증례보고 : 심한 척주관 협착증 환자에서 척추 마취 후 발생된 마미 증후군

정규돈 ( Kyu Don Chung ),유승준 ( Sung Jun Yu ),이상묵 ( Sang Mook Lee ),조현숙 ( Hyun Sook Cho ),손윤숙 ( Youn Suk Son ),윤건중 ( Keon Jung Yoon ),윤은경 ( Eun Kyeung Yoon ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3

Cauda equina syndrome is a well-known but rare complication of spinal anesthesia. An 80-year-old man was scheduled for both herniorrhaphy. Spinal anesthesia was performed at the L3-4 interspinous space with 0.5% hyperbaric bupivacaine 12 mg. Eight hours after anesthesia, the patient complained bilateral sensorimotor deficits of the lower extremities and peroneal region. Urinary and fecal incontinence were also observed. MRI and myelography showed severe central spinal stenosis at L3-4 and L4-5. EMG showed cauda equina syndrome. Seven weeks after the procedure, left decompressive subtotal laminectomy L2-L5 was done. The patient still complains the neuropathic pain in the both lower extremities and ambulates using a walker. The local anesthetic was injected into thecal sac between maximum stenoses, and it is likely that there was poor upward spread leading to maldistribution of local anesthetic and resultant local anesthetic toxicity. (Korean J Anesthesiol 2009;57:364∼6)

증례보고 : 안면 혈관종이 심한 Sturge-Weber 증후군 환자의 마취 경험

정규돈 ( Kyu Don Chung ),손윤숙 ( Youn Suk Son ),홍상현 ( Sang Hyun Hong ),조현숙 ( Hyun Sook Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3

Sturge-Weber syndrome is characterized by congenital skin angiomas throughout the facio-trigeminal region, which can cause difficulty in airway management in the case of general anesthesia. The problems with this syndrome include glaucoma, seizures, severe mental retardation, intracranial cavernous hemangioma, etc. We report a case of a patient with Sturge-Weber syndrome with severe facial hemangioma who underwent septoplasty and inferior turbinectomy under general anesthesia. We also review the literature on the anesthetic management for the Sturge-Weber syndrome and discuss methods for avoiding complications. (Korean J Anesthesiol 2006; 51: 371~4)

저용량의 Rocuronium을 사용한 기관내 삽관 시 사전예비정주법이 Rocuronium의 작용 발현시간과 삽관 조건에 미치는 영향

손윤숙 ( Yoon Suk Son ),정규돈 ( Kyu Don Chung ),조현숙 ( Hyun Sook Cho ),유승준 ( Sung Jun Yu ),김수화 ( Su Hwa Kim ),이상묵 ( Sang Mook Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4

Background: A priming dose of rocuronium can shorten the onset time of neuromuscular blockade. The purpose of this study was to evaluate the effect of priming with rocuronium on the onset time and intubation conditions during tracheal intubation with low-dose rocuronium (0.35 mg/kg) and to compare results with those for rocuronium 0.45 mg/kg. Methods: One hundred twenty four patients were randomly allocated to three groups. Following induction of anesthesia, groups I and III received normal saline while group II received a priming dose of rocuronium (0.05 mg/kg). Three minutes after priming, groups I, II and III received, respectively, 0.45 mg/kg, 0.3 mg/kg and 0.35 mg/kg rocuronium. Intubation was performed 2 minutes after the administration of an intubating dose and intubation conditions were evaluated. Neuromuscular blockade was assessed by accelerography. Results: The proportion of cases having optimal intubation conditions in group I was higher than in groups II and III. There was no significant difference in the onset times among groups. Neuromuscular blockade at 60, 90 and 120 seconds after an intubating dose was similar among all groups except at 60 sec. Maximal blockade for group I was deep compared to groups II and III. Conclusions: Rocuronium 0.35 mg/kg does not provide satisfactory intubation conditions. There are no effects on onset time and intubation conditions due to priming during tracheal intubation with rocuronium 0.35 mg/kg. (Korean J Anesthesiol 2009;57:444∼9)

소아 대상포진 환자의 치료 증례

유승준 ( Seung Jun Yu ),이상묵 ( Sang Mook Lee ),정규돈 ( Kyu Don Chung ),윤은경 ( Eun Kyeung Youn ),윤건중 ( Keon Jung Yoon ) 대한통증학회 2008 The Korean Journal of Pain Vol.21 No.1

임상연구 : 견관절 수술 후 지속적 사각근간 상완 신경총 차단의 진통 효과

오세철 ( Sae Cheol Oh ),조현숙 ( Hyun Sook Cho ),지종훈 ( Jong Hun Ji ),송철헌 ( Chul Hun Song ),정규돈 ( Kyu Don Chung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6

Background: Pain following shoulder surgery is usually severe and difficult to control using conventional postoperative pain control maneuvers. Therefore, we investigated the pain control efficacy, PONV (postoperative nausea vomiting) and complications by the use of a continuous brachial plexus block in patients who had undergone shoulder surgery. Methods: Thirty three shoulder surgery patients were enrolled in this study. According to the Borgeat`s modified lateral technique, 30 ml of 0.37% ropivacaine were injected into the patients, which was followed by insertion of a continuous brachial plexus catheter into the plexus sheath. The operation was then conducted under general anesthesia, and postoperative pain was evaluated in the recovery room 12, 24, 36, and 48 hr after surgery. In addition, nausea and vomiting was calculated using the visual analogue scale (VAS) and sedation was evaluated using the modified Ramsay score. A total of 400 ml of 0.2% Ropivacaine was administered at a rate of 8 ml/hr to control the postoperative pain for 2 days. In addition, other neurological complications were investigated, and the catheter tips were cultured after they were removed to determine if any infection had occurred. Results: The postoperative pain scores were below 2 on the 10 cm VAS, and the level of nausea and vomiting was also satisfactorily (< 2/10 cm VAS). In addition, the mean sedation score of the patients in the recovery room was 2. There were complications including motor weakness (24%), dyspnea (15%), Hornor`s syndrome (9%), postauricular numbness (9%) and metallic taste (3%), however, there were no patients who complained of neurological symptoms after one month of follow-up, and no signs of infection were found when the results of catheter tip cultures were evaluated. Conclusions: The use of a continuous interscalene brachial plexus block is a feasible method of postoperative pain control for patients who undergo major shoulder surgery. (Korean J Anesthesiol 2007; 53: 733∼9)

일측폐환기시 환기폐의 호기말양압과 비환기폐의 지속적기도양압이 동맥혈산소분압 및 기도저항에 미치는 효과

이정은,조정옥,정규돈 충남대학교 의과대학 지역사회의학연구소 1997 충남의대잡지 Vol.24 No.2

One lung ventilation is essential for the protection of the healthy lung from contamination by spilage of secretion from the diseased lung and offering acceptable condition for surgeon. But it can cause inadequate ventilation and oxygenation. The purpose of this sutudy is to evaluate the effect of application of PEEP(5cmH_2O) on ventilating lung and CPAP(5cmH_2O) on nonventilating lung respectively during one lung anesthesia. Mean arterial blood pressure, heart rate, arterial blood gas analysis and airway pressure were measured before, during and after one lung ventilation in eight lung cacer patients and seven pneumothorax patients. There were no significant changes with blood pressure and heart rate. And blood gas analysis results showed normal findings. Mean and peak airway pressures and lung compliance were increased significantly(p<0.05) following one lung ventilation and returned control values after two lung ventilation.

충남대학교병원 마취발전의 경향에 관한 분석 : 1967년부터 - 1996년까지 from 1967 to 1996

최세진,김상수,정규돈,윤석화,신용섭,손수창,이원형,김혜자,이정은 충남대학교 의과대학 지역사회의학연구소 1998 충남의대잡지 Vol.25 No.2

To evaluate the specificity and historical trends of the anesthesia in Chungnam National University Hospital, anesthetic experiences of 83,572 in total performed at Chungnam National University Hospital from January 1967 to December 1996 were analyzed statistically and clinically according to age, sex, surgical department, physical status, elective and emergency surgery, premedicants, IV anesthetics, anesthetic methods, inhalational anesthetics, muscle relaxants. The results were as follows : 1. The number of cases has been steadily increased year by year. 2. The ratio of male to female was 52.8% : 47.2%. 3. According to the age, There were 44,905 cases (54%) in the group of 13-45 years. 4. According to the ASA classification of physical status, most of the cases were belonged to the class 1 & 2 (72.5%). 5. The ratio of elective to emergency was 79.4% to 20.6%. 6. Recently, glycopyrrolate has been used increasingly. 7. Thiopental sodium has been mainly used for intravenous induction agent. 8. General anesthesia has been used mainly. 9. Enflurane is the most common inhalational anesthetic agent. but Isoflurane has been used increasingly. 10. Most of muscle relaxants are Pancuronium & Vecuronium(84.5%).

당뇨병성 자율신경 장애 환자의 전신 마취시 심혈관계의 변화

손수창,정규돈 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.6

Background : Autonomic reflex dysfunction in patients with diabetes is associated with unstable cardiovascular response in perioperative period. In this study we wanted to investigate the extent to which the intraoperative cardiovascular responses depend on the degree of autonomic dysfunction. Methods : The influence of diabetic autonomic neuropathy upon the behavior of the circulatory system was investigated in 35 patients who had undergone ophthalmological surgery. A standardized test combination was used to study the patient's cardiovascular refractory reactions. The patients were then divided into a control group, non-diabetics without autonomic neuropathy (n = 18), and an experimental group, diabetics with autonomic neuropathy (n = 17). The anesthetic and surgical procedures (vitrectomy) were standardized and always identical. Results : During the induction of anesthesia, patients in the experimental group didn't experience changes in mean arterial blood pressure and heart rate as compared to patients in control group. During the maintenance of anesthesia, there were significant decreases in mean arterial blood pressure and heart rate in the experimental group, but in the state of emergence of anesthesia, there were no significant differences in either group. Conclusions : Autonomic neuropathy represents a perioperative risk factor, especially during induction and maintenance of anesthesia. I therefore recommend an autonomic nervous function test for evaluation of diabetic autonomic neuropathy in preoperative anesthesiological examination. (Korean J Anesthesiol 1999; 37: 1034∼1040)

흰쥐에서 Propofol 의 혈관이완작용에 대한 기전 및 내독소와의 관계

최세진,김윤희,정규돈 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.6

Background: The relationship between the NO and its vasodilatory effect of propofol has been a somewhat controversial matter. And, the effects of propofol has not been evaluated in septic condition whether it is solely due to its increased iNOS activity. Methods: First experiment is to study that the vasodilatory effect of propofol could be caused by NO. Isolated aortic rings with or without endothelium were contracted phenylephrine (10-9- 10-3 M) cumulatevely after porprfol (10-5 M) administration. The effects of L-NAME (3 × 10-4 M) and methylene blue (10-5 M) on contractile responses for phenylephrine were evaluated. Second experiment is to study the effect of propofol on septic vesseles. the no LPS (lypopolysaccaride) and LPS treated rings with or without endothelium were contracted phenylephrine (10-9 - 10-3 M) cumulatevely after porpofol (10-3 M) administration. The development of sepsis was confirmed by iNOS expression using RT-PCR. Results: All the aortic rings showed decreased response on phenylephrine contractile response with popofol administration. These responses were significantly less in denuded ones than in ones with intact endothelium. The endothelium dependent relaxation of propofol was inhibited by pretreatment with L - NAME and methylene blue in rat aortic rings having intact endothelium. All the aortic rings incubated with LPS showed decreased phenylephrine contractile response. The addition of propofol produced significantly more decrease in contractile response in LPS incubated rings in a greater than additive effect. The LPS induced hyporesponsiveness to phenylephrine was reversed by addition of cycloheximide. However, with the addition of propofol to LPS treated rings, complete reversal of this hyporesponsiveness to phenylephrine, failed to occur by addition of cycloheximide. Conclusions: 1) The vasodilatory effect of propofol seems to be mediatede by EDRF/NO, 2) The vasodilatory effect of propofol is increased in septic vesseles. Moreover, the inability of nitric oxide synthase inhibitior to reverse this response completely suggest that increased induction of iNOS may not be a sole responsible factor for this finding. (Korean J Anesthesiol 200; 39: 860~870)