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실험연구 : Lidocaine 또는 MK-801의 척수강내 투여시 두가지 신경병증 통증 모델에서 항이질통 효과 비교

조선준 ( Sun Joon Cho ),강금내 ( Keum Nae Kang ),황재현 ( Jai Hyun Hwang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Background: Neuropathic pain can be induced by nerve injury or inflammation. An N-methyl-D-Aspartate (NMDA) antagonist (MK-801), and a sodium channel blocker (lidocaine) have been found to reduce mechanical allodynia. This study was conducted to determine whether intrathecal lidocaine or MK-801 had an antiallodynic effect on established mechanical allodynia in two well-characterized neuropathic pain rat models. Methods: Male Sprague Dawley rats (n = 107) were anesthetized, and the left L5 and L6 spinal nerves were ligated (SNL group) or Freund complete adjuvant (FCA) was administrated to the same spinal nerves (FCA group) in order to cause neuropathic pain. A catheter was then implanted into the lumbar intrathecal space. After obtaining the baseline scores, time-effect curves of each drug were established for the antiallodynic effects of lidocaine (30μg, 100μg and 300μg) and MK-801 (1μg, 3μg, 10μg and 30μg). The allodynic thresholds for the left hind paw withdrawal to von Frey hairs were assessed and converted to %MPE, and the ED50 value was then calculated using the %MPE. The antiallodynic effects of the two groups were then compared by analyzing the dose-response curves and the ED50 values. Results: Both intrathecal lidocaine and MK-801 resulted in a dose dependent antiallodynic effect. ED50 values and the analysis of dose response curves showed that intrathecal lidocaine provided more effective antiallodynia in the SNL group, whereas intrathecal MK-801 resulted in a greater antiallodynic effect in the FCA group. Conclusions: In the SNL group, lidocaine had a better effect in reducing allodynic pain, whereas in the FCA group, MK-801 showed a greater antiallodynic effect. (Korean J Anesthesiol 2007; 53: 497~503)
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임상연구 : 심박수 변이도, 혈압 변이도 및 압반사 민감도를 이용한 간경화 환자의 심혈관 자율신경계 평가

윤미옥 ( Mi Ok Youn ),강수진 ( Su Jin Kang ),전인구 ( In Gu Jun ),신원정 ( Won Jung Shin ),최병문 ( Byung Moon Choi ),도경준 ( Kyung Jun Do ),조선준 ( Sun Joon Cho ),최재혁 ( Jae Hyuk Choi ),송준걸 ( Jun Gol Song ),허인영 ( In You 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
Background: Liver cirrhosis is associated with several hemodynamic abnormalities, including an impairment of autonomic nervous system reflexes, but very few have compared the disease severity with cardiovascular autonomic dysfunction assessed by spectral analysis of blood pressure and electrocardiogram. The aim of this study was to investigate the relationship between Child-Turcotte-Pugh (CTP) score and autonomic indices in patients with liver cirrhosis using the heart rate variability (HRV), blood pressure variability (BPV) and baroreflex sensitivity (BRS). Methods: Fifty patients scheduled for liver transplantation recipients under general anesthesia were enrolled in the study. Beat-to-beat blood pressure and RR interval were measured for five minutes before anesthesia induction. HRV and BPV were estimated by power spectral analysis of RR interval and systolic blood pressure. BRS was estimated by both the sequence method (Sequence BRS) and high frequency (HF) gain of transfer function analysis (HF BRS). Results: Significant inverse correlations between CTP score and Sequence BRS (r = -0.61), HF BRS (r = -0.59), low frequency (LF) and HF power of HRV (r = -0.57, r = -0.46), LF power of BPV (r = -0.37) were found. However, no significant correlations were observed between CTP score and LF/HF ratio of HRV (r = -0.02) and HF power of BPV (r = 0.27). Conclusions: These results showed that autonomic dysfunction assessed by spectral analysis was associated with increasing severity of liver cirrhosis. Further study will be needed to clarify relationship between our findings and hemodynamic fluctuations during anesthesia for liver transplantation. (Korean J Anesthesiol 2006; 50: 655~62)
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임상연구 : Sevoflurane 흡입마취유도 시 동맥압 변화의 기전 평가: Modelflow 방법을 이용한 혈역학 변수의 Beat-to-Beat 분석

김영국 ( Young Kug Kim ),윤미옥 ( Mi Ok Youn ),서형석 ( Hyung Seok Seo ),최재혁 ( Jae Hyuk Choi ),최병문 ( Byung Moon Choi ),신원정 ( Won Jung Shin ),도경준 ( Kyung Jun Do ),조선준 ( Sun Joon Cho ),강수진 ( Su Jin Kang ),전인구 ( 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: A modelflow method provides beat-to-beat analysis of cardiovascular variables based on arterial pulse pressure analysis. In this study, we assessed the mechanism of arterial blood pressure (ABP) change during sevoflurane induction by the analysis of beat-to-beat hemodynamic changes using a modelflow method. Methods: Beat-to-beat ABP was measured during a stable conscious state (baseline) and vital capacity induction with sevoflurane 6 vol% and oxygen 8 L/min in 18 healthy living liver transplant donors. Alterations of beat-to-beat systolic ABP, mean ABP, diastolic ABP, heart rate (HR), stroke volume (SV), cardiac output (CO), and total peripheral resistance (TPR) by sevoflurane induction were estimated noninvasively using a modelflow method simulating aortic input impedance from an ABP waveform. Results: After sevoflurane induction, ABP, SV, CO, and TPR decreased significantly (all P < 0.05), but HR did not change significantly. After tracheal intubation, ABP, CO, and TPR did not change significantly compared with baseline, but HR increased and SV decreased significantly (both P < 0.05). Conclusions: Using a modelflow beat-to-beat analysis of cardiovascular variables, we found that ABP did not change significantly compared to baseline after tracheal intubation during sevoflurane induction, indicating the counteraction of increased HR and decreased SV, and that the reduction of SV by tracheal intubation suggests the suppression by increased HR and TPR compared with that after sevoflurane induction. (Korean J Anesthesiol 2006; 51: 17~23)

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