Magnesium: a versatile drug for anesthesiologists

도상환 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.1

Magnesium sulfate has been used in preeclampsia patients in order to prevent seizure. It is also used for the treatment of arrhythmia and asthma and as an anesthetic adjunct in patients undergoing surgery for pheochromocytoma. However, its potentiating effects on perioperative analgesia and muscle relaxation have drawn attention recently. These characteristics of magnesium (anesthetic- and analgesic-sparing effect) enable anesthesiologists to reduce the use of anesthetics during surgery and the use of analgesics after surgery. Magnesium sulfate has a high therapeutic index and cost-effectiveness. Considering these diverse characteristics useful for anesthesia, appropriate use of magnesium sulfate would improve surgical outcome and patients’ satisfaction.

The effect of injection rate on etomidate-induced myoclonus

도상환,한성희,박상현,김진희,황진영,손일순,김민석 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.53 No.3

Background: Etomidate frequently causes myoclonus. Since the myoclonus is caused by a transient disequilibrium due to etomidate exposure in the CNS, we hypothesized that a slow rate of injection of the drug may decrease the incidence of myoclonus. We conducted a prospective randomized study to compare the effect of two different types of the etomidate injection rate on the incidence and severity of myoclonus. Methods: Fifty patients were randomly assigned to the fast-injection group (group F) or slow-injection group (group S): Group F patients received etomidate (0.3 mg/kg) over ten seconds. The same dose was administered over two minutes for group S patients. The response to the injection of etomidate was graded on a four-point scale in a blinded manner. The time to loss of consciousness (LOC) was also recorded. Results: The incidence of myoclonus was significantly lower (P < 0.001) in group S patients; 84% and 28% in group F and group S patients, respectively. The myoclonus was also significantly less severe in group S patients (P < 0.001). The time to LOC was significantly longer in group S patients (106 ± 22 sec) than that of group F patients (49 ± 18 sec, P < 0.001). Conclusions: With same dose, a slower rate of injection resulted in a lower incidence of myoclonus and can effectively reduce myoclonus without the use of a pretreatment agent. Background: Etomidate frequently causes myoclonus. Since the myoclonus is caused by a transient disequilibrium due to etomidate exposure in the CNS, we hypothesized that a slow rate of injection of the drug may decrease the incidence of myoclonus. We conducted a prospective randomized study to compare the effect of two different types of the etomidate injection rate on the incidence and severity of myoclonus. Methods: Fifty patients were randomly assigned to the fast-injection group (group F) or slow-injection group (group S): Group F patients received etomidate (0.3 mg/kg) over ten seconds. The same dose was administered over two minutes for group S patients. The response to the injection of etomidate was graded on a four-point scale in a blinded manner. The time to loss of consciousness (LOC) was also recorded. Results: The incidence of myoclonus was significantly lower (P < 0.001) in group S patients; 84% and 28% in group F and group S patients, respectively. The myoclonus was also significantly less severe in group S patients (P < 0.001). The time to LOC was significantly longer in group S patients (106 ± 22 sec) than that of group F patients (49 ± 18 sec, P < 0.001). Conclusions: With same dose, a slower rate of injection resulted in a lower incidence of myoclonus and can effectively reduce myoclonus without the use of a pretreatment agent.

Halothane, Enflurane 및 Isoflurane 이 Xenopus Oocyte에 발현된 m1 및 m3 무스카린성 수용체에 미치는 영향

도상환 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.6

Background: Muscarinic receptors are distributed abundantly in the central nervous system and peri-pheral visceral organs, and have a close relationship with anesthesia. We investigated the effects of halothane, enflurane or isoflurane on ml or m3 muscarinic signaling. Methods: Using two electrode voltage clamps, Ca2+-activated Cl- currents (ICl(Ca)) were measured in Xenopus oocytes injected with an ml or m3 receptor mRNA. ICl(Ca) was induced with the application of acetyl β -methylcholine with or without exposure to volatile anesthetics. Results: Halothane depressed the ml and m3 receptor function significantly (ml: 0.49 ± 0.17 ㎂ → 0.1 ± 0.05 ㎂, m3; 0.74 ± 0.2 → 0.23 ± 0.06 ㎂, p < 0.05). Enflurane also decreased signaling though both receptors significantly (ml; 0.49 ± 0.1 → 1 0.15 ± 0.04 ㎂, m3; 0.95 ± 0.34 → 0.19± 0.05 ㎂, p < 0.05). However, while isoflurane depressed m3 signaling significantly (0.82 ± 0.19 → 0.3 ± 0.09 ㎂, p < 0.05), it did not cause significant changes in ICl(Ca) through the ml receptor (0.29 ± 0.05 vs 0.23 ± 0.09 ㎂, p > 0.5). From a concentration-response curve, enflurane decreased ml and m3 signaling dose-dependently. Conclusions: Our data suggests that ml and m3 muscarinic receptors were depressed by halothane, enflurane or isoglurane except for the fact that the ml receptor was not affected by isoflurane. (Korean J Anestgesiol 2000; 39: 854 ~ 859)

내경정맥 천자시 발생한 긴장성 기흉

도상환,손종찬 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.12

A case is presented of tension pneumothorax during internal jugular catheterization. Pneu- mothorax is one of complications of internal jugular catheterization but is very rare. If it occurs after anesthetic induction, discontinuence of N2O is very important in order not to inerease the size of pneumotborax. And if general safety measures are observed such as uae of fine locator needle, confinement of needle depth and cannulation in end-expiratory phase, the occurrence rate of pneumothorax during the procedure could be much lessened.

마취통증의학 영역에서 MgSO4의 유용성

도상환 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.3

Perioperative hypomagnesemia is common in major surgical patients. MgSO4 infusion may be useful in the treatment of arrhythmia, asthma and postoperative shivering and in the prevention of hemodynamic stimulation associated with endotracheal intubation and surgery of pheochromocytoma. It may also enhance muscular relaxation and improve postoperative analgesia. It can be an ideal adjunct to propofol-remifentanil-based total intravenous anesthesia.

Propofol이 Xenopus Oocyte에 발현된 제3형 글루탐산염염 운반자의 활성도에 미치는 효과 : Protein Kinase C의 역할 The Role of Protein Kinase C

도상환,김진희,함병문,zhiyi zuo 대한정맥마취학회 2003 정맥마취 Vol.7 No.4

종설 : 마취제와 Glutamate Transporter

도상환 ( Sang Hwan Do ),임영진 ( Young Jin Lim ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.44 No.5

Failure after cerebrospinal fluid flow and success after no cerebrospinal fluid flow during spinal anesthesia induction for intrapartum cesarean section -A report of two cases-

윤희조,도상환,김권일 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.2

We report on failed spinal anesthesia (SA) after free flow of cerebrospinal fluid (CSF) and successful SA after no free flow of CSF in SA for laboring parturients undergoing emergency cesarean section (CS). We introduced a 25-gauge Sprotte type spinal needle for anesthesia for case 1 and confirmed backflow and aspiration of CSF. We injected 10 mg bupivacaine plus 15 g fentanyl. However, sensory and motor block were not observed. During SA for case 2, a convincing dural “pop” was felt but without flow of CSF. Injection of 10 mg bupivacaine and 15 g fentanyl produced successful sensory and motor block suitable for CS. The failure or success of SA in these intrapartum CS cases ran contrary to our expectations and could be related to the use of pencil-point needle and movement of the dura mater during labor.

Vasovagal cardiac arrest during spinal anesthesia for Cesarean section -A case report-

장영은,도상환,In-Ae Song 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.64 No.1

The vasovagal response is characterized by an inappropriate combination of bradycardia and paradoxical vasodilation. During a general or neuraxial anesthesia-induced sympathectomy, a sudden vagal activation and/or an acute reduction in sympathetic tone can cause serious vasovagal responses. Neuraxial anesthesia for Cesarean section may trigger vasovagal response, due to multiple risk factors; high neuraxial block, sudden hemorrhage, aortocarval compression, peritoneal manipulation, and emotional stress. A 39-year-old pregnant woman, at 38 weeks of gestation with episodes of non-sustained ventricular arrhythmia and newly developed vasovagal syncope during pregnancy, was scheduled to undergo a spinal anesthesia for an elective Cesarean section. Immediately after the placental expulsion, a sudden severe bradycardia, followed by a cardiac arrest occurred. The patient fully recovered after prompt cardiopulmonary resuscitation with chest compression, manual ventilation with oxygen, rapid injection of epinephrine and hydration. This case illustrates a serious potential risk of vasovagal response superimposed on neuraxial anesthesia, during a Cesarean section, especially during placental expulsion.

피부에서 흉부 경막외강까지의 깊이에 관한 연구

김용락,도상환 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.2

The depth from the skin to the thoracic epidural space was measured in 121 patients (41 male and 80 female patients) receiving epidural analgesia. The patients age, sex, height, weight were obtained before measuring the distance. The needle angle to the vertical axis to the skin was obtained during inserting Touhy needle. The mean depth was 6.0± 1.3 cm, which correlated with other anatomic measurements except height. The depth was correlated with the needle angle. The group with needle angle greater than 30 was greater in depth than the other groups. The mean depth was 6.0±1.4 cm in males and 6.0±1.3 cm in females and there was no difference in depth between male and female. The mean depth was 5.7±1.3 cm at the T5-6 interspace and 6.2±1.3 cm at the T6-7 interspace and there was no difference in depth between the two groups. (Korean J Anesthesiol 1995; 29: 244~248)