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임상연구 : 슬관절 전치환술을 받는 노인환자에서 혈역학적 변화를 최소화하기 위해 지속 정주한 Remifentanil과 Esmolol, Nicardipine의 비교
백종화 ( Chong Wha Baek ),곽미정 ( Mi Jeung Gwak ),고나영 ( Na Young Ko ),강현 ( Hyun Kang ),박정원 ( Jung Won Park ),정용훈 ( Yong Hun Jung ),우영철 ( Young Cheol Woo ),김진윤 ( Jin Yun Kim ),구길회 ( Gill Hoi Koo ),박선규 ( Sun 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Background: The use of tourniquet is associated with severe hemodynamic changes, particularly in elderly patients. This study examined the effects of continuously infused remifentanil or nicardipine with esmolol on the attenuation of the hemodynamic changes with enflurane inhalation during total knee arthroplasty in elderly patients. Methods: Thirty elderly female patients undergoing total knee arthroplasty were enrolled into this randomized, prospective study. Remifentanil (group R) or nicardipine with esmolol (group EN) was infused using a titration method to maintain a mean arterial pressure (MAP) of 90 mmHg to 70 mmHg during tourniquet inflation. In addition, the inhalation of enflurane was adjusted to guarantee a hypnotic state based on entropy. The hemodynamic variables, inhaled concentration of enflurane, recovery time, and postoperative pain characteristics were measured and compared. Results: Following tourniquet inflation, the MAP was increased and maintained in the target since 20 min after that in both group. Following tourniquet deflation the MAP was decreased significantly in both groups and more patients in group R required a vasopressor. Group R inhaled a lower enflurane concentration and showed more rapid recovery than group EN. There were no significant differences in the level of postoperative pain between the two groups. Conclusions: These results suggest that remifentanil is more likely to be associated with hypotension after tourniquet deflation and require more attention than nicardipine with esmolol. (Korean J Anesthesiol 2007; 53: 463~9)
남소현,김대연,김성철,곽미정,이동명,김인구,Nam, So-Hyun,Kim, Dae-Yeon,Kim, Seong-Chul,Gwak, Mi-Jeung,Lee, Dong-Myung,Kim, In-Koo 대한소아외과학회 2006 소아외과 Vol.12 No.2
One day surgery in children has been practiced for last 10 years in this institution. This study is to examine its safety and effectiveness for patients younger than 15 years old treated at the Department of Pediatric Surgery, Asan Medical Center, from September. 1996 to December, 2005. A total of 3,709 patients, 37 % of the total pediatric operations, are included in this retrospective study. The most prevalent ages were between 1 and 3 years olds (1,199 patients). Twenty patients were younger than 6 months, and they all had one day surgery safely. Operations were herniorrhaphy in 3,126 patients,followed by excisional biopsy, chemoport removal, and OK 432 injection. There were 12 cases (0.32 %) of unplanned admissions, 7 occurred within 6 months of one day surgery. Perioperative fever was the most common cause of admission in 4 cases. The related conditions of unplanned admission were bleeding in 2 cases and radical surgery in 2. One day surgery in this institution was easily accessible and safe. This is to the result of appropriate selection of patients, cooperation with anesthesiologists, adequate control of postoperative pain, and home care programs.
증례보고 : 척수 근위축증 환자의 전신 마취 경험 1예
최윤희 ( Yun Hee Choi ),곽미정 ( Mi Jeung Gwak ),이윤경 ( Yoon Kyung Lee ),이유미 ( Yu Mi Lee ),이동호 ( Dong Ho Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Spinal muscular atrophy (SMA) is a rare lower motor neuron disease in which anesthetic management is often difficult, because the patients usually have muscle weakness and hypersensitivity to muscle relaxants. We describe the anesthesia for a 8 year-old girl with type II SMA who presented for a lower lid epiblepharon repair. We chose to use intravenous anesthesia based on propofol and remifentanil without any muscle relaxants. The peri-operative course was completely uneventful. We consider that intravenous anesthesia without muscle relaxants could be a good anesthetic choice for a patient with SMA undering general anesthesia. (Korean J Anesthesiol 2007; 53: 803∼5)
김대원,박평환,곽미정 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.6
In this study, the authors would like to establish the guideline for effective utilization of blood and blood components in various elective surgeries. We investigated the amount of tansfused blood and blood components units, C/T ratio (crossmatching to transfusion ratio), disused rate of blood ordered in 861 elective surgery cases during the period from October I990 to September 1991. Overall mean units of transfusional units per patient were 5.3 units and overall C/T ratio was 1.14. Of all the transfusional units the ratio of whole blood was 51.5%, packed red blood cell was 7%, fresh frozen plasma was 41% respectively. From this study, the guideline for the optimal blood ordering for each elective surgery was made.
출혈성 Shock 유발 고양이에서 Pentoxifylline 의 효과
김병권,조헌,박평환,홍정길,최종무,곽미정 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.4
It was reported that pentoxifylline(PTX) improved tissue oxygenation and increased survival rate in animal models of hemorrhagic shock. The authors investigated the salutary effects of PTX on hemodynamics, oxygen transport and tissue metabolism in animal models of hemorrhagic shock. 18 anesthetized cats were subjected to hemorrhage to MABP of 40∼45 mmHg and this pressure was maintained for 120 minutes. After this period, normal saline was administered in a volume double the original shed blood volume over 30 minutes. Thereafter the cats were observed for 120 minutes. Drug-treated cats received at 25 mg/kg i.v. bolus of PTX at the beginning of hemorrhage, followed by a continuous infusion of 25 mg/kg/hr throughout the experiment. PTX had no effect on MABP, pH(a-cv), P(cv-a) CO₂ and lactic acid value but, PTX group had more rapid HR and higher PcvO, than placebo group(P$lt;0.05). In addition, we found that pH(a-cv) and P(cv-a) CO₂ changes occurred more rapidly than lactic acid changes(P$lt;0.05) after hemorrhagic sck. So, pH(a-cv) and P(cv-a) CO₂ changes might be considered as useful parameters for early detection of derangement of tissue oxygenation in shock states. It was concluded that PTX had no effects on indices of representing tissue oxygenation except improvement of central venous oxygen tension in this feline hemorrhagic shock model. Further studies are needed
Poly(ADP-ribose)Polymerase 억제제가 신생백서의 저산소성 허혈성 뇌손상에 미치는 영향/1H 자기공명분광법을 이용한 연구
황현숙,이정희,박평환,석은하,임근호,곽미정 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.2
Background : Poly (ADP-ribose) polymerase (PARP) has been described as an important candidate for mediation of neurotoxicity after brain ischemia. This study was purposed to evaluate the effects of a PARP inhibitor on hypoxic-ischemic injury in the neonatal rat brain. In this study, a highly potent inhibitor of PARP, 3, 4-Dihydro-5-[4-(1-piperidinyl) butoxy]-1 (2H)-isoquinolinone (DPQ) was investigated. Methods : Seven-day old Sprague-Dawley rat pups were used. The right common carotid artery was ligated under halothane anesthesia. After a recovery period of 3 hours, they were exposed to 8% oxygen at 37℃ for about 120 minutes. The animals were divided into four groups: the pre-treatment group (n = 13) and post-treatment group (n = 21) were given DPQ 10 ㎎/㎏ and the pre-control group (n = 7) and post-control group (n = 14) were given a vehicle for controls. Pre-treatment and pre-control groups were injected 30 minutes prior to the hypoxic injury while post-treatment and post-control groups were injected 30 minutes after the hypoxic period intraperitoneally. The right cerebral hemisphere of the rats were examined with localized ^1H magnetic resonance spectroscopy on day 1 and 7 after the hypoxic insult. Lipid/N-acetyl aspartate (Lip/NAA) and lipid/creatine (Lip/Cr) ratios were used as apoptotic markers. On day 14, the degree of brain injury was scored by morphological changes. Results : In the DPQ treated groups, the Lip/NAA and Lip/Cr ratios were lower than those of the control groups on day 1 after the hypoxic-ischemic injury (P < 0.05). However on day 7, only the ratios of the pre-treatment group were lower than those of the control group (P < 0.05). The degree of morphological changes of the brain injury on day 14 were lower in the DPQ treated groups (P < 0.05). Conclusions : These results suggest that DPQ exerts a neuroprotective effect in cerebral hypoxicischemic injury probably by inhibiting apoptosis especially in the early stage after an insult. Acute inhibiton of PARP can have a therapeutic value in preventing ischemic brain injury. (Korean J Anesthesiol 2002; 42: 228~240)