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주진,고현정,이규상,이재민 대한의학회 2016 Journal of Korean medical science Vol.31 No.6
Increased intraocular pressure (IOP) during surgery is a risk factor for postoperative ophthalmological complications. We assessed the efficacy of systemically infused dexmedetomidine in preventing the increase in IOP caused by a steep Trendelenburg position, and evaluated the influence of underlying hypertension on IOP during surgery. Sixty patients undergoing laparoscopic surgery in a steep Trendelenburg position were included. Patients in the dexmedetomidine group received a 1.0 μg/kg IV loading dose of dexmedetomidine before anesthesia, followed by an infusion of 0.5 μg/kg/hr throughout the operation. Patients in the saline group were infused with the same volume of normal saline. IOP and ocular perfusion pressure (OPP) were measured 16 times pre- and intraoperatively. In the saline group, IOP increased in the steep Trendelenburg position, and was 11.3 mmHg higher at the end of the time at the position compared with the baseline value (before anesthetic induction). This increase in IOP was attenuated in the dexmedetomidine group, for which IOP was only 4.2 mmHg higher (P < 0.001 vs. the saline group). The steep Trendelenburg position was associated with a decrease in OPP; the degree of decrease was comparable for both groups. In intragroup comparisons between patients with underlying hypertension and normotensive patients, the values of IOP at every time point were comparable. Dexmedetomidine infusion attenuated the increase in IOP during laparoscopic surgery in a steep Trendelenburg position, without further decreasing the OPP. Systemic hypertension did not seem to be associated with any additional increase in IOP during surgery (Registration at the Clinical Research Information Service of Korea National Institute of Health ID: KCT0001482).
통원수술 환자에서 마취유도 시 심혈관계의 안정을 위해 nicardipine과 병용 투여한 esmolol의 적정량
주진,이재민,김정은,박지혜 대한마취통증의학회 2010 Anesthesia and pain medicine Vol.5 No.4
Background:We conducted this study to determine the optimal dose of esmolol in combination with nicardipine to block undesirable cardiovascular responses effectively during endotracheal intubation in patients undergoing ambulatory surgery. Methods:One-hundred and twenty patients were randomly allocated into one of the following 4 groups: the E0 group (no esmolol, control), the E0.25 group (esmolol 0.25 mg/kg), the E0.5 group (esmolol 0.5 mg/kg) and the E1.0 group (esmolol 1.0 mg/kg). Anesthesia was induced with propofol 2 mg/kg and rocuronium 0.9 mg/kg. All the patients received 20μg/kg of nicardipine, and esmolol was subsequently administered according to the group. Endotracheal intubation was performed 150 seconds after inhalation of 6 vol% of desflurane. The systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure and the heart rate (HR) were measured before and immediately after intubation, and at 1, 3, 5, and 10 minutes after intubation. The rate changes were calculated using the baseline values as the standard (change rate [%] = measured value/baseline value × 100). Results:There were no significant differences in SBP, DBP and MBP after intubation between the control and the experimental groups. The rate changes of HR in the experimental groups were significantly lower than those in the control group throughout the study period (P < 0.05). However, there was no difference in the rate changes of HR among the experimental groups. Conclusions:The combination of nicardipine 20 μg/kg and esmolol 0.25 mg/kg can most effectively and safely attenuate the cardiovascular responses during anesthetic induction in ambulatory patients.
주진,신지윤,윤재준,Mei Yin,윤명하 대한마취통증의학회 2018 Anesthesia and pain medicine Vol.13 No.1
Background: Curcumin is traditionally used as an herbal medicine. We explored the efficacy of intrathecal curcumin in relieving both postoperative and inflammatory pain and elucidated the mechanisms of action of curcumin interacting with g-aminobutyric acid (GABA) and opioid receptors at the spinal level. Methods: Experimental pain was induced in male Sprague-Dawley rats via paw incision or injection of intraplantar carrageenan. After examination of the effects of intrathecal curcumin on the pain, GABA and opioid receptor antagonists were intrathecally administered to explore the involvement of GABA or opioid receptors on the effect of curcumin. Additionally, the expression levels of the GABA and opioid receptors were assessed. Results: Intrathecal curcumin reduced the withdrawal threshold of both incisional surgery- and carrageenan injection-induced nociception. Intrathecal GABA and opioid receptor antagonists reversed the curcumin-mediated antinociception. Incisional surgery decreased the levels of the GABA receptors mRNA, but little changed the levels of the opioid receptors mRNA. Carrageenan injection increased the levels of the opioid receptors mRNA, but not the GABA receptors mRNA levels. Intrathecal curcumin increased or decreased the levels of GABA receptors mRNA and opioid receptors mRNA in the spinal cords of incised or carrageenan-injected rats, respectively. Conclusions: Intrathecal curcumin was effective to postoperative and inflammatory pain and such antinociception of curcumin was antagonized by both GABA and opioid receptor antagonists. Also, intrathecal curcumin altered the levels of GABA and opioid receptors. Thus, spinal GABA and opioid receptors may, respectively, be directly or indirectly involved when curcumin alleviates postoperative and inflammatory pain.