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윤명하(Myung Ha Yeon),김대현(Dae Hyun Kim),곽상현( 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1
N/A Background: Recently, it has been demonstrated that endothelin(ET) and endothelin related peptides are present in the blood and plasma ET levels are increased after operation. But the causes of increasing plasma ET levels are not clearly understood. This current study was to investigate the relationship between postoperative pain and endothelin. Methods: Thirty adult patients, scheduled for upper abdominal operation under general anesthesia, were included. After operation, epidural catheterization was done for postoperative analgesia. Before induction, on complained of pain and 1 hour after analgesics administration, blood samples were obtained to measure plasma ET levels. Plasma ET concentration was detennined by radioimmunoassay. Pain score was measured by visual analogue score(VAS). Mean arterial pressure(MAP) and heart rate(HR) were also recorded every sampling time. Results: There were no significant changes in plasma ET levels at the time before induction versus at the time of the pain complaints and at 1 hour after analgesic administration. Pain score was signifi- cantly reduced after epidural analgesia. There was no significant correlations between pain score and plasma ET levels. There were no significant correlation between plasma ET levels and either MAP or HR. Conclusions: These results indicate that there is lack of relationship between postoperative pain and endothelin.
윤명하(Myung Ha Yeon),유경연(Kyung Yeon Yoo),정성 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.1
N/A The purpose of this study was to compare postoperative analgesic effect according to in- travenous doses of ketorolac. The ninety-eight adult patients, scheduled' for elective surgery under general anesthesia, were randomly assigned to receive saline or one of the five doses of ketorolac (10, l5, 30, 45, 60 mg). After recoverg from anesthesia, saline or ketorolac was injected intravenously, and the visual analogue score, sedation secore, mean blood pressure, heart rate, and the incidence of nausea and vomiting were measured 30 minutes, 1 hour and 2 hours after the injection. Saline or 10 mg of ketorolac had no postanalgesic effect. Above l5mg of ketorolac had analgesic effect, but this analgesic effect was not increased with increasing doses of ketorolac (30, 4S, 60mg). Any side effects (nausea, vomiting, excessive sedation, cardiopul- monary depression, and renal and hematologic adverse events) was not observed associated with ketorolac administration. Those results suggested that 15mg of ketorolac is the most reliable dose for postopera- tive anlgesia in intravenous administration.
백서를 이용한 포르말린 통증 모형하에서 뇌실 내 Gabapentin의 효과
윤명하(Myung Ha Yoon),곽상현(Sang Hyun Kwak),정성수(Sung Su Chung),유경연(Kyung Yeon Yoo),정창연(Chang Young Jeong),임응모(Woong Mo Im) 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.2
N/A Background: Systemic or intrathecal administration of gabapentin has been shown to reverse various pain states. However, until now, the effect of intracerebroventricular (ICV) gabapentin to noxious stimuli has not been reported. The authors aim of this study was to determine the effect of ICV gabapentin on the inflammatory nociceptive model, formalin test, in rats. Methods: ICV catheters were implanted under halothane anesthesia. For the nociceptive test, 50μl of 5% formalin was subcutaneously injected into the hindpaw. The effect of ICV gabapentin, administered 10 min before formalin injection, were examined on flinching, mean arterial pressure and heart rate evoked by a injection of formalin. Results: Injection of formalin into the paw resulted in a biphasic flinching and cardiovascular response. ICV gabapentin produced a dose-dependent suppression of the flinching and mean arterial pressure response during phase 1. In contrast, in phase 2, ICV gabapentin did not attenuate the pain behavior. ICV gabapentin did not affect on the baseline mean arterial pressure and heart rate. Conclusions: ICV gbapentin was effective for the acute noxious stimulus but it had no effect on the facilitated states induced by tissue injury.
정창영(Chang Young Jeong),윤명하(Myung Ha Yeon),임 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.1
Piriformis syndrome is a syndrome of low back and leg radiating pain thought to be due to a chronic contracture of the piriformis muscle that causes irritation of the sciatic nerve. The piriformis muscle is a flat pyramidal muscle, an external rotator and abductor of the hip, originating from the front of the sacrum and inner aspect of the sacroiliac joint, then passes laterally out of the sciatic notch to attach posteriorly to the greater trochan- ter of the femur, the sciatic nerve passes between the two bellies of the muscle. Mechanical irritation of the sciatic nerve by an inflammatory reaction of the piriformis muscle and its fascia at this pelvic level causes pain to radiate in the dermatomal regions of the nerve roots similar to that disk entrapment. Diagnosis of piriformis syndrome is made primary on the basis of history and clinical exami- nation. The incidence is considerably higher in women, with the reported ratio of women to men of 6: 1. These patients frequently present with associated symptoms of pelvic pain and/or dyspareunia. Symptoms are usually unilateral but occasionally be bilateral. We had a 42 year-old woman patient with low back and left leg radiating pain and dyspareu- nia treated by caudal steroid and local anesthetic.
상복부 수술 환자에서 Fentanyl, Bupivacaine 및 Clonidine혼용에 의한 경막외 제통에 대한 평가
임웅모(Woong Mo Im),윤명하(Myung Ha Yeon),한상도(S 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1
N/A Background: Epidural analgesia has been widely used for postoperative pain relief. How- ever, it is not known which regimen provides the best result due to many variety. The aim of this study is to evaiuate the analgesia and side effects of epidural mixute of fentanyl, bupivacaine and clonidine, as one kind of regimen. Methods: One hundred adult patients scheduled for upper abdominal surgery under gener- al anesthesia were evaluated. Epidural catheterization was done after operation. A bolus, 0. 1% bupivacaine 10ml containing fentanvl 100 μg, was administered and followed up with continuous infusion of mixture of fentanyl 600μg, 0.5% bupivacaine 20ml and clonidine 150 μg at a rate of 2 ml, hr for 50 hours. Analgesia was assessed using VAS, PHS and PRS. Side effects and number of patients who took additional analgesics were evalutated Plas- ma samples were obtained to determine fentanyl concentration. Results: After the administrations of drugs, patients pain scores decreased notably, and pain relief scores increased significantly. Minimum side effects were noted. Twenty-one pa- tients required additional analgesics. Plasma concentration of fentanyl was 0.07-0.14 ng/mL Conclusion: Epidural infusion of mixture of fentanyl, bupivacaine and clonidine is an ef- fective regimen for postoperative pain relief after upper abdominal surgery.
백서를 이용한 포르말린 시험하에서 척수강내 Gabapentin 의 항침해작용에 대한 Serotonergic 수용체의 영향
최정일(Jeong Il Choi),유경연(Kyung Yeon Yoo),윤명하(Myung Ha Yoon) 대한통증학회 2002 The Korean Journal of Pain Vol.15 No.1
N/A Background: Spinal gabapentin actively encounters tissue-injury nociception. Serotonin is involved in the modulation of nociceptive transmission at the spinal level. Gabapentin increases the blood serotonin level. This study was designed to examine the role of spinal serotonergic receptors on the action of intrathecal gabapentin in rats. Methods: Intrathecal catheters were inserted into the lumbar enlargement. For nociceptive test, 50㎕ of 5% formalin was subcutaneously injecetd into the hind paw. The effects of intrathecal gabapentin on the formalin stimulation and of respective serotonin receptor antagonist on the action of gabapentin were examined. Results: Intrathecal gabapentin attenuated the flinching response during phase 2, but not during phase 1, of the formalin test. None of the serotonin receptor antagonists (1, 1A, 1B, 1D, 2, 2C, 3, 4) affected the antinociceptive of gabapentin. Conclusions: These results suggest that spinal serotonergic receptors are not directly involved in the antinociceptive action of intrathecal gabapentin
개에서 Halothane 마취가 심근허혈-재순환시 관상순환계의 Endothelin-1 생성에 미치는 영향
박찬진,윤명하,김별아,류경연 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7
Endothelin (ET), a vascular endothelium derived contracting factor, provokes a strong and long lasting contraction of blood vessels, including coronary artery. Chemical stirnuli such as Ca^(++) ionophore (in vitro) and myocardial ischemia (in vivo) are known to promote the production of ET. Since halothane has recently been shown to block Ca^(++) channel, it might blunt ET-1 release or production from ischemic myocardium. To test this hypothesis, open-chest dogs underwent eitber 15 minutes (n=7) of the left anterior descending coronary artery (LAD) occlusion or 30 minutes (n=7) and 120 minutes of reperfusion under the halothane anesthesia. Plasma concentration of ET-1 in the femoral artery (FA) and the great cardiac vein (CV) draining ischemic myocardium was measured using radioimmunoas-say. ET-1 production (pg/mL) was calculated by substrating the ET-1 levels in FA from those in CV. The results were as follows; 1) Baseline ET-1 levels in FA and CV were similar in both groups. 2) ET-1 levels in FA and CV remained unchanged during myocardial ischemia in both groups. 3) ET-1 production significantly increased from baseline at 30, 60 and 120 min into reperfusion, respectively, in the 30 min group, whereas no significant changes were observed from baseline in the 15 min group. These findings indicate that halothane may blunt, but could not block the production or release of ET-1 completely during myocardial ischemia-reperfusion, especially in the case of prolonged coronary arterial occlusion.