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Midazolam 전투약이 목표농도 조절방식으로 투여되는 Propofol과 Rocuronium 작용 발현에 미치는 영향
구의경 ( Eui Kyoung Goo ),정철희 ( Cheol Hee Jung ),김환희 ( Hwan Hee Kim ),소윤미 ( Yun Mi So ),나효석 ( Hyo Seok Na ),박희평 ( Hee Pyoung Park ),전영태 ( Young Tae Jeon ),황정원 ( Jung Won Hwang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4
Background: This clinical study was designed to evaluate the effect of midazolam as a premedication on the onset of propofol and rocuronium during propofol target-controlled infusion (TCI). Methods: Seventy four patients (ASA class I or II) were randomly allocated to receive either no premedication (control group) or premedication with 0.04 mg/kg intravenous midazolam (midazolam group). Anesthesia was induced and maintained with propofol TCI. Time from propofol injection to loss of consciousness (LOC) and estimated effect concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was injected. We monitored the degree of neuromuscular blockade by acceleromyography. The following parameters were measured and compared between groups: Time from rocuronium injection to depression of twitch height below 25%, time to maximal depression of twitch height (defined as rocuronium onset time). Results: Systolic blood pressure before induction was lower in midazolam group (125±15 vs 135±20 mmHg), however, there was no difference in blood pressure at LOC between groups (111±16 vs 106±21 mmHg). In midazolam group, time to LOC in propofol TCI was shorter (63±22 vs. 203±118 sec) and estimated effect site concentration of propofol was significantly lower than control group (0.9±0.3 vs. 2.2±0.4 μl/ml). The onset time of rocuronium was not different between groups (120±39 vs. 137±42 sec). Conclusions: Midazolam pretreatment fastens the onset time of propofol and decreases the propofol requirement for LOC. However, it does not influence the onset of rocuronium. (Korean J Anesthesiol 2009;57:434∼7)
증례보고 : 주산기 심근병증 산모의 제왕절개술을 위한 척추- 경막외 병용 마취
박희연 ( Hee Yeon Park ),구의경 ( Eui Kyoung Goo ),도상환 ( Sang Hwan Do ),박금숙 ( Kum Suk Park ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.5
Peripartum cardiomyopathy (PPCM) is a rare form of cardiomyopathy associated with a significant morbidity and mortality. The anesthetic management of a Cesarean section in patients with PPCM has not been well defined. Herein, our experience of a 31-year-old multipara, with recurrent PPCM and congestive heart failure, who presented for an elective cesarean section, is reported. Combined spinal-epidural anesthesia was successfully employed as the anesthetic technique for the procedure. The intra-arterial blood pressure and central venous pressure were monitored throughout the procedure. In addition, the patient`s postoperative pain was markedly reduced with the use of epidural PCA. Combined spinal-epidural anesthesia is suggested to be a reliable technique, which provides minimal hemodynamic changes, and a lower failure rate than epidural anesthesia only, and is also highly effective with a low dose of local anesthetic drug. (Korean J Anesthesiol 2007; 52: 605~8)
임상연구 : 상하지 광체적변동파형(Photoplethysmogram)의 진폭과 맥파전도시간을 이용한 지속적 동맥혈압 추정
서광석 ( Kwang Suk Seo ),김정수 ( Jung Soo Kim ),안원식 ( Won Sik Ahn ),박광석 ( Kwang Suk Park ),김현정 ( Hyun Jeong Kim ),염광원 ( Kwang Won Yum ),구의경 ( Eui Kyoung Goo ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: The amplitude (AMP) of Photoplethysmogram (PPG) is used as a marker of vasodilatation. The pulse transit time (PTT), which shows a good correlation with blood pressure (BP), is not strong enough to detect the changes in BP. This study examined the sensitivity of the combined effect of the finger and toe AMP, and the PTT of PPG as a marker of the changes in BP during general anesthesia. Methods: Forty patients receiving maxillofacial surgery under general anesthesia were enrolled in this study. During surgery, the intra-arterial BP, ECG, finger and toe PPG signals were measured. Using the R-wave from the ECG, the AMP and PTT was derived from PPG data. The correlation between BP and PPG parameters (AMP and PTT) were compared. New parameters that show high correlation with the BP were found. Regression equations for calculating the BP using the PPG parameters were formulated. Results: The new parameter, log (fingerAMP/toeAMP), showed the highest correlation in each patient (mean correlation coefficient in the systolic BP: -0.846, diastolic BP: -0.858). However, when the data from all 40 patients were combined, the correlation coefficient of the toe PTT was highest (systolic BP: -0.726, diastolic BP: -0.646). The regression equation showed the highest correlation between the actual BP and calculated BP when the toe PTT and log (fingerAMP/toeAMP) were included. Conclusions: The AMP of the toe and finger PPG can be used to estimate the invasive continuous blood pressure. (Korean J Anesthesiol 2007; 53: 159~68)