, ICNB using a posterior approach was performed with 15 ml of 0.25% bupivacaine plus epinephrine 1: 200,000 with (Group BEC n = 15) or without (Group BE n = 15) clonidine 75 pg. Analgesia was assessed by cold testing at 1/min intervals until cold sensation decreased. The duration of analgesia (time between injection and onset of pain was recorded. We also recorded the visual analogue scale (VAS) of pain, the number of supplemental analgesics, heart rate and blood pressure, and side effects over 24 hours postoperatively. Results: The onset time, duration of analgesia, number of analgesics, and heart rate and blood pressure were comparable in both groups. VAS scores were significantly lower in Group BEC than in Group BE at 12, 16, and 20 hours postoperatively. Conclusions: The addition of clonidine to bupivacaine with epinephrine may be a useful adjunct and can prolong the duration of analgesia after ICNB without significant side effects.

한국 성인에서의 Tuffier`s Line의 높이

장영호,전재규,김인정,유한목 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.3

Background : Tuffier's line, which connect the two iliac crests, is the often used landmark in determining the level for the needle insertion into lumbar intervertebral space for the spinal and/or epidural blocks. However, the level of Tuffier's line varies depending on the observer. Methods : Two methods were used to measure the level of Tuffier's line was measured on a simple abdominal X-ray taken in the supine position(study 1). Second, the level of Tuffier's line was also measured on fluroscopy of students in the sitting position(study 2). Results : Overall, the level of Tuffier's line was most frequently observed along the L4-5 intervertebral space and second most frequently observed along the lower one-third of L4. In study 1 using abdominal X-ray, the level of Tuffiers line was most frequently observed along the L4-5 intervertebral space, however, the second most frequently observed level varied depending on the ages of the volunteers. In study 2 using fluoroscopy, the level of Tuffier's line was most frequently observed along the L4-5 intervertebral space and second most frequently observed along the upper one-third of L5. Conclusions : The level of Tuffier's line was most frequently observed along the L4-5 intervertebral space both in the supine and sitting positions. Further, the level of Tuffier's line went higher with age for women but stayed constant independent of age for men in the supine position. (Korean J Anesthesiol 1997; 33: 467∼471)

경부 및 종격동내 수활액낭종 절제술을 위한 기관내 삽관직후 발생한 상기도 폐쇄

김진모,이주영,김인정,견일수,유한목 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.2

Abrupt increase in the size of cervico-mediastinal tumor due to infection or spontaneous hemorrhage into cyst can induce severe tracheal compression and therefore sudden death. A 5 year old boy, who had a history of URI, had an enlarging cystic hygroma on the right side of the neck and anterior mediastinum. Under diagnosis of the cervico-mediastinal cystic hygroma, surgical removal was scheduled. After induction of anesthesia, intubation was done without any difficulty. A few minutes later, signs of partial airway obstruction were appeared. And within a very short period, total airway occlusion occurred. The tracheal tube was removed and manual ventilation was performed with positive airway pressure, but ineffective. We attempted to puncture cricothyroid membrane with 14 Gauge needle in order to ventilate manually. As soon as we puncture cricothyroid membrane, straw-colored fluid, not air, gushed out through a needle. After aspiration of about 200ml of cystic fluid, the obstructive signs disappeared and the patency of the airway was maintained. Intraoperatively, no more airway problems occured and vital signs were stable. And postoperatively, patient had no specific complications and discharged on the 7th day after operation. (Korean J Anesthesiol 1997; 33: 371∼375)

지게차 성능특성에 대한 배기 열 회수 시스템의 영향

허만웅(Man-Woong Heo),이승엽(Seung-Yup Lee),김재덕(Jae-Deok Kim),유한성(Han-Sung Yoo),허형석(Hyung-Seok Heo),배석정(Suk-Jung Bae),홍성목(Sung-Mok Hong),정기석(Ki-Seok Jung),박승욱(Seung-Uk Park) 한국자동차공학회 2018 한국자동차공학회 학술대회 및 전시회 Vol.2018 No.11