정맥내 통증 자가조절법에 의한 술후 통증관리 1,590예에 대한 분석

송선옥(Sun Ok Song),지대림(Dae Lim Jee),구본업(Bon 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

N/A Background: We started postoperative pain management service using an intravenous patient-controlled analgesia(IV-PCA, PCA), which is known as convenient and effective an- algesic method. In this report, we describe the efficacy and safety of PCA and the experi- ence of developing an acute pain service to treat postoperative pain using a PCA. Methods: Practices of an acute pain service were started at a ward for general surgery after preparation of the standardized protocols for PCA. In each patient, PCA was con- nected following administration o;. initial loading doses of analgesics at recovery room after operation. All patients were checked by acute pain service team once or twice daily. The scope of acute pain service was gradually spread to other departments such as ortho- pedic, thoracic, obstetric and gynecologic departments by requests of patients or surgeons. We managed 1,590 patients during first 22 months. Among them, nine hundred seventy two cases were prospectively evaluated for their analgesic efficacy and side effects of PCA. Results: The number of patients was increased day by day. The most common type of operation was gastrectomy(21.6%). Cominonly used analgesics were nalbuphine(59%) and morphine(37%,). The mean duration of PCA attachment was 3.3 days. The degree of anal- gesia on operation day was good in 44.8#k and tolerable in 52.6% of patients. Only 3.9% of patients complained severe pain during their postoperative periods. One elderly patient ex- perienced respiratory depression(0.06%) owing to accidental misuse of PCA by his relatives. Overall patient's satisfaction was over 93%. Conclusions: According to our experiences, we conclude that PCA is an effective, relative- ly safe and highly satisfactory method for postoperative pain management. Because of these advantages of PCA, the creation of our acute pain service using a PCA was success- ful and expanded rapidly.

다한증 환자에서 흉강경하 교감신경연쇄절단술 중 발생한 심혈관계 허탈(증례보고)

박상진 ( Sang Jin Park ),지대림 ( Dae Lim Jee ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.1

일차성 인공 고관절 치환술과 재치환술 간의 술 후 폐합병증 발생빈도 및 위험인자의 비교

박상진 ( Sang Jin Park ),정걸 ( Gul Jung ),지대림 ( Dae Lim Jee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1

Background: Risk factors for postoperative pulmonary complication (PPC) after total hip arthroplasty (THA) are poorly studied. In addition, the risk factors associated with revision THA may differ from those associated with primary THA. The purpose of this study was to compare the incidences of PPC after revision THA with those observed after primary THA, and to evaluate the risk factors. Methods: We reviewed data describing patients who underwent primary (n=410) and revision THA (n=90) during a 10 year study period. The data included age, gender, body mass index, concurrent cardiopulmonary comorbidity, anesthetic techniques, operative time, the number of perioperative transfusions, the amount of fluid replaced, and the American Society of Anesthesiologists physical status. PPCs were grouped together as a single outcome and the incidence and the risk factors for PPC were analyzed. Results: The incidence of PPC after revision THA was significantly higher than after primary THA (23.3% vs. 11.5%, P=0.004). The significant risk factors in revision THA were the amount of fluid replaced ≥3,000 ml (P=0.014) and operative time ≥180 min (P<0.001), while there were no risk factors identified by primary THA during univariate analysis. Furthermore, the only significant risk factor identified by multiple logistic regression analysis was operative time (odds ratio=8.2, P<0.05). Conclusions: Patients undergoing revision THA are at higher risk of PPC than primary THA. The operative time is an important factor in the occurrence of PPC after revision THA. (Korean J Anesthesiol 2009; 57: 50~5)

증례보고 : 심장수술 후 발생한 총비골신경 마비

정태은 ( Tae Eun Jung ),문희림 ( Hi Lim Moon ),지대림 ( Dae Lim Jee ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.3

임상연구 : 슬관절 전치환술 시행 후 발생하는 폐합병증의 위험인자

박상진 ( Sang Jin Park ),박의균 ( Ui Kyun Park ),지대림 ( Dae Lim Jee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5

Background: Patients receiving an elective total knee replacement (TKR) are frequently older and immobilized. The related decline in respiratory function and structural changes may place these patients at an increased risk of perioperative pulmonary complications. Methods: This study reviewed the data of 239 consecutive procedures performed by a single surgeon. The data examined included the patient`s characteristics (age, gender, height, weight and body mass index [BMI]); concurrent pulmonary comorbidity (presence vs. absence); anesthetic techniques (general vs. spinal); types of operation (unilateral vs. bilateral); duration of operation (< 4 vs. ≥ 4 hr); duration of tourniquet inflation (< 2 vs. ≥ 2 hr); number of perioperative transfusions (≤ 4 vs. ≥ 5 units); and American society of anesthesiologists (ASA) physical status. Pulmonary complications were grouped together as a single outcome. A Chi-square test and multiple logistic regression analysis were used to identify the risk factors. A P value < 0.05 was considered significant. Results: Pneumonia, pulmonary edema, pulmonary congestion, atelectasis and pulmonary embolism were the pulmonary complications (n = 28; 11.7%) examined. Age, gender, BMI, pulmonary comorbidity, type and duration of surgery, duration of tourniquet inflation, anesthetic technique and ASA physical status were not associated with pulmonary complications. Only the number of packed cells transfused (≥ 5 units) was found to be associated with the pulmonary complications (odds ratio 5.21; P = 0.015). In particular, transfusions were related to pneumonia, pulmonary edema, pulmonary congestion and pulmonary embolism (P < 0.01). However, atelectasis was not related to any of the potential risk factors including the anesthetic technique. Conclusions: Transfusion requirements may be an important risk factor of the early postoperative pulmonary complications in patients receiving a TKR. (Korean J Anesthesiol 2006; 51: 573~7)

임상연구 : 소아에서 0.9% NaCl에 희석한 Rocuronium의 정주가 회피반응의 빈도 및 강도에 미치는 억제효과

박상진 ( Sang Jin Park ),이주영 ( Joo Young Lee ),지대림 ( Dae Lim Jee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2

Background: Rocuronium is suitable for short operations and rapidly controlling the airway on account of its rapid onset and intermediate action. However, the intravenous administration of rocuronium can cause pain and withdrawal movement in children. This study evaluated the effect of diluting rocuronium from 10 mg/ml to 1 or 0.67 mg/ml with 0.9% NaCl on the withdrawal response associated with the intravenous administration of rocuronium with the intubation dose. Methods: Ninety pediatric patients undergoing general anesthesia were randomized into one of three groups; Group OR (only rocuronium 0.6 mg/kg, n = 30), Group SRl0 (rocuronium 0.6 mg/kg diluted with 0.9% NaCl to 1 mg/ml, n = 30), Group SR15 (rocuronium 0.6 mg/kg diluted with 0.9% NaCl to 0.67 mg/ml, n = 30). After the loss of consciousness by a thiopental sodium 5 mg/kg injection, the patients from each group received the 0.6 mg/kg premixed rocuronium, respectively. Patients` withdrawal response to the injection were graded using a 4-point scale (Grade 0, 1, 2, 3). Results: The incidence and the intensity of the withdrawal response were significantly lower in the SRl0 and SR15 groups than in the OR group (P < 0.05). In the SR15 group, the intensity of the withdrawal response was under grade 2 in all patients. Conclusions: Diluting rocuronium to 0.67 mg/ml is a simple and effective method for preventing withdrawal movements during an intravenous rocuronium injection. (Korean J Anesthesiol 2006; 51: 157~61)

증례보고 : 척추 수술을 받은 척추 골절 환자에서 발생한 척수 경색

박상진 ( Sang Jin Park ),정현철 ( Hyun Chul Jung ),지대림 ( Dae Lim Jee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.4

Spinal cord infarction as a complication of spine surgery occurs rarely. Herein, a case of spinal cord infarction, which developed in a 69 year old woman following posterior decompression and internal fixation for a T11 bursting fracture, is descirbed. The anesthetic induction and intraoperative course were uneventful, except at the end of the procedure, where her blood pressure suddenly dropped from 130/90 to 90/60 mmHg. The patient was aggressively treated with a transfusion and vasopressor, the blood pressure then returned to its usual value within 10 minutes. However, during a physical examination in the recovery room, the patient was found to have flaccid lower limbs, with impaired sensory function below the T8 level. Her cord diameter had increased, and a high signal lesion was observed within the thoracic spinal cord, from T9 to T12 level on T2-weighted MR images, which was diagnosing as a spinal cord infarction, was and showed no improvement despite the immediate and aggressive treatment. (Korean J Anesthesiol 2007; 52: 471~4)

저산소-산소재공급 과정에서 propofol에 의한 별큰포식세포의 superoxide dismutase 활성도 상승과 세포보호 작용

노영철(Yeung Chul Noh),송인환(In Hwan Song),김주영(Joo Young Kim),성채림(Chae Rim Seong),지대림(Dae Lim Jee),성언기(Eon Gi Sung) 대한해부학회 2007 Anatomy & Cell Biology Vol.40 No.3

본 실험은 생체의 특성이 유지된 별큰포식세포를 일차 배양하여 간의 허혈-재관류 과정과 유사한 저산소-산소재공급 과정이 별큰포식세포에 미치는 영향과 이때 propofol을 함께 처리하여 이 약제가 어떠한 보호효과가 있는가를 유리된 젖산탈수소효소의 양과 별큰포식세포의 superoxide dismutase (SOD)활성도를 측정하여 조사하였다. 배양된 별큰포식세포에 저산소 및 산소재공급 처리를 한 결과 저산소 및 산소재공급 처리를 하지 않은 대조군에 비교하여 배양액에 유리된 젖산탈수소효소의 양이 유의하게 증가하였고(P⁄0.01), 별큰포식세포내의 SOD활성도는 유의하게 감소하였다(P⁄0.05). 저산소 및 산소재공급 처리에 의한 젖산탈수소효소의 증가와 SOD활성도의 감소는 0.5 및 5 μg/mL 농도의 propofol에 의하여 저산소 및 산소재공급을 처리하지 않은 대조군의 수준으로 젖산탈수소효소가 감소하였고, SOD활성도는 증가하였다. Propofol은 0.5와 5 μg/mL 농도에서 별큰포식세포의 젖산탈수소효소의 양과 SOD활성도에 미치는 영향은 없었다. 그러나 50 μg/mL 농도의 propofol은 젖산탈수소효소의 유리를 증가시켜 세포파괴 효과가 있었고(P⁄0.01), 저산소-산소재공급 과정에서는 SOD활성도 또한 매우 감소시켰다(P⁄0.01). 결론적으로 본 실험의 저산소-산소재공급 과정에서 별큰포식세포에 미치는 propofol의 효과는 향후 propofol이 간이식의 마취제로서의 유용성에 대한 기초 자료로 도움이 될 것으로 생각되었다. The aims of this study were to verify the hypoxia-reoxygenation injury of primary cultured Kupffer cells and the effect of propofol against the hypoxia-reoxygenation injury through quantitating lactate dehydrogenase (LDH) release and superoxide dismutase (SOD) activity.The sequential treatments with hypoxia and reoxygenation induced significant increasement of LDH release (P⁄0.01) and decresement of SOD activity(P⁄0.05) in primary cultured Kupffer cell. The level of LDH release and SOD activity after sequential treatments with hypoxia and reoxygenation were restored to the control level by the propofol treatment in the concentration of 0.5 and 5 μg/mL. Propofol in concentration of 50 μg/mL induced significant increasement of LDH release (P⁄0.01) on both normal culture and hypoxia-reoxygenation culture of the Kupffer cell. As hypoxia and reoxygenation procedures and propofol treatment were concurrently added to the cultured Kupffer cell, propofol treatment in the concentration of 50 μg/mL decreased significantly the SOD activity (P⁄0.01). In conclusion, propofol in this hypoxia-reoxygenation model could provide a valuable clue for the study of liver transplantation and of propofol.

배양된 별큰포식세포의 무산소-산소재공급 시험관실험모델

홍정숙(Jeong Sook Hong),성훈기(Hoon Ki Sung),송인환(In Hwan Song),김주영(Joo Young Kim),지대림(Dae Lim Jee),성언기(Eon Gi Sung) 대한해부학회 2003 Anatomy & Cell Biology Vol.36 No.3

본 실험은 생체의 특성을 잘 유지할 수 있는 별큰포식세포의 배양법을 확립하고, 배양된 별큰포식세포를 이용하여 간 의 허혈-재관류 과정에서 발생되는 별큰포식세포의 활성화를 재현할 수 있는 시험관내 실험모델을 제작하여 다음의 결과 를 얻었다. 별큰포식세포의 분리에서 collagenase의 관류, stainless 그물의 통과, Percoll gradient centrifugation 및 세포가 배양용기에 부착하는 시간의 차이를 이용한 분별부착법 등의 일련의 조작으로 90% 이상의 순수한 별큰포식세포를 얻을 수 있었다. 흰쥐 1개의 간에서 1~5×107개의 별큰포식세포를 얻었고, 다른 세포의 과다증식없이 별큰포식세포 배양을 10일 정도 유 지할 수 있었다. 배양된 별큰포식세포의 탐식능력은 배양액에 첨가된 latex beads의 탐식정도로 측정하였는데, 그 수가 한 개에서 수십 개로 다양하였다. 크고 둥근 모양의 별큰포식세포가 많은 latex beads를 탐식하였고 작거나 불규칙한 모양의 세포는 탐식 능력이 떨어져, 생체에서의 별큰포식세포의 다양성에 따른 탐식능력의 차이가 시험관에서도 유지되었다. 배양된 별큰포식세포의 무산소-산소재공급 처리한 실험군에서는 70.2%의 세포가 latex beads를 탐식하였고 latex beads 를 탐식한 세포들 중 57.5%의 세포가 5개 이상의 latex beads를 탐식하여 대조군의 48.9%와 44.3%에 비교하여 유의한 증 가를 보여 (p⁄0.01), 허혈-재관류 후에 발생되는 별큰포식세포의 활성화를 직접적으로 설명할 수 있는 결과였다. 결론적으로 본 실험에서 배양된 별큰포식세포는 탐식기능에서 생체의 특성을 잘 유지하였고, 이를 이용한 무산소-산소 재공급 시험관모델은 간의 허혈-재관류 손상에서 별큰포식세포의 역할을 이해하는데 적합한 것으로 생각된다. The aims of this study were to describe a reproducible method for the isolation, purification and primary culture of rat Kupffer cells, and were to develop in vitro system which could provide a tool for the study of ischemia-reperfusion injury. Kupffer cells were isolated following sequential collagenase digestion of the liver by perfusion and enrichment of a nonparenchymal cell fraction by a double-densities gradient centrifugation step using Percoll and were selected by allowing them to adhere to culture vessel for 2 h at 37�C under 5% CO2. The purity of obtained Kupffer cell was about 90% assessed by the phagocytosis of 3 μm latex beads. This method for Kupffer cell isolation resulted in yields of 1~5 ×107 Kupffer cells per liver and Kupffer cells were preserved in maintenance cultures for 10 days. The phagocytic capacity of cultured Kupffer cells was measured according to the amount of latex beads incorporated into the cytoplasm. Larger round Kupffer cells in the culture had higher phagocytic capacity compared with smaller round or irregular shaped Kupffer cells. The different phagocytic capacity of Kupffer cells which was dependent on size and shape in vivo was well preserved during culture. The experimental group of Kupffer cells in culture were sequentially treated with ischemia and reperfusion at 1h and 30 min. The ratio of Kupffer cells having latex beads in their cytoplasm was significantly increased compared with control (p⁄0.01). This result was able to explain the Kupffer cells’ activation after ischemia-reperfusion injury in vivo. In conclusion, Kupffer cells in this culture well resembled the cells in vivo and this in vitro model could provide a valuable tool for the study of Kupffer cells with a key role in pathophysiology of ischemia-reperfusion injury.

전신마취 후 회복실에서 발견된 무기폐의 치료

황창재 ( Chang Jae Hwang ),김흥대 ( Heung Dae Kim ),박대팔 ( Dae Pal Park ),서일숙 ( Il Suk Seo ),송선옥 ( Sun Ok Song ),김세연 ( Sae Yeon Kim ),지대림 ( Dae Lim Jee ),이덕희 ( Deok Hee Lee ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Atelectasis is a relatively common complication following surgery in anesthetized patient with respiratory symptoms, but rarely occur in normal healthy patient. Anesthesiologists must be wary to prevent atelectasis, because it may lead to hypoxia during and after the operation. This case reports a healthy patient without previous respiratory symptoms who developed left lower lobar atelectasis after general anesthesia. Vigorous chest physiotherapy including intended coughing, deep breathing, chest percussion and vibration under postural change was effective. Therefore, vigorous chest physiotherapy is essential part of early treatment modalities for atelectasis in postoperative recovery room.