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전우재,조상윤,김경헌,권용덕 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.4
Background: Because difficult airways are not commonlyencountered, simulation of a difficult airway using a cervical collarhas become a well-established technique of for modeling difficultlaryngoscopic views and evaluating interventions for use in difficultairway scenarios. In this study, we have determined the optimalremifentanil concentrations (EC50 and EC95) required for i-gelinsertion in anesthetized patients fitted with cervical collars atpropofol effect-site concentrations of 4.0 and 6.0 μg/ml (group 4.0and group 6.0). Methods: The remifentanil dosage for each propofol effect-siteconcentration group was determined by the modified Dixon’sup-and-down method using previous results. The experiment wasstarted using a 4.0 ng/ml effect-site remifentanil concentration, andthe dose was reduced by 0.5 ng/ml for the next attempt when tubeinsertion was successful; if tube insertion failed, the dose for thenext attempt was increased by 0.5 ng/ml. Results: EC50 and EC95 were respectively 2.11 ng/ml (95% CI,1.78–2.26 ng/ml) and 2.44 ng/ml (95% CI, 2.28–3.67 ng/ml) for the4.0 group, and 0.42 ng/ml (95% CI, −1.30 to 0.77 ng/ml) and 0.75ng/ml (0.56–14.3 ng/ml) for the 6.0 group. Conclusions: In this study, a cervical collar was attached andhead fixation was performed to induce a difficult airway. The optimalconcentration of remifentanil at a propofol effect-site concentrationof 4.0 μg/ml was greater than 2.44 ng/ml (95% CI, 2.28–3.67 ng/ml),and that at the propofol effect-site concentration of 6.0 μg/ml wasgreater than 0.75 ng/ml (0.56–14.3 ng/ml).
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의식진정을 위한 Propofol 투여시 시각 및 청각 자극에 대한 반응시간의 변화
전우재,노규정 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.6
Background: As the clinical-end point is not clear-cut in conscious sedation, there are no objective and feedback-providing methods to assess the depth of sedation within the levels appropriate for conscious sedation. Methods: The investigation was carried out on 19 ASA PS 1 patients. The authors developed a system to measure the reaction time to visual (red colored flash, 40 lux for 30 msec) and auditory (beep, 1,000 Hz, 67.5 dB for 30 msec) stimulations. The authors confirmed the beeps to be audible to all the patients before the test began. When they perceived a visual or auditory stimulation, the authors instructed the patients to signal by pushing a button as soon as possible. The reaction time was defined as the time from the beginning of stimulation to the push of a button. The patients were gradually sedated with propofol TCI. The authors measured the visual and auditory reaction time and BIS after evey 0.1㎍/ml increment of the effect site concentration of propofol. Results: As the effect site concentration of propofol increased, the reaction time to visual and auditory stimulations tended to be prolonged (P < 0.0001, respectively). The estimate was 409 and 498, respectively, which means the slope a in y=ax; x means unit change of the effect site concentration of propofol; y means the estimated values of the reaction time. The BIS values at loss of response to visual and auditory stimulations were 86±7 and 78±7 (means±SD). Conclusions: The responses to visual and auditory stimulations were prolonged and ultimately abolished as the effect site concentration of propofol increased. The loss of response to visual stimulations preceded the loss of response to auditory stimulations. The BIS values at loss of responses to visual and auditory stimulations suggested light and moderate sedation, respectively.
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Comparison of the Proseal LMA and intersurgical I-gel during gynecological laparoscopy
전우재,조상윤,백성진,김경헌 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.6
Background: The relatively recently developed I-gel (Intersurgical Ltd., Workingham, England) is a supraglottic airway device designed for single-use that, unlike conventional LMAs, does not require an inflatable cuff. In addition, the I-gel, much like the Proseal LMA (PLMA), has a gastric drainage tube associated with an upper tube for decompression of the stomach, thereby avoiding acid reflux and decreasing the risk of pulmonary absorption. The purpose of this study was to compare PLMA and I-gel devices in patients undergoing gynecological laparoscopy based on sealing pressure before and during pneumoperitoneum, insertion time, and gas exchange. Methods: Following Institutional Review Board approval and written informed consent, 30 adult patients were randomly allocated to one of two groups (the PLMA or I-gel group). In each case, insertion time and number of attempts were recorded. After successful insertion, airway leak pressure was measured. Results: Successful insertion and mechanical ventilation with both supraglottic airway devices was achieved on the first attempt in all 30 patients, and there were no significant differences with respect to insertion time. Likewise, leak pressure did not vary significantly either between or within groups after CO2 insufflation. In addition, differences between leak volume and leak fraction between groups were not significant. Conclusions: The results of our study indicate that the I-gel is a reasonable alternative to the PLMA for controlled ventilation during laparoscopic gynecologic surgery. Background: The relatively recently developed I-gel (Intersurgical Ltd., Workingham, England) is a supraglottic airway device designed for single-use that, unlike conventional LMAs, does not require an inflatable cuff. In addition, the I-gel, much like the Proseal LMA (PLMA), has a gastric drainage tube associated with an upper tube for decompression of the stomach, thereby avoiding acid reflux and decreasing the risk of pulmonary absorption. The purpose of this study was to compare PLMA and I-gel devices in patients undergoing gynecological laparoscopy based on sealing pressure before and during pneumoperitoneum, insertion time, and gas exchange. Methods: Following Institutional Review Board approval and written informed consent, 30 adult patients were randomly allocated to one of two groups (the PLMA or I-gel group). In each case, insertion time and number of attempts were recorded. After successful insertion, airway leak pressure was measured. Results: Successful insertion and mechanical ventilation with both supraglottic airway devices was achieved on the first attempt in all 30 patients, and there were no significant differences with respect to insertion time. Likewise, leak pressure did not vary significantly either between or within groups after CO2 insufflation. In addition, differences between leak volume and leak fraction between groups were not significant. Conclusions: The results of our study indicate that the I-gel is a reasonable alternative to the PLMA for controlled ventilation during laparoscopic gynecologic surgery.
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관상동맥질환과 대동맥판 폐쇄부전증을 동반한 복부 대동맥류 수술 중 대동맥 겸자 후 발생한 심정지
전우재,심재항,김경헌,조상윤,홍진범 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.2
Department of Anesthesiology and Paine Medicine, Hanyang University College of Medicine, Guri Hospital, Guri, Korea Patients with chronic aortic regurgitation have a hemodynamically fragile equilibrium; increased afterload during infrarenal aortic cross-clamping and acute decompensation. The tolerance of patients with severe coronary artery disease to the stress of infrarenal aortic cross-clamping differs from patients without overt coronary artery disease. Therefore, careful anesthetic management is needed during infrarenal aortic cross-clamping in patients with aortic regurgitation and coronary artery disease. We describe the anesthetic management of a man with an infrarenal aortic aneurysm that underwent cardiac arrest after aortic-cross clamping for aortoiliac bypass surgery.
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Propofol 투여시 청각 자극에 대한 반응시간을 이용한 진정심도의 평가
전우재,노규정,이동호 대한정맥마취학회 2001 정맥마취 Vol.5 No.3
Background: As the clinical-end point is not clear-cut in conscious sedation, there are few objective and feedback-providing methods to assess the depth of sedation within the levels appropriate for conscious sedation. Methods: The investigation was carried out on 30 ASA PS 1, 2 patients. We devised a system to measure the reaction time to an auditory stimulation (beep, 1000 ㎐, 67.5 ㏈ for 30 ㎳). We instructed the patients to give a signal by pushing a button whenever they heard a beep sound, promptly. The auditory reaction time was defined as the time from the beginning of auditory stimulation to the push of a button. The patients were gradually sedated with propofol target controlled infusion. We measured the reacton time to auditory stimulation and bispectral index in every 0.1 ㎍/㎖ increment of the effect site concentration of propofol. Ramsay sedation score was checked at the time of loss of response to auditory stimulation. Results: As the effect site concentration of propofol increased, the reaction time to auditory stimulations tended to bo prolonged (P < 0.0001). The BIS values at the time of loss of response to auditory stimulations were 76±11 (mean±SD). The Ramsay sedation score at the time of loss of response to auditory stimulation was distributed 3-5. Conclusions: The responses to auditory stimulations were prolonged and ultimately abolished as the effect site concentration of propofol increased. The BIS values at the time of loss of responses to auditory stimulations represented moderate to deep sedation. The response to an auditory stimulation could be used as a feedback providing method to assess the level of conscious sedation.
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