Pancuronium 및 Vecuronium 의 신경-근 차단작용에 미치는 Diltiazem 의 영향

송윤강,박종관,김태요,최봉규 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.1

The effects and interactions of pancuronium and vecuronium with diltiazem on the electri- cally-evoked twitch response, train-of-four and tetanic stimulation were studied in the isolated rat hemi-diaphragm preparation. Pancuronium(3 x 10^(-7) ∼ 10^(-5) M) and vecuronium(3 x 10^(-6) ∼ 15 x 10^(-6) M) decreased the electrically evoked(nerve stimulation, 0.1Hz, 0.5ms, 10V) twitch response, train-of-four and tetanus ratio in a dose-related fashion and pancuronium was more potent than vecuronium. The inhibitory effects of pancuronium and vecuronium were potentiated by pretreatment with 5 & 10 μM diltiazem, a Ca^(+-)-channel blocker, in which the concentration of diltiazem has no obvious effects on the twitch response itself. Furthermore, it is noteworth that the inhibitory effects of pancuronium and vecuronium were markedly potentiated by 150 μM hemicholinium pretreatment. In cases of the direct(muscle, 0.1 Hz, 5 ms, 10 V) stimulation, pancuronium and vecuronium decreased the electrically evoked twitch response dose depenntly, but the amplitudes of inhibition were less than those in indirect(nerve) stimulation. The inhibitory effects were not affected by diltiazem pretreatment except low doses of vecuronium. On the basis of these findings, the result of the present study suggests that the muscle relaxation by pancuronium and vecuronium is mediated by pre- and post-junctional receptor blockade, and that diltiazem intensifies neuromuscular blockade produced by muscle relaxants. The potentiating effect of diltiazem may be due to blocking influx of calcium and/or release of acetylcholine from presynaptic nerve terminals

Acute allergic reaction caused by hyaluronidase used in the pain management: a case report and literature review -A case report-

송윤강,Yeon Dong Kim,Jae-Hong Kim 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.3

Hyaluronidase is a protein enzyme extracted from goat or ovinetestis. It breaks down hyaluronic acid in connective tissues, therebyreducing swelling and edema and increasing drug penetration intotissues after injection. Because of these properties, it is beingincreasingly used in the field of pain management. The mostfrequently reported hyaluronidase-induced complications are allergicreactions, and are usually reported in cases involving eye surgery. However, there are only a few cases of allergic reactions reportedin the field of pain management. Here, we report a case involvinga 52-year-old patient diagnosed with an allergic reaction afterreceiving epidural administration of hyaluronidase. A literaturereview and comparison of our case with similar cases suggestedthe potential mechanisms underlying these allergic reactions andemphasized the importance of considering the possibility of thesereactions in patients receiving hyaluronidase during the course ofpain management procedures.

백서에서 Morphine의 진통효과에 미치는 Verapamil, Diltazem, Bay K 8644 및 KT 362의 영향

송윤강,곽용근,김기원,조규박,김용기 의과학연구소 1993 全北醫大論文集 Vol.17 No.2

백서에서 피하 또는 뇌실내 verapamil, diltiazem, Bay K 8644 및 KT 362의 진통효과를 검토하고 mor-phine의 진통효과에 미치는 이들 약물들의 영향을 관찰하여 다음과 같은 성적을 얻었다. 1. Morphine은 약물 용량에 비례하여 HPL 증가를 일으켰다. 2. Morphine은 정상 및 고농도의 KCL 자극 midbrain synaptosome에서 약물 용량에 비례하여 ^4^5 Ca^2^+ uptake를 억제하였다. 3. 피하 verapamil(20mg/kg)과 피하 diltiazem(20mg/kg)는 HPL 증가를 일으켰으나 피하 Bay K 8644(1mg/kg)와 피하 KT 362(1mg/kg)는 HPL에 아무런 영향을 미치지 아니하였다. 4. 뇌실내 verapamil(100㎍)과 뇌실내 diltiazem(100㎍)은 현저한 HPL 증가를 일으켰고 뇌실내 KT 362(100Mg)는 HPL에 아무런 영향을 미치지 아니하였다. 5. 피하 verapamil(2mg/kg)과 피하 diltiazem(2mg/kg)은 morphine의 진통작용을 강화하였고 피하 Bay K 8644(1mg/kg)는 morphine의 진통작용을 억제 하였으며 피하 KT 362(5mg/kg)는 morphine의 진통작용에 아무런 영향을 미치지 아니하였다. 이상의 실험성적은 morphine의 진통작용 발현에 Ca^2^+ - channel이 중요한 역할을 하고 있으며, Ca^2^+ - channel 차단제가 단독 또는 morphine과 병합하여 동통치료에 사용될 수 있음을 시사한다. The influences of subcutaneous or intraventricular verapamil, diltiazem, Bay K 8644 or KT 362 on the morphine induced analgesia were investigated by measuring the hot plate latency(HPL) of rats. 1. Morphine elicited dose-dependent analgesia and inhibited ^4^5Ca^2^+ uptake in naive or KCI-stimulated midbrain synaptosomes. 2. Bay K 8644 (1mg/kg, s.c.) or KT 362 (1mg/kg, s.c.) did not affect the HPL, but verapamil (20mg/kg, s.c.) and diltiazem (20mg/kg, s.c.) increased it. 3. Intracerebroventricular verapamil (100㎍) and diltiazem (100㎍) markedly increased the HPL of rat, but intracerebroventricular KT 362 did not affect the HPL. 4. Subcutaneous verapamil (2mg/kg) and diltiazem (2mg/kg) potenitiated the morphine-induced analgesia, while subcutaneous Bay K 8644 (1mg/kg) diminished the analgesic effect of morphine. However, subcutaneous KT 362(5mg/kg) did not affect the analgesic effect of morphine. These results, suggest that calcium channel is playing an important role in mediating the analgesic effect of opiates and that calcium channel blockers might may be clinically applied in controlling pain.

Interaction between postoperative shivering and hyperalgesia caused by high-dose remifentanil

송윤강,문서영,박성남,서동혁,이철,박창현 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.66 No.1

Background: High-dose remifentanil-based anesthesia is associated with opioid-induced hyperalgesia (OIH) and postanesthetic shivering (PAS). These effects can be prevented by N-methyl-d-aspartate (NMDA) receptor antagonists. This study aimed to investigate correlations between OIH and PAS caused by high-dose remifentanil and the effects of low-dose ketamine on OIH and PAS. Methods: Seventy-five patients scheduled for single-port laparoscopic gynecologic surgery were randomly allocated into three groups, each of which received intraoperative remifentanil: group L at 0.1 μg/kg/min; group H at 0.3 μg/kg/min; and group HK at 0.3 μg/kg/min plus 0.25 mg/kg ketamine just before incision, followed by a continuous infusion of 5 μg/kg/min ketamine until skin closure. Results: PAS, postoperative tactile pain threshold, and the extent of hyperalgesia in group H were significantly different (P < 0.05) than in the other two groups. PAS was significantly correlated with OIH, including mechanically evoked pain such as postoperative tactile pain threshold (r = -0.529, P = 0.01) (r = -0.458, P = 0.021) and the extent of hyperalgesia (r = 0.537, P = 0.002) (r = 0.384, P = 0.031), respectively, in group H and group HK. Notably, both groups were treated with high-dose remifentanil. Tympanic membrane temperature, time to first postoperative analgesic requirement, postoperative pain scores, analgesic consumption, and cumulative patient-controlled analgesia volume containing morphine were comparable in all three groups. Conclusions: OIH, including the enhanced perception of pain, and PAS were both associated with high-dose remifentanil, were significantly correlated and were attenuated by a low dose of ketamine. This suggests that a common mechanism in part mediated through activation of the central glutamatergic system (e.g., NMDA receptors), underlies the two effects caused by high doses of remifentanil.

흰쥐 횡격막 신경-근 표본에서 호흡 및 대사성 산-염기 변화가 비탈분극성 근 이완제의 효과에 미치는 영향

송윤강,최봉규,정대관 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.3

The effects and interactions of metabolic and respiratory acid-base changes on electrically-evoked twitch response, train-of-four and tetanic stimulation with pipecuronium (Pip), vecuronium (Vec) and atracurium (Tra) were studied in the isolated rat hemi-diaphragm preparation. Pip (3×10^(-7)∼4×10^(-6) M), Vec (3×10^(-6)∼15×10^(-6)M) and Tra (10^(-6)∼3×10^(-5)M) decreased the electrically-evoked (phrenic nerve stimulation, 0.1 Hz, 0.2 ms, 10 V) twitch response in a dose related fashion and Pip was more potent than Vec and Tra. In the alkali state (pH 7.6 or high HCO₃), the decrements of twitch response, train-of-four and tetanus ratio induced by Pip (1.5μM) were potentiated, but the effects of Vec or Tra were markedly intensified by acid midium (pH 7.2 or low HCO₃^-). And also, decreasing pH by increasing PCO₂ or by decreasing HCO₃^- intensified the effects of Vec and Tra, whereas it reversed by Pip. Conversely, increasing pH by decreasing PCO₂ or by increasing HCO₃^- antagonized the effects of Vec and Tra, whereas it potentihe Pip effect. On the basis of these finding, the result of the present study suggest that neither PCO₂ nor HCO₃^- has a specific action, but that changes in pH may be responsible for the results. In addition, the differences of the above results by each drugs may not be due to the number of quaternary ammonium of the agents. And also, indicate that the effective site of the influence of the acid-base change upon the neuromuscular blocking effects might be prejunctional nerve terminal.

Halothane 흡입 마취에 의한 림프구 세포아형의 변화

송윤강,정영표,이강창 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.3

It is generally recognized that immunosuppressive manifestations such as lymphopenia, granulocytosis, decreased transformation to various antigens and impaired neutrophil chemotaxis are followed by surgical operation. In connection with this, anesthetics were also targetted as the possible depressive agent in the immune mechanism. To elucidate the theories, the present study was carried out with patients who were subjected to surgical operation utilizing anesthesia by halothane inhalation. Lymphocytes, specially B-and T-cell lymphocytes were examine throughout the course from operation to 48 hours after the operation. In general, T-cells were decreased by operation with halothane anesthesia, and decrases of Helper-T cell and Inducing-T cell were prominent than suppressor T-cell or Killer T-cell. However, the decrases showed recovery from six hours after the operation, and reached to normal values in two days. The overall result in the study suggest that anesthesia utilizing halothane may bring potentially harmful effect on the immunologic responses to infectious diseases or malignant, but not systemic.

개심술시 마취관리와 임상적 고찰

송윤강,김태요 圓光大學校 醫科學硏究所 1985 圓光醫科學 Vol.1 No.1

Under hypothermia and extracorporeal circulation 19 cases of open heart surgery were done at Won-Kwang university hospital between July, 1984 and March, 1985. Among the 19 cases, 13 cases were male and 6 cases were female. There were 14 with congenital heart disease and 5 with acquired heart disease. The average age was 8.4 years in the congenital heart disease group and 47.6 years in the acquired heart disease group. Premedicants were mainly atropine, meperidine, morphine and diazepam. Induction agents were 2% thiopental 2-5 ㎎/㎏ in dosage and ketamine 1-3 ㎎/㎏ in dosage. The inhalation anesthetics were mainly halothane and enflurane. Succinylcholine and pancuronium have been used for intubation and maintenance of muscle relaxation. 3 cases of these cases were expired within a week.

가토 측뇌실내 Pancuronium 이 호흡 및 순환기능에 미치는 영향

김익수,송윤강 대한마취과학회 1984 Korean Journal of Anesthesiology Vol.17 No.1

In this study the action of pancuronium given directly into the lateral ventricle on the mean blood pressure, heart rate, respiratory frequency and skeletal muscular contractility of the rabbit were investigated. Pancuronium, which a dose of 10 rg/kg ana 30 kg/kg were given into the lateral ventricle of rabbit. 1) Intrayentricular injection of 10 rg/kg of pancuronium increased pulse rate, respiratory frequency and muscle contraction and the differences were not statiscally significant. 2) Intraventricular injection of 30 rg/kg of Pancuronium Produced a gradual increase of respiratory frequency which began at 5 minutes after drug injection and continued oyer a half hour. The difference between control and experimental value was statistically significant (P<0.005) while pulse rate and muscular contractility were increased but not significant. 3) Mean blood pr;ssure was not changed after intrayentricular injection of the pancuronium.

림프구 세포아형의 변화에 미치는 전신마취와 경막외마취의 영향

윤재승,송윤강,이영기 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.6

Many researchers and clinicians have been concerned about the potential impact of anesthetic agents on human immune system. There have been expanding evidences associating an- esthesia and surgery with down-regulation of immune functions. Immune alterations associated with anesthesia and surgery are manifested by lymphapenia and granulocytosis, decreased T cell and B cell counts, decreased delayed hypersensitivity responses, increased metastatic rates of tumors, depressed basal natural killer cell activity and enhanced antibody responses. All of the above effects have been described as short lived, returning to normal levels within 3-7 days following surgery. But the clinical significance of suppressed immunity in the perioperative period is important, it has been suggested that such suppression contributes to postoperative dissemination of carcinoma and to postoperative infections. The present study was designed to examine the effects of general and epidural anesthesia on the lymphocyte subpopulations in patients undergoing hysterectomy. Halothane was used as a main anesthetic agent in general anesthesia group(10 patients) while bupivacaine was used in epidural anesthesia group(10 patients). Lymphocyte, granulocytes and T-lymphocyte subpopulations were counted before, during and after anesthesia. A significant reduction in peripheral total T-lymphocyte to total lymphocyte ratio(CD3^+) percentage), Helper/Inducer T-lymphocyte to total T-lymphocyte ratio(CD4^+) percentage), Suppressor/Cytotoxic T-lymphocyte to total T-lymphocyte ratio(CD8^+ percentage) and Suppressor/Inducer T-1ymphocyte to total T-lympho-cyte ratio(CD4^+ and CD45R^+ percentage) was seen in patients under general anesthesia but minimal changes were found in the patients who had an epidural anesthesia. The results suggest that the immunosuppressive alterations in lymphocyte subsets induced by surgery and general anesthesia can be prevented to certain degree by epidural anesthesia.

각성 환자의 동맥혈 가스분압의 변화에 대한 비교 연구

김태요,송윤강,정경술 대한마취과학회 1986 Korean Journal of Anesthesiology Vol.19 No.4

Preoxygenation is routine preior to induction of general ancsthesia for the purpose of maintaining oxygenation during laryngoscopy and tracheal intubation. A common method of preoxygenation is 3∼5 minutes of 100% O_2 breathing. In some emergency states, there may not be adequate time for a full 3-5 min of preoxygenation. Recently, Gold and some others showed that four maximally deep inspirations of 100% O_2 within 30 seconds are as effective as 5minutes of inhaltion of 100% O_2 for increasing the PaO_2 We compared the changes of arterial blood gas beween a group which took deep breaths for 1 mimute with 100% O_2 and a group breathing spontaneously for 5 minutes with 100% O_2.