뇌간의 동통조절기전에 관한 연구 - Catecholamine과 GABA동작성 신경의 역할

염광원,이종흔,김중수 대한구강생물학회 1992 International Journal of Oral Biology Vol.16 No.1

This study was carried out to clarify the role of locus coeruleus(LC), periaqueductal gray(PAG), catecholaminergic and GABAergic neurones on the descending pain modulation of brainstem. Under light general anesthesia, anterior digastric EMG as jaw opening reflex evoked by noxious electrical stimuli and extracellular neural activity of medullary dorsal horn responded to mechanical stimuli applied to facial skin were recorded to evaluate the effect of conditioned-stimulation of PAG and LC, respectively. Muscimol and bicuculline were injected into cerebral ventricle with microsyringe and the effects of drugs and conditioned-stimulation of PAG were determined by per cent change of amplitude of digastric EMG and compared in normal, 6-hydroxydopamine(OHDA)-treated and 5, 7-dihydroxytryp-tamine(DHT)-treated animal. Conditioned-stimulation of LC had inhibitory effect on the jaw opening reflex evoked by noxious stimuli and inhibited the neural activity of nociceptive neurones responded to noxious mechanical stimuli. Muscimol inhibited the jaw opening reflex evoked by noxious stimuli and enhanced the inhibitory effect of PAG on jaw opening reflex in normal animal, but effects of muscimol and PAG decreased in 6-OHDA-treated animal and increased in 5, 7-DHT-treated animal. Bicuculline partially blocked the effect of muscimol.

진정법이란?

염광원 대한치과마취과학회 2005 Journal of Dental Anesthesia and Pain Medicine Vol.5 No.1

치과에 관련된 공포(fear)와 불안(anxiety)은 누구에게나 존재한다. 이러한 치과치료 자체가 주는 불안과 공포 때문에 환자가 편안하게 치과치료를 받을 수 있는 방법을 개발하는 것은 오래 전부터 모든 치과의사의 관심의 대상이었으며 역사적으로도 아산화질소(N2O)를 처음으로 임상에 도입한 사람이 치과의사인 Horace Wells였다는 것은 매우 흥미 있는 사실이다(Fig. 1).치과치료로 인한 통증은 국소마취로 상당 부분 효과적으로 조절되고 있지만 치과치료 자체에 대한 불안과 공포는 항상 큰 문제가 되고 있으며 많은 환자들에게 있어서 치과치료에 가장 큰 걸림돌이 되고있다. 대부분의 사람들이 술식의 난이도나 시간에상관없이 치과치료 자체에 심한 불안과 공포를 갖는것이 사실이며 경제나 사회복지가 발전할수록 증가하는 추세이다. 현재 미국과 일본에서는 치과치료에 진정법을 병용하는 것이 매우 일반화되어 있으며 많은 치과의사들이 진정법에 관심을 가지고 의욕적으로 참여하고 있다. 선진국에서의 개업의들을 위한 많은 진정법(특히 의식진정법) 연수회가 이를 증명하고 있다. 그렇다면 이렇게 치과 치료 자체에 불안과 공포를 갖는 환자들을 어떻게 효과적으로 치료할수 있을 것인가? 환자의 긴장을 완화시키고 불안과 공포가 최소화된 상태로 유도하여 환자에게는 편안함과 안전함을 제공하는 동시에 치과의사에게는 효과적인 치과치료를 가능하게 하는 방법이 바로 진정법이다.

Cimetidine, Ranitidine 및 Famotidine 전처치가 위액의 용량과 산도에 미치는 영향 비교

염광원,이원영,김현정 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.4

Background : Aspiration pneumonitis is one of the most severe anesthetic complications. The severity of this complication is associated with the acidic nature of aspirated gastric juice. H2 receptor antagonists inhibit gastric acid secretion and elevate the gastric juice pH. The purpose of this study was to compare the effects of preoperative night cimetidine, ranitidine and famotidine medications on gastric volume and pH. Methods : We studied 84 healthy patients, ASA physical status I or II, who were each randomly allocated to one of 4 groups. Group I ingested only 200 ml of milk up to 8 10 hours prior to anesthesia. Groups II, III and IV ingested 200 ml of milk and 400 mg of cimetidine, 150 mg of ranitidine and 20 mg of famotidine, respectively, on the evening before elective surgery. After the induction of anesthesia, gastric juice was collected with 18 French Salem sump tube, and gastric volume and pH were measured. Results : There were no significant differences in gastric juice volume among the numbers of the 4 groups. However, Group IV (famotidine) showed a significant high pH, compared with the other groups. Conclusions : Famotidine 20 mg, which is premedicated on the evening before elective surgery, is more effective in preventing aspiration pneumonitis than cimetidine 400 mg and ranitidine 150 mg. (Korean J Anesthesiol 1999; 37: 556∼562)

치과수술환자 마취관리 실태 보고

염광원,김광우,김규식,민병일,정창영 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.2

A clinical analysis of 1753 patients with dental surgery under the general anesthesia from January 1981 to December 1985 was made according to age, sex, disease, and status of intubation. The results were as follows: 1) Of 1753 patients with oral surgery, 1067 male and 686 female patients were operated on under general anesthesia and the male to female ratio was 1.6:l. 2) Of 1753 patients, there were 501 patients with oral surgery from 20 to 30 years of age and this was the most common age. 3) Benign tumors including cysts were the most common lesions operated on under general anesthesia. 4) Of 1753 patients, 1529 patients had nasotracheal intubations, but the patients with orotracheal intubations were 206, and the patients with endotracheal insertion through tracheostomy were only 18(l%)

경비 기관내 삽관 후에 발생한 합병증에 관한 전향적 연구

염광원,김현정 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.1

Background : Nasotracheal intubation is commonly and safely used in the anesthetic management of patients undergoing head and neck surgeries. There are some kinds of reports about complications associated with nssotracheal intubation which are related to long intubation period in the intensive care unit. But there are few reports about complications after nasotracheal intubation in surgery patients. A prospective study was carried out to evaluate the incidence and outcome of complications of nasotracheal intubation in oral and maxillofacial surgery patients in the Seoul National University Dental Hospital. Methods : We studied 317 nasally intubated patients over 8 months. Endotracheal tubes softened by soaking in hot nonnal saline were used. After general anesthesia, we followed the hospital course of patients from the view point of the incidence and outcome of complications associated with nasotracheal intubation. Results: The overall complication rate was 27.1%. Nasal bleeding and benign nasal obstruction were the most frequent events, accounting for a mean of 15.5% and 9.8%, respectively. Other low incidence complication was ulceration of the nose, None of the complications were fatal or resulted in serious sequelae. There was a slight relationship between complications and age or intubation period. Conclusions : These results suggest that short term use of nasotracheal intubation may be as safe as orotracheal intubation. Complications may be associated with elderly patients and long intubation duration over than 24 hours in surgery patients. (Korean J Anesthesiol 2000; 39: 72~76)

M2O-O2-Halothane 마취중 Lidocaine 정주가 혈력학에 미치는 영향

염광원,김용락 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.2

In 2D surgical paients wihose general anesthsia was maintained with one to one ratio of oxygen and nirtous oxide and 1 vo19 of halothane, 1 mg/kg of lidocaine was administered to the 10 patients in each group intravenously to evaluate the effects of lidocaine on cardiovascular changes. In these clinical study, heart rate (HR), mean arterial pressure (MAP), stroke volume (SV) and cardiac output (CO) were measured iri one minute interval after intravenous administration of lidocaine and these values were compared with the control. The following results were obtained: 1) There are no significant changes of the heart rate. 2) The mean arerial pressure was significantly decreased one minute after that, there was no significant change. 3) There were no signifieant changes in the stroke volume. 4) The cardiac outit was significantly decreased in all patients after the administration of lidocaine and there were also the significant decrease of the cardiac output three and four minutes in patients with 1.0 mg/kg of lidocaine and four and five minutes in patients with 1.5 mg/kg of lidocaine after the administration of lidocaine.

유도저혈압에 의한 치과수술 마취관리

염광원 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.2

In 9 patients who were expected to have the dental orthognatic surgery under the general anesthesia, Na Nitroprusside was administered to induce and maintain the hypotension. The following results were obtained during operation 1) Mean arterial pressure was 58mrnHg during controlled hypotension. 2) There were no significant changes in heart rates and central venous pressure during operation. 3) There were no significant changes in arterial pH and arterial contents of oxygen and carbon dioxide during operation. 4) Hemoglobin concentration and hematocrit were significantly decreased 90 minutes after administration of Na Nitroprusside and 30 minutes after discontinuing intravenous infusion of Na Nitroprusside. 5) There were no significant changes in the blood concentration of K, Na, and Cl. 6) The average amount of blood loss during operation was estimoted by 380 cc.

Propofol 마취시 이산화탄소분압의 변화가 뇌혈류의 변화에 미치는 영향

염광원,이민영 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.1

Background: Propofol is a relatively new intravenous anesthetic agent, and the cerebral blood flow (CBF) response to changes in PaCO₂ during propofol anesthesia has not been extensively studied. The purpose of this study was to investigate the effects of propofol anesthesia on the CBF response to changes in PaCO₂ in dogs. Methods: In six dogs, after surgical preparation for posterior sagittal sinus outflow method, loading dose of propofol 5~6 mg/kg was injected and then anesthesia was maintained with a propofol infusion of 20 mg·kg^(-1)·hr^(-1) during study.Ventilation was controlled to hypocapnia(PaCO₂ 20~35 mmHg), normocapnia(PaCO₂. 35-45 mmHg) and hypercapnia(PaCO₂. 45-60 mmHg) by adjustment of minute ventilation. Posterior sagittal sinus blood flow was measured by metered syringe and then CBF was calculated. Cerebral metabolic rate for oxygen(CMRO₂) was calculated with arterial and sagittal sinus blood analysis. Result: CBF at normocapnia (PaCO₂ 41±5 mmHg) was 28.7±11.6 ml·100 g^(-1)·min(-1ncreased to 46.5±14.4 ml·100 g^(-1)·min^(-1) and decreased to 22.1±8.9 ml·100 g^(-1)·min^(-1) on increasing PaCO₂ (63±18 mmHg) and decreasing PaCO₂ (33±3 mmHg), respectively. The slope of CBF versus PaCO₂. was 1.29 ml 100 g^(-1)·min^(-1) ·mmHg. Blood pressure, herat rate, PaO₂, CMRO₂. were not changed between groups. Conclusions: CBF response to changes in PaCO₂ during propofol anesthesia is maintained and the slope of the CBF-CO₂ response is similar to that found during anesthesia with other intravenous agents such as thiopental, midazolam, etomidate, opioids.

Benzodiazepine 유도체 Flunitrazepam 의 진정작용

염광원,김용락,곽일용 대한마취과학회 1973 Korean Journal of Anesthesiology Vol.6 No.1

치과수술환자 마취관리

염광원,김용락,김광우,이관우,김명진,남일우,정유조 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.2

In all patients with oral and maxillofacial surgery under the general anesthesia from January 1986 to December 1988, a clinical analysis had been made on preperative physical status, preoperative complicating medical disease ar abnormal laboratory finding, intubation and anesthetic agent used including the age and sex distribation of patients and the surgical lesion. The following results were obtained: 1) The male patients were 1.3 times more than the female in sex distribution 2) The patients between 20 and 29 years old were the most in age distribution 3) The benign tumors were the most common surgieal lesion(20.2%) 4) Of the 1393 patients with oral and maxillofacial surgery, the l34 patients were observed to have the underlying medical diseases or abnormal laboratory findings preoperatively(9.6%). In these patients the abnormal findings on E. K. G were most common. 5) Of the l393 patients, the 1170 patients were classified physical status l. and there were 206 patients of physical status 2 and 17 patients of physical status 3. 6) Of 1393 patients, the intubation were performed through tracheostomy in 6 patients and the fiberoptic endoscope were used to secure the endotracheal intubation in 20 patients. In 3 patients the blind nasotracheal intubation were made to secure the endotracheal intubation. 7) The conventional laryngoscopic instrumentations for the oral or nasotracheal intubation were performed in 1355 patients(97.3%). 8) The use of O₂, N₂O and halothane for the general anesthesia was the most common method for the general anesthesia.