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조춘규,성태윤,최석준,최혜란,김용범,이정은,양홍석 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.5
Background: Perioperative magnesium sulfate (MgSO4) is used for analgesic, anti-arrhythmic, and obstetric purposes. The effects of MgSO4 on the neuromuscular blockade (NMB) induced by rocuronium, and the sugammadex reversal thereof, have not been clearly quantified. We investigated the effect of various MgSO4 concentrations on the NMB by rocuronium, and sugammadex reversal, in isolated left phrenic nerve hemi-diaphragm (PNHD) preparations from the rat. Methods: Rat PNHD preparations were randomly allocated to one of four groups varying in terms of MgSO4 concentration (1, 2, 3, and 4 mM, each n = 10, in Krebs solution). The train-of-four (TOF) and twitch height responses were recorded mechanomyographically. The preparations were treated with incrementally increasing doses of rocuronium and each group’s effective concentration (EC)50, EC90, and EC95 of rocuronium were calculated via nonlinear regression. Then, sugammadex was administered in doses equimolar to rocuronium. The recovery index, time to T1 height > 95% of control, and the time to a TOF ratio > 0.9 after sugammadex administration were measured. Results: The EC50, EC90, and EC95 of rocuronium fell significantly as the magnesium level increased. The EC50, EC90, and EC95 of rocuronium did not differ between the 3 and 4 mM groups. The recovery index, time to T1 height > 95% of control, and time to a TOF ratio > 0.9 after sugammadex administration did not differ among the four groups. Conclusions: Increases in the magnesium concentration in rat PNHD preparations proportionally enhanced the NMB induced by rocuronium but did not affect reversal by equimolar amounts of sugammadex.
적절한 기관내관 기낭 압력 유지를 위한 Loss of Resistance Syringe의 적용
조춘규,권희욱,박성수,정원준,이미진 대한응급의학회 2010 대한응급의학회지 Vol.21 No.2
Purpose: The management of cuffed endotracheal (ET)tubes is routine practice for emergency physicians. Although various cuff inflation techniques are used, there is no standard technique identified in the literature as the method for cuff inflation or intracuffed pressure (ICP). A loss of resistance (LOR) syringe has been used for years and this is located in the epidural space. The purpose of this study was to measure the actual ICP obtained by a new estimation technique. Methods: Using a manikin simulation model, we assessed how physicians inflated the cuff in 5.5, 6.5, 7.5 mm inner diameter ET tubes. We measured the inflated air volumes and the ICPs obtained by the conventional technique (A group), by the commercial 10-ml syringe + passive release technique (B group), and by a LOR syringe + PRT (C group). Subsequently, a manometer was used to measure the actual ICP (normal: 16 to 40 cmH2O). Results: We sampled 90 participants. They were classified into three groups: those who underwent the conventional inflation technique (A group, n=30), those who underwent the commercial syringe technique (B group, n=30) and those who underwent the Perifix LOR syringe technique (C group, n=30). In the control group, the mean recorded ICPs were 78.2±30.7 cmH2O (A group) and 56.1±16.0cmH2O (B group). The initial cuff pressures were greater than 40 cmH2O in 25 (83.3%) cases. For the experimental group, the mean recorded ICP was 19.1±1.8 cmH2O. With respect to the rate of optimal cuff inflation, the LOR syringe technique was significantly higher than the conventional method or the PRT + 10-ml syringe method (100% vs. 16.7and 23.3%, respectively, p<0.001). Conclusion: Using conventional syringe technique, most cuff pressures exceeded a safe pressure and they required correction. Ultimately, PRT using the Perifix LOR syringe is a useful alternative cuff inflation method when direct intracuff pressure measurement is not available.
조춘규,김지은,양헌주,성태윤,권희욱,강포순 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.1
Background: Despite the established efficacy of dexamethasone and lidocaine for preventing postoperative airway symptoms, no study has investigated the effects of dexamethasone plus lidocaine for attenuating postoperative airway symptoms. The purpose of this study was to explore whether combined dexamethasone and lido- caine are superior to dexamethasone alone in reducing postopera- tive sore throat, cough, and hoarseness for 24 h after tracheal extubation. Methods: In total, 70 female patients undergoing breast mass excision were randomized in a prospective, double-blinded manner into two groups: Group DL received intravenous dexamethasone (8 mg) plus lidocaine (1.5 mg/kg) 5 min before induction of anes- thesia, and lidocaine was injected once more at the end of surgery. Group D received dexamethasone (8 mg) plus normal saline instead of lidocaine in the same manner as Group DL. We assessed the incidence and severity of postoperative sore throat, cough, and hoarseness 1 and 24 h after extubation. Results: The incidence of sore throat for 24 h after tracheal extubation was significantly lower in Group DL than in Group D (62.9% vs. 85.7%, respectively; P = 0.029). The severity of sore throat and hoarseness for 24 h after extubation was lower in Group DL than in Group D (P < 0.05). The incidence and severity of cough did not differ between the two groups for 24 h after extubation. Conclusions: Lidocaine combined with dexamethasone is more effectively reduces the incidence and severity of sore throat and severity of hoarseness for 24 h after extubation in patients who have undergone breast mass excision surgery.
조춘규,김현우,안세환,권희욱,강포순 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.2
Intramuscular Stimulation (IMS) is a refined technique of traditional oriental acupuncture, and IMS has proved effective for relieving chronic pain of a neuropathic origin.IMS is currently seen to be quite a safe procedure with minimal complications having been reported to date.Various complications have been documented for acupuncture, but few complications or adverse effects have been reported in relation to the relatively new technique of IMS.We report here on a case of cervical spinal epidural hematoma that manifested as a cause of delayed hemiparesis.The safety of this procedure in unpracticed hands seems to be questionable.
안전한 마취관리를 위한 국내 마취통증의학과 전문의 인력 현황 및 장래 공급량 예측
조춘규,김덕경,박혜진 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.1
Background: Recently, current or potential shortage and regional imbalance of anesthesiologists have become controversial issues due to political reasons. Thus, we examined the occurrence of current shortage of anesthesiologists in non-capital areas and forecasted the supply of anesthesiologists in the target period between 2020 and 2025. Methods: In November 2015, membership data including the type of anesthesia service, age, and regional distribution of the Korean Society of Anesthesiologists (accounting for 73.7% of all anesthesiologists) was renewed. Excepting unidentified members (n = 231), previous data from the 2007 survey were used for analysis. Future workforce projections were determined by adding the number of new anesthesiologists minus the predicted number of anesthesiologists who will retire or die in the targeted period. Results: In 2015, the cumulative number of anesthesiologists was 4,826. The available anesthesiologists in our country numbered 4,515. Of these, 2,675 anesthesiologists (59.2%) have provided surgical anesthesia services with centralization of the capital region (58.1%). The number of the available anesthesiologists in our country were expected to be 4,585 and 5,478 in 2020 and 2025, respectively. Conclusions: The regional distribution of anesthesia services reported by the Health Insurance Report indicated a current centralization of anesthesiologists in the capital region, as a result of anesthesia demand concentration in this area. The age composition of current anesthesiologists as well as the numeric trends of trainees acquiring professional license indicated a stable supply of anesthesiologists over the next 10 years.
조춘규,Chang Minhye,Lee Seok-Jin,조성애,성태윤 대한마취통증의학회 2022 Anesthesia and pain medicine Vol.17 No.2
Background: The presence of a urinary catheter, postoperative pain, and postoperative nausea and vomiting are risk factors for emergence agitation (EA). Antimuscarinic agents are primary agents used in the prevention and treatment of urinary catheter-related bladder discomfort. Chlorpheniramine has antimuscarinic, antinociceptive, and antiemetic effects. This retrospective study investigated the role of chlorpheniramine in EA prevention following ureteroscopic stone surgery.Methods: Of 110 adult patients who underwent ureteroscopic stone surgery under general anesthesia between January and December 2019, the medical records of 93 patients were analyzed retrospectively. The patients were divided into control (n = 52) and chlorpheniramine (n = 41) groups according to the receipt of intravenous chlorpheniramine before the induction of anesthesia. The incidence and severity of EA were compared between the groups as primary and secondary endpoints, respectively. The effects of chlorpheniramine on the requirement for inhalation anesthetic (desflurane) during surgery, changes in mean blood pressure and heart rate during emergence, and adverse events were also compared. Results: The incidence (21.2% in the control group, 24.4% in the chlorpheniramine group) and severity of EA did not differ between groups. The intraoperative requirement for desflurane, changes in mean blood pressure and heart rate during emergence, and adverse events were also similar between groups. Conclusion: Chlorpheniramine was not associated with a decrease in EA incidence or severity in patients who underwent ureteroscopic stone surgery.
정중법을 이용한 빗장 아래 상완 신경총 차단 환자에서의 0.5% Levobupivacaine과 0.5% Ropivacaine의 비교
조춘규 ( Choon Kyu Cho ),김중연 ( Joong Yeoun Kim ),정성미 ( Sung Mee Jung ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),김철웅 ( Chul Woung Kim ),한정욱 ( Jeong Uk Han ),양춘우 ( Chun Woo Yang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.2