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Propofol/Rocuronium을 이용한 신속 기관 내 삽관 시 Remifentanil의 세 가지 지속 정주 용량에서의 혈역학적 반응
곽미숙 ( Mi Sook Gwak ),최수주 ( Soo Joo Choi ),윤진선 ( Jin Sun Yoon ),이준용 ( Jun Yong Lee ),양미경 ( Mi Kyung Yang ),김갑수 ( Gaab Soo Kim ),이상민 ( Sang Min Lee ),김명희 ( Myung Hee Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Background: This study compared the effect of the three different infusion doses of remifentanil on the hemodynamic response to rapid sequence anesthesia induction and tracheal intubation. Methods: In this prospective, randomized double-blind study, 60 ASA I or II patients without any airway abnormalities, who were scheduled to undergo elective surgery requiring endotracheal intubation, were allocated to receive remifentanil 0.25, 0.5, or 1.0μg/kg/min. Anesthesia was induced with a remifentanil infusion and propofol 2.0 mg/kg. Rocuronium 1.0 mg/kg was given after a loss of consciousness and endotracheal intubation was performed 1 min after the rocuronium injection. The remifentanil infusion was stopped immediately before intubation. The noninvasive blood pressure (BP) and heart rate (HR) were recorded before induction (baseline), immediately before intubation, and at 1 min intervals until 5 min after intubation. Results: The HR and BP measured immediately before intubation decreased significantly in the three doses. The HR was similar in the three doses, and the BP was significantly different only between the 0.25 and 1.0μg/kg/min doses (P < 0.05). The hemodynamic response to endotracheal intubation was very well blunted in 0.5 and 1.0μg/kg/min, but not in 0.25μg/kg/min. The HR and BP increased significantly 1 min after intubation in the 0.25μg/kg/min (P < 0.05). There were no significant differences between the 0.5 and 1.0μg/kg/min doses until 5 min after intubation. Conclusions: Remifentanil 0.5μg/kg/min infusion without a bolus provides excellent hemodynamic stability for a rapid sequence endotracheal intubation using propofol and rocuronium. There are no advantages in using remifentanil doses higher than 0.5μg/ kg/min. (Korean J Anesthesiol 2006; 50: 385~9)
임상연구 : 간우엽 공여술 후 혈액응고 상태의 변화와 경막외 카테터 사용 시의 의미
최수주 ( Soo Joo Choi ),곽미숙 ( Mi Sook Gwak ),김갑수 ( Gaab Soo Kim ),이준용 ( Jun Yong Lee ),김태형 ( Tae Hyeong Kim ),김진경 ( Jin Kyung Kim ),김정수 ( Chung Soo Kim ),정익수 ( Ik Soo Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
Background: Living donors for liver transplantations may have a low pain threshold and should be given effective postoperative pain control. However, epidural catheterization has been the subject of intense debate because of the possibility of severe coagulation derangement after a right hepatectomy. This study examined the changes in the coagulation status in right lobe donors. Methods: The charts and computerized hospital data of 261 consecutive living donors who had undergone right hepatectomy were retrospectively reviewed. The coagulation profile including the platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) was analyzed at the preoperative period, immediately after surgery, and 5 days after surgery. Results: The platelet count decreased significantly from immediately after surgery until postoperative day (POD) 5 (P < 0.001). Nineteen donors (7.3%) had a minimum platelet count of < 100 × 103/mm3, and no case showed a platelet count of < 50 × 103/mm3. The PT increased significantly and reached at peak at POD 1 (1.56 ± 0.19 INR), and the PT values until POD 5 were significantly different from the preoperative values (P < 0.001). However, the peak PT was > 2.0 INR in only 4 donors (1.5%). The aPTT immediately after surgery showed severe prolongation (P < 0.001), but recovered rapidly on POD 1. Conclusions: Right lobe donors showed postoperative coagulation derangement but the changes appear to be acceptable for the maintenance and removal of the epidural catheters. These results suggest that careful epidural catheterizations are relatively safe in right lobe donors. (Korean J Anesthesiol 2006; 51: 685~9)
김명희 ( Myung Hee Kim ),곽미숙 ( Mi Sook Gwak ),박정아 ( Jung A Park ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Background: Core temperature changes during tourniquet inflation and deflation have been reported. The aim of this study is to investigate the extent of core temperature changes during inflation and deflation, depending on tourniquet time. Methods: Esophageal temperature in sixty patients who undergoing knee arthroscopy with tourniquet longer than 1 h (group L, n = 30) and less than 1 h (group S, n = 30) were measured before inflation, 30 and 60 min after inflation, just before deflation, and 1 min interval for 10 min after deflation. Results: Tourniquet time in L and S group was 109 ± 20 min and 46 ± 10.7 min, respectively. Compared to baseline value of 35.7 ± 0.07℃, significant increase of 0.14 ± 0.02℃, 0.25 ± 0.03℃, 0.4 ± 0.05℃ were observed at 30, 60 min after inflation, and just before deflation, respectively in group L, and the increase of 0.11 ± 0.03℃ and 0.18 ± 0.03℃ at 30 min after inflation and just before deflation, respectively in group S. Temperatures from 2 to 10 min after deflation were significantly lower than value of just before deflation in each group (P<0.05). At 10 min after deflation, 0.76 ± 0.13℃ in group L and 0.4 ± 0.04℃ in group S were lower than values of just before deflation in each group (P<0.05). Temperature at 10 min after deflation was significantly different between the groups (P<0.05). Conclusions: Extent of core temperature decrease after tourniquet deflation was dependent on the duration of tourniquet application. (Korean J Anesthesiol 2007; 53: 453~7)
증례보고 : 간이식 수술 후 중심성 뇌교 수초 용해증이 발생한 환자들의 혈중 나트륨 농도의 관찰 -증례보고-
정해근 ( Hae Keun Jeong ),곽미숙 ( Mi Sook Gwak ),김갑수 ( Gaab Soo Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Hyponatremia is common in end stage liver disease and central pontine myelinolysis (CPM) can occur after the rapid correction of hyponatremia. The blood sodium concentration can increase rapidly during the perioperative period of liver transplantation due to the administration of sodium-containing fluids and blood products. We experienced 5 cases of CPM after liver transplantation. Major changes in the blood sodium concentrations occurred during surgery in the first 3 cases while these changes occurred after surgery in the last 2 cases. We reviewed the blood sodium concentrations of these 5 patients and speculated on the correlation of CPM with a rapid increase in the blood sodium concentration. (Korean J Anesthesiol 2006; 50: 469~73)
증례보고 : 간이식을 받는 환자에서 마취 중 식도 정맥류의 파열과 관련된 관리
최지원 ( Ji Won Choi ),곽미숙 ( Mi Sook Gwak ),김한수 ( Han Su Kim ),김진경 ( Jin Kyoung Kim ),김갑수 ( Gaab Soo Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Portal hypertension may develop as a result of hepatic cirrhosis. One of the serious complications of portal hypertension is variceal hemorrhage. In recipients with esophageal varices, despite refinements in surgical techniques, variceal bleeding can occur during liver transplantation. The vascular isolation during cross-clamped inferior vena cava, hepatic and portal veins is associated with increases of inferior vena caval and portal venous pressures. We experienced three cases of bleeding from esophageal varices before and during living related liver transplantation and considered their management. One is bleeding during cross-clamped inferior vena cava, hepatic and portal veins. The others were carried out intraoperative endoscopy and endoscopic variceal ligation because of high risk of the esophageal variceal rupture. They were all managed successfully and recovered uneventfully. The anesthesiologists must keep in mind of the possibility of esophageal variceal bleeding during liver transplantation, and if that happens, prompt diagnosis and management must be taken. (Korean J Anesthesiol 2009;56:106~11)
실험연구 : 백서의 족관절 염좌모델에서 동시에 적용한 전기침구가 염좌 통증에 미치는 효과
조현성 ( Hyun Sung Cho ),곽미숙 ( Mi Sook Gwak ),이숙영 ( Suk Young Lee ),함태수 ( Tae Soo Hahm ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Background: Simultaneous acupuncture to two or more acupoints has been used to improve acupuncture-induced effects in clinical practice. However, there is little evidence supporting the effects of simultaneous electroacupuncture (EA). This study examined whether simultaneous EA with 2 and 2 Hz or 2 and 100 Hz can produce synergic effects on ankle-sprained pain in rats. Methods: Ankle sprain pain was induced by manually overextending the lateral ligament of the right ankle in rats. Electrical stimulation with 2 Hz was delivered to the Yangno acupoint (SI6) and with 2 or 100 Hz to the Zusanli (ST36), either individually or simultaneously. The level of pain evoked by the ankle sprain was measured by the stepping force of the sprained paw during walking. The analgesic effects of simultaneous EA was evaluated by the percentage recovery of the stepping force at 1, 2 and 4hr after EA and compared to that of individual EA. Results: Individual EA significantly increased the stepping force of the ankle-sprained paw during walking, but there is no difference in the effect between electrical stimulation with 2 and 100 Hz EA. Simultaneous EA with 2 and 2 Hz or 2 and 100 Hz showed no significant improvement of the stepping force compared to individual EA. Conclusions: Individual EA with 2 and 100 Hz produced comparable analgesic effects. Simultaneous EA applied to the SI6 and ST36 acupoints produced no synergic interaction, therefore has no beneficial effect for ankle-sprained pain compared to individual EA. (Korean J Anesthesiol 2007; 52: 566~70)