지주막하강에 투여한 Morphine으로 인한 소양감에 대한 임상적 고찰

백승완,정규섭,김인세,정찬종 대한통증학회 1988 The Korean Journal of Pain Vol.1 No.1

Herein is a review of eigthy six surgical cases from March to August, 1986 which recie- ved tetracaine hydrochloride spinal anesthesia. In an attempt to relieve postoperative pain, 0.5 mg morphine sulfate was administrsted into the lumbar subarachnoid space. Pruritus, a side effect of intraspinal morphine, was explored in detail. The results were as follows: 1) The incidence of pruritus was 67.4%, 65.5% in man and 71.0% in woman. 2) The time of onset of pruritus was between 30 and 120 minutes with an average of 79.1 minutes. 3) Pruritus primary occurred on the face(87.9%), especially on the nasal, perinasal and periocular areas. Other sites included the scalp, neck, chest, abdomen, shoulder, hip, thigh, flank, and whole body. 4) The severity of pruritus was classified as mild and moderate, bat 4 cases(6.9%) were regarded as severe and were treated with naloxone. 5) The duration of pruritus was from 15 minutes to 19 hours with an average of 4. 7 hours. 6) There was no significant difference in the prevention of pruritus between the groap recieving diphenhydramine and the one which received normal saline.

전신마취 및 경막외마취에서 손·발가락의 맥파전달시간 차의 변화

백승완,김태균,조아름,최병철 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.53 No.1

Background: Pulse wave velocity (PWV) and pulse transit time (PTT) are influenced by the arterial wall stiffness and compliance. Also, the PTT is dependent on blood pressure changes that can be accompanied by the anesthesia. The simply measured PTT has difficult to discriminate the arterial compliance changes from blood pressure changes. Therefore, we investigated that the differences of PTT between toe and finger as an independent parameter on blood pressure. Methods: Eighteen patients scheduled for elective lower abdominal gynecologic surgery were studied. General anesthesia was achieved with sevoflurane and epidural block was done with 0.2% ropivacaine and fentanyl 100μg via epidural catheter inserted into L1-L2 epidural space. PTT was measured in a finger (PTTf) and a toe (PTTt) by the time difference between the ECG R wave and the pulse wave of PPG. Blood pressure and PTT was measured at three instances such as preinduction (Pre), 5 minutes after intubation (Int5) and 30 minutes after injection of epidural dose (Epi). The time delay of PTT between toe and finger (PTTt-f) was measured. Results: PTTf and PTTt was prolonged at Int5 and Epi. But the PTTt-f was not different between the Int5 and Epi because of prolonged PTTf caused by the blood pressure decrement after the epidural block. Conclusions: PTTf, PTTt and PTTt-f can be a one of the convenient measurement of the arterial compliance but it was suggested that there need to be a parameter less dependent on the blood pressure changes.

마취 심도 측정을 위한 뇌파 스펙트럼 분석 연구

백승완,이성진,예수영,천상오,전계록 대한마취통증의학회 2004 Korean Journal of Anesthesiology Vol.46 No.2

Background: Monitoring the “depth of anesthesia” is an ongoing problem. To identify a useful parameter for determining the depth of anesthesia with enflurane, EEG data was obtained using a Physiolab 800. Methods: Variations in EEG signals were measured and analyzed by the stage of anesthesia. EEG data was obtained from 15 patients during general anesthesia with enflurane. The EEG signal was acquired and analyzed in 5 steps (one day before anesthesia, during induction, during skin incision, at end of anesthesia, and one day after anesthesia). Fp1 electrode and the EEG data mainly from the forehead were used to determine the depth of anesthesia using EEG characteristics during enflurane anesthesia. All data were preprocessed by filtering, baseline correction and using the linear detrend method to reliable analyze of sample data in the surgical environment. Data obtained were transformed to frequency and power spectrum analysis was performed. Results: α, β, δ and θ waves were detected by frequency area separation and the trend of each wave was observed during each anesthesia stage. EEG data was slowed down and the θ wave ratio increased as the depth of anesthesia increased. Accordingly, spectral edge frequency (SEF) and median frequency (MF) were used as parameters to determine the depth of anesthesia. The frequencies of SEF and MF decreased during anesthesia and returned to the preanesthetic level after the cessation of anesthesia. Conclusions: Our results suggest that SEF and MF can contribute as useful parameters to determine the depth of anesthesia. Anesthetics not only affect the central nervous system, but also affect the autonomic nervous system. If the autonomic nervous system signals such as heart rate variability are taken into account, more reliable evaluations would be possible. (Korean J Anesthesiol 2004; 46: 135~138)

Propofol의 진통효과에 대한 임상 연구

백승완 부산대학교 병원 암연구소 1999 부산대병원학술지 Vol.- No.6

마취심도 측정에 있어서 카오스이론의 적용

백승완 대한정맥마취학회 2001 정맥마취 Vol.5 No.1

전신 마취 중 심박동변이도와 맥파전달시간 변화의 비교

백승완,김태균,김재형,전계록,예수영,Baik, Seong-Wan,Kim, Tae-Kyun,Kim, Jae-Hyung,Jeon, Gye-Rok,Ye, Soo-Young 한국전기전자재료학회 2008 전기전자재료학회논문지 Vol.21 No.8

Autonomic nervous system of the anesthetized patients can be influenced by the many kinds of stimulations such as intubation, surgical incision and so on. The changes of the heart rates and blood pressures are surrogates of responses of the autonomic system to the external stimulations. Recently, the power spectral analysis of the heart rate variability (HRV) made it easy to know the fractions and changes of sympathetic and parasympathetic autonomic systems. In this study, the changes of pulse transit time, one of the response of vessels to stimulations, was investigated in relation to the HRV. Ten patients were examined and average age is 22.5 $\pm$ 11.04, average weight is 63 $\pm$ 14.4 kg. The patients were anesthetized only by sevoflurane inhalation. Pulse transit time is determined by calculating the difference of the time between the R peak of ECG and the characteristic point of the plethysmography. Power spectral density (PSD) of the HRV was achieved in the frequency of 0.04-0.15 (LF) and 0.15-0.4 (HF). Compared to preanesthetic period the values of LF and LF/HF ratio of HRV were decreased (p<0.05). HF and PTT was increased in anesthetic state with sevoflurane. Otherwise, after intubation, the HF was decreased and LF, LF/HF ratio and PTT were increased. PSD of the HRV is well-known for the index of the autonomic nervous activity. Not only HRV but PTT analysis also is a useful index reflecting the autonomic responses to various stimulations. And this analysis is useful in bed side monitoring because the calculating method is simple and it takes shorter processing time compared to the HRV analysis.

전신 마취 중 전력스펙트럼 분석을 이용한 마취심도 파라미터 개발

백승완,예수영,박준모,전계록,Baik, Seong-Wan,Ye, Soo-Young,Park, Jun-Mo,Jeon, Gye-Rok 한국전기전자재료학회 2009 전기전자재료학회논문지 Vol.22 No.6

In this paper, new parameters were developed to estimate the depth of anesthesia during a general anesthesia using EEG. Power spectral density(PSD) analysis was used for these parameters because EEG became slow wave during anesthesia. The new parameters were DTR, ATR, TDR, ADR, BTR and BDR applied to PSD. These parameters were compared with SEF which is conventionally used at clinic and confirmed clinical value. As the results, DTR, ATR, TDR, ADR among parameters were not useful compared with SEF but BTR and BDR is valuable for clinic. 15 patents, at pre-operation BDR the value is $265.36{\pm}25.29$, at induction the value is $129.23{\pm}34.92$, at operation the value is $154.99{\pm}38.34$, at awaked the value is $283.83{\pm}39.80$ and at post-operation the value is $234.80{\pm}23.46$. Also at pre-operation BTR value is $183.38{\pm}13.59$, at induction the value is $104.09{\pm}25.11$, at operation the value is $115.38{\pm}23.42$, at awaked the value is $190.33{\pm}23.31$ and at post-operation the value is $172.38{\pm}19.08$. Trend of BDR and BTR is similar to change of SEF, so two parameters are useful. to estimate the depth of anesthesia.

마취심도와 통증 측정 시 카오스 이론의 유용성에 대한 연구

백승완,김해규,신상욱,김경훈,민상기,예수영,전계록 대한정맥마취학회 2001 정맥마취 Vol.5 No.1

Background: During operation, patient's pulse wave signal among ECG, EEG and pulse wave, which are vital signals, are very useful to find out mechanical situation of heart, blood flow, and rarely received electrical noise from high frequency equipment. In this study, we analyzed anesthetic depth during surgical operation and pain stiffness of cancer patients using patient's pulse wave. Methods: To analyze non-linear feature of physiological parameter, we reconstructed a strange attractor using time-serial data with quantity and quality methods. The quantity method is a return-map and the quality method is a correlation-dimension. For reconstructing a strange attractor, two factors were needed, delayed time and dimension. After detecting correlation dimension values based on delay-time, embedding dimension, we compare BIS index to indicate depth of anesthesia and stiffness of cancer patient to correlation-dimension values. Results: According to the return-map, getting lower correlation-dimension values, it showed the more unstable patient's situation. Return-map of low correlation-dimension values showed that geometrical structures were small, discrete and simple. The results of correlation-dimension values using second differential in pain stiffness showed over 2.5 at normal, 1.5 - 2.0 at good, 1.1 - 1.3 at fair and below 1.1 at poor state. The results of correlation-dimension values from using second differential reflected patient's state of painless or painful. Also they showed over 90% accuracy respected to doctor's diagnosis. Conclusions: Continuous and efficient studies analyzing the feature of parameters will be needed. In the future, they will be able to apply to the patients who have autonomic dysfunction, vascular disease, nerve system disease as will as patients in the intensive care unit by using pulse waves which reflect state of patient suffering from the pain.

전정맥 마취시 Ketamine 병용에 의한 진통효과 : lidocaine과 비교하여

백승완 부산대학교 병원 암연구소 2000 부산대병원학술지 Vol.- No.7

소아의 자가조절진통에서 Morphine과 Fentanyl의 비교

백승완,김해규,김경훈,백승훈,김운성 부산대학교 병원 암연구소 2007 부산대병원학술지 Vol.- No.21

Purpose: Patient controlled analgesia (PCA) of opioids is a effective analgesic technique for children. But postoperative complications prevent children fully benefiting from their peA. We have compared morphine based PCA with fentauyl based PCA during pediatric orthopedic surgery. Subject and Methods: Sixty children (5-14 years old) after orthopedic surgeries allocated into two group. Morphine group received morphine based PCA; loading dose 0.1 ㎎/㎏, continuous infusion 0.05 ㎎/㎏/hr, bolous dose 0.025 ㎎/㎏. Fentanyl group received fentanyl based PCA; loading dose 1 ㎍/㎏, continuous infusion 0.5 ㎎/㎏/hr, bolus dose 0.25 ㎍/㎏. Pain was assessed by visual analogue scale (VAS). Scores for pain, respiratory depression, sedation, prutitus, nausea, vomiting and bolus counts and PCA dose were recorded at recovery room, 12 hour, 24 hours and 48hours after surgery. Results: There were no differences in VAS score between two groups on each times. The incidences of respiratory depression, sedation, pruritus, nausea and vomiting were no differences, too. But cumulative bolus demands was significantly higher in fentanyl group on 24 hours and 48 hours after surgery (P < 0.05). Conclusions: Morphine based PCA was similar effect with fentanyl based PCA, in controlling postoperative pain. Furthermore, morphine based PCA offer cost-effectiveness over fentanyl based PCA and do not increase the incidence of side effects.