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임상연구 : 복강경하 부인과 수술 시 Nicardipine 투여가 마취 유도, 마취유지 및 회복에 미치는 효과
전우재 ( Woo Jae Jeon ),최윤정 ( Yun Jeong Choi ),이건승 ( Gurn Seung Lee ),심재항 ( Jae Hang Shim ),조상윤 ( Sang Yun Cho ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: Pneumoperitoneum for a gynecologic laparoscopic surgery induces hemodynamic changes. We evaluated the effects of nicardipine on induction, maintenance, and recovery. Methods: Thirty patients scheduled for gynecologic laparoscopic surgery were randomly allocated to two groups: control group (placebo group, n = 15), group N (nicardipine group, 10μg/kg followed by 0.5-2.0μg/kg/min). The systolic arterial pressure, mean arterial pressure, and heart rate were measured at preinduction, induction, intubation and 5, 10, 15, 20 min after insufflation. Loss of consciousness, induction dose, effective site concentration, propofol maintenance dose (the maintenance dose of propofol from intubation to end of anesthesia, PMD) were also measured. Propofol was titrated to maintain a bispectal index value of 40-60. Results: There was a significant difference in PMD between two groups. The PMD of group N was significantaly less than group C. Nicardipine adminstration attenuated increase in the blood pressure, but did not affect on heart rates during CO2 insufflation. Conclusions: Co-administration of nicardipine was effective in attenuating the hemodynamic changes after pneumoperitoneum during gynecologic laparoscopic surgery, without changes of induction and recovery. (Korean J Anesthesiol 2006; 50: 515~8)
실험연구 : Midazolam이 가토의 대뇌동맥 평활근세포의 외향성 K+ 전류에 미치는 영향
신영철 ( Young Chul Shin ),심재항 ( Jae Hang Shim ),전우재 ( Woo Jae Jeon ),조상윤 ( Sang Yoon Cho ),신우종 ( Woo Jong Shin ),김경헌 ( Kyoung Hun Kim ),염종훈 ( Jong Hoon Yeom ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Background: Midazolam has a direct relaxing effect on vascular smooth muscle, but the mechanisms that this agent produces muscle relaxation are not fully understood. The current study was performed to identify the effects of the midazolam on K+ channels current in rabbit cerebral arterial smooth muscle cells. Methods: Whole cell patch-clamp recording technique was used to evaluate the effects of midazolam (0.1 to 100μM) on outward K+ channel currents in dispersed rabbit cerebral arterial smooth muscle cells. Results: Outward K+ currents of rabbit cerebral artery smooth muscle cells were voltage-dependent. Midazolam (10, 100μM) tested significantly inhibited outward K+ currents in a dose-dependent manner and half-blocking concentration (IC50) was 15.94μm at 60 mV. Conclusions: Midazolam inhibit outward K+ currents of rabbit cerebral arterial smooth muscle cells. Further study will be needed to determine the effect of midazolam on calcium channel current because it is unclear if the inhibitory effect of midazolam on outward K+ current induces vasoconstriction. (Korean J Anesthesiol 2007; 52: 67~71)
임상연구 : Clonidine 전투약이 Propofol에 의한 마취유도 및 기관내 삽관 시 A-Line(TM) ARX Index와 혈역학적 변화에 미치는 영향
최원진 ( Won Jin Choi ),전우재 ( Woo Jae Jeon ),심재항 ( Jae Hang Shim ),조상윤 ( Sang Yoon Cho ),염종훈 ( Jong Hoon Yeom ),신우종 ( Woo Jong Shin ),김경헌 ( Kyoung Hun Kim ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.1
증례보고 : Cornelia de Lange Syndrome 환자의 전신마취 경험
조상윤 ( Sang Yun Cho ),전우재 ( Woo Jae Jeon ),조영현 ( Yung Hyun Cho ),심재항 ( Jae Hang Shim ),염종훈 ( Jong Hoon Yeom ),신우종 ( Woo Jong Shin ),김경헌 ( Kyoung Hun Kim ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.6
Cornelia de Lange syndrome (Amsterdam dwarfism) is a congenital disease characterized by mental retardation associated with multiple malformation. A genetic etiology has been proposed, with suggestions of autosomal dominant and recessive inheritance. It affects one in 30,000 to 60,000 live births. Two-thirds of patients with the condition die before the end of their first year; death occurs from pulmonary aspiration in infancy, and from infections and bowel obstruction in later life. One reference to the syndrome highlights problems with seizures, cardiac abnormalities and difficult tracheal intubation but apart from this paper, there is little published information about the anesthetic management. (Korean J Anesthesiol 2008; 55: 769~73)
임상연구 : 광봉을 이용한 기관내 삽관 시 혈역학적인 변화를 최소화하기 위한 Remifentanil의 정적 효과처 농도는?
이정혁 ( Jeoung Hyuk Lee ),전우재 ( Woo Jae Jeon ),심재항 ( Jae Hang Shim ),조상윤 ( Sang Yoon Cho ),염종훈 ( Jong Hoon Yeom ),신우종 ( Woo Jong Shin ),김경헌 ( Kyoung Hun Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3
Background: In the previous studies, remifentanil reduces the hemodynamic change induced by endotracheal intubation. We studied the optimal effect site concentration of remifentanil for endotracheal intubation using light wand. Methods: Sixty ASA 1 or 2 patients scheduled for elective surgery under general anesthesia were classified in three groups according to the TCI (target controlled infusion) dose of remifentanil. Each group was administered 4μg/ml of propofol TCI, rocuronium, with 2 ng/ml (group 1), 4 ng/ml (group 2), 6 ng/ml (group 3) of remifentanil TCI. Blood pressure, heart rate and bispectral index score were measured before induction, 3 minutes after remifentanil and propofol TCI, after endotracheal intubation using light wand, and 3 minutes after endotracheal intubation. Statistical analysis was done for comparison of time and dose dependant change among the groups. Results: After endotrachal intubation, blood pressure and heart rate were significantly increased in group 1, and decreased in group 2 and 3. 3 minute after endotracheal intubation, heart rate significantly decreased in group 3, but there were no changes in group 2. Conclusions: The spontaneous BRS was decreased during ketamine induction of general anesthesia. These results suggest that anesthesia induction with ketamine impairs baroreflex control of heart rate, which may provoke hemodynamic instability. (Korean J Anesthesiol 2007; 52: 278~83)
인공 고관절 전치환술 후 관절 주위 연부 조직에 주입한 Bupivacaine과 Morphine이 수술 후 통증에 미치는 영향: 전향적 연구
황규태 ( Kyu Tae Hwang ),조창민 ( Chang Min Cho ),김이석 ( Yee Suk Kim ),심재항 ( Jae Hang Shim ),김영호 ( Young Ho Kim ) 대한고관절학회 2010 Hip and Pelvis Vol.22 No.4
Purpose: We wanted to assess the benefits and safety of periarticular soft tissue injection of bupivacaine and morphine in total hip arthroplasty by conducting a prospective randomized trial. Materials and Methods: Between February 2008 and January 2010, a prospective, randomized study was performed on fifty patients with an American Society of Anesthesiology stage of I or II. All the patients were administered COX-2 inhibitor and we used PCEA (Patient Controlled Epidural Analgesia) for 24 hours postoperatively. All the patients underwent their operation under general anesthesia. Fifty randomly selected patients were divided into two groups. After reduction of the hip joint, 50 ml of normal saline was intraoperatively injected into 25 patients (Group A) and 50 ml of locally injected analgesia that included 0.5 ml 5 mg of morphine HCL, 40 ml of 0.5% 50 mg chirocaine (Levo-bupivacaine) and 9.5 ml of normal saline was injected into the capsule and the soft tissue and muscle around the hip joint in 25 patients (Group B). The analgesic efficacy was evaluated by the visual analogue scale (VAS) at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and during a passive exercise (30˚) state. The consumption of PCEA and additional analgesic drugs was also evaluated postoperatively. Results: Significant differences were found between the 2 groups (P<0.05) with regard to the VAS at 6 and 12 hours postoperatively with the patients in a resting state and at 24, 48 and 72 hours postoperatively with the patients in a resting state and a passive exercise state. During 24 hours postoperatively, in the mixed analgesia injected group, the consumption of PCEA was significantly lower than that in the normal saline injected group (P<0.05). No significant differences were found for the consumption of additional analgesic drugs between the 2 groups (P>0.05). Conclusion: Intraoperative periarticular soft tissue injection of bupivacaine and morphine can significantly reduce pain and it can reduce the requirement for patient-controlled analgesia, with no apparent risks, following total hip arthroplasty.