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양측 슬관절 전치환술시 척추경막외병용마취가 스트레스 반응에 미치는 영향
천은희 ( Eun Hee Chun ),김종학 ( Jong Hak Kim ),백희정 ( Hee Jung Baik ),김윤진 ( Youn Jin Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
Background: Intraoperative stress may evoke various changes in hormonal secretion and autonomic nervous system activity. We designed this study to investigate the effect of combined spinal-epidural anesthesia on stress hormone responses. Methods: Thirty women more than 60 years of age, undergoing bilateral total knee replacement surgery were studied. Patients were randomized to receive either general anesthesia (group I), or combined spinal-epidural anesthesia (group II). Blood samples were obtained immediately before anesthesia induction, immediately after skin incision, after first knee prosthesis insertion, and end of operation, immediately for measurement of cortisol, epinephrine, and norepinephrine. Results: The plasma concentration of cortisol, epinephrine and norepinephrine were significantly lower in group II after the prosthesis insertion and at the end of operation, immediately. The plasma concentration of cortisol was significantly higher than basal values in both of two groups through the surgery. Conclusions: Combined spinal-epidural anesthesia has the blocking effect of releasing catecholamine during total knee replacement surgery and immediately after the surgery. The effect of combined spinal-epidural anesthesia on stress responses during total knee replacement is better than that of general anesthesia. (Korean J Anesthesiol 2009;57:296∼301)
척추-경막외 병용마취로 제왕절개술시 산소투여방법에 따른 태아의 산소화
천은희 ( Eun Hee Chun ),김종학 ( Jong Hak Kim ),김윤진 ( Youn Jin Kim ),백희정 ( Hee Jung Baik ),전주현 ( Joo Hyun Jun ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6
Background: During cesarean section under regional anesthesia, it is current practice to provide the parturient with a source of supplemental oxygen. We compared the effect of high flow oxygen by mask with that of low flow oxygen by nasal prongs. Methods: Fifty eight parturients presenting for elective cesarean section under combined spinal-epidural anesthesia were randomly assigned to one of the three groups to be given either oxygen 4 L/min by mask, oxygen 8 L/min by mask or oxygen 2 L/min by nasal prongs. Umbilical arterial and venous blood samples were taken and analysed immediately after delivery. Results: There were no significant differences in the umbilical arterial or venous pH, partial pressure of oxygen and partial pressure of carbon dioxide among the three groups. In neonatal outcome, there were no differences in Apgar scores. Conclusions: It makes no differences whether the parturients received supplemental oxygen by nasal prongs or simple face mask during cesarean section under combined spinal-epidural anesthesia. (Korean J Anesthesiol 2009; 57: 709∼13)
임상연구 : 척추 경막외병용마취하 슬관절전치환술 시 지주막하강 내로 투여된 Morphine의 효과
허민정 ( Min Jung Hur ),김윤진 ( Youn Jin Kim ),백희정 ( Hee Jung Baik ),김종학 ( Jong Hak Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2
Background: Low-dose intrathecal opioid has been used for early postoperative pain co1ntrol. This study was designed to assess effect intrathecal morphine on postoperative pain control for total knee arthroplasty (TKA) under combined spinal-epidural analgesia (CSE) in elderly patients. Methods: Fifty four patients over 60 years, undergoing TKA were randomly allocated to three groups. M0 group for control group did not received intrathecal morphine, M50 and M100 group received intrathecal morphine 50μg and 100μg respectively. The pain scores (verbal numeric rating scale, VNRS) at rest and coughing, analgesic consumption, patient satisfaction and side effects such as nausea, vomiting, pruritus, headache, dizziness, sedation, respiratory depression, and urinary retention were recorded immediately before and at 1, 3, 6, 12, 24, 48 hour after the initiation of patient-controlled epidural analgesia (PCEA). Results: VNRS were low at each time, and were not exceeding 2 in all groups. M50 and M100 group revealed significantly less analgesic consumption compared to M0 group (P < 0.05). PCEA first injection time after PCEA connection was shortest in M0 group compared to M50 and M100 group. The incidence of pruritus increased in M50 and M100 group with dose-dependence, but no significant differences were noticed in other side effects. Conclusions: Intrathecal morphine use showed no significant analgesic effect except pruritus compared to control group. Further studies are required into the effective intrathecal morphine without side effects in elderly patients for TKA. (Korean J Anesthesiol 2007; 52: 172~8)
임상연구 : 60세 이상 고혈압 환자의 척추-경막외 병용마취 시 심박수 변이도 변화
권미숙 ( Mi Suk Kwon ),백희정 ( Hee Jung Baik ),김윤진 ( Yoon Jin Kim ),김종학 ( Jong Hak Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
Background: We evaluated the changes in heart rate variability (HRV) in elderly patients with or without hypertension before and after combined spinal-epidural anesthesia (CSE). Methods: Elderly hypertensive (group H, n = 28) and non-hypertensive patients (group C, n = 32) were recruited. We analyzed the spectral components of HRV, total power (≤ 0.4 Hz), low and high frequency power expressed as natural logarithm (LnTP, LnLF, and LnHF), normalized HF (HFnorm), normalized LF (LFnorm), and LF/HF ratio, from 5-minute electrocardiography recordings. We also measured blood pressures (systolic; SBP, diastolic; DBP, mean; MAP), heart rate (HR) and analgesia level before and after CSE. Each group was divided into two subgroups (≤ T7 [L] or ≥ T6 [H]) according to fixed analgesia level. Results: Before CSE, group H showed significantly lower LnLF than that of group C (P < 0.05). Fifteen and 10 min after CSE, decrease of SBP and increase of HR in group HH were significantly greater compared with group CL and lesser with group CH, respectively. LnTP, LnLF and LnHF in both control groups (CL and CH) were significantly decreased 15-20 min after CSE compared with pre-CSE values. LnLF and LnHF in group HH were significantly lower than those in group HL 10-15 min after CSE. But there were no significant changes of LFnorm, HFnorm and LF/HF in all four groups. Conclusions: The group H showed significantly lower LnLF than that of group C before CSE. In group HH, LnLF and LnHF were significantly lower than those in group HL 10-15 min after CSE, but the balance of the autonomic nervous system was not changed significantly. (Korean J Anesthesiol 2006; 50: 663~73)
임상연구 : 양측 슬관절 전치환술 후 시행한 수술 후 혈액회수법의 효과
김윤진 ( Yun Jin Kim ),백희정 ( Hee Jung Baik ),김종학 ( Jong Hak Kim ),유은영 ( Eun Young Yu ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: This study investigated the clinical usefulness of an autotransfusion of drained blood using postoperative wound drainage and a reinfusion system to reduce the allogenic blood transfusion without complications. Methods: Eighty patients were allocated randomly to either a control group using a standard drainage system or an autotransfusion group using postoperative wound drainage and a reinfusion system. The collection period was 12 h, and the drainage blood retransfused after 6 h, or a maximum of 500 ml of blood was collected after connecting the reinfusion system. Immediately before reinfusion, blood samples were taken from the reinfusion system and analyzed for the functional and metabolic status of the drained blood and compared with the preoperative values of patient. The hemoglobin level, blood loss, allogenic blood requirement and transfusion-related complications were assessed. Results: The drained blood had lower hematological values, a prolonged PT and aPTT, a lower fibrinogen, and metabolic acidotic status than the preoperative values of the patients. There were no significant differences in the amount of blood loss compared with the control group. However, the autotransfusion group required significantly less allogenic blood (almost 20% less) without significant complications. Conclusions: Autotransfusion by reinfusion with drained blood in bilateral total knee arthroplasty reduces the allogenic blood requirement without significant complications. (Korean J Anesthesiol 2006; 51: 29∼35)
임상연구 : 당뇨병환자에서 Propofol-Remifentanil TCI를 이용한 마취유도 시 심박수변이도의 변화
임은빈 ( Eun Bin Yim ),백희정 ( Hee Jung Baik ),김종학 ( Jong Hak Kim ),김윤진 ( Yoon Jin Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: The aim of this study was to compare heart rate variability (HRV) changes between diabetics and non-diabetics throughout induction with maintaining BIS 40-60 by propofol-remifentanil target controlled infusion. Methods: Non-diabetic patients (n = 12) and non-insulin dependent diabetes mellitus (NIDDM) patients (n = 12) were recruited. Anesthesia was induced by target controlled infusion of propofol and remifentanil. Target effect-site concentration of propofol was adjusted to maintain bispectral index (BIS) 40-60, and target effect-site concentration of remifentanil was adjusted to maintain blood pressure (BP) within 20% of baseline value. The HRV was recorded at resting, after glycopyrrolate injection, during BIS 40-60, and after intubation. Log-transformed power spectrum (ms2) of TP (total power, ≤ 0.4 Hz), LF (low frequency, 0.04-0.15 Hz), HF (high frequency, 0.15-0.4 Hz), LFnorm (normalized LF, LF/[LF + HF]), HFnorm (normalized HF, HF/[LF + HF]), and LF/HF ratio were compared. Results: Initial LnTP, LnLF, and LnHF was significantly lower in diabetics (P<0.05). During BIS 40-60, LnTP, LnLF, and LnHF in non-diabetics decreased significantly (P<0.05). Immediately after intubation, LnLF, LnHF in non-diabetics, and LnHF in diabetics decreased significantly (P<0.05). LF/HF ratio showed no significant change throughout induction. Systolic, diastolic BP, mean arterial pressure, and heart rate have no significant differences between the groups. Conclusions: This study suggests that hemodynamic variables and balance of autonomic nervous system measured by HRV can not be altered during induction, by adjusting effect site concentration of propofol and remifentanil in accordance with BIS and BP in diabetic patients. (Korean J Anesthesiol 2007; 53: 180~7)