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실험연구 : Freund`s Complete Adjuvant로 염증을 유발한 흰쥐에서 기계적 이질통에 대한 α2 아드레날린성 수용체 작용제 및 Norepinephrine의 효과
정미애 ( Mi Ae Cheong ),김화년 ( Hwa Nyon Kim ),전종헌 ( Jong Hun Jun ),김경헌 ( Kyoung Hun Kim ),서정국 ( Jung Kook Suh ),황재현 ( Jai Hyun Hwang ),박평환 ( Pyung Hwan Park ),기화영 ( Wha Young Key ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.1
임상연구 : 뇌수술 시 스테로이드의 투여가 혈중 포도당 농도에 미치는 영향
김현정 ( Hyun Jung Kim ),정미애 ( Mi Ae Cheong ),김동원 ( Dong Won Kim ),심재철 ( Jae Chul Shim ),서정국 ( Jung Kook Suh ),이형중 ( Hyeong Joong Yi ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Background: Steroids are normally used in neurosurgery, especially when treating brain edema and reducing the intracranial pressure. Methylprednisolone is known to increase the blood glucose concentration. However, the effect of a single methylprednisolone injection on the blood glucose concentration is unknown. Therefore, this study measured and compared the blood glucose concentration in a methylprednisolone group with that in a placebo group at the same interval. Methods: Thirty-three adult patients were enrolled in this study. The patients were scheduled to undergoing an elective craniotomy with the procedure lasting 4 hours or longer. The candidates were divided in two groups. One group was the methylprednisolone group (patients receiving methylprednisolone 125 mg, n = 18), and the other group was the placebo group (n = 15). The exclusion criteria were a clinical diagnosis of diabetes mellitus, an impaired glucose tolerance and had received steroid previously. Before injecting 125 mg of either methylprednisolone or the placebo, the blood glucose concentration was checked by glucose analyzer. After the injection, blood glucose concentration was checked every 30 minutes for more than 4 hours. Results: The blood glucose concentration increased significantly over time compared with the baseline concentration in both groups. The glucose concentration increased significantly in the methylprednisolone group than in the placebo group (P < 0.05). The magnitude of this difference was greater in those who received methylprednisolone (54 mg/dl increase over 4 hours) than in the placebo group (11 mg/dl increase over 4 hours). Conclusions: In this study, compared with placebo controls, an injection of methylprednisolone (125 mg) produced a significant increase in the blood glucose concentration over a 4 hours period. Therefore, we recommend that the blood glucose level be monitored carefully in cases of brain surgery and/or when steroids are used. (Korean J Anesthesiol 2006; 50: 439~43)
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)
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)
하행 대동맥류를 동반한 산모의 선택적 제왕절개술을 위한 경막외 마취
김경헌,조상윤,정미애 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.3
A 35 year old primigravida at 38 weeks gestation was admitted for delivery. She was known to have an asymptomatic descending thoracic aortic aneurysm which had been diagnosed 1 year earlier. She remained in good general health during her pregnancy, and ultrasound examinations confirmed fetal well being. On admission, her arterial pressure was 130/80 mmHg, her heart rate was 88 beats/min, and her EKG was normal. On chest X-ray there was discovered a descending thoracic aortic aneurysm 10cm in diameter. She was delivered of a healthy boy weighing 3.3 kg with Apgar Score of 7 and 9 at 1 and 5 minutes by cesarean section under epidural anesthesia. The patient and her baby were discharged for home 7 days after the operation. Successful term preganancy and cesarean delivery after diagnosis of a thoracic aortic aneurysm has not been previously described in the literature. So we report this case with a brief review of the literature. (Korean J Anesthesiol 1999; 37: 522∼526)