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전신마취 중 치과 치료를 위한 Lidocaine 주입 후 발생한 아나필락시스 —증례보고—
인장혁,최진우,주진덕,김대우,정홍수,박희정 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.53 No.3
Anaphylaxis or anaphylactoid reactions rarely occur during the perioperative period but can be a devastating complication of general anesthesia. We experienced a patient with an unexpected anaphylaxis. A 11-yr-old boy was scheduled for extraction and treatment of caries under general anesthesia. Ketamine, thiopental sodium and rocuronium were used for induction of anesthesia. After induction lidocaine was injected through oral mucosa for pretreatment. About 3 minutes later hypotension, tachycardia, bronchoconstriction and reddish skin eruptions developed. The operation was put off and skin prick test for screening the contributing drug was performed. Lidocaine reacted positively to the test. Based upon the result, second operation could be performed safely and successfully without using lidocaine.
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인장혁 대한마취통증의학회 2007 Anesthesia and pain medicine Vol.2 No.1
Background: Decreased circulation of the tracheal mucosa caused by high intracuff pressure of endotracheal tube is responsible for increased incidence of postoperative sore throat. Stellate ganglion block (SGB) can improve the circulation of head and neck and upper extremities and affects postoperative sore throat. Methods: Sixty female patients were randomly assigned to get unilateral SGB with 1% lidocaine (group I) or saline (group II). Intracuff pressures of endotracheal tube of all patients were maintained at around 50 mmHg during anesthesia. The frequency of sore throat and hoarseness, the severity of sore throat were estimated at arrival of recovery room and 6, 24, 48 hours after extubation. Results: The incidence of sore throat was significant lower at only 6 hours after extubation in the Group I (P<0.05) than in Group II. There were no significant differences of the incidence of hoarseness or severity of sore throat between two groups. Conclusions: There was statistical significance of the incidence of postoperative sore throat in the SGB patients at 6 hours after extubation. However it may not be possible to alleviate the severity of sore throat with SGB.
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한국 성인의 나이와 성별에 따른 pseudocholinesterase 의 활성도
조대순,인장혁 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.5
Serum pseudocholinesterase activities, using butyrylthiocholine as substrate, measured in 639 employees of Korea Cancer Center Hospital in 1993. Overall mean value of pseudocholinesterase was 9.38±2.10 U/ml, 10.6±2.10 U/ml in male, and 8.58±1.67 U/ml in female, respectively. Male in the first five decades of life had higher pseudocholinesterase activity than female, and after the age of 50 tbere was no intersexual difference. These findings suggest that adults before the age of 50, male has higher pseudocholinesterase activity than female.
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주진덕,인장혁,김대우,정홍수,강재혁,염제화,최진우 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.5
Background: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. Methods: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST),Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. Results: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P <0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). Conclusions: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50’s side effects. Background: The patient-controlled sedation (PCS) allows for rapid individualized titration of sedative drugs. Propofol has been the most widely used IV adjuvant, during the monitored anesthesia care (MAC). This study was designed to compare the sedation quality, side effect and recovery of the propofol alone, and propofol-remifentanil combination, using PCS for breast biopsy. Methods: Seventy five outpatients, undergoing breast biopsy procedures with local anesthesia, were randomly assigned to receive propofol alone (group P), propofol-25 ug/ml of remifentanil (group PR25), and propofol-50 ug/ml of remifentanil (group PR50), using PCS. Pain visual analogue scores (VAS) and digit symbol substitution test (DSST),Vital signs, bi-spectral index (BIS) and observer assessment of alertness and sedation (OAA/S) score were recorded. Results: Apply/Demand ratio in the group PR50 had a significant increase over the other groups (P < 0.05). The incidence of excessive sedation and dizziness were significantly more frequent in the group PR50 (P < 0.05). BIS and OAA/S score significantly decreased in the group PR25, PR50 at 15 min after the operation, the end of surgery (P <0.05). At 5 min after the start of PCS, patients in the group PR25 and PR50 gave significantly less correct responses on the DSST than that of the group P (P < 0.05). Conclusions: Compared with the propofol alone, intermittent bolus injection of propofol-remifentanil mixture could be used, appropriately, for the sedation and analgesia during MAC. The group PR25 in a low dose of remifentanil has more advantages in terms of sedation and satisfaction because of the group PR50’s side effects.
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한국인에서 전치치를 위한 Midazolam 의 적정용량
김대우,인장혁,주진덕 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.3
Adequate Dosage for Midazolam Premedication in Koreans Jin Deok Joo, M.D., Dae Woo Kim, M.D., and Jang Hyeok In, M.D. Department of Anesthesiology, College of Medicine, The Catholic University of Korea, Suwon, Korea Background: Midazolam is often used a s an anxiolytic premedication before surgery. Although the sedative, anxiolytic, and amnestic properties of midazolam may be desirable before the induction of general anethesia, respiratory function is impaired frequently by larger doses of midazolam. Therefore, we evaluated thd adequate doses of midazolam premedication on anxiolytic and sedation without its serious side effects. Methods: Eighty ASA Ⅰ or Ⅱ adult patients scheduled for elective minor surgery were randomly allocated to four groups according to premedication doses of midazolam. They were group 1: midazolam 0.05 mg/kg IM for lean body mass (LBM); group 2: midazolam 0.075 mg/kg IM for LBM; group 3: midazolam 0.1 mg/kg IM for LBM.; group 4: midazolam 0.125 mg/kg IM for LBM. Blood pressure, heart rate, bispectral index (BIS), oxygen saturation (S_pO_2), anxiety visual analogue scale (VAS), and observer's assessment of alertness andsedation (OAA/S) scores were measured before and at 30 minutes after midazolam premedication. The frequency of apnea, defined as a cessation of spontaneous respiration for more than 10 seconds, was recorded. Induction time and dose requirements in propofol-induced general anesthesia were recorded at the loss of opening their eyes on verbal command and eyeld reflex after starting the propofol infusion. Following intubation, blood pressure and heart rate were measured. Results: The bispectral index and anxiety VAS was significantly decreaced in group 3 and group 4. However, oxygen saturation were significantly lower in group 4 compared with group 3. Conclusions: We conculded that group 3 (midazolam 0.1 mg/kg IM for LBM) is the proper premedication dosage for anxiolytic and sedation in Koreans without respiratory side effects. (Korean J Anesthesiol 2001; 41: 269~274)
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김대우,인장혁,서소운 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.3
Background : This study was undertaken to evaluate the analgesic effect of a self administered surgical wound infusion of local anesthetic alone compared to combination of local anesthetic and morphine or ketorolac. Method : Forty eight patients undergoing minor surgery were randomly classified into four groups: Group 1 (saline, n = 10), Group 2 (bupivacaine only, n= ll), Group 3 (bupivacaine with morphine, n = 14), and Group 4 (bupivacaine with ketorolac, n 13). A two-hole 19 G epidural catheter was tunneled subcutaneously into the surgical wound and was connected to 100 ml elastometric balloon pump filled with either 0.5% bupivacaine only, 0.5% bupivacaine and morphine 40 mg, or 0.5% bupivacaine and ketorolac 80 mg. We assessed the postoperative visual analogue scale (VAS) pain scores at postoperative 0.5, 1, 2, 6, 12, 24, 36, and 4S hours, and the side effects, sedation score and total amount of infused bupivacaine were recorded. Results : VAS pain score were significantly decreased until 36 hours in groups 2, 3, and 4 compared to group 1, and significantly lower at 1, 2, 12, and 24 hrs in groups 3, 4 than in group 2 (P $lt; 0.05). The total requirement of infused bupivacaine in groups 3, 4 is significantly decreased compared to that of group 2. Side effects like nausea, vomiting, urinary retension, pruiritis, respiratory difficulty, sedation, and dizziness did not occur in the four groups but seroma did in one case. Conclusion : Patient-controlled surgical wound infusion of bupivacaine reduced postoperative pain after minor surgery without any side effects. The combination of bupivacaine with morphine or ketorolac gave rise to a significant additive effect to local analgesia. (Korean J Anesthesiol 2000; 38: 481~487)
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김용신,전연수,인장혁,최진우,주진덕,황미연 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.2
Background: The insertion of a nasogastric tube can be difficult in an anesthetized patient who has a cuffed endotracheal tube in place. The placement of a silastic nasogastric (NG) tube can lead to nasal bleeding or a submucosal dissection in the posterior pharynx. The aim of this study was to determine if the insertion of a nasogastric tube with a nasophryngeal airway can be made easy. Methods: Sixty patients were randomly assigned to one of two groups; Group 1 and Group 2. For Group 1, a nasogastric tube was inserted first. If this method was not successful with two consecutive attempts, then a nasogastric tube with a nasopharyngeal airway was inserted and if unsuccessful again with two attempts, then Magill forceps were used under laryngoscopy. For Group 2, a nasogastric tube with a nasopharyngeal airway was inserted first. If this method was not successful with two consecutive attempts, then a nasogastric tube was inserted and if unsuccessful again with two attempts, then Magill forceps were used under laryngoscopy. Results: The success rate of the 1st pass in Group 2 was significantly higher than in Group 1 (P < 0.05). The success rate with the 1st intended method in Group 2 was significantly higher than in Group 1 (P < 0.05). The rate of using Magill forceps was not significantly different between the two groups. Conclusions: The insertion of a nasogastric tube with a nasopharyngeal airway in anesthetized and intubated patients is effective in increasing success rate of insertion. Nasopharyngeal airway traverses the nasopharynx atraumatically and serves as a conduit for the smaller nasogastric tube. (Korean J Anesthesiol 2006; 50: 127~31)
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