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임상연구 : 외래 사시 수술의 Monitored Anesthetic Care에서 Fentanyl과 Ketamine 병용사용의 효과
이윤기 ( Yoon Ki Lee ),장혜원 ( Hae Wone Chang ),심재용 ( Jae Yong Shim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Background: Monitored anesthetic care can provide patient safety and optimal surgical conditions. However, propofol and fentanyl decrease the hypoxic ventilatory response and heart rate. Ketamine has less respiratory depression and blocks bradycardia. Furthermore, ketamine can reduce the amount of opioid use but it delays discharge in the outpatient anesthesia. Therefore, this study retrospectively examined the effects of combined fentanyl and ketamine administered during monitored anesthetic care on the use of opioids, cardiorespiratory side effects, and patient discharge. Methods: The anesthetic room, the recovery room and day surgery center records of ambulatory strabismus surgery with monitored anesthetic care was reviewed by anesthesiologists from Oct. 2004 to July 2005. The patients were classified as those receiving either fentanyl (F group: n = 32) or fentanyl and ketamine (FK group: n = 19) with a propofol infusion. The fentanyl dose used, the need for airway support, anticholinergics and naloxone were compared. The stay in the recovery room and the day surgery center was also examined. Results: The FK group used significantly less fentanyl than the F group (P < 0.05). Although airway support was needed, there was less anticholinergics and naloxone used in the FK group, but this difference was not significant. The stay in recovery room and the day surgery center were similar. Conclusions: Co-administered ketamine reduces the amount of fentanyl-needed, but it does not reduce the need for airway support and anticholinergics. In addition, co-administered ketamine does not affect the number of days in the recovery room and day surgery center. (Korean J Anesthesiol 2006; 50: 434~8)
임상연구 : 비뇨기과 수술을 받는 노인 환자의 척추마취 시 첨가된 Fentanyl의 용량에 따른 임상효과의 비교
김정은 ( Jeong Eun Kim ),문영은 ( Young Eun Moon ),홍상현 ( Sang Hyun Hong ),전준표 ( Joon Pyo Jeon ),장혜원 ( Hae Wone Chang ),김수진 ( Su Jin Kim ),고현정 ( Hyun Jung Koh ),유건희 ( Keon Hee Ryu ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5
Background: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10 μg and 20 μg when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. Methods: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10 μg; and group 3, bupivacanie 5 mg + fentanyl 20 μg. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3-4 or L4-5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. Results: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P=0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P=0.016, P=0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P=0.005). Conclusions: The addition of fentanyl 10 μg and 20 μg to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10 μg is recommended as outpatient anesthesia. (Korean J Anesthesiol 2008;55:579~84)
임상연구 : 혈액가스 분석기와 휴대용 혈당측정기로 측정된 혈당 수치의 평가
박휴정 ( Hue Jung Park ),박철수 ( Chul Soo Park ),박종민 ( Chong Min Park ),유건희 ( Keon Hee Ryu ),장혜원 ( Hae Wone Chang ),조은정 ( Eun Jeong Cho ),이윤기 ( Yoon Ki Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: A portable glucometer is commonly used to immediately check the blood glucose level. In the anesthetic field, some blood gas analyzers can also give a rapid indication of the blood sugar level but the accuracy is unknown. Therefore, this study assessed the accuracy of the blood glucose values measured by either a blood gas analyzer or portable glucometer. Methods: Venous blood from diabetic patients was used to measure the glucose level with either a blood gas analyzer or a portable glucometer. The difference and 5% deviation from reference values was analyzed. These values were also assessed using a Bland-Altman plot and clinical significance was examined using a Clarke error grid. Results: The differences from the reference values were smaller using the blood gas analyzer (1.3 ± 7.8 mg/dl) than using the portable glucometer (-5.1 ± 16.7 mg/dl)(P < 0.01). 73.4% of the values measured by the blood gas analyzer and 40.0% of those measured by the portable glucometer were within 5% of the reference value. The 95% limits of agreement in the difference ranged from -14.3 to 16.9 in the blood gas analyzer and -38.5 to 28.2 in the portable glucometer. Error grid analysis showed that 100% of the values measured by the blood gas analyzer were located in zone A. When locating the values measured using the portable glucometer, 95.6% were located in zone A, and the remaining 4.4% are located in zone B. Conclusions: The blood gas analyzer measures the blood glucose more accurately than the portable glucometer. However, the blood glucose values measured by the portable glucometer are clinically acceptable. (Korean J Anesthesiol 2006; 50: 506~10)