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Propofol/Rocuronium을 이용한 신속 기관 내 삽관 시 Remifentanil의 세 가지 지속 정주 용량에서의 혈역학적 반응
곽미숙 ( Mi Sook Gwak ),최수주 ( Soo Joo Choi ),윤진선 ( Jin Sun Yoon ),이준용 ( Jun Yong Lee ),양미경 ( Mi Kyung Yang ),김갑수 ( Gaab Soo Kim ),이상민 ( Sang Min Lee ),김명희 ( Myung Hee Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Background: This study compared the effect of the three different infusion doses of remifentanil on the hemodynamic response to rapid sequence anesthesia induction and tracheal intubation. Methods: In this prospective, randomized double-blind study, 60 ASA I or II patients without any airway abnormalities, who were scheduled to undergo elective surgery requiring endotracheal intubation, were allocated to receive remifentanil 0.25, 0.5, or 1.0μg/kg/min. Anesthesia was induced with a remifentanil infusion and propofol 2.0 mg/kg. Rocuronium 1.0 mg/kg was given after a loss of consciousness and endotracheal intubation was performed 1 min after the rocuronium injection. The remifentanil infusion was stopped immediately before intubation. The noninvasive blood pressure (BP) and heart rate (HR) were recorded before induction (baseline), immediately before intubation, and at 1 min intervals until 5 min after intubation. Results: The HR and BP measured immediately before intubation decreased significantly in the three doses. The HR was similar in the three doses, and the BP was significantly different only between the 0.25 and 1.0μg/kg/min doses (P < 0.05). The hemodynamic response to endotracheal intubation was very well blunted in 0.5 and 1.0μg/kg/min, but not in 0.25μg/kg/min. The HR and BP increased significantly 1 min after intubation in the 0.25μg/kg/min (P < 0.05). There were no significant differences between the 0.5 and 1.0μg/kg/min doses until 5 min after intubation. Conclusions: Remifentanil 0.5μg/kg/min infusion without a bolus provides excellent hemodynamic stability for a rapid sequence endotracheal intubation using propofol and rocuronium. There are no advantages in using remifentanil doses higher than 0.5μg/ kg/min. (Korean J Anesthesiol 2006; 50: 385~9)
전신 마취후 발생한 전율현상에 대한 Meperidine, Doxapram, Fentanyl 의 치료 효과
곽미숙,강양자,최윤정,염광원 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2
Background : Shivering is a common postanesthetic complication. Because all shivering patients feel uncomfortable and increase oxygen consumption, various attempts have been made to prevent its occurrence or to control it. Among the pharmacological methods of treating shivering, meperidine has been known to be the most effective. This study was designed to evaluate whether there was any difference among meperidine, fentanyl, doxapram and normal saline in the treatment of post-anesthetic shivering. Methods : Forty patients (ASA class I or II) who showed postoperative shivering were randomly assigned into four groups(n=10): Normal saline group: normal saline 5 ml, Doxapram group: doxapram 1.5 mg/kg, Meperidine group: meperidine 25 mg, Fentanyl group: fentanyl 25 g. And all patients received routine care: oxygen by T-piece and heat-reflective blanketrol (cincinati Subzero, U.S.A.). Evaluation of the state of shivering was done every 5 minutes from the beginning of the treatment by the same investigator who had injected the drugs intravenously for treatment of shivering. The age, sex, weight and duration of surgery were recorded. Results: There were no significant statistical differences in age, sex, weight and duration of surgery among the four groups. By 5 minutes, 90% of doxapram group and 30% of meperidine group had stopped shivering. By 10 minutes, 90% of doxapram group and 70% of meperidine group had stopped shivering. But in fentanyl and normal saline group, only 20% had stoppd shivering by 10 minutes. Conclusions: We conclude that both meperidine and doxapram are effective on post-anesthetic shivering. In cases of patient with respiratory depression, doxapram is especially effective because it stimulates the respiratory center. (Korean J Anesthesiol 1998; 34: 389∼393)
Gwak, Ho-Shin,Yoo, Hyung-Jun,Youn, Sang-Min,Lee, Dong-Han,Kim, Mi-Sook,Rhee, Chang-Hun The Korean Neurosurgical Society 2009 Journal of Korean neurosurgical society Vol.45 No.5
Objective : We retrospectively analyzed survival, local control rate, and incidence of radiation toxicities after radiosurgery for recurrent metastatic brain lesions whose initial metastases were treated with whole-brain radiotherapy. Various radiotherapeutical indices were examined to suggest predictors of radiation-related neurological dysfunction. Methods : In 46 patients, total 100 of recurrent metastases (mean 2.2, ranged 1-10) were treated by CyberKnife radiosurgery at average dose of 23.1 Gy in 1 to 3 fractions. The median prior radiation dose was 32.7 Gy, the median time since radiation was 5.0 months, and the mean tumor volume was $12.4cm^3$. Side effects were expressed in terms of radiation therapy oncology group (RTOG) neurotoxicity criteria. Results : Mass reduction was observed in 30 patients (65%) on MRI. After the salvage treatment, one-year progression-free survival rate was 57% and median survival was 10 months. Age(<60 years) and tumor volume affected survival rate(p=0.03, each). Acute (${\leq}$1 month) toxicity was observed in 22% of patients, subacute and chronic (>6 months) toxicity occurred in 21 %, respectively. Less acute toxicity was observed with small tumors (<$10cm^3$. p=0.03), and less chronic toxicity occurred at lower cumulative doses (<100 Gy, p=0.004). "Radiation toxicity factor" (cumulative dose times tumor volume of <1,000 Gy${\times}cm^3$) was a significant predictor of both acute and chronic CNS toxicities. Conclusion: Salvage CyberKnife radiosurgery is effective for recurrent brain metastases in previously irradiated patients, but careful evaluation is advised in patients with large tumors and high cumulative radiation doses to avoid toxicity.
Comparison of Glucosinolates Contents in the Germplasm of Different Cruciferous Vegetables
On-Sook Hur,Jung-Bong Kim,Jung-Sook Sung,Sang Gyu Kim,Jae-Gyun Gwak,Sukyeung Lee,Yu-mi Choi,Do yoon Hyun,Myung-chul Lee,Hyung-Jin Baek,Binod Prasad Luitel,Kyoung-Yul Ryu,Ho-Cheol Ko 한국원예학회 2015 한국원예학회 학술발표요지 Vol.2015 No.10
양미경,정익수,곽미숙,김갑수,심우석,함태수 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.5
Background: Compared with blockers mounted on the endotracheal tube, (a conjugated blocker), studies about blockers that are independent of a single-lumen tube, (a separated blocker) are rare. This study's object was to find several characteristics about these new blokers. Methods: We compared the peak and plateau airway pressures in intubated patients (n = 30) with, (group EB) and without, (group E) blockers. We measured the depth of the blockers and the pressures of the balloon of the blockers. Balloon pressures were measured twice outside and inside of the E-tube with 7 ml of air. All of these measurements were done in the supine position with 1 L/min flow rate. The frequency of malposition, the score of the lung collapse, and bronchial mucosa change were checked thereafter. Results: The peak airway pressures of group EB were significantly higher than those of group E (P<0.05). However, the plateau pressures of both groups were not different. The depth of the blockers was 52.0±1.8 cm, and the balloon pressures of the blockers were 124±22 and 139±20 mmHg, respectively. Six patients needed additional bronchoscopy because of malposition. The lung collapse score was good in 17 patients, fiar in 10 patients, and poor in 3 patients. There was not any severe bronchial mucosa damage. Conclusions: Understanding the characteristics of these new blockers, we can consider the use of them in some situations in which the use of a double-lumen tube is impossible or inconvenient.
A Clinical Report on a Patient with Type 2 Diabetes
Shin, Ae-sook,Gwak, Ja-young,Cho, Seung-yeon,Lee, In-whan,Kim, Hye-mi,Kim, Na-hee,Park, Sung-wook,Park, Jung-mi,Ko, Chang-nam,Bae, Hyung-sup The Society of Stroke on Korean Medicine 2009 대한중풍.순환신경학회지 Vol.10 No.1
Type 2 diabetes mellitus (T2DM) is a progressive disorder caused by a combination of insulin resistance and 𝛽 cell dysfunction. Sogal(消渴) is a traditional Korean medical term referring to a condition pertaining 3 major symptoms - thirst, polyphasia, polyuria. Sogal has been reported to have similar characteristics with DM. This case report demonstrates a patient with T2DM complaining of typical Sogal symptoms. We diagnosed him as So-yang person Sogal and treated him with acupuncture and herbal medicine.