• 대한전기학회논문지:시스템및제어부문D
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• 제55권1호
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• pp.35-41
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• 2006

Although reachers have studied for a long time, they don't make criteria for anesthesia depth. anesthetists can't make a prediction about patient's reaction. Therefor, patients have potential risk such as poisonous side effect late-awake, early-awake and strain reaction. EEG are received from twenty-five patients who agreed to investigate themselves during operation with Enflurane-anesthesis in progress of anesthesia. EEG are divided pre-anesthesia, before incision of skin, operation 1, operation 2, awaking, post-anesthesia by anesthesia progress step. EEG is applied pre-processing, base line correct, linear detrend to get more reliable data. EEG data are handled by electronic processing and the EEG data are calculated by bicoherence. During pre-anesthesia and post anesthesia, appearance rate of bicoherence value is observed strong appearance rate in high frequency range($15\~30Hz$). During the anesthesia of patient, a strong appearance rate is revealed the low frequency area(0~10Hz). After bicoherence is calculated by percentage of a appearance rate, that is, Bicpara$\#$1, Bicpara$\#$2, Bicpara$\#$3 and Bicpara$\#$4 parameter are extracted. In result of bicoherence analysis, Bicpara$\#$2 and Bicpara#4 are considered that the best parameter showed progress of anesthesia effectively. And each separated bicoherence are calculated by average bicoherence's numerical value, divide by 2 area, appear by each BicHz$\#$1, BicHz$\#$2, and observed BicHz$\#$1/BicHz$\#$2's change. In result of bicoherence analysis, BicHz$\#$1, BicHz$\#$2 and BicHz$\#$1/BicHz$\#$2 are considered that the best parameter showed progress of anesthesia effectively. In conclusion, I confirmed the anesthesia progress phase, concluded to usefulness of parameter on bispectrum and bicoherence analysis and evaluated the depth of anesthesia. In the future, it is going to use for doctor's diagnosis and apply to protect an medical accident owing to anesthesia.

• Korean Journal of Acupuncture
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• 제22권1호
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• pp.95-108
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• 2005

Objective : In the present study, the effect of electroacupuncture (EA) applied to several acupoints and non-acupoint in CFA-induced knee arthritis was examined. Methods : A common source of persistent pain in humans is arthritis. Arthritis was induced by injection of CFA $125\;{\mu}l$ into knee joint cavity under enflurane anesthesia. The rat subsequently showed swelling of the ankle and a reduced stepping force of the affected limb for the next several days. The reduced stepping force of the limb was presumably due to a painful knee. EA was applied to either of $LR_2,\;LI_4$, or non-acupoint on the contralateral forelimb for 30 min under gaseous anesthesia. After the termination of EA, behavioral tests measuring stepping force were periodically conducted during the next 4 h. Results : EA applied to $LR_2$ point produced a significant improvement of stepping force of the affected foot lasting for at least 2 h. However, neigher $LI_4$ point nor non-point produced any significant increase of weight bearing force. The improvement of stepping pressure was interpreted as an analgesic effect. The analgesic effect was specific to the acupuncture point since the analgesic effect on CFA-induced knee arthritic pain model could not be mimicked by EA applied to a point, $LI_4$ or non-acupoint. In addition, both NO production and iNOS protein expression increased by arthritis were suppressed by EA applied to $LR_2$ point. Conclusion : These data suggest that EA produces a potent analgesic effect in the rat model of CFA-induced knee arthritis. This analgesic effect is produced by applying EA to an acupoint at opposite side from the painful area in a stimulus point-specific way.

• The Korean Journal of Pain
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• 제18권2호
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• pp.165-170
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• 2005

Background: It is difficult to treat tourniquet-induced hypertension despite adequate anesthesia, and the mechanism of that is not known. And it may be possible that intraoperative continuous infusion of opioid induces preemptive analgesia postoperatively. We investigated the effect of intraoperative continuous i.v. fentanyl on tourniquet induced cardiovascular changes and postoperative preemptive analgesia in total knee replacements. Methods: Sixty patients were randomly assigned to two groups; In study group ($1.5{\mu}g/kg$ loading and $0.5{\mu}g/kg/hr$ continuous infusion of fentanyl before skin incision and tourniquet inflation) and control group (no treatment). Anesthesia was maintained with enflurane (1-2 MAC) and 50% nitrous oxide in oxygen. Arterial pressure and heart rate were compared between two groups. They received postoperative pain treatment with patient-controlled analgesia (PCA) with fentanyl during the postoperative 48 hours after total knee replacement. Visual analog scale (VAS) scores at either rest or movement were used to assess pain. Total fentanyl dose delivered, number of PCA requests, supplemental analgesics, overall satisfaction score and adverse events were evaluated. Results: There were no significant differences between the two groups on cardiovascular changes by tourniquet induced pain effect. VAS, PCA delivered dose and PCA demands at movement in the 24-48 hour decreased in study group compared with control group (P < 0.05). But there were no significant differences between the two groups on the other time periods except 24-48 hour's patient satisfaction and adverse events. Conclusions: We suggest that intraoperative continuous i.v. fentanyl infusion dose not affect cardiovascular change by tourniquet induced pain. But it may induce preemptive analgesia postoperatively.

• Korean Journal of Acupuncture
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• 제21권1호
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• pp.113-127
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• 2004

Objectives : The usage of acupuncture has gained popularity as an alternative method of treatment for certain chronic pain conditions. However, the efficacy of acupuncture in various diseases has not been fully established and the underlying mechanism is not clearly understood. In the present study, the effect of electroacupuncture (EA) applied to foot samli$(ST_{36})$ on the carrageenan-induced knee arthritic pain was examined. Methods : A common source of persistent pain in humans is the knee arthritis. Knee arthritis was induced by injection of 2 % carrageenan $50\;{\mu}l$ into the knee joint cavity. When rats developed pain behaviors, EA was applied for 30 min. under enflurane anesthesia with repeated train stimuli at the intensity of 10X of muscle twitch threshold. The weight bearing force of the hind limb was measured for an indicator of pain level after each manipulation. Results : The average weight borne by the hind limb during normal gait was 55% of total body weight, which was reduced to less than 10% after knee arthritis. EA improved the weight bearing of the arthritic hind limb significantly for the duration of 4 hr. EA applied to $ST_{36}$ point produced a significant improvement of stepping force of the arthritic foot lasting for at least 4 h. However, $GB_{31}$ point did not produce any significant increase of weight bearing force. The analgesic effect was specific to the acupuncture point since the analgesic effect on the knee arthritis model could not be mimicked by EA applied to a nearby point, $GB_{31}$. The relations between EA-induced analgesia and endogenous nitric oxide(NO) and inducible NO synthase(iNOS)/neuronal NOS was also examined. Results were turned out that both NO production and nNOS/iNOS protein expression which is increased by arthritis were suppressed by EA stimulation applied to $ST_{36}$ point. Conclusions : The data suggest 1) that EA produces a potent analgesic effect on the rat model of chronic knee arthritis pain in a point specific manner and 2) that EA-induced analgesia modulate endogenous NO through the suppression of nNOS/iNOS protein expression.

• Korean Journal of Acupuncture
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• 제21권2호
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• pp.47-67
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• 2004

Objectives : In the present study, the effect of Scolopendrid Water-Alcohol Extract (SWAE) applied to acupuncture point BL23 (Shinsu) on the neuropathic pain was examined. A common source of persistent pain in humans is the neuropathic pain. Anti-convulsant drugs are used to treat the neuropathic pain. In the oriental medicine, Scolopendrid was used for long time to treat convulsant syndrome and back pain, etc. Methods : On the bases of the Scolopendrid clinical application, the effect of SWAE applied to the acupuncture point was tested in the rat model of neuropathic pain. Neuropathic pain was induced by tight ligation of L5 spinal nerve. When rats developed pain behaviors, One hundred microliter of SWAE was applied into the ipsilateral BL23 point at a dose of 10 mg/ml under enflurane anesthesia. The foot withdraw latency of the hind limb was measured for an indicator of pain level after each manipulation. Results : SWAE injection increased the mechanical threshold of the foot in the rat model of neuropathic pain significantly for the duration of 4h, suggesting a partial alleviation of pain. SWAE applied to BL23 point produced a significant improvement of mechanical sensitivity of the foot lasting for at least 4h. However, neither contralateral BL23 point, ST25 (Chonchu) point, nor LR3 (Taechung) point produce as much increase of mechanical sensitivity as ipsilateral BL23 point. And, this increase of mechanical sensitivity was dose-dependent. The improvement of mechanical threshold was interpreted as an analgesic effect. In addition, the analgesic effect of Scolopendrid 4 mg/kg injection is equivalent to that of gabapentin 50 mg/kg injection. The relations between SWAE-induced analgesia and endogenous nitric oxide(NO), inducible NO synthase (iNOS)/neuronal NO synthase (nNOS) were also examined. Results were turned out that both NO production and nNOS/iNOS protein expression which are increased by nerve injury were suppressed by SWAE injection applied to BL23 point. Conclusions : The data suggest 1) that SWAE produces a potent analgesic effect on the neuropathic pain model in the rat and 2) that SWAE-induced analgesia modulate endogenous NO through the suppression of nNOS/iNOS protein expression.

• 동의생리병리학회지
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• 제19권5호
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• pp.1356-1362
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• 2005

The purpose of this study os to investigative the effect of Carrageenan-Induced Pain on lower limb muscle and ligament of rat. To evaluate pain mechanism in muscle and ligament, pain was induced by the injection of 2% $0.1m{\ell}$ carrageenan into the left lower limb muscle of rats after rats were anesthesized with 3% enflurane. Rats were killed on 72 hours after pain induction under the anesthesia. anterior rectus femoris muscle and its ligament were removed from rat hind limb. Morphological changes of them were peformed by the observation of light and electron microscopes. In the light microscopic findings, the muscle cells were polyheadral and situated with each other without small gap in control group. nucleus of cell was seen along the cell margin, and muscle cell groups were divided by regular narrow gap in cross section. In the pain-induced group, muscle cell groups were divided each other by the irregular gap, and some of groups formed larger than other cell groups by the fusion. Intercellular gap of most cell groups were increased compared with control groups. And also, perimysium of muscle cell groups was swollen in cross section. In control group, muscle cells contacted each other closely and each cell was divided by perimysium. The intracellular gaps were not seen between myofibrills, and also striations were well defined between muscle cells in longitudinal section. In pain-induced group, muscle cells were divided by the small intracellular gaps. And also, muscle cell showed many a short cross or longitudinal intercellular gaps in longitudinal section. In light microscopic findings of control group, tendon was composed with many tendon fibers contacted each other closely without gap. The free margin of tendon was fused, and apso the tendon fibers did not invaded between muscles. In pain-induced group, tendon was divided small groups by intertendinous gap, and also the margin of tendon divided by small groups. In the free margin, tendon invaded into muscle cells, and also fibroblasts between tendon fibers were long and lance-shaped. From these results, it is suggested that pain induction by carrageenan injured rat skeletal muscle and ligament by the morphological changes.

• Korean Journal of Acupuncture
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• 제21권3호
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• pp.59-76
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• 2004

Objectives : The usage of acupuncture has gained popularity for certain chronic pain conditions. However, the efficacy of acupuncture in various diseases has not been fully established and the underlying mechanism is not clearly understood. In the present study, the effect of electroacupuncture (EA) applied to yangno$(SI_6)$ on the neuropathic pain was examined. Methods : A common source of persistent pain in human is a neuropathic pain. Neuropathic pain was induced by tight ligation of L5 spinal nerve. When rats developed pain behaviors, EA was applied for 30 min. under enflurane anesthesia with repeated train stimuli at the intensity of 10X of muscle twitch threshold. The foot withdraw latency of the hind limb was measured for an indicator of pain level after each manipulation. Results : EA increased the mechanical threshold of the foot in the rat model of neuropathic pain significantly for the duration of 1 hr. suggesting a partial alleviation of pain. EA applied to SI6 point produced a significant improvement of mechanical sensitivity of the foot lasting for at least 1 h. However, $ST_{36}$ point did not produce any significant increase of mechanical sensitivity. The improvement of mechanical threshold was interpreted as an analgesic effect. The analgesic effort was specific to the acupuncture point since the analgesic effect on the neuropathic pain model could not be mimicked by EA applied to a point, $ST_{36}$. In addition, this analgesic effect of EA is mediated by a adrenergic mechanism of descending control of spinal cord from the brain. Conclusions : The data suggest that EA produces a potent analgesic effect on the neuropathic pain model in the rat; and 2) that EA-induced analgesia is mediated by a adrenergic mechanism of descending control in a point specific manner.

• Korean Journal of Acupuncture
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• 제22권1호
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• pp.7-21
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• 2005

Objectives : In the present study, the effect of electroacupuncture (EA) applied to SI6 and won-rak point on the ankle sprain model was examined. A common source of persistent pain in humans is the lateral ankle sprain. Methods : To model this condition, the rat's right ankle was bent repeatedly, overextending lateral ligaments, for 4 min under enflurane anesthesia. The rat subsequently showed swelling of the ankle and a reduced stepping force of the affected limb for the next several days. The reduced stepping force of the limb was presumably due to a painful ankle. EA was applied to the several acupuncture point on the contralateral forelimb for 30 min under gaseous anesthesia. After the termination of EA, behavioral tests measuring stepping force and Paw volume were Periodically conducted during the next 4 h and 18 h respectively. Results : EA applied to $SI_6$ with won-rak point produced more powerful improvement of stepping force of the sprained foot than to $SI_6$ alone lasting for at least 4 h. However, neigher $KI_4$ point nor $BL_{64}$ point produced any significant increase of weight bearing force. The improvement of stepping pressure was interpreted as an analgesic effect. The analgesic effect was specific to the acupuncture point since the analgesic effort on the ankle sprain pain model could not be mimicked by EA applied to $KI_4$ or $BL_{64}$. In addition, EA applied to $SI_6$ with won-rak combination point showed inhibitory effect on the paw edema induced by ankle sprain. Also, COX-2 protein expression increased by ankle sprain were suppressed by the EA stimulation. Conclusion : These data suggest that EA with won-rak combination point produces a more potent analgesic effect on the ankle sprain pain model in the rat and that EA with won-rak combination point induced anti-inflammatory effect through the suppression of COX-2 protein expression.

• Journal of Yeungnam Medical Science
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• 제24권2호
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• pp.206-215
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• 2007

복와위는 신체 후부 노출이 필요한 척추 수술을 위해 주로 사용되고 있으며 수술부위로의 접근이 용이하고 수술 도중에 척추를 안정적으로 유지해주는 장점이 있다. 하지만 전신마취하에 있는 환자를 앙와위에서 복와위로의 전환은 여러 가지 부작용을 동반하며 특히 순환기계의 변화를 초래할 수 있다. 이를 줄이기 위해 다양한 복와위 전용 수술대들이 연구 개발되어 임상에 사용되고 있다. 이에 저자들은 앙와위에서 복와위로의 체위 변환 시에 Jackson spinal surgery table의 이용이 체위에 의한 압박 때문에 생기는 환자의 순환기계 변화를 얼마나 효과적으로 줄여줄 수 있는지 알아보고자 하였다. 본 연구는 추간판탈출증, 퇴행성척추전방전위증, 척추협착증의 진단 하에 본원 정형외과와 신경외과에서 수술을 받기로 예정된 환자 중 미국 마취과학회 신체등급 분류 1급 또는 2급에 해당하는 성인 환자 30명을 대상으로 하였다. 연구 대상 환자의 성별은 남자가 15명, 여자가 15명이었고, 심혈관계나 호흡기계 질환이 있는 환자는 연구 대상에서 제외하였다. 모든 환자는 마취전투약으로 수술 시작 1시간 전에 glycopyrrolate 0.2 mg, fentanyl $1{\mu}g/kg$을 근주하였으며 수술실에 도착한 후 비침습적 자동 혈압 측정기, 심전도 및 맥박산소 계측기를 거치하였다. Thiopental sodium과 vecuronium으로 마취를 유도하였으며 환자의 의식소실과 충분한 근이완을 확인한 후 기관내 삽관을 시행하였다. Enflurane 1.5-2.0 vol%와 $O_2$, $N_2O$ 각각 2 L/min을 사용하여 마취유지를 하였으며 급격한 활력 징후의 변동으로 마취유지가 용의치 않은 경우는 연구 대상에서 제외시켰다. 환자의 활력 징후 안정 후 요골 동맥에 카테터를 거치하여 지속적으로 동맥압을 측정하였고, 우측 쇄골하 정맥에 중심정맥 카테터를 거치하여 중심정맥압을 측정하였다. 부분재호흡 심박출량 감시기 ($NICO^{(R)}$, Novametrix Medical Systems INC., USA)를 통해 비침습적으로 환자의 심박출량을 측정하였다. 앙와위에서 복와위로 체위변경 직전에 심박출 계수, 심박출량, 평균동맥압, 심박수, 중심정맥압을 측정하여 앙와위의 값으로 삼았으며, 척추 수술 전용 수술대인 Jackson spinal surgery table을 사용하여 복와위를 취하였다. 복와위로 체위 변경 뒤 심박출 계수, 심박출량, 평균동맥압, 심박수, 중심정맥압을 측정하여 복와위의 값으로 기록하였다. 본 연구 결과 앙와위와 복와위의 혈역학적 지수의 비교시 심박수와 평균동맥압은 별다른 차이가 없었다. 중심정맥압은 유의한 정도는 아니지만 감소 소견을 보여 수술시 출혈의 위험성을 감소시킬 것으로 생각된다. 심박출량과 심박출 계수도 유의한 감소 소견을 보였으나 convex saddle table을 이용한 경우와 kneechest position을 취한 경우보다 적은 변화를 보여 Jackson spinal surgery table의 사용은 유용할 것으로 사료된다. 그러나 Jackson spinal surgery table을 사용하여 복부와 흉부에 과도한 압력이 가해지지 않더라도 유의한 심박출량 감소가 있을 수 있음을 유념해야 할 것이다. 특히 심폐여력이 부족한 환자들에 있어서는 심박출량의 감소는 위험한 결과를 초래할 수 있으므로 복와위에 의한 생리적 변화에 관한 충분한 이해와 함께 마취 시 보다 적극적인 감시와 관리가 요구된다고 여겨진다.