위절제술 후 경막외 통증자가조절에 사용한 Butorphanol과 Fentanyl의 비교

황기백,정찬종,이승철,이종환,오세혁 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.01

Background: Epidural butorphanol produces effective analgesia with fewer side effects than morphine in obstetric patients. The analgesic efficacy and side effects of epidural butorphanol were compared with epidural fentanyl for patient-controlled epidural analgesia (PCEA) after gastrectomy. Methods: After obtaining patient consent, 75 patients undergoing elective gastrectomy were randomly allocated to epidural butorphanol and epidural fentanyl groups. An epidural catheter was introduced at the T7-8 or T9-10 intervertebral spaces before operation. General anesthesia was maintained with N2O / O2, enflurane and vecuronium. Postop-erative analgesia was provided using a PCEA with either fentanyl 5μg/ml or butorphanol 50μg/ml in a 0.05% bupivacaine solution. When patients first required analgesics after complete recovery of conscious-ness from general anesthesia, a bolus of 5 ml of PCEA solution was initially administered in both groups. The PCEA was set to deliver a bolus of 2 ml, with a lockout interval of 10 min, and no basal infusion. PCEA consumption, pain intensity using a visual analog score (VAS), patient's satisfaction to PCEA, and side effects were evaluated. Results: No significant difference in PCEA consumption, VAS pain score, or patient's satisfaction to PCEA was found between the two groups. The incidence of pruritus in the butorphanol group was less than that in the fentanyl group (P < 0.05). Conclusions: PCEA with butorphanol provided similar postoperative analgesia with less pruritus than fentanyl in gastrectomized patients.

위절제술 후 경막외 통증자가조절에 사용한 Butorphanol과 Fentanyl의 비교

황기백 ( Ki Baek Hwang ),정찬종 ( Chan Jong Chung ),이승철 ( Seung Cheol Lee ),이종환 ( Jong Hwan Lee ),오세혁 ( Se Hyuk Oh ) 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.1

뇌동맥류가 파열된 산모에 제왕절개술과 뇌동맥류 클리핑을 동시에 시행한 마취관리

이수일,황기백,이정유,허재택,배승환 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.3

Aneurysmal subarachnoid hemorrhage in a pregnant woman is a rare catastrophic situation that places both the mother and fetus at high risk. When this situation arises, numerous relevant issues must be individualized in the effort to reduce hazards threatening both the mother and fetus. A 29 year old woman who was 39 weeks pregnant presented with a subarachnoid hemorrhage, secondary to a ruptured left ophthalmic artery aneurysm. Following initial full recovery, the simultaneous sequence of cesarean section followed by aneurysmal clipping was electively underwent. Successful maternal and perinatal outcome was achieved. The anesthetic management of the case is described and discussed. (Korean J Anesthesiol 1997; 32: 463∼466)

Logit, Probit, S형Emax로 계산된 효과농도의 추정값을 서로 비교할 수 있을까?

이수일,황기백,백창열 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.3

Propofol과 Enflurane 마취중 발생한 심부정맥

이수일,여광환,황기백,이황재,이종국 大韓臨床藥理學會 1998 臨床藥理學會誌 Vol.6 No.2

Isoflurane 의 최소폐포농도에 대한 Nalbuphine 의 효과

이종환,이수일,황기백,이정유 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.5

Background : The present study was performed to elicit what effect nalbuphine would have on isoflurane MAC(minimum alveolar concentration) in the patients undergoing lower abdominal surgery. Methods : Sixty-two women were randomly allocated to one of five study groups to receive an intravenous injection of no nalbuphine (group I), 0.25 mg/kg (group II), 0.5 mg/kg (group III), 1.0 mg/kg (group IV), 1.5 mg/kg (group V). Anesthesia and tracheal intubation were induced with propofol 2 mg/kg, succinylcholine 1 mg/kg. Patients were inhaled at a preset end-tidal concentration of isoflurane, which was maintained for 20 min. Response to skin incision, movement or no movement, was determined 30 minutes after nalbuphine injection. The isoflurane concentration of the next patient in the same group moved up or down in steps of 0.1∼0.3%, according to the previous patient's response. MAC was determined using the $quot;up-down$quot; method and logistic regression. Results : The MAC's of isoflurane were 1.09 vol% end-tidal in the cntrol group, 0.89 vol% in group II, 0.65 vol% in group III, 0.55 vol% in group IV, and 0.51 vol% in group V. Conclusions : It would be suggested that nalbuphine dose-dependently reduce the isoflurane MAC, and have ceiling effect on the reduction of isoflurane MAC. (Korean J Anesthesiol 1998; 34: 937∼943)

백서의 횡격막근-신경 표본에서 Vecuronium 의 근이완 작용에 미치는 캄슘 농도의 효과

이수일,이종환,황기백,고대권 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.2

Influence of Calcium Concentration on the Neuromuscular Effects of Vecuronium on the Hemidiaphragm-Phrenic Nerve of Rats Soo-il Lee, M.D., Dae Kwon Ko, M.D., Jong Hwan Lee, M.D. and Gi Baeg Hwang, M.D. Department of Anesthesiology, Dong-A University College of Medicine, Busan, Korea Background: Calcium disturbance may clinically produce diaphragmatic weakness. Extracellular calcium is necessary for diaphragmatic contraction, suggesting that the diaphragm behaves more like cardiac muscle. The effect of extracellular Ca^2+ concentrations on the relaxation action of vecuronium was studied in rat hemidiaphragm-phrenic nerve preparations. Methods: Hemidiaphragm-phrenic nerve preparations were obtained from male Sprague-Dawlley rats (200-300 g). Preparations were bathed in Kreb`s solution of (mM): NaCl 118, KCI 5, CaCl_2 2.5, NaHCO_3 30, KH_2PO_4 1, MgCl_2 1 and glucose 11, then maitained at 37℃ when aspirated with a mixture of 95% O_2 and 5% CO_2. Isometric forces generated in response to 0.1 Hz, 2 Hz for 2 seconds and, 50 Hz for 2 seconds with supramaximal electrical stimulation (0.2 msec, rectangular) to the phrenic nerve, were measured with a force transducer. Single twitch tension and peak tetanic tension were calculated as a percentage of control TOF fade was calculated as (1 ? [T_4/T_1] )×100. Each preparation was exposed to the alterations in calcium concentrations of the Kreb`s solution (3.75, 3.125, 1.5, 1.25, 0.625, 0.3125 (mM), and the adequate volume of vecuronium stock solution was added to the tissue bath for desired bath concentration. The effects of calcium and vecuronium were allowed to reach a steady state before measurement of tension parameters was done. Single twitch tensions or peak tetanic tensions, which were measured at each calcium concentration, were compared respectively. EC_5, EC_25, EC_50, EC_75, and EC_95 of vecuronium for a single twitch tension, TOF fade, and peak tetanic tension at each calcium concentration, were calculated using a sigmoid E_max model. We compared the EC _50 of vecuronium according to calcium concentrations. Data was compared by the Kruskal-Wallis test with a post hoc Wilcoxon rank sum test. A p-value of below 0.05 was considered significant. Results: The range of calcium concentration studied didn`t produce differences among single or tetanic tensions respectively. The EC_50` of vecuronium decreased as calcium concentration decreased. Conclusions: The reduction of calcium concentration can augment the action of vecuronium on the diaphragm. (Korean J Anesthesiol 2001; 41: 202~206)

다량의 Fentanyl을 사용한 신생아 및 유소아 심장수술 마취시 Pancuronium, Vecuronium 및 Pipecuronium의 심맥관계 영향

김상범,진영준,조상선,황기백 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.4

Back ground : High dose fentanyl for cardiac surgery in neonates, infants and children can cause severe bradycardia and chest wall rigidity that result in decreased cardiac output and oxygen desaturation due to fixed stroke volume in pediatric patients. To ameliorate the effects of fentanyl, it is common to administer neuromuscular blocking drugs with wanted cardiovascular side effects. This study was designed to compare the cardiovascular variables and oxygen saturation among different muscular relaxants in high dose fentanyl anesthesia. Methods : Thirty pediatric cardiac patients were allocated randomly into three muscle relaxant groups treated with 0.2 mg/kg pancuronium(n=10), 0.2 mg/kg vecuronium(n=10) or 0.2 mg/kg pipecuronium (n=10) after receiving an initial bolus dose of 25 g/kg of fentanyl. Changes of heart rate (HR), mean arterial blood pressure (MAP), rate-pressure-product (RPP) and oxygen saturation (SpO2) were observed. The same cardiovascular variables were also observed 1 and 2 minutes after the second bolus dose of 25 g/kg fentanyl and compared to the results among muscle relaxants. Results : HR, MAP and RPP decreased significantly(p<0.05) 1 and 2 minutes after injection of the 1st fentanyl, which returned to levels above the control value after administration of pancuronium, vecuronium or pipecuronium. Among muscle relaxants, pancuronium caused the most rapid and significantly high level compared to the control value in HR and MAP. Next was pipecuronium and then vecuronium. In clinical setting, SpO2 was decreased after the 1st fentanyl injection and increased after the injection of muscle relaxants, but not significant statistically. Conclusion : In view of hemodynamic changes, pancuronium is most efficient and rapid in returning the hemodynamic variables that was decreased after high dose fentanyl anesthesia in neonates, infants and children whose cardiac output was dependent on HR due to relatively fixed stroke volume. (Korean J Anesthesiol 1997; 33: 669∼675)

산소유량과 일회환기량이 아산화질소 배출에 미치는 영향의 약동학적 고찰

이정현,이수일,정찬종,황기백,배승환 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.6

Background: There are few literatures which show the role of tidal volume on the excretion of nitrous oxide(N₂O). The purpose of this study is to pharmacokinetically evaluate the effect of varying oxygen inflow rates and tidal volumes on the excretion of N₂O. Methods: Ten patients undergoing general anesthesia on supine position were selected. Administering N₂O 3 L/min and oxygen 2 L/min with enflurane, ventilatory pattern was tidal volume 10 mL/kg and respiratory rate 11/min. Administration of N₂O was stopped after 30 minutes, when end-tidal N₂O concentration(ETN₂O) were near 60% at steady state. Oxygen was given at 4 L/min with tidal volume(V(T)) 8 mL/kg(treatment 1), 4 L/min with VT 16 mL/kg(treatment 2), 8 L/min with V(T) 8 mL/kg(treatment 3) and 8 L/min with V(T) 16 mL/kg(treatment 4). ETN₂O was measured every 15 seconds for first 3 minutes and every 1 minute thereafter. The order of 4 treatments were determined with bloc randomization. The time interval between treatments was 30 minutes. Pharmacokinetic parameters were obtained using PKCALC data program. Results: Area under curve and clearance in treatments 1 and 2 were significantly larger than those in treatments 3 and 4. Mean residence time and half-life in treatment 4 were significantly shorter than those in other treatments. Conclusions: The oxygen inflow rate enhances the excretion of N₂O more than the tidal volume does, and the tidal volume does so when the oxygen inflow rate is 8 L/min.

폐 수술을 받는 환자의 미다졸람 약동학

이수일,이종환,김승수,황기백 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.5

Background : The nature of operation alters the volume of distribution at steady state(Vdss) of drug. The hepatic extraction ratio of midazolam(0.3∼0.7) could be influenced by hepatic blood flow(HBF), and hepatic enzyme activity. The pharmacokinetics of intravenous midazolam were determined in patients undergoing lung surgery. Methods : Midazolam, 0.2 mg/kg, was administered to five patients undergoing lung surgery at 30 minutes after induction of anesthesia. Anesthesia was maintained with O2-enflurane for one lung ventilation. Blood samples from artery were drawn at increasing intervals for 12 h. Plasma midazolam concentrations were measured by gas chromatography. Computer simulations of the times required for 20%, 50%, and 80% decreases in midazolam concentrations were performed. Results : A three compartment model best described the concentration versus time data. The volume of the central compartment(Vc) and volume of distribution at steady state(Vdss) were 4.3 2.8 l and 59.9 20.1 l, respectively. The elmination half-life was 3.4 2.2 h. Simulations indicate that under all the situations, the concentrations would decrease more rapidly in our patients in spite of similar Vdss and elimination half-life of patients undergoing minor gynecological surgery. Conclusion : The elimination half-life was in the range of previously reported values. The shorter recovery time is apparently due to relatively faster redistrubution, and relatively greater capacity for redistribution. (Korean J Anesthesiol 1997; 33: 822∼828)