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양경아 ( Kyeong A Yang ),정락경 ( Rack Kyung Chung ),김동연 ( Dong Yeon Kim ),배민증 ( Min Jeong Bae ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.6
Background: Pulse oximetry provides valuable data on the arterial oxygen saturation. Significant impairment in the arterial oxygen saturation can occur under vasoconstriction, hypothermia, and hypotension. This study compared the percutaneous oxygen saturation (SpO2) at the hand and the foot with the arterial oxygen saturation (SaO2) during spinal anesthesia. Methods: Twenty eight, ASA physical status 1 or 2, patients received a spinal block with 0.5% hyperbaric bupivacaine. Two pulse oximeter probes were applied to the index finger and second toe of the patients, and the SpO2 values were recorded before, 10, 20, and 30 minutes after the intrathecal injection. The SaO2 was measured before and 30 minutes after the intrathecal injection. Results: During spinal anesthesia, there were similar changes in the SpO2 value from the hand. However, there was a progressive decrease in SpO2 of the foot of 97.6 ± 2.8%, 97.3 ± 2.8%, and 97.2 ± 3.3% at 10, 20, and 30 minutes, respectively (P < 0.05 compared with the baseline). There were significant differences between the hand and foot SpO2 in 20 and 30 minutes (0.79 ± 1.55%, 0.93 ± 1.86%) after the intrathecal injection. The SaO2 value was similar before and 30 minutes after the intrathecal injection. Before spinal anesthesia, there were significant differences between the SaO2 (96.4 ± 2.6%) and SpO2 values of the hand (98.1 ± 2.6%) and the foot (98.3 ± 2.6%). Conclusions: During spinal anesthesia, it is appropriate to measure the SpO2 from the hand because it dose not change significantly. (Korean J Anesthesiol 2008; 55: 700~3)
성상신경절 차단 후 초음파로 확인한 국소마취제 분포가 증상에 미치는 영향
손미경 ( Mi Kyoung Son ),정락경 ( Rack Kyung Chung ),김윤진 ( Youn Jin Kim ),김동연 ( Dong Yeon Kim ),이희승 ( Hee Seung Lee ),한종인 ( Jong In Han ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Background: The aim of this study is to evaluate the effects of local anesthetic distribution on symptoms using ultrasound image after C6 stellate ganglion block (SGB). Methods: Twenty-six patients underwent SGB via an anterior paratracheal approach at the sixth cervical level using 6 ml of 1% mepivacaine. We divided the patients into two groups by local anesthetic distribution using ultrasound image after SGB. In the group `sub`, injected local anesthetic was beneath the prevertebral fascia. In the group `supra`, some of injected local anesthetic was above the prevertebral fascia. The occurrence of Horner`s syndrome, warm sensation on the face and hand, brachial plexus block, hoarseness, and foreign body sensation in the throat were evaluated. The skin temperature of the bilateral thumbs was measured pre and post SGB. Results: The occurrence of hoarseness and the foreign body sensation in the throat was significantly reduced in the group `sub` than the group `supra` (P<0.05). The skin temperature of the ipsilateral thumb significantly increased in both groups compared to the pre SGB values, and the change of the skin temperature significantly increased in the group `sub` than the group `supra` (P<0.05). Conclusions: Subfascial distribution of local anesthetic under ultrasound image after SGB reduces the typical complications. It is more effective in the sympathetic block than suprafascial distribution. (Korean J Anesthesiol 2009;57:579∼83)
임상연구 : 전신 마취 시 노인 환자의 Etomidate 마취유도 용량
문지현 ( Ji Hyun Moon ),정락경 ( Rack Kyung Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Background: Etomidate is frequently used as an induction agent in the elderly patients. We compared the induction dose of etomidate in the elderly patients. Methods: Sixty ASA 1-2 patients were randomly allocated to four groups. They were Group 1 (age < 65, receiving 0.2 mg/kg of etomidate, n = 15), Group 2 (age < 65, receiving 0.3 mg/kg of etomidate, n = 15), Group 3 (age ≥ 65, receiving 0.2 mg/kg of etomidate, n = 15), and Group 4 (age ≥ 65, receiving 0.3 mg/kg of etomidate, n = 15). The time interval from etomidate infusion to loss of verbal response and eyelash reflex, to decrease BIS 50, to return of bispectral index (BIS) 50 were measured. Mean arterial pressure (MAP), heart rate (HR), responses to isolated forearm test and postoperative recall were recorded. Results: Time interval were not significantly different between groups. BIS value did not show statistical differences between groups, though value of group 1 at 1 min after intubation was higher than that of group 2. MAP and HR were increased after intubation in 4 groups. The changes in MAP were significantly different between group 1 and 2. Isolated forearm test was positive in 10, 6, 4, 3 patients in groups 1, 2, 3 and 4, respectively. Only 1 patient in group 1 showed postoperative recall. Conclusions: Age does not influence the BIS value in these etomidate doses. Loss of consciousness and hemodynamic changes during induction with 0.2 mg/kg of etomidate were inappropriate in younger patients, whereas they were appropriate with 0.2 and 0.3 mg/kg of etomidate in the elderly patients. (Korean J Anesthesiol 2006; 50: 402~7)
임상연구 : Lidocaine과 Fentanyl 전처치가 Rocuronium 정주 시의 회피반응에 미치는 영향
조화연 ( Hwa Yeon Cho ),김동연 ( Dong Yeon Kim ),정락경 ( Rack Kyung Chung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: This study compared the efficacy of intravenous fentanyl with lidocaine as a pretreatment for the prevention of a withdrawal response after a rocuronium injection. Methods: Eighty patients were divided into four groups according to the drugs used for pretreatment as follows: group I: normal saline, group II: lidocaine 0.5 mg/kg, group III: lidocaine 1.0 mg/kg, group IV: fentanyl 1μg/kg. Twenty seconds after inducing anesthesia, each pretreatment drug was injected. After twenty seconds, rocuronium was injected. The incidence and severity of the withdrawal responses was assessed. The BIS value and heart rate was recorded at each point (T0: baseline, T1: pretreatment drug injection, T2: 10 seconds after pretreatment drug injection, T3: rocuronium injection, T4: 10 seconds after rocuronium injection, T5: 20 seconds after rocuronium injection). Results: The incidence of withdrawal movement was significantly lower in groups II and III than in groups I and IV (P = 0.002). The BIS was significantly lower in group IV than in groups I, II and III at T2 and group I at T3 (P<0.05). The heart rate at T4 was significantly lower in group IV than in group II (P<0.05). An assessment of BIS at the withdrawal movements showed a significantly higher value in the severe group than in the none and mild groups at T5 (P<0.05). Conclusions: A pretreatment with 0.5 mg/kg or 1.0 mg/kg of lidocaine effectively reduced the incidence of a withdrawal response by the rocuronium injection. However, 1.0 mg/kg of lidocaine most effectively prevented the withdrawal response without causing any significant changes in heart rate. (Korean J Anesthesiol 2007; 53: 174~9)
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)
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)