방광암 환자에서 안장차단법에 의한 지주막하 페놀주입의 증례보고

조선준,신진우,성승혜,민홍기,송준걸,임정길,이청 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.3

We encountered two bladder cancer patients who suffered from perineal pain that was intractable despite the use of adjuvant medication. A phenol intrathecal (saddle) block was performed without any specific complications. The results were excellent and allowed the systemic opiate dose to be reduced by more than 80%. We report our clinical experience, including a brief review of the relevant literature. (Korean J Anesthesiol 2006; 50: 351~4)

공동주택 층간소음 분쟁해결에 대한 기준조사

조선준,김태희,한찬훈 대한건축학회지회연합회 2010 대한건축학회지회연합회 학술발표대회논문집 Vol.2010 No.1

국내 주거환경은 인구의 도시집중과 지가 상승 등으로 공동주택이 대표적인 도시의 주거양식이 되고 있다. 우리나라의 대표적인 주거형태로 자리잡고 있는 아파트는 구조적으로 세대간에 벽과 천장, 바닥 등을 공유하고 있어 세대간에 소음 진동의 문제가 발생할 수 있다. 연구자료 등에 따르면 공동주택에 거주하는 사람이 받는 소음피해의 유형을 분석해보면, 옆집에서 들리는 소음으로는 문 여닫는 소리, 계단발자국 소리, 아이들 뛰노는 소리 등이 있고, 이야기 소리, TV, 라디오 소리등 공기음에 대해서는 피해를 크게 받지 않는 것으로 나타났다. 그러나 윗층에서 발생하는 소음에 대한 지적율은 매우 높았으며 아이들 뛰노는 소리, 계단, 복도의 발소리등 바닥 충격음계의 층간소음이 주요 피해요인으로 나타나있다. 국민생활 수준향상에 따라, 정온한 생활환경을 바라는 국민들의 욕구가 커지고 있어, 층간소음에 대한 민원이 증가하고 있으며, 관련 KS규격의 제정이 공고되고, 주택건설기준 등에 대한 규정이 층간소음에 대한 기준을 마련하고자하는 사회의 관심이 집중되고 있다. 이에 층간소음의 개념과 대책등에 문헌 조사를 통해 간략하게 설명하고 적합한 해결책을 제시하여 주택 층간 소음 발생시 원만한 해결을 이끌어 낼 수 있는 해결방안을 제시하는데 그 목적이 있다.

실험연구 : Lidocaine 또는 MK-801의 척수강내 투여시 두가지 신경병증 통증 모델에서 항이질통 효과 비교

조선준 ( Sun Joon Cho ),강금내 ( Keum Nae Kang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4

Background: Neuropathic pain can be induced by nerve injury or inflammation. An N-methyl-D-Aspartate (NMDA) antagonist (MK-801), and a sodium channel blocker (lidocaine) have been found to reduce mechanical allodynia. This study was conducted to determine whether intrathecal lidocaine or MK-801 had an antiallodynic effect on established mechanical allodynia in two well-characterized neuropathic pain rat models. Methods: Male Sprague Dawley rats (n = 107) were anesthetized, and the left L5 and L6 spinal nerves were ligated (SNL group) or Freund complete adjuvant (FCA) was administrated to the same spinal nerves (FCA group) in order to cause neuropathic pain. A catheter was then implanted into the lumbar intrathecal space. After obtaining the baseline scores, time-effect curves of each drug were established for the antiallodynic effects of lidocaine (30μg, 100μg and 300μg) and MK-801 (1μg, 3μg, 10μg and 30μg). The allodynic thresholds for the left hind paw withdrawal to von Frey hairs were assessed and converted to %MPE, and the ED50 value was then calculated using the %MPE. The antiallodynic effects of the two groups were then compared by analyzing the dose-response curves and the ED50 values. Results: Both intrathecal lidocaine and MK-801 resulted in a dose dependent antiallodynic effect. ED50 values and the analysis of dose response curves showed that intrathecal lidocaine provided more effective antiallodynia in the SNL group, whereas intrathecal MK-801 resulted in a greater antiallodynic effect in the FCA group. Conclusions: In the SNL group, lidocaine had a better effect in reducing allodynic pain, whereas in the FCA group, MK-801 showed a greater antiallodynic effect. (Korean J Anesthesiol 2007; 53: 497~503)

심장수술에서 저체온 체외순환 후 발생한 허혈성 뇌손상시 BIS의 변화

이은호,최재용,조선준,심지연,함경동,정용보,최인철 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.6

The bispectral index (BIS) has been developed as a measure for monitoring the hypnotic drug effect. EEG processing results in a BIS scale from 0 to 100, where 100 represents an awake and responsive patient, and the scale decreases when hypnotics are administered. Here we describe two patients in whom the BIS decreased to nearly 0 during cardiac surgery. Postoperatively both patients showed hypoxic brain injury. There are several possible causes for a decrease in the BIS during surgery, including deep anesthesia, hypothermia and cerebral ischemia. In the present cases, cerebral hypoperfusion was the likely cause. During cardiac surgery, hemodynamic changes such as acute hypotension and cardiac arrest can cause cerebral ischemia. Cerebral ischemia develops most commonly during cardiopulmonary bypass (CPB). Therefore, the BIS may be useful for detecting severe cerebral ischemia during CPB, although it has some limitations as a cerebral monitor.

실험연구 : 두 신경병증 통증 쥐 모델에서 척수강 내 투여 Cholinesterase Inhibitors와 NMDA Antagonists의 항이질통 효과 비교

강금내 ( Keum Nae Kang ),조선준 ( Sun Jun Cho ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6

Background: Cholinesterase inhibitors and N-methyl-D-aspartate (NMDA) antagonists reduce the mechanical allodynia in neuropathic pain models. In this study our aim was to compare the antiallodynic effects between intrathecal cholinesterase inhibitors and NMDA antagonists on two well-characterized neuropathic pain rat models. Methods: Male Sprague Dawley rats were anesthetized and either had the left L5 and L6 spinal nerves ligated (SNL group) or Freund complete adjuvant (FCA) administrated to the sciatic nerve (FCA group) in order to cause neuropathic pain. A catheter was implanted into the intrathecal space for drug administration. After obtaining baseline values, edrophonium (3-100μg), neostigmine (0.3-10μg), AP-5 (0.3-3μg) and MK-801 (1-30μg) were administered intrathecally to each group. The allodynic left hind paw withdrawal thresholds to von Frey hairs were assessed and converted to % MPE. Antiallodynic effects on the two groups were compared by analyzing dose-response curves and ED 50 values. Motor weakness was also checked. Results: Intrathecal edrophonium, neostigmine, AP-5 and MK-801 had a dose-dependent antiallodynic effect on the two neuropathic pain models. Comparing the antiallodynic effect dose response curves, intrathecal cholinesterase inhibitors had lower ED 50 with steep slopes in the SNL model, whereas intrathecal NMDA antagonists had lower ED 50 in the FCA model, but there were no statistically significant differences between the two models. Conclusions: Intrathecal cholinesterase inhibitors and NMDA antagonists have relatively better antiallodynic effects on the SNL and FCA neuropathic pain rat models, respectively. (Korean J Anesthesiol 2007; 53: 767∼73)

Sevoflurane 마취에 의한 혈압 변이도의 변화

황규삼,윤미옥,허인영,강수진,신원정,최병문,도경준,조선준,이수경,김영국 대한마취과학회 2005 Korean Journal of Anesthesiology Vol.49 No.2

임상연구 : Sevoflurane 흡입마취유도 시 동맥압 변화의 기전 평가: Modelflow 방법을 이용한 혈역학 변수의 Beat-to-Beat 분석

김영국 ( Young Kug Kim ),윤미옥 ( Mi Ok Youn ),서형석 ( Hyung Seok Seo ),최재혁 ( Jae Hyuk Choi ),최병문 ( Byung Moon Choi ),신원정 ( Won Jung Shin ),도경준 ( Kyung Jun Do ),조선준 ( Sun Joon Cho ),강수진 ( Su Jin Kang ),전인구 ( 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1

Background: A modelflow method provides beat-to-beat analysis of cardiovascular variables based on arterial pulse pressure analysis. In this study, we assessed the mechanism of arterial blood pressure (ABP) change during sevoflurane induction by the analysis of beat-to-beat hemodynamic changes using a modelflow method. Methods: Beat-to-beat ABP was measured during a stable conscious state (baseline) and vital capacity induction with sevoflurane 6 vol% and oxygen 8 L/min in 18 healthy living liver transplant donors. Alterations of beat-to-beat systolic ABP, mean ABP, diastolic ABP, heart rate (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) by sevoflurane induction were estimated noninvasively using a modelflow method simulating aortic input impedance from an ABP waveform. Results: After sevoflurane induction, ABP, SV, CO, and TPR decreased significantly (all P < 0.05), but HR did not change significantly. After tracheal intubation, ABP, CO, and TPR did not change significantly compared with baseline, but HR increased and SV decreased significantly (both P < 0.05). Conclusions: Using a modelflow beat-to-beat analysis of cardiovascular variables, we found that ABP did not change significantly compared to baseline after tracheal intubation during sevoflurane induction, indicating the counteraction of increased HR and decreased SV, and that the reduction of SV by tracheal intubation suggests the suppression by increased HR and TPR compared with that after sevoflurane induction. (Korean J Anesthesiol 2006; 51: 17~23)

임상연구 : 심박수 변이도, 혈압 변이도 및 압반사 민감도를 이용한 간경화 환자의 심혈관 자율신경계 평가

윤미옥 ( Mi Ok Youn ),강수진 ( Su Jin Kang ),전인구 ( In Gu Jun ),신원정 ( Won Jung Shin ),최병문 ( Byung Moon Choi ),도경준 ( Kyung Jun Do ),조선준 ( Sun Joon Cho ),최재혁 ( Jae Hyuk Choi ),송준걸 ( Jun Gol Song ),허인영 ( In You 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6

Background: Liver cirrhosis is associated with several hemodynamic abnormalities, including an impairment of autonomic nervous system reflexes, but very few have compared the disease severity with cardiovascular autonomic dysfunction assessed by spectral analysis of blood pressure and electrocardiogram. The aim of this study was to investigate the relationship between Child-Turcotte-Pugh (CTP) score and autonomic indices in patients with liver cirrhosis using the heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS). Methods: Fifty patients scheduled for liver transplantation recipients under general anesthesia were enrolled in the study. Beat-to-beat blood pressure and RR interval were measured for five minutes before anesthesia induction. HRV and BPV were estimated by power spectral analysis of RR interval and systolic blood pressure. BRS was estimated by both the sequence method (Sequence BRS) and high frequency (HF) gain of transfer function analysis (HF BRS). Results: Significant inverse correlations between CTP score and Sequence BRS (r = -0.61), HF BRS (r = -0.59), low frequency (LF) and HF power of HRV (r = -0.57, r = -0.46), LF power of BPV (r = -0.37) were found. However, no significant correlations were observed between CTP score and LF/HF ratio of HRV (r = -0.02) and HF power of BPV (r = 0.27). Conclusions: These results showed that autonomic dysfunction assessed by spectral analysis was associated with increasing severity of liver cirrhosis. Further study will be needed to clarify relationship between our findings and hemodynamic fluctuations during anesthesia for liver transplantation. (Korean J Anesthesiol 2006; 50: 655~62)