비노인과 노인에서 척추마취 시 비교

박상융,김정호,임종철,김정아,이지현,최소론,이승철,이종환,정찬종 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.2

Background: The clinical features of spinal anesthesia may differ between young and old patients because of the anatomical and physiological changes that occur with an increase in age. This study was performed retrospectively to compare the clinical aspects of spinal anesthesia between the non-elderly and elderly patients. Methods: We investigated the medical records of 1,180 adult patients who received spinal anesthesia during a one-year period. They were divided into two groups on the basis of 65 years of age; the non-elderly patient group (Y group, n = 813) versus the elderly patient group (E group, n = 367). Pre-, intra-, and postoperative data related to spinal anesthesia were collected. The data about satisfaction and causes of dissatisfaction with the procedure were evaluated. Results: There were significant differences between the two groups in terms of age, height, and weight, except for sex. Significantly more than two attempts at spinal puncture were performed in the E group (37.6%) than in the Y group (21.4%). There were no statistically significant differences in perioperative complications after spinal anesthesia between the two groups. There were no significant differences in the reported causes of dissatisfaction between the two groups. The rate of wanting to undergo spinal anesthesia in the future was 96.4% in the Y group and 97.5% in the E group, which showed no statistically significant difference. Conclusions: Although the elderly patients had to undergo more spinal puncture attempts, more than 90% of the elderly patients were satisfied with spinal anesthesia and wanted to undergo spinal anesthesia again for similar surgeries in the future.

Antinociceptive Effect of BPC-157 in the Formalin-induced Pain Model

박상융,최소론,김정호,이승철,정성엽,정준호,이태영 고신대학교(의대) 고신대학교 의과대학 학술지 2021 고신대학교 의과대학 학술지 Vol.36 No.1

Objectives: Body protective compound-157 (BPC-157) is a stable gastric pentadecapeptide that has been effective in trials aiming to increase wound healing capabilities and decrease inflammatory cell influx, including studies on the healing of muscles and tendons. There are no studies about the effect of BPC-157 on pain transmission via nociception. This study examined the antinociceptive effects of BPC-157 using formalin tests and immunohistochemistry. Methods: Rats were randomly divided into the control, morphine and BPC-157 groups. Pain behavior was quantified periodically at 5- and 35- min intervals (representative values of phases 1 and 2) by counting the number of flinches exhibited by the injected paw after injection. The dorsal root ganglia (DRG) and spinal cords (SC) were collected, and then, the number of cytokine-positive cells was determined via immunostaining. Results: BPC-157 dose-dependently decreased the number of flinches during phase 1 but did not decrease the number of flinches during phase 2. During phase 1, interleukin-1β (IL-1β) in the DRG tissue was significantly different in the morphine, 10 μg/kg BPC-157, and 20 μg/kg BPC-157 groups. During phase 2, statistical significance was achieved in the DRG tissue in the morphine, 20 μg/kg BPC-157, and 40 μg/kg BPC-157 groups. During phase 1, interleukin-6 was significantly different in the DRG tissue in the morphine group and the SC tissue in the 10 μg/kg BPC-157 group. During phase 2, statistical significance was achieved in the morphine group and the BPC-157 20 μg/kg group in both the DRG and SC tissues. There were no significant differences in tumor necrosis factor-α between the DRG and SC tissues. Conclusions: BPC-157 was effective during phase 1 but not during phase 2, as determined by the formalin test. BPC-157 decreased the expression of IL-1β in the DRG tissue in phases 1 and 2.

Adrenal incidentaloma: a case of asymptomatic pheochromocytoma

박상융,최소론,임종철,조현철,이윤찬,김정아 고신대학교(의대) 고신대학교 의과대학 학술지 2018 고신대학교 의과대학 학술지 Vol.33 No.2

An incidentaloma is a tumor found incidentally without clinical symptoms or suspicion; the lesion may be adrenal, pituitary, or thyroidal. We report the case of an asymptomatic individual with preoperatively undiagnosed pheochromocytoma (size: 4.86 ㎝) that was revealed using elective nonadrenal surgical procedures. The patient demonstrated peri- and post-operative hypertensive crisis and tachycardia. Three days after the dramatic onset of symptoms, the patient expired due to pulmonary edema, multiple organ failure, and terminal sepsis, despite administration of extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation. A left medial kidney mass obtained at autopsy confirmed pheochromocytoma.

Spinal anesthesia for urgent Cesarean section in a patient with uncontrolled hyperthyroidism due to Gra-ves’ disease - A case report

박상융,최소론,Jeong Joonho,김정호 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.3

Background: Effective treatment of Graves’ disease during pregnancy is important because uncontrolled hyperthyroidism is associated with increased fetal and maternal morbidity and mortality. While there have been case reports of patients with Graves’ disease who failed to achieve euthyroid state during pregnancy, anesthesiologists rarely encounter patients with uncontrolled hyperthyroidism undergoing urgent Cesarean section.Case: A 31-year-old pregnant patient had uncontrolled hyperthyroidism due to Graves’ disease despite medical treatment. Her signs and symptoms suggested fetal distress and aggravation of the disease, leading to hospitalization. After a failed induction for vaginal delivery, an urgent Cesarean section was performed under spinal anesthesia via an interlaminar approach using 9 mg of 0.5% heavy bupivacaine and 20 μg of fentanyl. It resulted in successful delivery, with no perioperative complications for the mother and neonate. Conclusions: This case demonstrates that spinal anesthesia may provide clinical stability to patients with uncontrolled hyperthyroidism undergoing urgent Cesarean section.

The safety and efficacy of minimal-flow desflurane anesthesia during prolonged laparoscopic surgery

박상융,정찬종,장정훈,배재영,최소론 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.6

Background: Minimal-flow anesthesia can meet the demands of a modern society that is more sensitive to environmental protection and economic burdens. This study compared the safety and efficacy of minimal-flow desflurane anesthesia with conventional high-flow desflurane anesthesia for prolonged laparoscopic surgery. Methods: Forty-six male patients (ASA physical status II or III) undergoing laparoscopic urologic surgery for more than 6 hours were randomly divided into two groups: the high-flow (HF) group and the minimal-flow (MF) group. The HF group was continuously administered a fresh gas flow of 4 L/min. In the MF group, a fresh gas flow of 4 L/min was administered for the first 20 minutes and was thereafter lowered to 0.5 L/min. Inspiratory and expiratory desflurane concentrations, respiratory variables, and hemodynamic variables were continuously monitored during administration of anesthesia. Measurements of carboxyhemoglobin (COHb) concentration and arterial blood gas analysis were performed every 2 hours during anesthesia. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN) and creatinine were measured on the first and second day after the surgery. Results: Demographic data and duration of anesthesia were not different between the two groups. Significant differences were not observed between the two groups in terms of hemodynamic variables, respiratory variables, and inspiratory and expiratory desflurane concentrations. Inspiratory O2 concentration was maintained lower in the MF group than in the HF group (43-53% vs. 53-59%; P < 0.05). Compared with the HF group, COHb concentrations was higher (P < 0.05), but not increased from the baseline value in the MF group. Serum AST, ALT, BUN, and creatinine were not significantly different between the two groups. Conclusions: In prolonged laparoscopic surgery, no significant differences were found in safety and efficacy between minimal-flow and high-flow desflurane anesthesia.

소아에서 전신마취 후 각성 흥분의 위험 인자: 다기관 연구

박상융,정찬종,박재원,이승윤,최소론 대한마취통증의학회 2013 Anesthesia and pain medicine Vol.8 No.2

Background: Emergence agitation (EA) frequently occurs after general anesthesia in children. This multicenter study was investigated to determine incidence and risk factors of EA after general anesthesia in children. Methods: This prospective study evaluated 816 pediatric patients receiving elective surgery under general anesthesia at 10 university hospitals. Emotional and behavioral status of the patients upon emergence from anesthesia was assessed by Aono’s four point scale. Those with an Aono’s four point scale of 3 or 4 were considered to be affected by EA. Patient physical, anesthetic, and surgical variables were analyzed to find the risk factors of EA. Results: One-hundred-fifty-two children (18.6%) developed EA. No relationships between the incidence of EA and age, sex, ASA physical status, premedicants, anesthetic induction agents,anesthetic maintenance methods, or postoperative analgesia were found. A multivariate analysis identified preanesthetic emotional status (OR = 1.774, P < 0.001), perioperative airway complication (OR = 1.867, P < 0.007) and rhinolaryngologic surgery (OR =1.597, P < 0.017) as risk factors of EA. Conclusions: Preanesthetic emotional status, perioperative airway complication and rhinolaryngologic surgery were risk factors of EA after general anesthesia in children.

단속자 입장에서 본 마약류관리에관한법률의 문제점

박상융 한국에프디시규제과학회(구 한국에프디시법제학회) 2009 한국에프디시법제학회 학술대회 Vol.2009 No.1

Iatrogenic Tension Pneumothorax after Surgical Tracheostomy in a Child with Idiopathic Subglottic Stenosis - case report

박상융,김정호,임우재,정준호,이승철,최소론,이종환,정찬종 고신대학교(의대) 고신대학교 의과대학 학술지 2019 고신대학교 의과대학 학술지 Vol.34 No.2

Tracheostomy is increasingly performed in children for upper airway anomalies. Here, an 18-month-old child (height 84.1 cm, weight 12.5 kg) presented to the emergency department with dyspnea, stridor, and chest retraction. However, exploration of the airways using a bronchoscope failed due to subglottic stenosis. Therefore, a surgical tracheostomy was successfully performed with manual mask ventilation. However, pneumomediastinum was found in the postoperative chest radiograph. Although an oxygen saturation of 99% was initially maintained, oxygen saturation levels dropped, due to sudden dyspnea, after 3 hours. A chest radiograph taken at this time revealed a left tension pneumothorax and small right pneumothorax. Despite a needle thoracostomy, the pneumothorax was aggravated, and cardiac arrest occurred. Cardiopulmonary- cerebral resuscitation was performed, but the patient was declared dead 30 minutes later. This study highlights the fatal complications that can occur in children during tracheostomy. Therefore, close monitoring, immediate suspicion, recognition, and aggressive management may avoid fatal outcomes.

공무집행방해사범 처리개선방안

박상융 한국경찰이론과실무학회 2010 경찰연구논집 Vol.6 No.-

Comparison of i-gelⓇ and LMA SupremeⓇ during laparoscopic cholecystectomy

박상융,임종철,김혁,이지현,정찬종 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.5

Background: In laparoscopic surgical procedures, many clinicians recommend supraglottic airway devices as good alternatives to intubation. We compared the i-gelⓇ (i-gel) and LMA SupremeⓇ (Supreme Laryngeal Mask Airway, SLMA) airway devices during laparoscopic cholecystectomy regarding sealing pressure and respiratory parameters before, during, and after pneumoperitoneum. Methods: Following Institutional Review Board approval and written informed consent, 93 patients were randomly allocated into the i-gel (n = 47) or SLMA group (n = 46). Insertion time, number of insertion attempts, and fiberoptic view of glottis were recorded. Oropharyngeal leak pressure (OLP), the use of airway manipulation, peak inspiratory pressure, lung compliance, and hemodynamic parameters were measured before, during, and after pneumoperitoneum. Results: There were no significant differences between the two groups regarding demographic data, insertion time, fiberoptic view of glottis, and the use of airway manipulation. The gastric tube insertion time was longer in the i-gel group (20.4 ± 3.9 s) than in the SLMA group (16.7 ± 1.6 s) (P < 0.001). All devices were inserted on the first attempt, excluding one case in each group. Peak inspiratory pressure, lung compliance, and OLP changed following carbon dioxide pneumoperitoneum in each group, but there were no significant differences between the groups. Conclusions: Both the i-gel and SLMA airway devices can be comparably used in patients who undergo laparoscopic cholecystectomy, and they offer similar performance including OLP.