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Charcot-Marie-Tooth씨병 산모의 척추-경막외 병용마취
구본녀,최승호,이우경,한솔,전동혁 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.1
Charcot-Marie-Tooth disease (CMTD) comprises a group of disorders characterized by progressive distal muscle weakness and atrophy. We report the management of a 37-year-old multigravida with CMTD scheduled for Cesarean section. The combined spinal-epidural anesthesia was selected as the anesthetic management and postoperative pain control. Mother and baby had an uneventful recovery and they discharged home on the seventh postoperative day. Combined spinal-epidural anesthesia is thought to be a safe and effective method of anesthesia for Cesarean section in a patient with CMTD. (Korean J Anesthesiol 2006; 50: 108~10)
The Analgesic Effect of Single Dose of Intrathecal Magnesium Sulfate
구본녀,이종화,김미경,신양식 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.6
Background: Intrathecal (IT) magnesium has antinociceptive effects on animals and has been reported to prolong spinal opioid analgesia in humans. This study examined the effect of IT magnesium on spinal anesthesia and postoperative epidural analgesia. Methods: Sixty patients undergoing total knee replacement were enrolled in this study. Before the IT injection of 0.5% isobaric tetracaine (10 mg), group C and group M received 0.9% saline or 50% magnesium sulfate 0.1 ml, respectively. The epidural solution for postoperative analgesia contained 0.2% ropivacaine (100 ml) only in group M, and 0.2% ropivacaine plus morphine (50μg/ml) in group C. The verbal rating scale (VRS) scores for pain, sensory block level, intensity of motor block and side effects were recorded at 5, 60, and 120 minutes after the IT injection and at 1, 12 and 36 hours after surgery in the post-anesthesia care unit (PACU). Results: The VRS score at 120 minutes after the IT injection were lower in group M than in group C (P < 0.05). There were no differences in the VRS scores and the use of supplemental analgesics at the postoperative period. The incidence of PONV, pruritus and urinary retention was significantly lower in group M than in group C at 12 and 36 hours after surgery. Conclusions: IT magnesium can be used as a local anesthetic adjuvant to strengthen the analgesic effect of spinal local anesthesia and to intensify the analgesic effect of epidural local anesthesia for postoperative pain control to the extent of 5 mg epidural morphine.
The Relationship of the Anthropometric Variables to the Infusion Rate of Rocuronium in the Elderly
구본녀,배선준,신양식,이우창 연세대학교의과대학 2005 Yonsei medical journal Vol.46 No.5
We have determined the infusion rates of rocuronium in the elderly and young adult patients during sevoflurane and nitrous oxide anesthesia. The correlation of some anthropometric predictors with infusion rate of rocuronium was also investigated for both elderly and young adult. Participating patients were assigned to one of two groups: 1) young adult patients aged 20 to 50 years (n=30); 2) elderly patients aged over 65 years (n=30). The anthropometric variables such as height, weight, ratio of weight to body surface area, subscapularis and suprailiac skin folds, body surface area, body mass index and % ideal body weight were evaluated as predictors for infusion rate. The infusion rate in elderly patients was significantly less compared with that in young adult patients (p<0.05). In elderly patients, no anthropometric predictor was related to the infusion rate of rocuronium. This suggests that the infusion rate of rocuronium for an elderly patient needs to be individualized by monitoring neuromuscular transmission to avoid excessive dose.
구본녀,한동우,신서경,김소연,강영란,정규희 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.5
Purpose: Sedatives must be carefully titrated for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) as oversedationmay lead to disastrous respiratory outcomes. This study aimed to investigate the relations between the effect-site concentration(Ce) of propofol and sedation and airway obstruction levels in patients with OSAHS. Materials and Methods: In 25 patients with OSAHS, sedation was induced by 2% propofol using target-controlled infusion. Sedationand airway obstruction levels were assessed using the Observer’s Assessment of Alertness/Sedation Scale and a four-category scale, respectively. The relationships between propofol Ce and sedation and airway obstruction were evaluated using a sigmoid Emax model. Pharmacodynamic modeling incorporating covariates was performed using the Nonlinear Mixed Effects Modeling VII software. Results: Increased propofol Ce correlated with the depth of sedation and the severity of airway obstruction. Predicted Ce50(m) (Ce associated with 50% probability of an effect≥m) for sedation scores (m≥2, 3, 4, and 5) and airway-obstruction scores (m≥2, 3, and 4) were 1.61, 1.78, 1.91, and 2.17 μg/mL and 1.53, 1.64, and 2.09 μg/mL, respectively. Including the apnea-hypopnea index (AHI) as a covariate in the analysis of Ce50(4) for airway obstruction significantly improved the performance of the basic model (p<0.05). Conclusion: The probability of each sedation and airway obstruction score was properly described using a sigmoid Emax model with a narrow therapeutic range of propofol Ce in OSAHS patients. Patients with high AHI values need close monitoring to ensure that airway patency is maintained during propofol sedation.