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임상연구 : 관상동맥우회술을 위한 내시경두렁정맥채취 시 동맥혈액가스의 변화
강동욱 ( Dong Uk Kang ),유병훈 ( Byung Hoon Yoo ),이상석 ( Sang Seok Lee ),연준흠 ( Jun Heum Yon ),송철민 ( Cheol Min Song ),장지민 ( Ji Min Chang ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: Endoscopic surgical procedure has recently been applied to not only intraabdominal or intrathoracic surgery but also saphenous vein harvesting, because it is less invasive and more cosmetically advantageous. Carbon dioxide insufflation during an endoscopic saphenous vein harvesting may cause an adverse effects on arterial blood gas and hemodynamic variables. This study was conducted to evaluate the safety of carbon dioxide insufflation during endoscopic saphenous vein harvesting. Methods: Patients in ASA physical status III or IV, scheduled for an endoscopic saphenous vein harvesting (n=30) were gathered for the evaluation. Until the end of the procedure, controlled mechanical ventilation (tidal volume: 10 ml/kg, respiratory rate: 10 rates/min) and ventilator mode was fixed in this tidal volume and respiratory rate. Arterial blood gas analysis, end-tidal carbon dioxide, blood pressure and heart rate were measured before and at 10, 20, 30, 40 minutes after carbon dioxide insufflation. Results: Preinsufflation values of PaCO2 (partial pressure of arterial carbon dioxide) and PETCO2 (partial pressure of end-tidal carbon dioxide) were 33.4 ± 3.6 mmHg and 24.1 ± 4.1 mmHg, respectively. PaCO2 was significantly increased at 30 and 40 minutes after carbon dioxide insufflation (40.1 ± 7.4 mmHg and 41.4 ± 8.6 mmHg). PETCO2 was significantly increased at 20, 30 and 40 minutes after carbon dioxide insufflation(27.6 ± 5.5 mmHg, 28.9 ± 7.0 mmHg and 29.6 ± 7.8 mmHg). But, the magnitude of difference between PaCO2 and PETCO2 was not significantly different. Conclusions: During endoscopic saphenous vein harvesting, PaCO2 was significantly increased compared with preinsufflation values. Careful monitoring of PaCO2 is mandatory during the procedure. (Korean J Anesthesiol 2007; 53: 194~8)
증례보고 : 근육위축가쪽경화증 환자에서의 경막외마취 관리
권영석 ( Young Suk Kwon ),임윤희 ( Yun Hee Lim ),우승훈 ( Seung Hoon Woo ),연준흠 ( Jun Heum Yon ),김계민 ( Kye Min Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
Amyotrophic lateral sclerosis (ALS) is a degenerative disease of motor ganglia in the anterior horn of spinal cord and spinal pyramidal tracts. The impairments of respiratory function and weakened upper airway muscle affect anesthetic management. General anesthesia may cause respiratory problem. Regional anesthesia such as spinal and epidural anesthesia is also relative contraindication for patients with a motor neuron disease, including ALS, for the fear of exacerbating the disease. Therefore patients with ALS are needed careful management during perioperative period. We report a case of epidural anesthesia for transurethral ureteroscopic lithotripsy in a patient with ALS. The patient recovered from anesthesia without exacerbating the disease. (Korean J Anesthesiol 2009;57:361∼3)
임상연구 : Propofol 주입 시 기관내 삽관에 따른 심혈관 반응을 억제하는 성별 Remifentanil의 효과처 농도
이해광 ( Hae Kwang Lee ),유병훈 ( Byung Hoon Yoo ),이상석 ( Sang Seok Lee ),임윤희 ( Yun Hee Lim ),연준흠 ( Jun Heum Yon ),홍기혁 ( Ki Hyuk Hong ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Background: Tracheal intubation induces clinically adverse hemodynamic changes. Various pharmacological strategies for controlling these reponses have been suggested with opioids being widely used. The purpose of this study was to determine the effect site concentration of remifentanil in blunting the cardiovascular responses to tracheal intubation according to gender. Methods: Eighty ASA physical status I or II patients, aged 20-40 years undergoing elective surgery, were classified into a male group (n = 40) and a female group (n = 40). Anesthesia was induced using a propofol target controlled infusion (TCI: Marsh model). A propofol target effect-site concentration of 4μg/ml was chosen. Rocuronium 0.6 mg/kg was administered after the patients lost consciousness. Remifentanil TCI (Minto model) was started 1 min after the propofol injection. Initially, an effect-site concentration of 3 ng/ml was chosen. The next concentration was chosen using the up-and-down method reported by Dixon. The non-invasive blood pressure and heart rate were recorded before induction (baseline), after the remifentanil injection, immediately after intubation as well as 1 and, 3 minutes after intubation. Results: Probit analysis revealed a remifentanil effect-site EC50 and EC95 in the male group to be 1.94 ng/ml (95% CI, 1.60-2.27 ng/ml ), 3.07 ng/ml (95% CI, 2.65-4.06 ng/ml), respectively. The EC50 and EC95 in the female group were 1.69 ng/ml (95% CI, 1.35-2.01 ng/ml), 2.81 ng/ml (95% CI, 2.39-3.81 ng/ml), respectively. There were no significant differences between the two groups. Conclusions: The effect-site concentration of remifentanil blunting the cardiovascular responses to tracheal intubation during propofol TCI anesthesia was between 2 and 3 ng/ml. There were no gender differences. (Korean J Anesthesiol 2007; 52: 521~5)