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임상연구 : 위절제술 후 경막외강 Fentanyl-Neostigmine의 진통효과
김세열 ( Se Yol Kim ),윤명하 ( Myung Ha Yoon ),김석재 ( Seok Jai Kim ),정성태 ( Sung Tae Chung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: This study evaluated the efficacy of an epidural single dose of neostigmine combined with fentanyl to provide postoperative analgesia after radical subtotal gastrectomy. Methods: Fifty two adults patients with ASA physical status 1 and 2 are randomly allocated to receive a single injection of either epidural fentanyl 100μg or combination of fentanyl 100μg with neostigmine 250, 500 and 750μg in a total volume of 10 ml. Pain scores were recorded after 0, 5, 10, 15, 20, 30 mins to determine the onset of analgesia. Patients` vital signs as well as side effects were monitored at regular intervals. Results: Patients` demographic data were not different from each other. Epidural neostigmine 750μg with fentanyl 100μg produced effective analgesia (visual analog scale at 10 min; 35 ± 10.6 mm). The time to first rescue analgesics administration was significantly longer in the neostigmine group (250μg: 84.2 ± 9.4, 500μg: 90.9 ± 7.1, 750μg: 92.5 ± 14.4 min) than the control group (53.0 ± 20.0 min). Conclusions: Combination of fentanyl with neostigmine was proven to be more effective for treating postoperative pain after subtotal gastrectomy than fentanyl alone. Additionally, the most effective dose of epidural neostigmine was 750μg. (Korean J Anesthesiol 2007; 53: 217~21)
임상연구 : Doxapram Hydrochloride가 후두마스크기도를 이용한 전 정맥마취 시 환기반응에 미치는 영향
윤영철 ( Young Chul Yoon ),곽상현 ( Sang Hyun Kwak ),정성태 ( Sung Tae Jeong ),김석재 ( Seok Jai Kim ),배홍범 ( Hong Beom Bae ),정성수 ( Sung Su Chung ),정창영 ( Chang Young Jeong ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Background: Intravenous anesthetics causes depression of ventilatory response to hypercapnea. Doxapram stimulates ventilation via peripheral and central chemoreceptors. This study was aimed to evaluate the effect of doxapram on ventilation during total intravenous anesthesia (TIVA). Methods: 60 patients undergoing operation under spontaneous ventilation via laryngeal mask airwaywere randomly divided into 3 groups: Control group received 5% dextrous infusion, D-2 group received doxapram injection of 1 mg/kg followed by continuous infusion of 2 mg/kg/hr, and D-4 group received doxapram injection of 2 mg/kg followed by continuous infusion of 4 mg/kg/hr. Anesthesia was induced and maintained with propofol and remifentanil. Respiratory rate, tidal volume (VT) and arterial carbon dioxide tension (PaCO2) were measured before and 15 min after induction of anesthesia, 0(15 min after start of operation), 1, 2, 3, 5, 15, 30, 45, and 60 min after start of doxapram infusion during TIVA. Results: VT was significantly increased 1 min after start of doxapram infusion and returned to the value of pre-doxapram infusion immediately. In D-4 group, VT was significantly (P<0.05) increased again 5 min after doxapram infusion compared with the value of pre-doxapram infusion and control group. PaCO2 was decreased 1 min after start of doxapram infusion and then increased again 2 min after doxapram infusion. In D-4 group, the degree of increase of PaCO2 was significantly (P<0.05) less than those of D-2 group. Conclusions: Doxapram injection of 2 mg/kg followed by continuous infusion of 4 mg/kg/hr improved the depression of ventilatory response during TIVA. (Korean J Anesthesiol 2007; 53: 470∼6)
임상연구 : Propofol 마취 유도 후 후두경을 이용한 기관내 삽관시 나타나는 혈역학반응을 둔화하기 위한 Remifentanil의 적정용량
차진욱 ( Jin Wook Cha ),곽상현 ( Sang Hyun Kwak ),김석재 ( Seok Jai Kim ),최정일 ( Jeong Il Choi ),김창모 ( Chang Mo Kim ),정성태 ( Sung Tae Jeong ),유경연 ( Kyung Yeon Yoo ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: A laryngoscopy and endotracheal intubation cause an increase in the blood pressure and heart rate. Remifentanil is an opioid that is often used to reduce the hemodynamic responses after tracheal intubation. This study evaluated the effect of three bolus doses of remifentanil on the hemodynamic responses to a laryngoscopy and tracheal intubation. Methods: Eighty patients, aged 35-65 years, with an ASA physical status of I and II were randomly divided into four groups containing 20 patients each. Anesthesia was induced with propofol 2 mg/kg followed 30 s later by saline (control) or remifentanil 0.5 (R0.5), 1 (R1) or 2 (R2) μg/kg given as a bolus over a 30 s period. A laryngoscopy and tracheal intubation were performed 90 s later (corresponding to 3 min after induction), and anesthesia was maintained using 2% sevoflurane and 50% nitrous oxide in oxygen. Rocuronium 1 mg/kg was given as a neuromuscular block. The systolic arterial blood pressure (SAP) and heart rate (HR) were recorded until 5 min after intubation. Results: In all groups, the SAP decreased after inducing anesthesia and then increased after intubation in all groups (P < 0.05), but the maximum increases (46, 15, and 9 mmHg in the R0.5, R1, and R2 groups, respectively) after intubation were lower in the remifentanil groups than that of the control group (73 mmHg) (P < 0.05). The HR decreased in the remifentanil groups while it remained stable in the controls after the induction of anesthesia. However, it increased after intubation in all groups. The mean maximum HR (83, 71, and 69 bpm in the R0.5, R1 and R2 groups, respectively) was significantly lower in the remifentanil groups than that in the controls (98 bpm) (P < 0.05). All remifentanil doses significantly attenuated the pressor and tachycardiac responses (P < 0.05). Conclusions: All remifentanil doses were effective in controlling the pressor and tachycardiac response to endotracheal intubation in patients in whom anesthesia was induced with propofol. However, the use of the 1 and 2μg/kg dose was associated with a decrease in the SAP to less than 85 mm Hg in 10 patients (50%) each. Therefore, 0.5μg/kg appears to be the optimal dose to attenuate the cardiovascular responses to endotracheal intubation in patients. (Korean J Anesthesiol 2006; 51: 292~6)
차진욱 ( Jin Wook Cha ),곽상현 ( Sang Hyun Kwak ),김석재 ( Seok Jai Kim ),김창모 ( Chang Mo Kim ),정성태 ( Sung Tae Jeong ),배홍범 ( Hong Beom Bae ),유경연 ( Kyung Yeon Yoo ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
A tracheal bronchus is an aberrant, accessory or ectopic bronchus arising almost always from the right lateral wall of the trachea at the level less than 2 cm above the carina. An endotracheal or endobronchial tube can obstruct or migrate into a tracheal bronchus, resulting in pulmonary atelectasis, hypoxemia, or both during general anesthesia. We report two patients in whom the anomalous tracheal bronchus had been surgically resected under general anesthesia. The anomaly was identified before surgery in each patient and anesthesia was uneventful. (Korean J Anesthesiol 2006; 51: 638~40)
임상연구 : 제왕절개술환자에서 호기말 Sevoflurane 농도를 1%로 유지 시 수술전 분만통 유무에 따른 이중분광계수의 비교
강명우 ( Myung Yoo Kang ),유경연 ( Kyung Yeon Yoo ),김석재 ( Seok Jai Kim ),정성태 ( Sung Tae Chung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: An end-tidal concentration of 1% sevoflurane with 50% nitrous oxide (N2O) during a Cesarean section resulted in bispectral index (BIS) values > 60, which are considered at risk for awareness. The present study aimed to determine whether the presence or absence of labor pain prior to the Cesarean section would affect the BIS value. Methods: Sixty women scheduled to undergo Cesarean section under general anesthesia, were allocated to three groups of 20 patients: women undergoing elective surgery without labor pain (group 1, control), or emergency surgery without (group 2) or with (group 3) active labor pain. After endotracheal intubation, anesthesia was maintained with end-tidal 1% sevoflurane and 50% N2O in oxygen throughout the surgery. The BIS value, systolic blood pressure and heart rate were measured before (baseline) and during the induction of anesthesia, intubation, skin incision, uterine incision, delivery and at 1, 3, 5 and 10 min after delivery. Neonatal effects were assessed using Apgar scores at 1 and 5 min after delivery. Results: BIS values were significantly lower in group 3 than in groups 1 and 2 throughout the study, except at baseline and induction (P < 0.05). However, the systolic blood pressure, heart rate and Apgar scores did not differ among the three groups. Conclusions: These results demonstrate that 1.0% sevoflurane combined with 50% N2O results in BIS values < 60 during Cesarean delivery in women with active labor pain but not in those without active labor pain, consistent with an adequate depth of anesthesia to prevent recall. (Korean J Anesthesiol 2007; 53: 709∼13)