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Burn Young Heo,곽미숙,정재웅,오은정,최수주,Sangmin Maria Lee,김영욱 대한마취통증의학회 2013 Anesthesia and pain medicine Vol.8 No.4
We report two cases of high-risked patients with cardiac dysfunction undergoing femoro-popliteal or tibial arterial bypass surgery anesthetized by ultrasound guided peripheral nerve blocks; femoral nerve, femoral branch of genitofemoral nerve and sciatic nerve block. We used an anesthetic solution consisting of 0.375% ropivacaine with epinephrine. We provided sufficient surgical anesthesia. These nerve blockades provided stable intraoperative and postoperative hemodynamic status, which is valuable knowledge from the perspective of postoperative pain control as well as satisfaction of both patients and surgeons. We believe that femorosciatic nerve block with concurrent femoral branch block of genitofemoral nerve could be an excellent anesthetic choice for patients receiving femoro-popliteal or tibial arterial bypass surgery, especially in patients with cardiac dysfunction.
Kyung Mi Kim,최수주,김명희,곽미숙,Mi Hye Park,Burn Young Heo 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.3
Background: During carotid endarterectomy (CEA), hemodynamic stability and adequate fluid management are crucial to prevent perioperative cerebral stroke, myocardial infarction and hyperperfusion syndrome. Both pulse pressure variation (PPV) and stroke volume variation (SVV), dynamic preload indices derived from the arterial waveform, are increasingly advocated as predictors of fluid responsiveness in mechanically ventilated patients. The aim of this study was to evaluate the accuracy of PPV and SVV for predicting fluid responsiveness in patients undergoing CEA. Methods: Twenty seven patients undergoing CEA were enrolled in this study. PPV, SVV and cardiac output (CO) were measured before and after fluid loading of 500 ml of hydroxyethyl starch solution. Fluid responsiveness was defined as an increase in CO ≥ 15%. The ability of PPV and SVV to predict fluid responsiveness was assessed using receiver operating characteristic (ROC) analysis. Results: Both PPV and SVV measured before fluid loading are associated with changes in CO caused by fluid expansion. The ROC analysis showed that PPV and SVV predicted response to volume loading (area under the ROC curve = 0.854 and 0.841, respectively, P < 0.05). A PPV ≥ 9.5% identified responders (Rs) with a sensitivity of 71.4% and a specificity of 90.9%, and a SVV ≥ 7.5% identified Rs with a sensitivity of 92.9% and a specificity of 63.6%. Conclusions: Both PPV and SVV values before volume loading are associated with increased CO in response to volume expansion. Therefore, PPV and SVV are useful predictors of fluid responsiveness in patients undergoing CEA.
펜타닐 정주로 인한 기침반사반응에 대한 클로니딘의 효과
이상민,조현성,정익수,최덕환,이정진,허번영 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.2
Background : The opioid agonist fentanyl has been used at induction of anesthesia to stabilize hemodynamic parameters. But it can induce cough and in some patients, it can be hazardous. We investigated the effect of α2- agonist clonidine premedication on fentanyl induced cough reflex. Methods: 83 patients (ASA class 1) were involved in this study and divided into two groups: Group 1 (no premedication group, n=43) and Group 2 (clonidine 300 g p .o. 1 hour prior to anesthesia, n=40). Before induction of anesthesia, in each group, fentanyl was injected within 1 second through a peripheral venous cannula in dorsum of hand and rapid fluid infusion was followed. We checked cough response, cough emerging time and it's duration. We graded the duration of cough into grade I and II (Grade I: shorter than 5 seconds, Grade II: longer than 5 seconds). Results : There was no significant difference in the incidence of fentanyl induced cough reflex between Group 1 (34.9%) and Group 2 (25.6%). The incidence of Grade II i higher in Group 1 (18.3%) than in Group 2 (2.5%). Conclusions : Clonidine, as a premedication agent, couldn't reduce the incidence of fentanyl induced cough reflex. But it reduced the degree of cough response. (Korean J Anesthesiol 1998; 35: 285∼289)