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임상연구 : 한국인에서 Propofol-Remifentanil 전정맥 마취시 기관내 삽관에 따르는 혈압과 맥박수의 증가를 예방하기 위한 Remifentanil의 효과처 농도
신혜란 ( Helen Ki Shinn ),이홍식 ( Hong Sik Lee ),이춘수 ( Choon Soo Lee ),정종권 ( Chong Kweon Chung ),차두천 ( Doo Cheon Cha ),김혜하 ( Hye Ha Kim ),송장호 ( Jang Ho Song ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: Combination of propofol and remifentanil is an ideal regimen for total intravenous anesthesia. The purpose of this study is to determine the effect-site concentration of remifentanil for prevention of hemodynamic responses to tracheal intubation during fixed propofol infusion (4μg/ml) and to find any sexual differences. Methods: Thirty ASA physical status I-II patients undergoing general anesthesia were assigned to male (n = 15), and female (n = 15) group. All patients received a target controlled infusion (TCI) of propofol with a fixed effect-site concentration of 4μg/ml. After target effect-site concentration of propofol and remifentanil was reached, tracheal intubation was performed. The hemodynamic changes (systolic/diastolic blood pressure, mean arterial pressure, and heart rate) were measured at 1 and 2 min before tracheal intubation (baseline), immediately after, 1, 2, 3, 4 and 5 min following tracheal intubation. In both groups, effect-site concentration of remifentanil was initiated with 3 ng/ml. Subsequent concentration of remifentanil was determined by hemodynamic responses of the previous patient to tracheal intubation based on up and down sequential allocation. Results: The mean EC50 of remifentanil for prevention of hemodynamic responses to tracheal intubation were 1.37 ng/ml (95% CI, 0.95-1.81 ng/ml) in male group and 1.05 ng/ml (95% CI, 0.68-1.40 ng/ml) in female group, respectively. In addition, there were no statistical significant differences between two groups. Conclusions: Relatively small dosages of remifentanil (0.68-1.81 ng/ml) for attenuation of hemodynamic responses to tracheal intubation was needed in Korean population in propofol TCI and there were no sexual differences. (Korean J Anesthesiol 2006; 51: 312~7)
증례보고 : 내경 정맥을 통한 중심 정맥 도관술시 발생한 의인성 척추 동정맥루
신혜란 ( Helen Ki Shinn ),송장호 ( Jang Ho Song ),한정욱 ( Jeong Uk Han ),고희창 ( Hee Chang Ko ),조병권 ( Byung Kwan Cho ),음선형 ( Son Hyoung Eum ),정종권 ( Jong Kwon Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Iatrogenic vertebro-vertebral arteriovenous fistula (AVF) is an uncommon complication resulting from various procedures such as central venous catheter insertion. The incidence may be underestimated since the diagnosis is not easy because of its rarity. A central venous catheterization via the internal jugular vein was attempted in a 43-year-old female who presented for intracranial aneurysmal clipping under general anesthesia. Inadvertent arterial puncture was recognized as pulsatile arterial blood flow through the needle. The needle was removed and local compression was applied to the puncture site. The catheter was inserted via the right femoral vein. After surgery, the patient recovered from anesthesia without any complications. On postoperative day 5, thrill and bruit on the right side of the neck were noted on physical examination. Angiography confirmed vertebro-vertebral AVF, which was successfully obliterated with a stent 3 months later. (Korean J Anesthesiol 2007; 53: 806∼9)
임상연구 : 한국인에서 OPRM1 (A118G)/ MDR1 (C3435T) 유전자 다형성과 경막외강 Morphine의 진통 작용 및 부작용과의 상관성
신혜란 ( Helen Ki Shinn ),김태정 ( Tae Jung Kim ),이홍식 ( Hong Sik Lee ),강주희 ( Ju Hee Kang ),한정욱 ( Jeong Uk Han ),임현경 ( Hyun Kyoung Lim ),류승훈 ( Seung Hun Ryu ),송장호 ( Jang Ho Song ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Background: The effect of a single nucleotide polymorphism (SNP) of the μ-opioid receptor gene at nucleotide position 118 (OPRM1:118A > G) and the MDR1 gene (exon 26: C3435T) have an influence on the interindividual variability of clinical opioid pain therapy. This study aims to evaluate the correlation among pain control and side effects of epidural morphine and these pharmacogenetic modulators. Methods: 194 patients who were undergoing abdominal surgery were included in the study. Patients received a morphine 2 mg bolus and 2 mg/day via epidural route. The VAS score and opioid side effects were checked at postoperative 6, 24 and 48 hr. Patients were genotyped for the known SNPs of the OPRM1 and MDR1. Results: For the SNP of OPRM1, the mutated genotype frequency (homo-wild, heterozygous, and homo-mutants) were 36.8, 47.9 and 15.3%, respectively, and the mutated genotype frequencies for the MDR1 SNP were 46.7, 40.2 and 13.1%, respectively. There were no significant differences in the VAS scores and side effects among the three groups of OPRM1 and MDR1. Yet carriers of the mutated allele 3435 TT, CT of the MDR1 gene showed marginally greater significant sedation effects than did non-carriers (CC) (P = 0.065, the OR was 1.78, 95% CI 0.98-3.24, P = 0.059) and also a lower incidence of analgesic usage (P =0.058). Conclusions: In our data there was a large difference in OPRM1 SNP allele frequency for the Korean population compared to other populations. The SNP of OPRM1 and MDR1 genes did not have significant altered clinical morphine analgesia and side effects via the epidural route. But the SNP of MDR1 gene is more sensitive genetic predictor of the clinical side effects (especially for sedation) and analgesic effects by opioid. (Korean J Anesthesiol 2007; 52: 16~22)