기관암 재건술시 후두 마스크를 이용한 전신마취관리

우성창,차동석,강건,백종화,신제균 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.6

The laryngeal mask airway (LMA) is new method for maintaining the airway and has many advantages such as easy insertion without muscle relaxant, decreasing cardiovascular change, decreasing damage of pharynx and larynx and useful in difficult intubation. It has being increasingly used in the management of difficult airway problems, but has not been widely used in tracheal surgery. A 59 year old woman with tracheal stenosis due to tracheal tumor was admitted for tracheal reconstruction. The stenotic lesion was 5 cm above the carina and the length of the stenotic segment was 2 cm. Anesthetic management should be focus on maintenance of the airway and adequate ventilation with the number 3 sized LMA during the tracheal resection. The tracheal segmental resection and primary end-to-end anastomosis were performed without serious hypoxia and hypercarbia. We discuss the advantages and limitations of the LMA in tracheal surgery. (Korean J Anesthesiol 1998; 35: 1169∼1173)

Resveratrol Inhibits Nicotinic Stimulation-Evoked Catecholamine Release from the Adrenal Medulla

우성창,나광문,임동윤 대한약리학회 2008 The Korean Journal of Physiology & Pharmacology Vol.12 No.4

Resveratrol has been known to possess various potent cardiovascular effects in animal, but there is little information on its functional effect on the secretion of catecholamines (CA) from the perfused model of the adrenal medulla. Therefore, the aim of the present study was to determine the effect of resveratrol on the CA secretion from the isolated perfused model of the normotensive rat adrenal gland, and to elucidate its mechanism of action. Resveratrol (10∼100μM) during perfusion into an adrenal vein for 90 min inhibited the CA secretory responses evoked by ACh (5.32 mM), high K+ (a direct membrane-depolarizer, 56 mM), DMPP (a selective neuronal nicotinic Nn receptor agonist, 100μM) and McN-A-343 (a selective muscarinic M1 receptor agonist, 100μM) in both a time- and dose- dependent fashion. Also, in the presence of resveratrol (30μM), the secretory responses of CA evoked by veratridine 8644 (an activator of voltage-dependent Na+ channels, 100μM), Bay-K-8644 (a L-type dihydropyridine Ca²+ channel activator, 10μM), and cyclopiazonic acid (a cytoplasmic Ca²+-ATPase inhibitor, 10μM) were significantly reduced. In the simultaneous presence of resveratrol (30μM) and L-NAME (an inhibitor of NO synthase, 30μM), the CA secretory evoked by ACh, high K+, DMPP, McN-A-343, Bay-K-8644 and cyclopiazonic acid were recovered to a considerable extent of the corresponding control secretion compared with the inhibitory effect of resveratrol alone. Interestingly, the amount of nitric oxide (NO) released from the adrenal medulla was greatly increased in comparison to its basal release. Taken together, these experimental results demonstrate that resveratrol can inhibit the CA secretory responses evoked by stimulation of cholinergic nicotinic receptors, as well as by direct membrane-depolarization in the isolated perfused model of the rat adrenal gland. It seems that this inhibitory effect of resveratrol is exerted by inhibiting an influx of both ions through Na+ and Ca²+ channels into the adrenomedullary cells as well as by blocking the release of Ca²+ from the cytoplasmic calcium store, which are mediated at least partly by the increased NO production due to the activation of NO synthase.

혈역학적 변화가 경막외 차단후 감각차단 범위감소에 미치는 영향

우성창 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.1

Background : The aim of this study was to compare the difference in regression of sensory analgesia on hemodynamic changes between bupivacaine and lidocaine in epidural blockade. Methods : The thirty-six patients (ASA physical status Ior II) scheduled for elective cesarean section, we performed lumbar epidural blockade using 2% lidocaine(group I, II) or 0.5% bupivacaine(group III, IV). Eighty minutes after surgery, we divided the patients into 4 groups: The group I, III received normal saline, 20 ml, for 30 min; the group II, IV received normal saline, 20 ml, containing ephedrine, 2 mg ml, for 30 min. We compared the regression of sensory analgesia at 80 min with that at 140 min. Results : The proximal extent of sensory analgesia at 140 min was significantly lower than that at 80 min in group II. However, no such significant changes occurred in group I, III, IV. Conclusions : The ephedrine-induced blood pressure increase accelerates regression of epidural blockade using lidocaine. We thought that even moderate and clinically insignificant cardiovascular activation by anxiety or pain can be a cause of reduction in the efficacy and duration of epidural blockade. (Korean J Anesthesiol 1998; 34: 67∼71)

Influence of Cilnidipine on Catecholamine Release in the Perfused Rat Adrenal Medulla

우성창,백영주,임동윤 대한약리학회 2004 The Korean Journal of Physiology & Pharmacology Vol.8 No.5

암성통증치료를 위한 경막외카테테르 거치술중 혈성천자로 발생한 경막외혈종

우성창(Sung Chang Woo),차동석(Dong Suk Cha),강 건( 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1

We report a case of epidural hematoma occuring after bloody tap during epi-dural catheter for cancer pain control in thrombocytopenic patient. Two hours after epidurl puncture, patient experienced severe back pain and numbness of both legs. Following day, patient complained of motor paralysis and urinary difficulty. Diagnosis utilizing magnetic reasonance imaging, showed epidural hematoma extending from T11 to T12. Thrombocytopenia prevented surgical intervention. Therefore we restored conservative therapy with packed red cell, platelet concentration, steroid and hemostatic, which provided complete neurologic recovery, spontaneously over several days without surgical intervention.

Lidocaine 의 피내침윤시 용액의 알칼리화가 진통효과에 미치는 영향

강건,우성창,백종화,박순은,김영재 대한정맥마취학회 1999 정맥마취 Vol.3 No.4

서론: 혈관내에 카테테르를 거치전에 진통목적으로 lidocaine을 피내에 침윤한다. 이 때 Lidocaine에 sodium bicarbonate를 첨가하여 알칼리화시키면 lidocaine만 주사했을 때보다 통증완화의 발현속도가 빠르고 지각차단이 신속하다고 보고되어 왔었다. 이에 저자들은 lidocaine 단독과 lidocaine에 sodium bicarbonate의 혼합액을 피내에 침윤한 후 각각 통증점수를 통해 지각차단의 정도를 알아보고 진통발현의 신속성을 추정하였다. 방법: 선택수술이 계획된 환자 35명을 대상으로 연구의 목적과 방법을 설명하고 동의를 받았다. 전박 두군데를 설정하며 한쪽은 2% lidocaine 0.2 ㎖, 다른쪽에서 2% lidocaine 0.16 ㎖와 8.4% sodium bicarbonate 0.04 ㎖의 혼합용액 0.2 ㎖를 각각 26 gauge 주사침으로 피내주사하였다. 5초후 20 gauge 주사침으로 pin-prick test를 시행하여 visual analog scale (VAS)로 통증정도를 평가하였다. VAS 통증점수는 통증이 통증이 없는 것을 0으로 가장 아픈 것을 10으로 점수를 매기도록 교육시켜 표시하였다. 결과: 2% lidocaine을 피내주사 했을 때 VAS 통증점수는 2.6 ± 0.6이었고, lidocaine-sodium bicarbonate 혼합용액을 주사했을때는 0.7 ± 0.5이었다. lidocaine-solidum bicarbonate군에서 VAS 통증점수는 의미있게 낮았다(P<0.05). 결론: 혈관내 카테테르를 거치하기 전에 진통목적으로 lidocaine 단독주사보다는 sodium bicarbonate를 혼합해서 주사하는 것이 진통발현시간이 신속하다. 그러므로 현관내 카테테르를 거치하기 전 피내침윤시 lidocaine을 sodium bicarbonate로 알칼리화시키는 것이 추천된다. Background: It is common for anesthesiologists to use intradermal anesthesia to provide analgesia with lidocaine before IV catheter placement. The addition of sodium bicarbonate to 2% lidocaine has been reported to decrease the onset time of conduction blockade. The aim of this study was to compare the pain score of intradermal anesthesia with lidocaine alone and with the combination of lidocaine and sodium bicarbonate. Methods: We studied 35 patients. Each patient received intradermal injection at forearm with the following two solutions: 1) 2% lidocaine 0.2 ml (lidocaine group); 2) 2% lidocaine 0.16 ml mixed with sodium bicarbonate 0.04 ml (lidocaine-sodium bicarbonate group). Pin-prick test was done for appropriate analgesia using 20 gauge needle on the skin wheal. The visual analog scale during was recorded at 5 seconds after each intradermal injection. Subjects were instructed to score a pain-free injection as zero and the worst pain imaginable as 10. Results: The visual analog scale of lidocaine group (2.6 ± 0.6) was significantly higher than that of lidocaine-sodium bicarbonate group (0.7 ± 0.5) (P < 0.05). Conclusions: Our study demonstrates that the alkalinization of lidocaine produce more rapid spread of sensory blockade and potentiate neural blockade. Alkalinization of lidocaine is therefore recommended when intradermal infiltration of lidocaine is performed for IV catheter placement.

Fentanyl과 Isoflurane이 뇌혈관의 이산화탄소 반응성에 미치는 효과

김종욱,한성민,최종호,우성창,황재현,조성강 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.3

Correction of malposition of central venous catheter with 9-Fr introducer sheath assisted by mobile type diagnostic X-ray apparatus -a case report-

류재규,윤지현,이은준,이가안,우성창,정창영 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.4

Central venous catheters provide long-term available vascular access. They are useful for central venous pressure monitoring, rapid fluid management, massive transfusion and direct cardiovascular medication, especially in operation. Central venous catheterization is usually performed by the landmark bedside technique without imaging guidance. The complications of central venous catheterization are frequent, which include malposition, pneumothorax, hemothorax, chylothorax, arterial puncture, hematoma, air embolism and infection. Malposition of a central venous catheter is not rare and may cause several complications such as malfunction of the catheter, default measurement of central venous pressure, catheter erosion, thrombophlebitis and cardiac tamponade. In this case, we report a malposition of central venous catheter with 9-Fr introducer sheath which is located in the right subclavian vein via ipsilateral internal jugular vein and the correction of this misplacement assisted by mobile type diagnostic X-ray apparatus (C-arm fluoroscope).

간이식술의 마취경험:4예

이청,서병태,권진형,우성창,윤창섭 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.5

We managed four cases of anesthesia for liver transplantation from August, 1992 to January, 1993. Four recipients, all male patients and ages of 40th, were suffered from liver cirrhosis related to Chronic hepatitis B and one recipient (case 1) was diagnosed as combined hepatocellular carcinoma. Operation risks by Pugh's classification were 10 (case 1), 8 (case 2), 7 (case 3) and 12 (case 4). Duaration of anesthesia was in the range of 13 to 22.5 hours. Various hemodynamic monitorings were observed and anesthetic managements were uneveritful. C.O., SVR, temperature and coagulation factors were analyzed. 2 patients (case 1 & 4) were expired due to acute rejection (case 1) and primary non-function of the grafted liver (case 4) postoperatively.

Anesthetic experience using extracorporeal membrane oxygenation for cesarean section in the patient with peripartum cardiomyopathy -a case report-

김한영,전형준,윤지현,이종혁,이강근,우성창 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.66 No.5

Peripartum cardiomyopathy is a rare form of cardiomyopathy that is associated with significant mortality. It can cause a cardiac arrest during cesarean section even though the patient does not have any previous symptom and sign. The most important thing of anesthesia in this patient is an optimization of hemodynamic and respiratory status. We report the successful general anesthesia using of extracorporeal membrane oxygenation for cesarean section in a 34-year-old woman with fulminant peripartum cardiomyopathy.