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임상연구 : 무릎 관절경 수술 시 Ketorolac 투여가 압박띠 사용에 따른 혈압 변화에 미치는 영향
김운영 ( Yoon Young Kim ),신연식 ( Youn Sik Shin ),민두재 ( Doo Jae Min ),이윤숙 ( Yoon Sook Lee ),김재환 ( Jae Hwan Kim ),박영철 ( Young Cheol Park ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Background: The use of a tourniquet can produce pain and cause increased blood pressure. Ketorolac is known to have analgesic effects at the peripheral and central levels, however, its effect on the increased blood pressure due to a tourniquet is unknown. Therefore, the effects of ketorolac on the tourniquet-induced changes in the systolic, and diastolic blood pressures (SBP & DBP), as well as the heart rate (HR), were investigated. Methods: ASA physical status I and II patients, who were scheduled for knee arthroscopic surgery using a tourniquet, were assigned to control (n = 20), K30 (n = 20) and K60 groups (n = 20). Anesthesia was maintained with enflurane, N2O and O2. Either 30 or 60 mg ketorolac was injected 10 min prior to tourniquet inflation in both the K30 and K60 groups. The changes in the SBP, DBP and HR were measured before and 10, 20, 30, 40, 50, and 60 min after tourniquet inflation. Results: There were no differences in the baseline SBP, DBP, and HR values. The SBP was higher than the baseline value at 10, 20, 30, 40, 50, and 60 min in the control and at 30, 40, 50, and 60 min in the K30 groups, but only at 60 min in the K60 group. At 60 min, the SBP was lower in the K60 than the control group. The DBP was higher than the baseline value at 50, and 60 min in the control, but not in the ketorolac groups. Conclusions: A 60 mg ketorolac injection prior to tourniquet inflation can attenuate the tourniquet induced increase in blood pressure in knee arthroscopic surgery patients. (Korean J Anesthesiol 2007; 52: 511~5)
이윤숙 ( Yoon Sook Lee ),김운영 ( Woon Young Kim ),김경근 ( Kyoung Gun Kim ),장문석 ( Moon Seok Chang ),김재환 ( Jae Hwan Kim ),박영철 ( Young Cheol Park ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
Joubert syndrome is a rare autosomal recessive condition in which there is complete or partial agenesis of the cerebellar vermis. The clinical features are hypotonia, ataxia, mental retardation, abnormal ocular movements, typical facial features and episodic tachypnea with alternating apnea. The abnormal respiratory pattern and hypotonia may be exacerbated by anesthetics, and especially, the apneic episodes may be prolonged by administering opioids. Joubert syndrome has been associated with various airway abnormalities such as a high and arched palate, a large or protruding tongue, laryngomalacia, a variable epiglottis and micrognathia. These abnormalities may cause difficulty with tracheal intubation. In this present case, direct laryngoscope-assisted, fiberscopic guided intubation was performed. This case is the first report of anesthetic management in a patient with Joubert syndrome and who underwent palatoplasty in Korea. (Korean J Anesthesiol 2009; 57: 96~9)
임상연구 : 두개전기자극(Cranial Electrotherapy Stimulation) 전처치가 수술 전 불안감 및 혈역학적 반응에 미치는 영향
김현정 ( Hyun Jung Kim ),김운영 ( Woon Young Kim ),이윤숙 ( Yoon Sook Lee ),장문석 ( Moon Seok Chang ),김재환 ( Jae Hwan Kim ),박영철 ( Young Cheol Park ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.6
Background: Cranial electrotherapy stimulation is used as a treatment for depression, anxiety, insomnia, and adjunctive intervention for pain management. The aim of this study is to evaluate the effect of cranial electrotherapy stimulation pretreatment on the level of preoperative anxiety and the hemodynamic responses. Methods: Sixty patients undergoing general anesthesia were randomly assigned into two groups to receive either no pretreatment (Control group, n = 30) or cranial electrotherapy stimulation pretreatment (CES group, n = 30). Anxiety score, systolic and diastolic blood pressure, and heart rate were measured in the preoperative holding area and the operating room. Results: The anxiety score in the operating room compared with the preoperative holding area decreased in the CES group, but increased in the Control group. Systolic blood pressure and heart rate in the operating room were lower in the CES group compared with the Control group. Conclusions: Cranial electrotherapy stimulation pretreatment reduced the level of the preoperative anxiety and the hemodynamic responses. (Korean J Anesthesiol 2008; 55: 657~61)
무릎 관절경 수술 시 Fentanyl 투여가 압박띠 사용에 따른 혈역학적 변화에 미치는 영향
이윤숙 ( Yoon Sook Lee ),김재환 ( Jae Hwan Kim ),차문호 ( Moon Ho Cha ),민두재 ( Doo Jae Min ),김운영 ( Woon Young Kim ),장문석 ( Moon Seok Chang ),박영철 ( Young Cheol Park ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Background: The use of a tourniquet can produce pain and increase in blood pressure. It is known that fentanyl reduces central sensitization, however its effect on blood pressure increase due to tourniquet is unknown. So we investigated the effect of fentanyl on tourniquet-induced changes of mean arterial blood pressure (MBP), heart rate (HR), and cardiac index (CI). Methods: ASA physical status I and II, who were scheduled for knee arthroscopic surgery using a tourniquet, were assigned into control (n=30) and fentanyl group (n=30). Anesthesia was maintained with enflurane, N2O and O2. Fentanyl was injected 1.5 ug/kg at 10 min before inflation of the tourniquet in the fentanyl group. Changes of the MBP, HR, CI were measured before and 10, 20, 30, 40, 50, 60 min after inflation of the tourniquet. Results: There were no differences in the baseline values. MBP was increased at 40, 50, 60 min in the control group. At 60 min, MBP was lower in the fentanyl than the control group. HR was decreased at 10 min in the fentanyl group. CI was decreased in all groups after tourniquet inflation. At 60 min, CI was more decreased in the control than the fentanyl group. Conclusions: Fentanyl injection prior to tourniquet inflation can attenuate the tourniquet induced hemodynamic changes in the knee arthroscopic surgery patients. (Korean J Anesthesiol 2009;56:6~10)
실험연구 : Sufentanil 투여가 흰쥐적출심장에서 허혈시 심근기능 및 관상동맥혈류에 미치는 영향
서경원 ( Kyung Won Seo ),신명강 ( Myoung Gang Shin ),이윤숙 ( Yoon Sook Lee ),장문석 ( Moon Seok Chang ),김운영 ( Woon Young Kim ),김재환 ( Jae Hwan Kim ),박영철 ( Young Cheol Park ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
Background: Some opioids have been shown to attenuate an ischemia-reperfusion injury in an isolated-heart model. The aim of this study was to evaluate the effect of sufentanil on the cardiac function in isolated-heart models when given before and after prolonged periods of low flow ischemia. Methods: Isolated rat hearts were stabilized for 30 minutes and subdivided into four groups (each n = 7). The control group was subjected to low flow ischemia (LFI 0.3 ml/min) of 5% dextrose water for 30 minutes, followed by perfusion with a modified Krebs solution at a constant pressure for 60 minutes. In the sufentanil groups, different sufentanil (12.5 mg/L, 25 mg/L, 50 mg/L) doses were administered with the modified Krebs solution after 30 minutes of stabilization until the end of the experiment with the exception of the LFI group. The left ventricular end systolic pressure (LVESP), dP/dt max, heart rate and coronary flow were measured. After reperfusion, the infarct size of all groups was measured. Results: The control and the sufentanil groups had a lower LVESP, dP/dt max, coronary effluent flow and arrhythmia duration after ischemia and reperfusion than those before ischemia. The infarct sizes in the sufentanil groups were smaller than those in the control group. However the infarct sizes of the sufentanil groups were similar. Conclusion: Sufentanil reduces the infarct size but does not improve the post-ischemic functional dysfunction. (Korean J Anesthesiol 2006; 51: 216~21)
골반경 보조 질식 자궁절제술시 심혈관계 및 동맥혈 가스 변동에 미치는 영향
박영철,윤석민,김운영,임혜자 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7
In the last decade, advances in laparoscopic equipments have allowed the development of laparoscopic surgical treatment for gynecologic affeetion. The purpose of this study is to investigate the cardiovascular effects and blood gas changes during laparoscope assisted vaginal hysterectomy (LAVH) in Trendelenburg position and intraabdominal CO₂ insufflation to obtain optimal surgical field. Mean arterial pressure (MAP), heart rate. SaO₂, PaO₂, end-tidal CO₂ (ETCO₂) PaCO₂, pH, and peak airway pressure (PAP) were measured in twenty patients who underwent laparoscope assisted vaginal hysterectomy in Trendelenburg position and intraabdominal CO₂ insufflation. Each measurement was taken immedistely after intubation (control), 15 minutes after Trendelenburg position, 30 minutes after CO₂ insufflation, 15 minutes, 1 hour and 6 hrs. after CO₂ deflation. ETCO₂ and PAP were not measured 1 hour and 6 hrs. after deflation The results were as follows; 1) Mean arterial pressure and heart rate were decreased after Trendelenburg position, but increased after CO₂ insufflation. 2) Arterial O₂ saturation was decreased after CO₂ insufflation, 1 hour after deflation 3) Arterial PO₂ was decreased after CO₂ insufflation. 4) End-tidal CO₂ was increased after CO₂ insufflation. 5) Arterial PCO₂ was increased after CO₂ insufflation compared to control value, but it was decreased at 15 minutes after CO₂ deflation. Arterial PCO₂ at 1 hour after CO₂ deflation was higher than at 15 minutes after CO₂ deflation and 6 hrs. after CO₂ deflation. 6) Arterial pH was decreased after CO₂ insufflation. 7) Peak airway pressure was increased after Trendelenburg position and after CO₂ insufflation.