원저 : 소량의 Ketamine 에 의한 선행진통 효과 ( Original Article : The Effect of Low - Dose Ketamine on Preemptive Analgesia )

이두익(Doo Ik Lee),함석희(Seok Hee Ham),강철호(Chull Ho Kang),김동옥(Dong Ok Kim),김동수(Dong Soo Kim) 경희대학교 경희의료원 1998 慶熙醫學 Vol.14 No.1

Midazolam 사전 정주가 Propofol 에 의한 마취유도 및 기관 내 삽관 시 Bispectral Index 와 혈역학적 변화에 미치는 효과

함석희,최영규,김동욱,김건식,권무일,신광일 대한정맥마취학회 2000 정맥마취 Vol.4 No.1

서론: 환자의진정상태를 평가하기 위해 개발된 Bispectral Index (BIS) 감시장치는 마취제 및 유해 자극과의 관계성에 대해서 연구가 진행중이다. 저자들은 propofol로 마취 유도를 하는 동안 midazolam의 사전 정주 여부에 따른 기관내 삽관 전후의 BIS치와 혈압, 심박수를 측정하여 심혈관계에 미치는 영향을 관찰하였다. 방법: 미국 마취과학회 신체등급 분류 1, 2에 속하는 18-60세의 환자중 수술시간이 두시간 미만인 남녀환자 20명을 대상으로 하였다. 대조군(제1군, n=10)은 마취유도시 일시용량으로 propofol 2 ㎎/㎏을 투여한 다음 12 ㎎/㎏/h을 지속 주입한 군, 실험군(제2군, n=10)은 마취 유도 2분전에 midazolam 0.1 ㎎/㎏을 투여한 다음 12 ㎎/㎏/h을 지속 주입한 군으로 하였다. 마취유도제로 사용한 propofol은 40초 이상에 걸쳐서 정주하였으며, 이때 다른 정맥로를 통하여 근이완제인 vecuronium을 0.15 ㎎/㎏ 투여한 다음 약 5분 이상에 걸쳐 100% 산소를 이용하여 보조호흡과 조절호흡으로 유지하다가 BIS치가 40전후인 경우 기관내 삽관을 시도하였다. 마취유도전, midazolam(또는 생리식염수) 투여후 2분, propofol 1 또는 2 ㎎/㎏ 및 vecuronium 0.15 ㎎/㎏ 투여 후 3-5분, 기관내 삽관후 1분, 삽관후 3분 및 5분에 BIS치, 혈압 및 심박수를 측정하고 이를 비교분석하였다. 결과: BIS 및 수축기 혈압은 midazolam을 사전정주한 군에서 일시적으로 감소되었다. 양군에서 propofol로 마취유도하는 동안 20% 정도 감소하였다. BIS는 기관내 삽관 5분 후에 의미있게 감소하였다. 결론: Midazolam 사전정주는 기관내삽관시 심혈관계 반응을 둔화시켜 주었으며, BIS는 정맥마취 동안 최면상태늘 예측하기에 좋은 감시장치라고 사료된다.Background: The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to be related to anesthetic agents and noxious stimulus. In this study, we measured BIS, blood pressure (BP) and heart rate (HR) during induction of anesthesia (IA) with propofol, with and without midazolam pretreatment. Background: The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to be related to anesthetic agents and noxious stimulus. In this study, we measured BIS, blood pressure (BP) and heart rate (HR) during induction of anesthesia (IA) with propofol, with and without midazolam pretreatment. Methods: A study design was used in 20 ASA physical status 1 and 2 patients aged from 18to 60 years undergoing short (2 h) operation times. In the control group (group 1, n = 10), propofol 12 ㎎/㎏/hr was infused continuously ofter propofol 2 ㎎/㎏ as an intravenous bolus for IA preceded by normal saline. In group 2 (n = 10), propofol 12 ㎎/㎏/hr was infused continuously after half-strength propofol 1 ㎎/㎏ as an intravenous bolus for IA preceded by 0.1 ㎎/㎏ midazolam 2 min before. Patients received intravenous propofol for IA over 40 seconds. During the infusion, vecuronium (0.15 ㎎/㎏) was given 3 - 5 min before intubation. The assistant and controlled ventilation were maintained with 100% oxygen over 5 min, and continued until BIS decreased to 40 and intubation was called for. The BIS, BP and HR were measured 2 min after midazolam or normal saline infusion, 3 - 5 min after propofol with vecuronium and 1, 3 and 5 min after endotracheal intubation. Results: The midazolam pretreatment produced transient decreases in systolic BP and the BIS. During IA with propofol, BP decreased 20% in both groups. BIS decreased significantly 5 min after endotracheal intubation. Conclusions: Midazolam pretreatment attenuated the cardiovascular response to intubation, so BIS is considered a good monitor as a predictor of hypnotic state during intravenous anesthesia.

전기경련요법 시 Clonidine 이 심혈관계와 경련기간에 미치는 영향

최영규,함석희,신광일 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.2

Background: Elecroconvulsive therapy (ECT) is frequently associated with cardiovascular complications such as hypertension and tachycardia. The aim of this study was to evaluate whether clonidine given as an oral preanesthetic medication would inf1uence the hemodynamic stress response, peripheral oxygen saturation and seizure duration which follows ECT. Methods : Twenty-two ASA physical status 1, ll patients with major depressive disorders were included in a crossover study design and assigned randomly to either a control group who received placebo, or a clonidine group who received oral clonidine of 3 mg/kg 90 min before preparation of ECT. All patients received glycopyrrolate 0.2 mg intramuscularly 60 min before anesthetic induction. Electrocardiography, pulse oximetry, and blood pressure monitors were applied to all patients. Patients were pre-oxygenated with 100% 02. Patients received thiopental 2.5 mg/kg and succinylcholine 0.5 mg/kg for anesthetic indtlction. Noninvasive mean arterial blood pressur (MAP), heart rate, and oxygen saturation were recorded .iust before test drug admlinistration, immediately before ECT, and each minute for five minutes after ECT. The times from ECT stimulus to the cessation of clonictonic motor activity in the $quot;isolated$quot; arm were noted. Results : There was a significan decrease in MAP (P = 0.007) through the peri-ECT period in groups with oral clonidine pretreatment (3 mg/kg) relative to the control group. There were no significant differences in heart rate and peripheral oxygen saturation values between two groups. The duration of motor sizure activity was similar between the clonidine pretreatment and placebo groups. Conclusions: We conclude that oral clonidine 3 mg/kg as a pretreatment medication is effective in attenuating the MAP increase in routine ECT. (KOREAN J Anesthesiol 2000: 38: 243 ~250)

두개강내 거대동맥류의 마취관리

최영규,함석희,백미경 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5

A 50 year-old woman was scheduled for clipping of giant middle cerebral artery (MCA) aneurysm. Preoperative four-vessel angiography and computed tomography scan revealed a giant aneurysm (3.5×3.3×3.5 cm) at bifurcation of right MCA. Induced hypotension and brain protection using sodium nitroprusside (SNP) and thiopental loading were planned to prevent cerebral damage during the operation. Before induction, esmolol, lidocaine and vecuronium were administered. Mask ventilation with isoflurane in N2O and O2 was performed over 5 minutes and then tracheal intubation was done. Anesthesia was maintained by isoflurane+N2O+O2 with pancuronium. Electrocardiography, pulse oxymetry, capnography, central venous pressure, evoked potential and invasive arterial blood pressure were monitored. She was hyperventilated intraoperatively with a PaCO2 around 30 mmHg. Perioperative hypotension was achieved with infusion of SNP (0.3∼1.0 g/kg/min). During the actual aneurysm surgery, mean arterial pressure was lowered to approximately 50 mmHg. Adjuvant drugs such as methylprednisolone, mannitol and furosemide to reduce intracranial pressure were also administered. This technique established good brain conditions during clipping of the aneurysm. A thiopental loading (4 mg/kg) was supplied while the aneurysm was approached. Satisfactory and well-controlled hypotension was obtained after thiopental and SNP. Postoperatively, the patient was transferred to the intensive care unit. (Korean J Anesthesiol 1998; 35: 1012∼1017)

Succinylcholine 사용전 투여된 소량의 Vecuronium이 기관내 삽관후 혈압 및 심박동수에 미치는 영향

신옥영,함석희,김건식,강화자,김동옥,최영규,신광일 경희대학교 1997 慶熙醫學 Vol.13 No.3

Midazolam 사전 정주가 Propofol에 의한 마취유도 및 기관내 삽관시 Bispectral Index와 혈역학적 변화에 미치는 효과

김동옥,최영규,권무일,함석희,신광일,김건식 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.5

Background : The bispectral index (BIS) has been used as an indicator of sedative state and has been considered to be related to anesthetic agents and noxious stimulus. In this study, we measured BIS, blood pressure (BP) and heart rate (HR) during induction of anesthesia (IA) with propofol, with and without midazolam pretreatment. Methods : A study design was used in 20 ASA physical status 1 and 2 patients aged from 18 to 60 years undergoing short (2 h) operation times. In the control group (group 1, n = 10), propofol 12 mg/kg/h was infused continuously after propofol 2 mg/kg as an intravenous bolus for IA preceded by normal saline. In group 2 (n = 10), propofol 12 mg/kg/h was infused continuously after half-strength propofol 1 mg/kg as an intravenous bolus for IA preceded by 0.1 mg/kg midazolam 2 min before. Patients received intravenous propofol for IA over 40 seconds. During the infusion, vecuronium (0.15 mg/kg) was given 3 5 min before intubation. The assistant and controlled ventilation were maintained with 100% oxygen over 5 min, and continued until BIS decreased to 40 and intubation was called for. The BIS, BP and HR were measured 2 min after midazolam or normal saline infusion, 3 5 min after propofol with vecuronium and 1, 3 and 5 min after endotracheal intubation. Results : The midazolam pretreatment produced transient decreases in systolic BP and the BIS. During IA with propofol, BP decreased 20% in both groups. BIS decreased significantly 5 min after endotracheal intubation. Conclusions : Midazolam pretreatment attenuated the cardiovascular response to intubation, so BIS is considered a good monitor as a predictor of hypnotic state during intravenous anesthesia. (Korean J Anesthesiol 1999; 37: 756∼762)