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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 : Midazolam 정주 후 Sevoflurane 8%와 N2O에 의한 후두 마스크 삽입에 대한 평가
최주연 ( Ju Yeon Choi ),이귀용 ( Guie Yong Lee ),김동연 ( Dong Yeon Kim ),한종인 ( Jong In Han ),정락경 ( Rack Kyoung Chung ),김치효 ( Chi Hyo Kim ),백희정 ( Hee Jung Baik ),김종학 ( Jong Hak Kim ),이춘희 ( Choon Hi Lee ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.2
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 : 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)
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)
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)
증례보고 : 전신마취하 견관절경 수술로 생긴 기도 폐쇄
문지현 ( Ji Hyun Moon ),이희승 ( Hee Seung Lee ),한종인 ( Jong In Han ),이귀용 ( Guie Yong Lee ),강신영 ( Sin Young Kang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
The use of a shoulder arthroscopic procedure provides advantages in the diagnosis and treatment of shoulder injuries. However, this technique is not free from complications. We encountered a patient who presented with an airway obstruction caused by the accumulation of extraarticular arthroscopy fluid after arthroscopic shoulder surgery under general anesthesia. (Korean J Anesthesiol 2006; 51: 375~8)