담낭절제술 환자에서 늑막강내에 투여된 Bupivacaine의 진통효과

구길회(Gill Hoi Koo) 대한통증학회 1989 The Korean Journal of Pain Vol.2 No.2

N/A Inadequate pain relief after upper abdominal surgery increases the incidence of pulmonary compli- cations due to the difficulty in coughing and deep breathing. Kvalheim and Reiestad (1984) introduced intrapleural administration of local anesthetic solutions to produce analgesia following cholecystectomy performed through a subcostal incision, unilateral breast surgery and renal surgery. We studied continuous intrapleural administration of bupivacaine and epinephrine, and its effect in controlling pain after cholecystectomy. In 9 patients, an intermittent dosage technique was used. An intrapleural catheter was inserted and 20 ml of 0.5% bupivacaine and 1:100,000 epinephrine was administered. Results were as following: 1) Mean analgesic duration from the initial intrapleural injection to secondary administration of supplementary bupivacaine was 13.5 hours. 2) No specific changes were noted on vital signs and arterial blood gases. 3) Effective analgesia, produced by intrapleural bupivacaine resulted in significant improvement in tidal volume as measured by spirometry. 4) No signs of systemic toxicity and complications were encountered. 5) lntrapleural administration of a local anesthetics after cholecystectomy provides a satisfactory duration of analgesia.

임상연구 : 마취동의서에 대한 실태 연구

구길회 ( Gill Hoi Koo ),정용훈 ( Yong Hun Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2

Background: As the problems of medical malpractices become a very serious social issue, it is necessary to increasingly relate law to medical practice and evaluate medical services. However, it is not easy to legally call someone to account, as medical services are highly specific, especially anesthetic management. Anesthesiologist can expect to be involved in legal action alleging malpractice, either as a defendant or expert witness. Methods: The anesthetic informed consent form was examined at 42 general hospitals in the Republic of Korea. The chief physician of the department of anesthesiology and pain medicine was asked for the anesthetic informed consent form they used in clinical anesthetic practice, and then what constitutes adequate informed consent analyzed. Results: All of the hospitals were using informed consent forms, but 42.9% of the hospital used a specific form to describe the complications or risks associated with anesthetic management. In 71.4% of hospitals, the anesthesiologists or anesthetic residents explained the anesthetic risk, but 28.6% of hospitals the anesthetic complications were explained by nurses or surgeons. In 76.2% of hospitals, the anesthetic risks were explained to both the patients and parents, but in 23.8% these were explained to parents only. Conclusions: We propose a new anesthetic informed consent form for adequate explanation and agreement to legal requirements. (Korean J Anesthesiol 2007; 52: 179~86)

우측 성상 신경절 차단이 기관내 삽관에 따른 심혈관계 반응에 미치는 영향

오수원(Soo Won Oh),구길회(Gill Hoi Koo) 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1

N/A Back ground: Endotracbeal intubation is one of the methods most securely establishing airway. But accompanying hemodynamic responses ate harmful to coronary or cerebral vascular disease patients. These hemodynamic responses are regarded as the results of sympathetic stimulation due to pbaryn- golaryngeal stimulation, and sympathetic blocking method-stellate ganglian block- may be obtundate these hemodynamic respmees. Methods: 75 paticnts of ASA physical status I-II were selected. There were 40 patients normotensive (Group 0, 35 patients hypertensive (Group II) Group I, steliate ganglion block was performed on 20 patients (Group I-S) the remainder bad no procedure (Group I-O). Group II, 18 patients received SG3 (Group II-S), 17 patients had no procedure (Group II-O). SGB was performed with 1% lidocaine 8 ml on right stellate genglion after patients consent. Blood pressure 0IP) and pulse rate(PR) were first measured in the pre-anestbesia room. Follow up BP and PR are checked immediately following SGB and every 5 minutes far subsequent 20 minutes, then after arrival at operatig room, then immediately after intubation and at 3, 5, 10, 15 and 20 minutes after intubation. Results: All poup experienced significantly increased blood pressure and pulse rate upon arrival at the pre-anesthesetic and opeating rooms, as compared to when patients rates in the ward. After intubation and for subsequent 5 minutes, significant changes were measured. Patients then recovered to preblock value. In Group I, no statistical significance was recorded between subgroup I-S and I-O. However in Group II, there were significant differences between sub-group II-S and II-O. In evaluating pulse rate changes, there were no significant differences between Group I-S and I-O; nor II-S and II-O. Conclusion: The proper diagnosis of Stellate Ganglion Block had some measure of protective effect as hemodynamics following endotracheal intubation, especially in hypertensive patients.

가토에서 국소 마취제와 Epinephrine이 대퇴동맥의 혈류에 미치는 영향

오수원(Soo Won Oh),구길회(Gill Hoi Koo),이춘희(Cho 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1

N/A Many surgeons and anesthesiologists prefer using vasoconstrictor mixed with local anes- thetic agent to reduce the incidence of side effects and prolong the duration of analgesia because most local anesthetic agents, except cocaine, were believed to possess vasodilating effect. However, some investigators recently reported vasoconstricting effect of local anes- thetic agents. There is still controversy on the vasoactive effect of local anesthetic agents. So this study is aimed to clarify the vasoactive effect of local anesthetics in the animal model resembling clinical settings. Rabbits were anesthesized with ketamine and halothane, and respirations were controlled with Harvard animal ventilator. Lidocaine(0.5%, 1.0%, 1.5%) and bupivacaine(0.125%, 0.25% and 0.5%) with or without 1:100,000 epinephrine were subdermaly injected on the femoral areas of 24 rabbits. The concentration-dependent vasoactive effects of lidocaine and bupivacaine on the femoral artery were measured with Doppler flow meter in vivo. The mean arterial pressure, pulse rate, arterial blood gases, pH and level of serum electrolytes were measured at every 2 minute interval for 30 minutes. Results were as follows: l) There was no significant vasoconstriction with 0.5% lidocaine and 0.125% bupivacaine. 2) Statistically significant(p<0.05) vasodilations were observed with lidocaine(1.0-2.0%) and bupivacaine(0.25-0.5%). 3) There were no changes on the duration of vasodilation induced by local anesthetic a- gents of various concentrations. 4) Onset of vasodilation induced by local anesthetic agents of high concentrations were faster than that of lower concentrations. 5) In the mixed injection group of epinephrine and local anesthetic agent, the vasocon- striction induced by epinephrine was completely reversed by local anesthetics, approxi- mately 5 minutes later. In conclusion, local anesthetic agents at dose exceeding 1.0 % lidocaine and 0.25 bupivacaine increase local blood flow significantly in animal study in vivo which is appli- cable in human clinical settings. The increase blood flow may be due to dilatation of blood vessel. Further study on the analysis of association between amount of absorbed local an- esthetics in the blood vessels and dilatation of blood vessels is needed.

양측 교대형 안면신경 마비의 치험

우영철(Young Cheol Woo),구길회(Gill Hoi Koo) 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.2

Facial nerve paralysis is a common pain clinical diagnosis. But ipsilateral or contralateral recurrent facial paralysis is found in about 2.6-19.5% of facial paralysis and especially bilateral facial paralysis is rare. While idiopathic facial paralysis is the most common diagnosis, a comprehensive evaluation must be completed prior to this diagnosis in patients with bilateral facial paralysis. A representative case of bilateral alternating facial paralysis treated with stellate ganglion block (SGB) is presented. A 57 years old male patient who had the onset of a right facial paralysis 7 months ago visited pain clinic. Five months after the onset of right facial paralysis, as it was improving, he developed a left facial paralysis. He had history of hypertension, diabetus mellitus and pain episode on mastoid process before facial paralysis developed. Electrical test showed incomplete neuropathy on both side and computed tomography (CT) scan was normal. He was treated with SGB, physical theraphy and aspirin medication. After 25 times SGB, he was recovered almost completely.

증례보고 : 상장간막동맥증후군 환자의 전신마취 유도 중 발생한 흡인성 폐렴

정용훈 ( Yong Hun Jung ),구길회 ( Gill Hoi Koo ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4

Superior mesenteric artery syndrome (SMAS) is a rare clinical disease. SMAS is defined as the entrapment of the third portion of the duodenum by the aorta and the superior mesenteric artery. A 14-year-old male patient was admitted to the local hospital for an emergency appendectomy under general anesthesia. In the process of inducing general anesthesia, massive pulmonary aspiration of gastric contents and bile juice occurred by accident. After surgery, he was transferred to our hospital due to severe ARDS. The gastroduodenoscopy observations, CT, and clinical symptoms, were indicative of SMAS. Surgery was considered because medical conservative treatment of SMAS was ineffective. SMAS was confirmed on the surgical fields. We report our experience with a review of the relevant literature because this condition can be associated with serious complications during general anesthesia. (Korean J Anesthesiol 2006; 51: 512~5)

임상연구 : 백내장적출술을 위한 안구후차단시 Remifentanil, Alfentanil, Fentanyl이 혈역학적 변화와 진통, 진정효과에 미치는 영향

임세근 ( Sei Keun Im ),구길회 ( Gill Hoi Koo ),강현 ( Hyun Kang ),백종화 ( Chong Wha Baek ),박정원 ( Jung Won Park ),정용훈 ( Yong Hun Jung ),우영철 ( Young Cheol Woo ),김진윤 ( Jin Yun Kim ),박선규 ( Sun Gyoo Park ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4

Background: This study was designed to compare the effects of remifentanil, alfentanil, and fentanyl on the hemodynamic changes, sedation, and analgesia when administered with small doses of midazolam in patients undergoing a retrobulbar block for cataract surgery. Methods: Sixty patients scheduled for cataract surgery were divided into 4 groups (n = 15 for each group). Firstly, group C received 5 ml of a normal saline solution, 3 min before a retrobulbar block. Next, group R received remifentanil 0.3μg/kg. Furthermore, group A received a 4.5μg/kg dose of alfentanil, 90 s before a retrobulbar block, and group F received fentanyl 0.6μg/kg, 210 s before a retrobulbar block. All solutions were mixed with normal saline to a 5 ml volume. In group R, A, and F, midazolam (0.5 mg for patients over the age of 65 years; 1.0 mg in patients under the age of 65 years) was injected 3 min before the retrobulbar block. Results: The systolic blood pressure in patients significantly increased at 1 or 2 minutes after a retrobulbar block in group C and at 1 minute in group F. For group R, the systolic blood pressure decreased significantly at 3, 4, 5, and 10 minutes, and at 2, 3, 4, 5, and 10 minute in group A. The mean OAA/S scale during a retrobulbar block significantly declined in groups R and A. The VAS score for pain was significantly lower in groups R and A, whereas the VAS anxiety index was significantly lower in groups R, A, F compared to group C (P<0.05). Conclusions: We found that the combination of remifentanil or alfentanil with midazolam showed better hemodynamic stability, sedative, and analgesic effects compared to fentanyl with midazolam in the retrobulbar block for cataract surgery. (Korean J Anesthesiol 2007; 53: 441~7)

실험연구 : 백서에서 산성식염수 반복주사로 유발된 이질통에 대한 Minocycline의 영향

강현 ( Hyun Kang ),우영철 ( Young Cheol Woo ),백종화 ( Chong Wha Baek ),박정원 ( Jung Won Park ),정용훈 ( Yong Hun Jung ),김진윤 ( Jin Yun Kim ),구길회 ( Gill Hoi Koo ),박선규 ( Sun Gyoo Park ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1

Background: Activation of glial cells (microglia and astroglia) has been observed in rat neuropathic pain models and they are known to play a role in inducing allodynia in these animals. Minocycline (MC), a tetracycline derivative antibiotics, displays selective inhibition of microglial activation. The author investigated antinociceptive effect of intrathecal administration of MC on muscular pain model induced by repetitive intramuscular injection of low pH saline. Methods: pH 5 saline was injected into gastrocnemius muscle of rat. Second injection of pH 5 saline was done 3 days after first injection. To study preventive effect of MC, normal saline or MC 50μg or 100μg was administered intrathecally 15 min before each low pH saline injection. To evaluate the therapeutic effect, normal saline or MC 500μg was administered intrathecally after pain model made. To quantify the mechanical allodynia, withdrawal threshold to mechanical stimuli was measured using von Frey filament. Results: Preventive administration of MC 50μg did not attenuate the mechanical allodynia, on the contrary MC 100μg administration showed pain attenuation. Therapeutic administration of MC 500μg did not show analgesic effect. Conclusions: Preventive intrathecal administration of MC 100μg attenuated mechanical allodynia, but not in preventive MC 50μg and therapeutic administration. (Korean J Anesthesiol 2007; 53: 97~103)

부인과 환자에서 정맥 내 자가통증 조절시 수술 후 오심 및 구토를 예방하기 위한 Ondansetron의 지속투여

임승모 ( Seung Mo Lim ),김진윤 ( Jin Yun Kim ),강현 ( Hyun Kang ),백종화 ( Chong Wha Baek ),박정원 ( Jung Won Park ),정용훈 ( Yong Hun Jung ),우영철 ( Young Cheol Woo ),구길회 ( Gill Hoi Koo ),박선규 ( Sun Gyoo Park ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.2

임상연구 : 슬관절 전치환술을 받는 노인환자에서 혈역학적 변화를 최소화하기 위해 지속 정주한 Remifentanil과 Esmolol, Nicardipine의 비교

백종화 ( Chong Wha Baek ),곽미정 ( Mi Jeung Gwak ),고나영 ( Na Young Ko ),강현 ( Hyun Kang ),박정원 ( Jung Won Park ),정용훈 ( Yong Hun Jung ),우영철 ( Young Cheol Woo ),김진윤 ( Jin Yun Kim ),구길회 ( Gill Hoi Koo ),박선규 ( Sun 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4

Background: The use of tourniquet is associated with severe hemodynamic changes, particularly in elderly patients. This study examined the effects of continuously infused remifentanil or nicardipine with esmolol on the attenuation of the hemodynamic changes with enflurane inhalation during total knee arthroplasty in elderly patients. Methods: Thirty elderly female patients undergoing total knee arthroplasty were enrolled into this randomized, prospective study. Remifentanil (group R) or nicardipine with esmolol (group EN) was infused using a titration method to maintain a mean arterial pressure (MAP) of 90 mmHg to 70 mmHg during tourniquet inflation. In addition, the inhalation of enflurane was adjusted to guarantee a hypnotic state based on entropy. The hemodynamic variables, inhaled concentration of enflurane, recovery time, and postoperative pain characteristics were measured and compared. Results: Following tourniquet inflation, the MAP was increased and maintained in the target since 20 min after that in both group. Following tourniquet deflation the MAP was decreased significantly in both groups and more patients in group R required a vasopressor. Group R inhaled a lower enflurane concentration and showed more rapid recovery than group EN. There were no significant differences in the level of postoperative pain between the two groups. Conclusions: These results suggest that remifentanil is more likely to be associated with hypotension after tourniquet deflation and require more attention than nicardipine with esmolol. (Korean J Anesthesiol 2007; 53: 463~9)