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임상연구 : 노인에서 Propofol 마취유도 용량에 따른 Bispectral Index 및 혈역학적 변화
정아리 ( A Lee Chung ),이귀용 ( Guie Yong Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Background: Propofol is a good choice for elderly patents because it produces rapid onset and quick recovery with few side effects. Propofol produces dose-dependent cardiovascular depression. This effect is more pronounced in elderly patients during induction and can be minimized by a slow injection. The aim of this study was to determine the appropriate induction dose of propofol using a slower infusion rate for elderly patients to obtain desirable sedation and hypnotic conditions with minimal hemodynamic changes. Methods: Thirty-nine patients aged over 70 years were assigned to receive a propofol infusion of either 1.5 mg/kg (n = 21, Group 1) or 2.0 mg/kg (n = 18, group 2). The infusion rate was 20 mg/kg/hr. The systolic and diastolic pressure, heart rate, BIS and modified observers assessment of the alertness/sedation scale (OAA/S) were measured before the induction (baseline), after the propofol infusion, as well as immediately, 3 and 5 minutes after intubation. Results: The systolic pressure decreased significantly after the propofol infusion in both groups (group 1: 17%, group 2: 25%) but there were no significant differences between them. The BIS values after the propofol infusion and intubation were 67.1 ± 12.6 and 62.3 ± 12.7 in group 1, 49.6 ± 11.1 and 51.7 ± 11.7 in group 2, respectively which showed significant differences between the groups. Conclusions: When 2.0 mg/kg of propofol is administrated to elderly patients, a slower infusion rate is more appropriate for maintaining the desirable sedation and hypnotic conditions and cause no significant hemodynamic changes. (Korean J Anesthesiol 2006; 50: 417~21)
임상연구 : 편도절제술을 받은 환아에서 수술 후 통증 조절을 위해 사용한 Ketorolac과 Propacetamol의 비교
이인화 ( In Hwa Lee ),한종인 ( Jong In Han ),김동연 ( Dong Yeon Kim ),이귀용 ( Guie Yong Lee ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.6
Background: Both ketorolac and propacetamol have been used to control mild to moderate pain after operation. Ketorolac is a non-steroid anti-inflammatory drug (NSAID) with strong analgesic activity, but should be avoided in patients with renal dysfunction or bleeding complications. Propacetamol is a prodrug of paracetamol and can be delivered intravenously. Importantly, it has fewer side effects and therefore generally considered safe. The purpose of this study is to compare the analgesic efficacy of ketorolac and propacetamol for pain control after tonsillectomy in pediatric patients. Methods: The pediatric patients were randomly divided into three groups. All patients were given propofol and fentanyl for induction. During induction, one group received ketorolac 1 mg/kg (group K), another group received propacetamol 30 mg/kg (group P), and the other group received saline (group C). Postoperative pain was assessed by Visual Analogue Scale (VAS) and Faces Pain Scale (FPS) at 15, 30 and 60 min after arrival at the recovery room. Results: VAS and FPS at 30 and 60 min after arrival were significantly lower in group K and P than in group C (P < 0.05). No adverse side effect was observed in all groups after tonsillectomy. Conclusions: Propacetamol can be used as a safe alternative to ketorolac for pain control after tonsillectomy in pediatric patients. (Korean J Anesthesiol 2008; 55: 704~8)
이경수 ( Kyung Su Lee ),정태영 ( Tae Young Jung ),박철하 ( Chull Ha Park ),한주환 ( Ju Hwan Han ),이귀용 ( Gui Yong Lee ),구창덕 ( Chang Duck Koo ) 한국산림과학회 2012 한국산림과학회지 Vol.101 No.4
Berchemia berchemiaefolia is a rare and endangered species and important as a honey resource. The purposes of this study were to investigate physical environmental factors and the population and community structure of Berchemia berchemiaefolia stands at Mt.Gunja in Sogrisan National Park in Chungcheongbuk-do. The B berchemiaefolia stands belonged to deciduous forests in mid-temperate zone and were 5~25˚ in slope 30~90% in rock ratio and 6.37 in soil pH. They had 656 trees within the area of 36 ha and their average density was 18.2 trees per ha. The trees within the stands were 11.8m in tree height 22.6 cm in DBH and 56 years old. The number of branched stems was the maximum 8 and 32.9% of the trees were branched. B. berchemiaefolia trees over 12cm diameter occupied 89.9% but young B. berchemiaefolia did only 11%. The structure of B. berchemiaefolia stands were classified into three groups as Acer pseudo-sieboldianum & A. mono community group A. pseudo-sieboldianum & Quercus aliena community group and B. berchemiaefolia & Quercus serata community group. The mean importance value of B. berchemiaefolia was 10.9% while species diversity of the community ranged 0.77~1.31 and interspecific competition ranged 0.78~0.94. The dominance of the community ranged of 0.07~0.29 and the evenness ranged 0.71~0.93. Although B. berchemiaefolia was dominant in the habitat but the species was already in natural successional stage to cornus controversa or Ulmus davidiana var. japonica.
Midazolam 및 Remifentanil의 사전 투여가 Propofol 마취유도 및 기관내 삽관 시 혈역학적 변화에 미치는 영향
손미경 ( Mi Kyoung Son ),이귀용 ( Guie Yong Lee ),김치효 ( Chi Hyo Kim ),정락경 ( Rack Kyung Chung ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Background: The combined induction using two or more agents has a potential benefit that anesthesia could be induced with smaller anesthetic agents with fewer side effects. We studied the effects of co-administration with midazolam and remifentanil on the dose of propofol, the time to loss of consciousness (LOC) and hemodynamics during tracheal intubation. Methods: Sixty patients were randomly assigned to three groups. Group 1 was induced with target-controlled propofol alone. Group 2 received midazolam (0.05 mg/kg) and target-controlled propofol. Group 3 received midazolam (0.025 mg/kg), remifentanil (2 ng/ml) and target-controlled propofol. The time to LOC, the infused propofol dose and the effect site concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was given and tracheal intubation was performed. The noninvasive blood pressure, heart rate (HR) and bispectral index were recorded. Results: The time and the dose of propofol to LOC were significantly reduced in group 2, 3 than in group 1 (P<0.05). Compared with pre-induction values, mean blood pressure at immediately after intubation was increased in group 1, 2 with no change in group 3. The HR immediately after intubation was significantly increased in all groups compared to the pre-induction values, but the rate of increase of HR in group 3 were significantly lower than those group 1, 2 (P<0.05). Conclusions: The co-administration with midazolam and remifentanil reduces the time to LOC and the dose of propofol. That also attenuates hemodynamics during tracheal intubation under target-controlled infusion of propofol. (Korean J Anesthesiol 2009: 56: 619~23)
임상연구 : 노인환자의 마취유도 시 Remifentanil 투여방법에 따른 혈역학적 변화
임은빈 ( Eun Bin Yim ),이귀용 ( Guie Yong Lee ),한종인 ( Jong In Han ),정락경 ( Rack Kyung Chung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: The elderly have increased sensitivity to opioids and anesthetics. The hemodynamic effects of propofolremifentanil during induction are not known in the elderly. This study was designed to compare two different remifentanil administration methods during propofol-remifentanil induction and tracheal intubation in the elderly. Methods: Forty patients, ages over 65 years were enrolled. Anesthesia was induced with propofol 1 mg/kg and remifentanil. In Group T (TCI : target controlled infusion), remifentanil 3.5 ng/ml were infused until laryngoscopy and tracheal intubation. In Group R (rapid infusion), infusion were stopped when effect-site concentration reaches 5.0 ng/ml. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction (baseline), after remifentanil reaches its target effect-site concentration, after administration of propofol, 1 minute before intubation, 1 minute after intubation and 3 minute after intubation. Results: In both groups, MAP decreased significantly after induction and then increases significantly after intubation (P < 0.05). In Group R, MAP decreased earlier and was significantly lower than that of Group T (P < 0.05) before intubation. HR shows no significant changes between groups. Conclusions: In these two methods, there are no severe hemodynamic compromise during induction and tracheal intubation in the elderly. However, lesser degree of hypotension occurs in Group T. So we conclude that TCI method can provide better hemodynamic stability than rapid infusion method. (Korean J Anesthesiol 2007; 53: 714∼9)
임상연구 : 회복실에서 초음파 스캐너로 조사한 수술 후 요정체
길양숙 ( Yang Sook Gil ),이귀용 ( Guie Yong Lee ),정우식 ( Woo Sik Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
Background: Postoperative urinary retention is a common postoperative complication. Persistent distention of the bladder may affect the function of the detrusor, resulting in impairment of micturition. This study examined the risk factors and incidence of early postoperative urinary retention and distention in PACU (postanesthesia care unit) using an ultrasound scanner. Methods: The bladder volume was measured in 228 surgical patients before discharge from the PACU using an ultrasound scanner. The postoperative urinary retention was defined as the inability to void at a bladder volume exceeding 500 ml within 30 min. The potential variables of urinary retention were collected including age, gender, type of surgery and anesthesia, duration of anesthesia, amount of perioperative fluid, post operative patient-controlled analgesia, and anticholinergics. The independent risk factors for postoperative urinary retention were identified by multivariate analysis. Results: The incidence of postoperative urinary retention in the PACU was 14.0%. Risk factors of the early postoperative urinary retention in the PACU detected by the ultrasound scanner were age (50 yr, odds ratio = 3.3), spinal anesthesia (odds ratio = 2.6) and the amount of perioperative fluid (700 ml, odds ratio = 4). Conclusions: It is recommended that early postoperative urinary retention be evaluated routinely using an ultrasound scanner in the PACU, particularly in older patients and patients given a large amount of perioperative fluid after spinal anesthesia. (Korean J Anesthesiol 2006; 50: 674~8)