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복강경하 담낭절제술을 받는 심질환 노인에서 역 Trendelenburg체위가 혈역학에 미치는 영향
김교상 ( Kyo Sang Kim ),이시민 ( Si Min Yi ),전종헌 ( Jong Hun Jun ),정미애 ( Mi Ae Cheong ),구민석 ( Min Seok Koo ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.4
Background: We studied the hemodynamic changes induced by pneumoperitoneum and a reversed Trendelenburg in elderly patients with increased cardiac risk (ASA class III; n=30; age 70.8±4.9 years, mean±SD) and compared the results with elderly patients at normal risk (ASA class II; n=30; age 69.2±4.1 years) during laparoscopic cholecystectomy. Methods: The transesophageal Doppler monitor was performed after induction of general anesthesia (pre-incision), after onset of pneumoperitoneum (insufflation), after head-up (20°) and a left lateral tilt (15°) (reversed Trendelenburg) and after deflation and horizontal position (desufflation). Mean arterial pressure (MAP), heart rate, cardiac index (CI) and systemic vascular resistance (SVR) were measured, respectively. Results: Induction of pneumoperitoneum and head-up tilt in patients with cardiac risk resulted significantly in a decrease in CI and an increase in SVR compared with patients with normal risk (P<0.05), and that remained until deflation, but no interval changes in MAP and heart rate. The CI, MAP and heart rate decreased and SVR increased significantly in patients with cardiac risk compared with patients with normal risk before incision (P<0.05). No complications occurred. The results indicate that pneumoperitoneum and a reversed Trendelenburg are associated with significant but relatively benign hemodynamic changes. Conclusions: Anesthesia for laparoscopic cholecystectomy in elderly patients with increased cardiac risk should be performed with an adequate hemodynamic monitoring. (Korean J Anesthesiol 2009;56:398~402)
임상연구 : 고혈압 노인 환자에서 슬관절 수술 시 지혈대가 혈역학에 미치는 영향
김교상 ( Kyo Sang Kim ),민형기 ( Houng Ki Min ),윤홍준 ( Hong Jun Youn ),정미애 ( Mi Ae Cheong ),전종헌 ( Jong Hun Jun ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
Background: The hemodynamic and metabolic effects of tourniquet application undergoing knee surgery with general anesthesia in elderly patients with hypertension have been rarely reported. We evaluated the hemodynamic and metabolic effects in elderly patients compared with young adults. Methods: Thirty elderly patients (elderly hypertension group, 71.8 ± 3.9 years) with chronic hypertension undergoing total knee replacement and 30 young adults (normal group, 33.1 ± 5.1 years) undergoing knee surgery were studied. Mean arterial pressure (MAP), heart rate, cardiac index (CI) by esophageal doppler method, and systemic vascular resistance index (SVRI) were measured before, during, and after tourniquet application. pH, PaO2, PaCO2, Hb and lactate blood concentrations were also measured. Results: MAP increased 25% and 16% in elderly hypertension and normal groups during inflation, respectively (P < 0.05) and returned to basal values after deflation. CI increased to 30% higher than basal values in both groups after deflation (P < 0.05). SVRI decreased 31% and 19% in elderly hypertension and normal groups after deflation, respectively (P < 0.05). After deflation, PaCO2 and lactate increased (P < 0.05). Conclusions: Elderly patients with hypertension have the significant hemodynamic changes during and after tourniquet application than before, however, there are no differences compared to normal group. These elderly patients should be needed the active hemodynamic monitoring due to the lower compensatory ability. (Korean J Anesthesiol 2006; 51: 695~700)
제왕절개술을 위한 전신마취 시 병적비만 산모에서 Sugammadex의 사용
오유나 ( You Na Oh ),김교상 ( Kyo Sang Kim ),윤성렬 ( Sung Ryul Yoon ),김건식 ( Keon Sik Kim ) 경희대학교 경희의료원 2016 慶熙醫學 Vol.31 No.1
Morbid obesity in a pregnancy is a great challenge to medical practice especially when the patient requires Caesarean section. A 38-year-old primigravida (127.5 kg, 164 cm, BMI 47.4 kg/m2) with fetal breech presentation was scheduled Caesarean section at 39-week gestation. After informed consent, anesthesia was induced in rapid sequence with propofol and rocuronium (1 mg/kg), which was monitored with train- offour stimulation and bispectral index scale. Intubation was performed using Pentax-AWS<sup>®</sup> video laryngoscope, and anesthesia was maintained with sevoflurane and remifentanil. When the operation was over, the patient was extubated at TOF ratio 0.98 after reversal with sugammadex (2 mg/kg). We report sugammadex is a quick, safe, and effective reversal of rocuroniuminduced neuromuscular block in morbidly obese paturient during Caesarean section under general anesthesia.
임상연구 : 의식 있는 중환자실 환자에서 기관 내 흡인 시 Propofol과 Fentanyl의 정맥 내 투여가 Bispectral Index에 미치는 영향
이재익 ( Jae Ik Lee ),전종헌 ( Jong Hun Jun ),김교상 ( Kyo Sang Kim ),서정국 ( Jung Kook Suh ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2
Background: We performed a prospective, randomized, and controlled trial to evaluate the effect of an intravenous fentanyl and propofol on the variation in BIS level associated tracheal suction. Methods: Thirty ICU patients intubated or tracheostomized were randomly allocated to control and experimental groups. Control group was received saline and experimental groups were received propofol with or without fentanyl intravenously prior to tracheal suction. And then we monitored BIS index, blood pressure, heart rate and SpO2 before, during and after tracheal suction. Results: BIS index was significantly lower in propofol plus fentanyl group than others during experiment (P < 0.05). Heart rate and blood pressure in propofol plus fentanyl group also less increased than those in control or propofol group during tracheal suction (P < 0.05). Conclusions: These results suggest that co-administration of propofol and fentanyl has more effective than propofol alone in sedation and analgesia of ICU patients during tracheal suction. (Korean J Anesthesiol 2007; 52: 156~60)