노인마취

노규정(Gyu-Jeong Noh) 대한종양외과학회 2013 Korean Journal of Clinical Oncology Vol.9 No.2

As a result of improvements in health care, nutrition, and general living standards, the average life expectancy and elderly population is increased worldwide. Aging is associated with a universal and progressive loss of functional reserve and degenerative changes in all organ systems. Although physiologic compensation for age-related changes may be adequate in most geriatric patients, the functional reserve of organ systems is reduced, and susceptibilities to stress- and disease-induced organ system decompensation can occur. Anticipating the interactions between underlying diseases, limited end-organ reserve, and perioperative stress should aid physicians in providing the best perioperative care possible. We review the age-related physiologic changes in organ systems and pharmacokinetic and pharmacodynamic changes of anesthetics in elderly surgical patients.

완전정맥마취와 휘발성유도/유지마취에서 정량적 뇌파를 이용한 마취심도의 감시

이수한,노규정,정병현,Lee, Soo-Han,Noh, Gyu-Jeong,Chung, Byung-Hyun 대한수의학회 2006 大韓獸醫學會誌 Vol.46 No.1

To evaluate method for monitoring anesthetic depth with quantitative electroencephalography (q-EEG), we recorded processed EEG (raw EEG) and pain score till 100 minutes in beagle dogs anesthetized for 60 minutes with propofol (n = 5, PRO group), isoflurane (n = 5, ISO group) and propofol-ketaminefentanyl (n = 5, PFK group). Raw EEG was converted into 95% spectral edge frequency (SEF) by fast Fourier transformation (FFT) method. We investigated anesthetic depth by comparing relationship (Pearson's correlation) between q-EEG (95% SEF) and pain score. Pearson's correlation coefficients are +0.2372 (p = 0.0494, PRO group), +0.79506 (p < 0.001, ISO group) and +0.49903 (p = 0.0039, PFK group).

간헐적 일시 정맥주사 마취에서 정량적 뇌파분석을 이용한 마취 심도의 평가

이수한,배춘식,노규정,배균섭,김진영,정병현,Lee, Soo-Han,Bae, Chun-Sik,Noh, Gyu-Jeong,Bae, Kyun-Seop,Kim, Jin-Young,Chung, Byung-Hyun 대한수의학회 2005 大韓獸醫學會誌 Vol.45 No.1

To assess anesthetic depth using quantitative electroencephalography (q-EEG), we recorded processed EEG (raw EEG) till 100 minutes in beagle dogs anesthetized for 60 minutes with tiletamine/zolazepam (n=5, TZ group), xylazine/ketamine (n=5, XK group) and propofol (n=5, PI group) by intermittent bolus injection. Raw EEG was converted into 95% spectral edge frequency (SEF) and median frequency (MF) through fast fourier transformation (FFT) method. 95% SEF value of TZ group was significantly higher (p<0.05) than the XK group from 10 minutes to 100 minutes. 95% SEF value of PI group was significantly higher (p<0.05) than the XK group from 10 minutes to 40 minutes, and significantly low (p<0.05) than XK group at 90 and 100 minutes. MF was significantly higher (p<0.05) in TZ group from 60 minutes to 100 minutes. Based on these results, using dissociative agent with ${\alpha}_2$-adrenergic agent is more potent in CNS depressed than using dissociative agent alone, and low doses of propofol has a disinhibitory effect on CNS.

임상연구 : 수술 후 환자에서 기계식 통증자가조절기의 안전성 및 유효성에 관한 임상연구

정용보 ( Yong Bo Jeong ),이무송 ( Moo Song Lee ),최병문 ( Byung Moon Choi ),진지현 ( Ji Hyun Chin ),노규정 ( Gyu Jeong Noh ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2

Background: The disposable patient-controlled analgesia (PCA) devices are convenient for portability and management. An ideal PCA can be developed as an electronic device with various functions of safety and control. Recently, Accumate 1000(R). was developed as an electronic pump in Korea, and has passed the relevant laboratory criteria of safety and efficacy. We conducted a clinical study on the safety and efficacy when the device is applied to patients. Methods: Fentanyl 1,500μg, ketorolac 180 mg, and ondansetron 8 mg were used for PCA. Continuous infusion rate, bolus dose, and lockout time were set at 1 ml/h, 1 ml, and 15 min, respectively. Fifty patients were monitored for 48 h. The safety of Accumate 1000(R). was evaluated by backflow and siphonage, auto-clamp function, and lockout time intraoperatively. The efficacy was evaluated by the accuracy of bolus and total infused dose, and the satisfaction rates of patients and users. Results: Backflow and siphonage did not occur, and the auto-clamp function was excellent. There was no bolus infusion during lockout time, and the bolus dose was infused accurately after lockout time. For the accuracy of the total infused dose, the mean and median value of performance error between the infused and target doses were -0.55%, and -0.29%, respectively. Noise, button sense, and convenience of cable were rated as satisfactory by 90%, 78%, and 84%, of patients respectively. Conclusions: The safety and efficacy of Accumate 1000(R) were established by clinical trial. We can provide patients with the more precise and optimal analgesia. The history of drug infusion can be used as research data. (Korean J Anesthesiol 2007; 52: 161~5)

증례보고 : 마취 중 요도 카테터 삽입 후 발생한 Chlorhexidine 아나필락시스

김태희 ( Tae Hee Kim ),조석주 ( Suk Ju Cho ),김혜진 ( Hye Jin Kim ),노규정 ( Gyu Jeong Noh ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1

Chlorhexidine is a widely used antiseptic and disinfectant that has eliminating effects on gram-positive bacteria, gram-negative bacteria, some mycobacteria, candida albicans, and some viruses. There have been a few reports regarding severe adverse reactions associated with chlorhexidine. But, there was no report about the anaphylactic shock due to chlorhexidine during anesthesia in Korea. We report a severe anaphylaxis reaction after the use of chlorhexidine jelly for the urethral catheterization, presenting the positive skin test for chlorhexidine. This case shows that the ``innocent`` products such as urethral lubricants may elicit serious life-threatening reactions. (Korean J Anesthesiol 2007; 52: 104~6)

실험연구 : Propofol 미세유탁액을 지속정주하여 진정된 비글견에서 집단 약동력학적 모형화

최병문 ( Byung Moon Choi ),정성문 ( Sung Moon Jung ),배균섭 ( Kyun Seop Bae ),노규정 ( Gyu Jeong Noh ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6

Background: Aquafol(R) is a microemulsion formulation of propofol. This study was designed to investigate the population pharmacokinetic and pharmacodynamic modeling in beagle dogs sedated by Aquafol(R). Methods: Electroencephalogram was recorded and venous blood was sampled at preset times in 15 beagle dogs during 3 hours of infusion of Aquafol(R) and subsequently during 3 hours of recovery. Venous blood was sampled at 0, 2, 10, 30, 60, 120, 180, 190, 240 and 360 minutes after infusion. We evaluated the effect of propofol on electroencephalogram by calculating SEF90. In the preliminary analysis, two compartment model best described all data from all subjects. The pharmacodynamics were best described using an effect compartment model and ke0, a first-order elimination rate constant characterizing the effect-site equivalent to estimate the apparent effect-site concentrations. The relationship between propofol effect-site concentration and SEF90 was analyzed using an inhibitory sigmoid Emax model. Results: The final pharmacokinetic model was best described with the followings: V1 = 18.5e0.114*BWT, k10 = 1.86 min-1, k12 = 0.6 min-1, k21 = 0.684 min-1. The final pharmacodynamic model was best described with the followings: t1/2ke0 = 0.62 min, Ce50 = 32.2 ng/ml, Eo = 31.3 Hz, Emax = 20.9 Hz, γ = 1.28. Conclusions: The propofol microemulsion shows different pharmacokinetics and pharmacodynamics compared with the propofol lipid emulsion. (Korean J Anesthesiol 2006; 50: 689~97)

Sodium Nitroprusside 로 혈압을 조절한 척수손상 환자 마취중 발생한 자율신경반사항진

오용석,노규정,박재현,김정수,정성량 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.4

Autonomic hyperreflexia is a syndrome of massive reflex sympathetic discharge that occurs in patients with chronic spinal cord lesions above the major sympathetic splanchnic outflow (T₄-T_6). We experienced autonomic hyperreflexia that occured in a patient with spinal cord trans-section at T_5 level during general anesthesia with O₂-N₂O-halothane. Hypertension was controlled with intravenous infusion of sodium nitroprusside (1-2 ug/kg/min) and ventricular arrhythmia was treated with intra-venous lidocaine. We recommend that direct acting vasodilators are useful drugs to control hypertension in autonomic hyperreflexia during anesthesia in patients with chronic spinal cord injury.

전신마취시 경막외 Morphine 이 Isoflurane 의 평균흡입농도에 미치는 영향

오용석,노규정,함태수 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.6

The effect of epidural morphine on the mean inspired concentration of isoflurane was inves- tigated in 34 patients undergoing hepatoma surgery, The patients were randomly assigned to the control(CTRL), epidural morphine(MORP) or epidural bupivacaine(BUPI) groups. Before induction of anesthesia, epidural catheter was inserted beween T6-10 intervertebral space in the right lateral decubitus position. MORP group(n=13) received morphine sulfate 4 mg in 4 ml normal saline and BUPI group(n=10) received 0.5% bupivacame 10 md through epidural eatheter. CTRL group(n=11) wss treated in an identical fashion except that, after placement of epidural catheter, nothing was injected. After endotracheal intubation, general anesthesia was maintained during surgery with oxygen-nitrous oxide(1:1 ratio) and isoflurane. Inspired concentration of isoflurane was adjusted to maintain blood pressure in the range of blood pressure at the ward during surgery. Mean inspired concentration of isoflurane was monitored from incision to last skin suture. Mean inspired concentration of isoflurane(±SD) of CTRL, MORP and BUPI group was 1.41±0.36, 1.52±0.39 and 0.37±0.16 vol%, respectively. There was no difference in mean inspired concentration of isoflurane between CTRL and MORP group. Under the condition of this study, epidural morphine did not reduce inspired concentration of isoflurane during surgery even though epidural morphine is effective for post operative pain control.

제왕절개술시 기관내 삽관 후 즉시 수술을 시작하여야 하는가?

이동호,노규정 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.2

Background: If general anesthesia is used for cesarean section, important considerations include minimizing the duration of general anesthesia. One may think that skin incision should be started immediately after endotracheal intubation. If so, intra-operative awareness and perception of pain may occur due to light anesthesia. Allowing skin incision to be started 5 min after intubaton while administering 50% nitrous oxide and isoflurane 0.75%, we investigated the changes of BIS (bispectral index), and Apgar scores. Methods: The investigation was carried out on 33 full-term ASA 1 or 2 patients underwent elective cesarean section under general anesthesia. If any fetal abnormalities were found, we excluded those cases. Premedication was omitted. After rapid sequence induction with sodium thiopental 4 mg/kg, succinylcholine 1 mg/kg, we made skin incision immediately after intubation in control group (n = 18) and 5 min after intubation in experimental group white administering 50% nitrous oxide and isoflurane 0.75%. Muscle relaxation was maintained with intravenous administration of atracurium 0.5 mg/kg. We measured BIS, mean arterial pressure (MAP), heart rate in 1 min interval from preinduction period to delivery and recorded Apgar scores 1 and 5 min after delivery, skin incision to delivery time and uterine incision to delivery time. And we counted the number of patients whose BIS values had been below 60 and 70 from skin incision to delivery in each group. Result: Apgar scores recorded 1 and 5 min after delivery did not show significant differences between control and experimental group. During the periods of abdominal wall traction, uterine incision and delivery, BIS values of experimental group were significantly lower than control group and moreover, tended to remain below 60 while those of control group during the same periods tended to be above 60 (P < 0.05). The number of patients of experimental group, whose BIS values had been below 60 from skin incision to delivery, was twice as much as that of control group (P < 0.05), but in case of BIS value below 70, there was no significant difference between control and experimental group. During the periods of skin incision and abdominal wall traction, the MAP's of experimental group were significantly lower than control group (P < 0.05). In cases of heart rate, skin incision to delivery time and uterine incision

일측 폐환기시 허탈된 폐의 고빈도 제트환기가 전신산화에 미치는 영향

전우재,노규정 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.6