양측 하악 매복지치 동시 발치를 위한 의식하 진정의 비교 연구: Propofol, Fentanyl과 Diazepam, Morphine

김영균,채병국,최현규,Kim, Young-Kyun,Chae, Byung-Kook,Choi, Hyun-Kyu 대한치과마취과학회 2003 Journal of Dental Anesthesia and Pain Medicine Vol.3 No.2

Background: The purpose of this study was to compare the availability of propofol and fentanyl (P + F) with diazepam and morphine (D + M) for intravenous conscious sedation during third molar surgery. Methods: Forty patients without systemic disease were operated under IV conscious sedation administered by either of the two techniques. Monitoring consisted of continuous observation of pulse rate, blood pressure, oxygen saturation, and the respiratory rate and were recorded every 15 minutes. Cooperation score was measured 5 and 15 minutes after induction of IV sedation. Following the operation, the surgeon and patients completed questionnaires including pain visual analog scale, amnesia, and side effects. Results: The P + F group was significantly more cooperative than the D + M group. The side effects of D + M group included pain on injection, nausea/vomiting and abdominal pain. The side effects of P + F group included talkativeness, nausea/vomiting, temporary apnea, pain on injection and vertigo. Conclusions: In this study, there were following benefits in the P + F group; more cooperative status and less pain perception. But respiratory depression developed in some patients.

의학교육에 있어서의 Tutorial System

박정율(Jung Yul Park),채병국(Byung Kook Chae),유세화(Se Wha You) 한국의학교육학회 1996 Korean journal of medical education Vol.8 No.1

급성 술후 통증 조절을 위한 경막외차단 2,381예의 임상적 평가

장문석(Moon Suck Chang),채병국(Byung Kook Chae),이 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.2

N/A A retrospective study was performed to evaluate the effects, and side effects, of epidural an- algesia for postoperative pain relief of 2,381 surgical patients who received general-epidural, or epidural anesthesia only. Anesthesia records, patients charts, and pain control records were reviewed and classified according to: age, sex, body weight, department, operation site, epidural puncture site, degree of pain relief by injection mode 8r, epidural injectate, and side effects (including nausea, vomit- ing, pruritus, urinary retention and respiratory depression). The results were as follows: 1) From the total of 2,381 patients, there were 1,563(66%) female patients, 1,032(43%) patients were from Obstetrics and Gynecology. 2) Lower abdomen, thorax, lower extremity and upper abdomen in the operation site, and lumbar, upper, lower thoracic in puncture site were order of decreasing frequency. Length of epidural injection for pain relief averaged l.72±1.02 days. 3) Ninety three percent of the patients experienced mild or no pain in the postoperative course. Analgesic quality was not affected by the kind of epidural injectate. 4) Nausea occurred in 3.2% of all patients, vomiting in 1.l%, pruritus 0.9%, urinary retention 0.6%, respiratory depression 0.08%. 5) Frequency of nausea was higher with female patients compared to male patients(p<0.05). 6) Pruritus frequency was higher with male patients than female patients(p<0.05); and more frequent with patients who received epidural injection with morphine than patients who re- ceived epidural injection without morphine(p<0.01). 7) Urinary retention was higher in female patients, and more frequent with patients who had received epidural injection with morphine than epidural injection without morphine(p<0.05). 8) There were two cases of respiratory depression. The course of treatment consisted of: ces- sation of epidural infusion, then administration of oxygen and intravenous naloxone. We conclude that postoperative epidural analgesia with a combination of local anesthetics and opiate is an effective method for postoperative pain relief with low incidence of side ef- fects. However, patients should be carefully evaluated as rare but severe complications of respiratory depression may ensue.

氣管內 揷管을 위한 d-Tubocurarine chloride(d-Tc)의 定量에 대한 臨床的 考察

蔡秉國,吉燦一,辛正順 고려대학교 의과대학 1982 고려대 의대 잡지 Vol.19 No.1

Administration of succinylcholine for endotracheal intubation may cause untoward reactions such as elevation of intraocular pressure, increased plasma potassium level, increased intragastric pressure, bradycardia, and development of postoperative muscle pain, etc. Several attempts have been made to minimize the development of muscle fasciculation following administration of succinylcholine such as pretreatment with small doses of nondepolarizing neuromuscular blocking agent, self-taming of succinylcholine, or the use of hexafluorenium. When small doses of nondepolarizing neuromuscular blocking agent are given before succinylcholine administration, larger doses of succinylcholine should be given to chieve satisfactory relaxation. So, this study was intended to determine the adequate doses of d-tubocurarine chloride(d-Tc) for endotracheal intubation in patients with relative contraindication of using succinylcholine. We Observed the degree of vocal cord relaxation 3 minute after d-Te administration by fiberscopic examination and measured changes in mean blood pressure (MBP) and heart rate, just before, and after intubation, and 5 minutes after intubation. The total number of patients in this study was 100, and the patients were divided into five groups: Group 1, consisting of 10 patients, recieved 0.3㎎/㎏ of d-tubocurarine. Group 2, of 32 patients, recieved 0.4 ㎎/㎏ of d_Tc. Group 3, of 16 patients, recieved 0.45㎎/㎏ of d-Tc. Group 4, of 26 patients, recieved 0.5 ㎎/㎏ of d-Tc. Group 5, of 16 patients, recieved 0.6 ㎎/㎏ of d-Tc. The conclusions are summarized as follows; 1) The adequate doses of d-Tc for endotracheal intubation is 0.5 ㎎/㎏. 2) Maximum reductions in MBP were present 3 minutes following d-Tc administration in each group. 3) Heart rate did not change significantly after d-Tc administration in each group.

항암치료를 받고있는 환자의 마취관리

채병국 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.6

흰쥐에서 急性出血性 쇽에 의한 血小板 形態 變化의 電子顯微鏡的 觀察

蔡秉國,張聖鎬,辛正順 고려대학교 의과대학 1988 고려대 의대 잡지 Vol.25 No.1

Experimental studies have suggested that increased and liberated lysosomal enzymes contribute directly to the pathophysiology of hemorrhagic shork by exerting a splanchnic vasoconstrictor effect in the pancreas and in the entire splanchnic region. The major sources of these enzymes are thought to be the intestinal epithelium, liver, pancreas, spleen or kidney. On the other hand, blood platelet also contain large amount of lysosomal enzymes. Response of rat platelet to hemorrhagic shock was examined through using ultrastructural technique. The blood platelet of the rat pretreated with saline responded to hemorrhagic shock with decrease of α-granules and the development of the platelet canalicular system which opens to the extracellular environment and the pseudoped formation . So, these facts suggest that the granules observed to be released from platelet have strongly contributed to the rise in serum lysosomal enzyme. Glucocorticoid has been considered controversial in the treatment of hemorrhagic shock. Glucocorticoid, however, seems to stablized lysosomal membranes, providing cellular protection in hemorrhagic shock. The effect of dexamethasone almost completely inhibited morphological alterations in rat platelet 180 minutes after induction of hemorrhagic shock, and delayed the decrease of α-granules.

개흉수술후 Fentanyl 과 Bupivacaine 혼합약제의 경막외 지속적주입이 술후 진통효과 및 폐기능에 미치는 효과

김병기,장성호,채병국 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.2

Patients undergoing thoracotomy experience severe postoperative pain and marked respiratory impairment. Analgesics(narcotics or loeal anesthetics) administered via epidural catheter in epidural space have been shown to provide postoperative analgesia and improve respiratory mechanics after thoracotomy. Several different methods have been utilized in an attempt to reduce pain and pulmonary mechanics after thoracotomy. These include epidural blocks using local anesthetics, epidural narcotics, ketamine, steroid, and clonidine. These methods have been shown to provide pain relief with relative preservation of lung volumes in the postoperative period, but have disadvantages. Especially epidural local anesthetics may cause hypotension and motor blockade of lower extremities, and epidural narcotics may cause pruritus, nausea and vomiting, urinary retension and respiratory depression. In an attempt to provide excellent analgesia and improve pulmonary mechanics after thoracotomy and to decrease the side effects associated with the intermittent bolus administration of epidural narcotics or local anesthetics, we performed a study of continuously administered epidural infusion of small concentration of fentanyl combined with low concentration of bupivacaine. Twenty eight patients undergoing thoracotomy were randomized into groups based upon a postoperative pain regimen as indicated: Group I: intermittent intramuscualr injection of nalbuphine 0.2 mg/kg(n=13), Group II: continuous epidural injection of mixtures of 0.2/ bupivacaine and fentanyl 3 ug/ml(n= 15). Two, 8, 24 and 48 hours postoperative, the following indices were measured: visual analogue pain scale, vital capacity, tidal volume, arterial blood gas analysis(pH, PaCO₂, PaO₂), side effects, and 24 hour urine 17-ketosteroids. The results were as follows: 1) Pain score was evaluated by visual analogue pain scale postoperatively and the pain scores significantly decresed in group II as compaired with those in group I. 2) Vital capacity and tidal volume in group II were more improved than group I. 3) There was no difference in arterial blood gas analysis except for decreased PaO₂ at 2 hour and 24 hour compared with preoperative value in group I. 4) Major complications in group II were two cases of nausea and vomiting, one case of urinary retension, whereas only I patient in group I complained of nausea and vomiting. 5) No significant difference occurred in 24 hour urine l7-ketosteroid at 24 hour and 48 hour postoperatively in group I and group II, which were within normal limits.

실험견에서 흉추경막외마취가 급성미만성 폐포저산소증과 Nw-nitro-L-arginine 으로 유도된 폐고혈압증에 미치는 영향

김종욱,채병국 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.3

Thoracic epidural anesthesia has been used to manage intraoperative and postoperative pain for thoracic surgical patients with general anesthesia recently, And this combined anesthesia has been associated with less sedation, earlier ambulation, blunting of the stress response and better pain control in the post-operative period. But the effects of thoracic epidural anesthesia on pulmonary shunt, pulmonary vasoactivity and oxygenation are still unknown. The author has investigated the effects of thorarcic epidural anesthesia on pulmonary hypertension induced by acute diffuse alveolar hypoxia and N^W -nitro-L-arginine(L-NNA) in 12 mongrel dogs. Acute diffuse alveolar hypoxia which is similar to the early stage of acute respiratory failure may induce the pulmonary hypertension. And L-NNA, inhibitor of endothelium derived relaxing factor(EDRF), may also induce pulmonary hypertension under hypoxic state. The measurements were made three times, the first was baseline at room air ventilation. Following baseline recordings, saline 4 ml(group A, n=6) or 2% lidocaine 4 ml(group B, n=6) was injected through the epidural catheter and ventilation was started with hypoxic gas mixture(10% O2, 90% N2). The seeond measurements was made 30 min after the hypoxic ventilation and third was 20 min after infusion of L-NNA(50 mg/kg mixed with distill water 50 ml, infusion rate is 50 ml/20min) under the continuous ventilation with hypoxic gas mixture. The results were as follows: 1) There were significant changes in mean pulmonary arterial pressure, pulmonary vascular resistance in group A(p$lt;0.05) and in arterial and mixed venous oxygen tension, arterial and mixed venous oxygen content, intrapulmonary shunt in both groups(p$lt;0.05) 30 minutes after hypoxia but there were not significant differences between groups. 2) There were significant changes in mean pulmonary arterial pressure, in group B (p$lt;0.05) and pulmonary vascular resistance, systemic vascular resistance and mixed venous oxygen tension and content in both groups (p$lt;0.05) 20 miniutes after infusion of L-NNA under the continuous ventilation with hypoxic gas mixture but there were not significant differences between groups. But there were significant changes in central venous pressure in group B(p$lt;0.05) and significant differences between groups(p$lt;0.05) at 20 miniutes after infusion of L-NNA. These results indicate that thoracic epidura1 anesthesia does not influence the pulmonary hypertension directly and does not praduce any unfavorable hemodynamic events during pulmonary hypertension induced by acute diffuse alveolar hypoxia and N^W-nitro-L-arginine. Therefore thoracic epidural anesthesia shoud be valuable assistant to the general anesthesia for pulmonary hypertensive patients. (Korean J Anesthesiol 1995; 29: 317~328)

입원전후의 혈압과 마취유도전후 혈압의 관계

이병호,장성호,채병국,김지연 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.5

Background: There has been a study reporting those cases with elevated blood pressure (BP) above 140/90 mmHg on admission and normotension on ward showed more increase in mean arterial pressure(MAP) and pressure-pulse product than the normotensive or hypertensive patients in both situations. But the mean ages of the groups were different each other. This study was done to see if the same results would come without age differences. Methods: One hundred and sixty-two patients between the age of 45 and 64 were divided into three groups. The patients with BP below 140/90 mmHg on admission and on ward were included in group l(N=66) and those with BP above 140/90 mmHg on admission and below 140/90 mmHg on ward, in group 2(N=42) and those with BP above 140/90 mmHg in both situations were included in group 3(N=54). Preiinduction BP, PR, the changes of BP, PR during operation, incidence of hypertension at post-anesthesia room(PAR), and the number of cases who needed the use of inotropics or anti- hypertensives perioperatively were checked. Results: As for the increase of BP just before induction the group 2 showed the greatest, group 1 was the next, and group 3 showed the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next, and group 3 the least amount increase. As for the increase of preinduction pressure-pulse product(PPP) group 2 showed the greatest, group 3 the next, and group 1 the least compared to ward value. Just after induction group 1 showed the greatest, group 2 the next,and group 3 the least amount increase. Conclusions: Intensive anesthetic care is needed also at periinduction period for the patients who showed hypertensive BP on admission and normotension on ward thereafter.

전신마취후 전율시 Doxapram 용량에 따른 전율 억제 효과

이일옥,채병국 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.1

Among the pharmacological methods treating postoperative shivering, there were no studies which compare the doses of doxapram. In this study, we have compared the effectiveness of doxapram in a placebo-controlled, double blind method. Sixty patients who shivered after operation under general anesthesia were examined. They were allocated randomly to receive normal saline(n=15), doxapram l mg/Kg(n=15), 1.5 mg/Kg(n=15) or 2 mg/Kg(n=15) from identical syringes intravenously. The investigator who gave the intravenous injection was unaware of the treatment received by the patient, and assessed the shivering. Both doxapram 1.5 mg/Kg and 2 mg/Kg were effective on shivering within 1~2 minutes after intravenous injection. In the saline group, all patients were still shivering 10 minutes after injection. In the doxapram 1 mg/Kg group, only two patients had stopped shivering by 6, 7 minutes after injection. In the doxapram 1.5 mg/Kg group, only three patients were shivering after injection. In the doxapram 2 mg/Kg group, only one patient was shivering after injection. We conclude that doxapram 1.5 mg/kg and 2 mg/kg were effective on postoperative shivering. And the results suggested that doxapram 2 mg/kg may be marginally superior to doxapram 1.5 mg/kg in this respect. (Korean J Anesthesiol 1995; 29: 70~75)