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Jun Heum Yon,Jae Keun Jo,Young-Suk Kwon,Hae-Gyun Park,이상석 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.60 No.6
Background: Transillumination using a light wand is an alternative type of laryngoscope used for tracheal intubation. There is little information available on the effect-site concentration of remifentanil required to control hemodynamic changes induced by tracheal intubation using the transillumination method during total IV anesthesia. We therefore conducted this study to determine the effect-site concentration of remifentanil blunting hemodynamic responses after tracheal intubation in patients receiving propofol anesthesia. Methods: We enrolled 26 healthy adult patients (ASA physical status I-II), aged 16-67 scheduled for surgery within 2 hours. All patients received a target-controlled infusion of 4 μg/ml propofol. The effect-site target-concentration of remifentanil of 5.0 ng/ml was chosen for the first patient. We used the Dixon’s up-and-down sequential allocation method for determining the next remifentanil concentration. The time required for tracheal intubation was measured as the level of intubation stimulation. Results: The average intubation time was 13.9 ± 9.1 seconds. From the Dixon’s method, the EC_50 of remifentanil blunting the hemodynamic response to tracheal intubation was 2.94 ng/ml. Conclusions: This study shows that effect-site concentrations of remifentanil of 2.94 ng/ml is effective in blunting sympathetic responses to tracheal intubation in 50% of patients with normal airway anatomy when combined with a target controlled infusion of propofol (4 μg/ml).
제왕절개술의 전신마취 유도 시 투여한 Alfentanil이 산모와 태아에 미치는 효과
김준영,정유성,연준흠,김계민,이윤석,홍기혁,김경태 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.5
Background: During general anesthesia for a cesarean section, light depth of anesthesia frequently leads to matemal awareness and pain responses. The aim of this study was to evaluate the effects of alfentanil on the mother and neonate during a cesarean section. Methods: Forty four parturients undergoing general anesthesia for an elective cesarean section were enrolled in this study. General anesthesia was induced with propofol 2 mg/kg and succinylcholine 1.5 mg/kg after an intrvenous injection of normal saline 0.02 ml/kg for the control group of alfentanil 10㎍/kg for the alfentanil group. After tracheal intubation, anesthesia was maintained with O_2 (2 L/min)-N_2O (2 L/min)-isoflurane (0.5% end tidal). Mean blood pressure (MBP), heart rate, bispectral index (BIS) and maternal pain responses by an isolated forearm technique were measured every 1 min until delivery. Apgar scores of neonates were measured at 1 min and 5 min after delivery. Results: There were no differences between groups in the MBP, BIS or maternal pain responses. However heart rates were lower in the alfentanil group than in the control group (P = 0.017). Conclusions: The supplemental administration of alfentanil 10㎍/kg can attenuate the changes in matemal heart rate during general anesthesia for a cesarean section without neonatal Apgar score decline. (Korean J Anesthesiol 2002; 43: 619~624)
심장 수술시 발생하는 뇌손상의 평가 지표로서의 혈청 S100β 단백
김준영,권택민,연준흠,김계민,이윤석,홍기혁 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.6
Background: S100β protein has been reported to be an early marker of brain injury. It is released from the glial cell and Schwann cell specifically after brain injury, and it,s serum concentration correlates with the severity of injury. The aim of this study was to measure the serum concentration of S100β protein during cardiac surgery and to reveal the correlation between cerebral oxygenation and S100β protein. Methods: Eighteen patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) were enrolled in this study. After induction of general anesthesia, the arterial-jugular venous oxygen difference (AjDO_2), regional cerebral oxygen saturation (rSO_2) and lactate oxygen index (LOI) were measured. They were measured after induction (T0), during CPB (T1) and at the end of CPB (T2). Serum S100β protein was measured at T0, T2, T3 (5 hours after CPB), and T4 (24 hours after CPB) using an immunoluminometric assay. We observed correlations between rSO_2, AjDO_2, LOI and the S100β protein concentration. Results: Serum concentrations of S100β protein were 0.18 ± 0.20, 5.72 ± 4.25, 1.06 ± 1.38 and 0.58 ± 0.44 (㎍/L) at T0, T2, T3 and T4 respectively (normal value ≤ 0.5㎍/L). The duration of CPB correlated with the S100β protein concentration at T2, T3 and T4 (P=0.028, r=0.518; P=0.016, r=0.557; P=0.026, r=0.522). There was a significant correlation between the rSO_2 at T1 and S100β protein concentration at T2, T3 and T4 (P=0.004, r=-0.643; P=0.006, r=-0.620; P=0.001, r=-0.724). A correlation between AjDO_2, LIO and S100β protein was not proven. Conclusions: Our results show that serum concentrations of S100β protein correlates with the duration of CPB and rSO_2 during CPB. S100β protein can be considered an early marker of cerebral injury after CPB, but further studies are needed for it's correlation with severity of injury. (Korean J Anesthesiol 2002; 43: 728~734)
임상용량의 Clonidine 이 Propofol-N2O 마취 중 환자의 움직임을 억제하는 Propofol 효과부위농도에 미치는 영향
김준영,이승준,김계민,연준흠,홍기혁,이윤석 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.1
Background : Clonidine has been known to be an α_2-agonist and may potentiate the anesthetic effect. Clonidine also suppresses hemodynamics, which confounds the indices of anesthetic depth. Thus, the author regarded patient's movement as a standard of anesthetic depth as well as hemodymanic change. Interaction between clonidine and propofol in clinical anesthesia was evaluated when given in clinical dose. Methods : Forty patients scheduled for spine surgery were randomly assigned into two groups; propofol only (control group, n = 20) and propofol with clonidine (study group, n = 20). In the study group, clonidine was administered intravenously. Anesthesia was inducted with propofol TCI and N_2O, ans then the effect site concentration of propofol was controlled. The changes of mean arterial pressure, heart rate, and the effect site concentration was observed and analyzed at baseline, before and after skin incision, and then EC_50 was obtained and analyzed. Results : Mean arterial pressure and heart rate significantly changed between before and after the skin incision in both groups. There was no significant difference of propofol EC_50 in the prevention of patient's movement at the time of skin incision. Conclusions : The authors concluded that preoperative administration of clinical dose clonidine provides stable homodynamic conditions in propofol-N_2O anesthesia, but no changes in the depth of anesthesia. (Korean J Anesthesiol 2002; 42: 17~22)
이승준,오태호,연준흠,손지영 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.1
Freeman-Sheldon syndrome is a rare congenital myopathy principally characterized by facial and skeletal abnormalities. We report a case of a Freeman-Sheldon syndrome in 12-year-old girl correction of undergoing kyphoscoliosis under somatosensory evoked potential monitoring. She had a characteristic appearance of Freeman-Sheldon syndrome such as hypoplastic alae nasi, high narrow palate, marked microstomia with pursed lips and clenched fingers. On arriving at the operating room, she was intubated by awake nasotracheal intubation with fiberoptic bronchoscopy and anesthetized with propofol and fentanyl. (Korean J Anesthesiol 1999; 36: 158∼161)