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임상연구 : 전신마취 중 심전도의 교정 QT 간격에 대한 Ondansetron의 영향
김종익 ( Jong Ik Kim ),이상귀 ( Sang Kyi Lee ),손지선 ( Ji Seon Son ),고성훈 ( Seong Hoon Ko ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: Prolongation of the corrected QT interval (QTc) has a potential risk of inducing life-threatening cardiac dysrhythmia. Although 5-HT3 antagonists are useful antiemetics, several cases of cardiac dysrhythmia after administration of 5-HT3 antagonists have been reported. Therefore, this study was conducted to evaluate the changes in QTc interval that occur after administration of a clinical dose of ondansetron during general anesthesia. Methods: Seventy-five patients, who underwent elective surgery under standardized general anesthesia were evaluated. After anesthetic induction, the patients were given either normal saline, 2 mg or 4 mg of iv ondansetron. The QTc on the electrocardiogram was measured immediately prior to administration of the treatment drug and then every minute after injection of the study drug for 10 minutes, 12 and 15 minutes. Results: There were no differences observed in the baseline QTc of the different treatment groups. In addition, there were no significant changes in the QTc interval of the control group, however, the QTc interval was prolonged significantly in both the ondansetron 2 mg and 4 mg groups. Further, ΔQTc (the difference in QTc interval from the baseline value) was significantly prolonged in the ondansetron 2 mg and 4 mg groups when compared with the control group. There were no differences in the number of patients who showed abnormal QTc and there were no incidences of dysrhythmia in any of the three groups. Conclusions: Ondansetron administration for emesis prophylaxis during general anesthesia was associated with statistically significant prolongation of the QTc interval. The authors recommend that caution be used when ondansetron is administered to prevent and/or treat postoperative nausea and vomiting, particularly in patients who have a prolonged QTc interval. (Korean J Anesthesiol 2007; 53: 704∼8)
그리셀증후군 환자에서 I-gel 성문상기도유지기를 사용한 기도관리 -증례보고-
이철형,두아람,우철종,손지선,이상귀,김연동,Lee, Cheolhyeong,Doo, A Ram,Woo, Cheol Jong,Son, Ji-Seon,Lee, Sang-Kyi,Kim, Yeon-dong Korea Convergence Society 2021 한국융합학회논문지 Vol.12 No.10
그리셀 증후군은 환축관절의 비외상성 탈구로 인하여 전신마취 시 경추손상이 발생할 가능성이 있어 신중한 마취관리를 요한다. 이에 우리는 과거에 그리셀 증후군을 받은 진단받은 환자의 전신마취 하 전립선 레이저절제술 시 I-gel을 이용한 기도관리를 성공적으로 진행하였고, 환자는 신경학적 합병증 없이 잘 회복된 사례를 보고하고자 한다. 그리셀 증후군 환자의 마취 관리 시 기도관리를 위하여 I-gel을 사용하는 것이 좋은 대안이 될 수 있을 것이다. Grisel's syndrome is a non-traumatic subluxation of the atlantoaxial joint with an inflammatory condition in the adjacent soft tissues. Due to the instability of the cervical spine, careful airway management is crucial to prevent potential cervical spinal cord injury following airway manipulation. We successfully secured the patient airway using a supraglottic airway device (I-gel) in a patient who had previously diagnosed with Grisel's syndrome. The operation was successfully completed, and the patient recovered without any neurological complications. I-gel can be a good option for airway management during general anesthesia in a patient diagnosed with Grisel's syndrome.
초보자에서 ProSeal(TM) 후두마스크(LMA)의 집게손가락 삽입법과 도관 유도 삽입법의 비교
김유일 ( Yu Yil Kim ),이상귀 ( Sang Kyi Lee ),이지선 ( Ji Sun Yi ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Background: Insertion of a ProSeal(TM) laryngeal mask airway (PLMA(TM)) by experienced users was more successful with using a catheter-guided (CG) technique than a digital technique. The purpose of this study is to assess the efficacy of the CG insertion technique for a PLMA(TM) by inexperienced personnel. Methods: Forty patients aged 18-65 yr and who were undergoing general anesthesia were randomly allocated to the index finger (IF) or CG insertion techniques for PLMA(TM) insertion. The IF technique was performed with the routine insertion technique. The CG technique was performed using a catheter inserted PLMA(TM), which was primed into the drain tube of the PLMA(TM) with using a soft flexible catheter. Successful insertion was primarily judged by the clinical function of the airway. The number of insertion attempts and the insertion time were recorded. Postoperative airway morbidity (sore throat, dysphonia, dysphagia) was assessed at 24 hr postoperatively. Results: The success rate was similar between the groups (IF, 18/20; CG, 15/20). The successful insertion time (the time to provide an effective airway) was similar between the groups but the insertion time at the first attempt was shorter for the IF technique (IF, 21.6±5.3 s; CG, 27.4±10.3 s). There were no differences between the groups for the postoperative airway morbidity. Conclusions: This study suggests that the CG insertion technique is not a useful alternative technique for inexperienced personnel. (Korean J Anesthesiol 2009; 56: 634~8)
33권6호 영문부록 : 흰쥐의 적출 심장에서 허헐처리후 Ketanine 의 양성 변력성 효과의 기전
고성훈(Seong Hoon Ko),김동찬(Dong Chan Kim),이상귀(Sang Kyi Lee),최훈(Hun Choe),송희선(He Sun Song) 대한마취과학회 1997 영문부록 Vol.- No.-
서 론: Ketamine은 여러 실험동물의 적출 심장에서 양성 변력성 작용을 보인다. 이러한 작용의 기전은 K+ 이온통로 억제에 의한 세포막 전위의 탈분극에 의해, 전압 민감성 Ca2+ 이온통로를 경유한 Ca2+ 이온의 세포내 증가로 여겨지고 있다. 본 연구에서는 K+ 이온통로의 일종으로 심장에서 허혈이나 저산소증시 활성화되는 ATP-민감성 K+ (ATP-sensitive K+, KATP) 이온통로와 심근허혈시 ketamine의 양성 변력성 작용의 상호 관계를 알아보고자 하였다. 방 법: 흰쥐 적출심장을 Langendorff 장치에 현수한 후 Krebs-Henseleit (KH)용액을 55 mmHg의 압력으로 관상동맥으로 관류시키면서 관류량을 측정하여 이때 관류량의 절반을 일정한 속도로 관류시켜 심근의 허혈을 유발하였다. 수축력의 측정은 좌심실의 압력 변화를 측정하였으며, 세포내 Ca2+ 농도의 변화는 단일 심실근 세포를 분리후 Ca2+과 결합하는 형광색소인 fura-2를 이용하여 측정하였다. 결 과: Ketamine은 수축력의 지표인 좌심실압을 용량 의존성으로 증가 시켰으며, 이는 propranolol (10-6 M)의 영향을 받지 않았다. 100 M의 ketamine은 좌심실압을 대조치에 비해 31.2 4.6% 증가 시켰으나, KATP 이온통로의 길항제인 glibenclamide (10-5 M) 존재하에서는 10.5 3.3%만을 증가 시켰다. 또한, K+ 이온통로 활성제인 pinacidil (3x10-5 M)은 좌심실압을 34.7 4.9% 감소시켰으나, ketamine 존재하에서는 단지 21.2 4.4%만을 감소시켰다. 고농도의 ketamine은 세포내 Ca2+ 농도를 증가시켰다. 결 론: Ketamine은 좌심실압과 세포내 Ca2+ 농도를 용량의존성으로 증가시켰다. 이러한 결과는 흰쥐의 적출심장에서 허혈시 ketamine이 양성 변력성 작용을 나타내며, 이는 KATP 이온통로의 억제가 부분적으로 관여함을 시사한다. (Korean J Anesthesiol 1997; 33: S1∼S8)
임상연구 : Propofol-Alfentanil 마취 시 Ephedrine 투여에 따른 혈압과 심박수의 변화: 각성 환자에서의 변화와 비교
문성신 ( Seong Shin Moon ),손지선 ( Ji Seon Son ),최훈 ( Huhn Choe ),한영진 ( Young Jin Han ),이상귀 ( Sang Kyi Lee ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5
Background: Hypotension and bradycardia in the propofol and alfentanil anesthesia are common during induction and maintenance. Ephedrine has been used to attenuate hypotension and bradycardia in the propofol and alfentanil anesthesia. We designed this study to determine whether propofol and alfentanil anesthesia could affect the blood pressure and heart rate response to intravenous ephedrine when compared with the awake state. Methods: Forty patients of ASA physical status 1 or 2 were assigned to one of two groups (Awake vs Propofol-alfentanil [P-A] group). Each patients received ephedrine 0.15 mg/kg after assessment of baseline hemodynamic values. In the awake patients, ephedrine were administered after hemodynamic parameters are stabilized. If hemodynamic parameters are stabilized after intubation, ephedrine were administered in the propofol-alfentanil anesthesia patients. The changes in systolic/diastolic blood pressure (SBP/DBP), mean blood pressure (MBP), and heart rate (HR) were recorded every one minute for 10 minutes. Results: Ephedrine increased the heart rate significantly in Awake group but not in P-A group. In the P-A group, 3 min after the administration of ephedrine, MBP increased 25.3%. In Awake group, 2 min after the administration of ephedrine, MBP increased only 6.3%. Conclusions: We conclude that propofol and alfentanil anesthesia augments the BP response to intravenous ephedrine but not HR. (Korean J Anesthesiol 2008;55:560~4)
당뇨병성 자율신경병증 환자에서 Desflurane에 의한 혈역학적 변화
김덕규 ( Deok Kyu Kim ),김은아 ( Eun Ah Kim ),서명조 ( Myung Jo Seo ),임형선 ( Hyung Sun Lim ),고성훈 ( Seong Hoon Ko ),이상귀 ( Sang Kyi Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Background: Diabetic cardiovascular autonomic neuropathy (CAN) causes perioperative cardiovascular instability. A rapid increase in the desflurane concentration induces tachycardia and hypertension (HTN). This study examined the effects of the cardiovascular response to desflurane on patients with diabetic CAN. Methods: Forty diabetes mellitus (DM) patients with CAN were divided two groups: one with HTN (DM+HTN group, n=17) and one without HTN (DM group, n=23). The control group (n=20) was composed of healthy patients without DM or HTN. In each group, the concentration of desflurane inspired was increased abruptly to 12.0 vol% 2 minutes after a thiopental injection. The target was to produce an end-tidal concentration of desflurane of 10.0 vol%, which was maintained until the end of the study by adjusting the vaporizer dial setting. The heart rate (HR), mean arterial pressure (MAP), and cardiac index (CI) were measured. Results: The HR, MAP and CI increased significantly in all three groups when compared with the baseline (P<0.05). Additionally, the HR and MAP showed did not differ among the three groups at any of sampling times. However, the CI of the DM group and the DM+HTN group differed when compared with the control group at 90 and 120 seconds after intubation (P<0.05). Conclusions: In diabetic patients with CAN, the hemodynamic responses to a rapid increase in desflurane concentration are similar to those in non-diabetic patients before endotracheal intubation. However, after endotracheal intubation, increments in CI are blunted in diabetic patients with CAN. (Korean J Anesthesiol 2009;57:560∼5)