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만성 허혈 후 통증모델에서 발생한 건측의 이질통과 척수의 중추감작
곽경화 ( Kyung Hwa Kwak ),정경영 ( Kyung Young Jung ),최지영 ( Jy Young Choi ),류태하 ( Tae Ha Ryu ),여진석 ( Jin Seok Yeo ),박성식 ( Sung Sik Park ),임동건 ( Dong Gun Lim ),김시오 ( Si Oh Kim ),백운이 ( Woon Yi Baek ),홍정길 ( Ju 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4
Background: Mirror-image allodynia is a mysterious phenomenon that occurs in association with many clinical pain syndromes including complex regional pain syndromes (CRPS). Underlying mechanisms for the development of such pain are still a matter of investigation. Several studies suggest that activation of the N-methyl-D-aspartate (NMDA) receptor is essential for central sensitization as a base for persistent pain. The aim is to assess whether alteration of NMDA receptor expression correlates with the contralateral allodynia in the chronic post-ischemia pain (CPIP) model rats representing CRPS-Type I. Methods: Application of a tight-fitting tourniquet for a period of 3 hours before reperfusion produced CPIP in male Sprague-Dawley rats. The mechanical paw withdrawal thresholds to von Frey stimuli (using a dynamic plantar aesthesiometer) were measured as pain indicators in ipsilateral and contralateral hindpaws. Phosphorylation of the NMDA receptor 1 subunit (pNR1), assessed with Western blot, was measured in the contralateral L4-6 spinal cord. Results: Ipsilateral and contralateral mechanical allodynia is present at 4 hours after reperfusion, peaked at 3 days, and continued for 7 days after reperfusion. The relative density of pNR1 of CPIP rats significantly decreased in the contralateral L4-6 spinal cord compared to baseline value (P<0.05). There was significant correlation between paw withdrawal threshold and the relative density of pNR1 (ipsilateral; R2=0.75, P<0.01, contralateral; R2=0.60, P<0.01). Conclusions: These data suggest that pNR1 is correlated to the contralateral mechanical allodynia in CPIP rats. (Korean J Anesthesiol 2009;56:419~24)
임상연구 : 갑상선절제술 환자에서 술 후 오심과 구토 예방을 위한 Ramosetron의 효과
김현지 ( Hyun Jee Kim ),곽경화 ( Kyung Hwa Kwak ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Background: Postoperative nausea and vomiting remains a common problem following thyroidectomy. This study was designed to compare the prophylactic effects of ramosetron with dexamethasone on postoperative nausea and vomiting (PONV) in women undergoing thyroidectomy. Methods: In this randomized, double-blinded, placebo-controlled study, one hundred fifty women (ASA physical status 1, 2), scheduled for thyroidectomy, were allocated to one of three groups. They received an intravenous saline (group C), dexamethasone 0.15 mg/kg (group D) or ramosetron 6μg/kg (group R) after induction of anesthesia. The incidence and severity of PONV, the need for rescue antiemetics, and the side effects of antiemetics during 48 hours after surgery were evaluated. Results: The incidence of PONV of group R and D was similarly lower than that of group C, with an incidence of 14%, 22%, 66%, respectively (P<0.01; group R versus group C, group D versus group C). However, the severity of nausea and the need for rescue antiemetics of group R were significantly lower than those of group D and C. Conclusions: Our results showed that both ramosetron and dexamethasone were effective as prophylactic antiemetics in women undergoing thyroidectomy. But, compared with dexamethasone, ramosetron was more effective in reducing the severity of PONV and the need for rescue antiemetics. (Korean J Anesthesiol 2007; 53: 425~9)
김영수 ( Young Soo Kim ),곽경화 ( Kyung Hwa Kwak ),홍정길 ( Jung Gil Hong ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.2
We experienced an unusual complication of acute radial nerve palsy presenting as wrist drop after application of automated cycled blood pressure monitoring for 3 hours. A 19-year-old ASA physical status 1 female was scheduled to undergo nail removal, had been operated internal transport over the nail lengthening for fibular hemimelia. Blood pressure cuff was affixed to her right upper arm and worked automatically every 5 minute during surgery. One day after operation she complained of pain over the lower lateral aspect of the right upper arm and examination revealed zero power of the wrist and finger extensor muscles. Electromyelography (EMG) and nerve conduction velocity (NCV) revealed right radial neuropathy. She was discharged 20 days after operation with improvement of the right upper arm pain. After three months of physical therapy, the muscle power of wrist extensors reverted to completely normal and the muscle power of the finger extensors improved to fair. (Korean J Anesthesiol 2009;57:217∼20)
증례보고 : 술 후 난치성 딸꾹질 환자에서의 일측 횡격막 신경차단 치료 -증례보고-
최광욱 ( Gwang Wook Choi ),곽경화 ( Kyung Hwa Kwak ),전영훈 ( Young Hoon Jeon ),홍정길 ( Jung Gil Hong ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Hiccup is caused by synchronous contractions of the diaphragmatic and intercostal muscles followed by the closure of the glottis. Intractable hiccup is defined as hiccup bouts lasting more than 48 hours or recurring despite various treatments. Recently we have experienced a case of postoperative intractable hiccup. We failed to stop intractable hiccup by pharmacological treatment, but succeeded by unilateral phrenic nerve block. (Korean J Anesthesiol 2006; 50: 592~5)
임상연구 : 대장 절제술에서 수술 중 N-acetyl-cysteine의 투여가 수술 후 회복 시간에 미치는 영향
하인호 ( In Ho Ha ),곽경화 ( Kyung Hwa Kwak ),한창규 ( Chang Gyu Han ),이인택 ( In Taek Lee ),최규석 ( Gyu Seog Choi ),김인겸 ( In Kyeom Kim ),백운이 ( Woon Yi Baek ),임동건 ( Dong Gun Lim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Background: The gut is an important area for inflammatory responses. Gut manipulation during open laparotomy compared with laparoscopic surgery, increases the inflammatory responses. Laparoscopic assisted colectomy (LC) with less bowel manipulation might minimize the inflammatory responses and oxidative stress, and offer a faster postanesthetic recovery than an open colectomy (OC). This study evaluated the effect of N-acetyl-cysteine (NAC), an antioxidant, on the recovery after colectomy. Methods: 116 colorectal tumor patients were reviewed retrospectively. The patients were divided into 3 groups; LC by surgeon A (A-L), OC by surgeon A (A-O) and OC by surgeon B (B-O). The postanesthetic recovery scores (PARS) were compared. In the prospective randomized controlled trial, the colorectal tumor patients were assigned to one of four groups; laparoscopic assisted colectomy (L - N) with NAC infusion (L + N), open colectomy (O-N) with NAC infusion (O + N). In the NAC groups, NAC (5 mg/kg/h) was infused after intubation to extubation. The PARS were compared. Results: In the retrospective study, the time to reach 10 points, which satisfies the discharge criteria in the PACU, was significantly lower in the A-L group than in the other groups. In the prospective study, the time to 10 points was shorter in the O + N group than in the O-N group. NAC offered no added benefits to the L + N and L-N groups. Conclusions: NAC offered faster recovery in the OC group but not in the LC group. (Korean J Anesthesiol 2006; 51: 436~42)
임상연구 : Remifentanil과 Ketamine 전투여가 Propofol 정주 시 발생되는 혈관통에 미치는 영향
홍성욱 ( Seong Wook Hong ),곽경화 ( Kyung Hwa Kwak ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: There is a high incidence of pain associated with an intravenous injection of propofol, and different methods have been used in an attempt to minimize the incidence and severity of this pain. This study compared the effect of a ketamine pretreatment with that of a remifentanil pretreatment on the pain associated with a propofol injection. Methods: 225 ASA physical status 1-2 adult patients scheduled for elective surgery were enrolled into this randomized double blind study. The patients received 2 ml of saline (n = 45), 2 ml of ketamine 20 mg (n = 45), 2 ml of remifentanil 0.01 mg (n = 45), or 2 ml of remifentanil 0.02 mg (n = 45) or 2 ml of remifentanil 0.03 mg (n = 45) 30 seconds prior to administering 2 mg/kg of 1% propofol. An anesthesiologist who was blinded to the study asked the patients to evaluate the pain using a four-point scale (none, mild, moderate, severe). Results: The remifentanil 0.02 mg, remifentanil 0.03 mg and ketamine groups showed significantly less frequent and intense pain than the saline group (P < 0.05). The remifentanil 0.02 mg and 0.03 mg provided as much pain relief as ketamine (P > 0.05), but the remifentanil 0.01 mg did not (P < 0.05). There was a similar incidence of injection pain in the remifentanil 0.02 mg and remifentanil 0.03 mg groups. Conclusions: An intravenous remifentanil 0.02 mg or remifentanil 0.03 mg pretreatment is as effective in alleviating the pain associated with a propofol injection as a intravenous ketamine pretreatment. The remifentanil 0.03 mg pretreatment had a similar analgesic effect relative to the remifentanil 0.02 mg pretreatment. (Korean J Anesthesiol 2006; 51: 302~7)
증례보고 : 양측 경피적 신절석술 후 발생한 급성 폐부종
김지안 ( Jee Ahn Kim ),곽경화 ( Kyung Hwa Kwak ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Percutaneous nephrolithotomy (PCNL) is currently the procedure of choice for the removal of large and complex renal calculi. With recent developments in percutaneous access technique and in equipment for the disintegration of calculi, simultaneous bilateral PCNL has become safe. However the complications include hemorrhage, extravasation and absorption of large volumes of irrigation fluid, fever, infection, colonic perforation and pneumothorax. A 46-year-old, 59 kg, female patient in our care developed acute pulmonary edema after simultaneous bilateral PCNL under general anesthesia. The preoperative chest X-ray was normal. The patient recovered following 36 hours of intensive treatment involving fluid restriction, diuretics, sedation and continuous airway pressure ventilation. (Korean J Anesthesiol 2007; 53: 270~3)