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임상연구 : 백내장적출술을 위한 안구후차단시 Remifentanil, Alfentanil, Fentanyl이 혈역학적 변화와 진통, 진정효과에 미치는 영향
임세근 ( Sei Keun Im ),구길회 ( Gill Hoi Koo ),강현 ( Hyun Kang ),백종화 ( Chong Wha Baek ),박정원 ( Jung Won Park ),정용훈 ( Yong Hun Jung ),우영철 ( Young Cheol Woo ),김진윤 ( Jin Yun Kim ),박선규 ( Sun Gyoo Park ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Background: This study was designed to compare the effects of remifentanil, alfentanil, and fentanyl on the hemodynamic changes, sedation, and analgesia when administered with small doses of midazolam in patients undergoing a retrobulbar block for cataract surgery. Methods: Sixty patients scheduled for cataract surgery were divided into 4 groups (n = 15 for each group). Firstly, group C received 5 ml of a normal saline solution, 3 min before a retrobulbar block. Next, group R received remifentanil 0.3μg/kg. Furthermore, group A received a 4.5μg/kg dose of alfentanil, 90 s before a retrobulbar block, and group F received fentanyl 0.6μg/kg, 210 s before a retrobulbar block. All solutions were mixed with normal saline to a 5 ml volume. In group R, A, and F, midazolam (0.5 mg for patients over the age of 65 years; 1.0 mg in patients under the age of 65 years) was injected 3 min before the retrobulbar block. Results: The systolic blood pressure in patients significantly increased at 1 or 2 minutes after a retrobulbar block in group C and at 1 minute in group F. For group R, the systolic blood pressure decreased significantly at 3, 4, 5, and 10 minutes, and at 2, 3, 4, 5, and 10 minute in group A. The mean OAA/S scale during a retrobulbar block significantly declined in groups R and A. The VAS score for pain was significantly lower in groups R and A, whereas the VAS anxiety index was significantly lower in groups R, A, F compared to group C (P<0.05). Conclusions: We found that the combination of remifentanil or alfentanil with midazolam showed better hemodynamic stability, sedative, and analgesic effects compared to fentanyl with midazolam in the retrobulbar block for cataract surgery. (Korean J Anesthesiol 2007; 53: 441~7)
경요도 방광절제술을 위한 척추마취 후 발생한 지속적인 음경발기
임세근 외 중앙대학교 의과대학 의과학연구소 2008 中央醫大誌 Vol.33 No.1,2
Penile erection following regional or general anesthesia is rare. An incidence was reported less than 1% in patients undergoing urologic procedures. Erection during transurethral procedures can cause complication. A 62-year-old man with bladder cancer underwent spinal anesthesia for transurethral resection of bladder. After neural block was fixed up to the T10 dermatome level, a persistent penile erection was developed, so a urologist couldn't insert a 24 French cystoscope. A 2 mg midazolam was injected twice at 10 minutes interval intravenously. Then corpus cavernosum blood was aspirated. After that, the erection was disappeared and the operation was done without any complication.