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Buerger 병 환자의 통증 치료에서 경막외 Clonidine 투여의 임상적 고찰
유건희(Keon Hee Ryu),길현자(Hyeon Ja Kil),서재현(J 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.2
N/A Buergers disease(Thromboangiitis Obliterans) is characterized by peripheral arterial occlu- sion of the extremities in young smokers, and leading to ischemia of the tissue and gangrene. Most of these patients suffered from severe pain. Therapy for Buergers disease not enable to undergo reconstructive arterial surgery has been discouraging while multiple modes of analge- sics have advanced. Eight subjects who had been operated due to Buergers disease or diagnosed with this disease were evaluated retrospectively. Continuous epidural block was done at L 2-3 or L3-4 inter- vertebral space and multiday continuous infusor was connected to epidural catheter. The con- tent of the infusor was clonidine-bupivacaine or clonidine-morphine-bupivacaine mixture. The minimum dose of clonidine was 75 μg/day and the maximum 450 μg/day. The results were as follows: 1) The analgesia produced by clonidine was superior to any other analgesics. 2) The incidence of the side effects produced by clonidine-bupivacaine mixture were less than that of clonidine-morphine-bupivacaine mixture. 3) Minimum dose of clonidine for the pain relief was required more than 225 μg per day. From the above results, we recommend that clonidine is an effective agent to provide pain relief for the patients with Buerger's disease.
임상연구 : 정형외과적 수술을 받는 고령의 환자에서 주술기 혈전탄성묘사도의 변화
김창재 ( Chang Jae Kim ),유건희 ( Keon Hee Ryu ),박성찬 ( Sung Chan Park ),이재민 ( Jae Min Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Background: There is a high incidence of thromboembolism after major orthopedic surgery. However, more perioperative thromboembolic complications are expected after orthopedic surgery in geriatric patients due to the more offensive therapeutic measures and the increasing number of such patients with multimorbidity. Therefore it is important to investigate the perioperative blood coagulation status in detail. Methods: Forty-five patients who were over 65 years old and scheduled for major orthopedic surgery were enrolled in this study. Patients with preoperative coagulation abnormalities, or receiving anticoagulants or antiplatelet medications were excluded. Preoperative thromboelastography (TEG), intraoperative TEG after blood loss equaling approximately 10% of the estimated blood volume, and postoperative TEG at the recovery room were measured and compared. Results: During the operation, the R time and coagulation time (r + k) showed significant decreases, whereas the alpha angle, maximum amplitude (MA) and TEG index increased significantly (P < 0.05), indicating increased coagulability. The A60, CL30 and CL60 also increased, indicating decreased fibrinolysis (P < 0.05). These hypercoagulable findings were relieved after surgery to levels similar to those observed preoperatively. Conclusions: The intraoperative coagulability increased compared with the preoperative and postoperative period according to the TEG. This means that the intraoperative period is the period of most susceptibility to thromboembolic complications. (Korean J Anesthesiol 2006; 50: 422~7)
임상연구 : 혈액가스 분석기와 휴대용 혈당측정기로 측정된 혈당 수치의 평가
박휴정 ( Hue Jung Park ),박철수 ( Chul Soo Park ),박종민 ( Chong Min Park ),유건희 ( Keon Hee Ryu ),장혜원 ( Hae Wone Chang ),조은정 ( Eun Jeong Cho ),이윤기 ( Yoon Ki Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5
Background: A portable glucometer is commonly used to immediately check the blood glucose level. In the anesthetic field, some blood gas analyzers can also give a rapid indication of the blood sugar level but the accuracy is unknown. Therefore, this study assessed the accuracy of the blood glucose values measured by either a blood gas analyzer or portable glucometer. Methods: Venous blood from diabetic patients was used to measure the glucose level with either a blood gas analyzer or a portable glucometer. The difference and 5% deviation from reference values was analyzed. These values were also assessed using a Bland-Altman plot and clinical significance was examined using a Clarke error grid. Results: The differences from the reference values were smaller using the blood gas analyzer (1.3 ± 7.8 mg/dl) than using the portable glucometer (-5.1 ± 16.7 mg/dl)(P < 0.01). 73.4% of the values measured by the blood gas analyzer and 40.0% of those measured by the portable glucometer were within 5% of the reference value. The 95% limits of agreement in the difference ranged from -14.3 to 16.9 in the blood gas analyzer and -38.5 to 28.2 in the portable glucometer. Error grid analysis showed that 100% of the values measured by the blood gas analyzer were located in zone A. When locating the values measured using the portable glucometer, 95.6% were located in zone A, and the remaining 4.4% are located in zone B. Conclusions: The blood gas analyzer measures the blood glucose more accurately than the portable glucometer. However, the blood glucose values measured by the portable glucometer are clinically acceptable. (Korean J Anesthesiol 2006; 50: 506~10)
임상연구 : TIVA 및 VIMA시 내분비 스트레스 반응 및 마취특성 비교
정홍수 ( Hong Soo Jung ),김대우 ( Dae Woo Kim ),최진우 ( Jin Woo Choi ),강유진 ( Yoo Jin Kang ),임용걸 ( Yong Gul Lim ),유건희 ( Keon Hee Ryu ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: Anesthetic procedures are major potent stimulus for the neuroendocrine hormonal axis, which results in release of the stress hormone. It is important to know the influence of specific anesthetic procedures on those host responses. We compared endocrine stress response and anesthesia characteristics for TIVA (total intravenous anesthesia) and VIMA (volatile induction and maintenance of anesthesia). Methods: Forty patients scheduled for elective total abdominal hysterectomy were randomly assigned to TIVA or VIMA group. The patients in TIVA group (n = 20) received target controlled infusion (TCI) of propofol and fentanyl TCI with Stelpump software, and the patients in VIMA group (n = 20) received sevoflurane-nitrous oxide for induction (6%) and maintenance (1.5%) of anesthesia. Blood sampling was done 5 minutes before induction (baseline blood sample, BBS), just after intubation (intubation blood sample, IBS), just after extubation (extubation blood sample, EBS), and at arrival in recovery room (recovery room blood sample, RBS). Plasma concentration of glucose, cortisol, epinephrine, norepinephrine were measured. Bispectal Index (BIS) and systolic, diastolic blood pressure, heart rate, induction and recovery profiles were also measured. Results: In both groups, there was significant increase of the blood cortisol and glucose level in EBS and RBS. But only in VIMA group, there was significant increase of the blood cortisol level in IBS. There was no change of the blood epinephrine and norepinephrine in both groups at EBS and RBS, but only in VIMA group, there was significant increase of epinephrine and norepinephrine at IBS. Blood pressure and heart rate increased significantly at IBS in VIMA group, compared with TIVA group. Conclusions: In VIMA group, there was significant increase of stress response and hemodynamic change only during induction of anesthesia. However, in TIVA group, there was no significant increase of stress response and hemodynamic change during induction, maintenance and recovery of anesthesia. (Korean J Anesthesiol 2006; 51: 278~84)