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Desflurane 흡입 마취 유도 시 기도 과민성에 대한 Lidocaine과 Fentanyl의 효과
최인규 ( In Gyu Choi ),최영순 ( Young Soon Choi ),민진혜 ( Jin Hye Min ),김용호 ( Yong Ho Kim ),채영근 ( Young Keun Chae ),이우경 ( Woo Kyung Lee ),이용경 ( Yong Kyung Lee ),이애리나 ( Ae Re Na Lee ),조형래 ( Hyong Rae Cho ),채홍석 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6
Background: Inhalation induction with desflurane can cause airway irritability and sympathetic stimulation. The aim of this study was to investigate whether lidocaine and fentanyl could reduce these unwanted reactions. Methods: Seventy-five patients who had premedication with midazolam were randomly allocated to one of three groups to receive intravenous saline (S group), lidocaine 1.5 mg/kg (L group), fentanyl 1 μg/kg (F group), respectively, before tidal volume induction with desflurane in oxygen and nitrous oxide. We recorded airway irritability such as cough, apnea, laryngospasm and excitatory movement and hemodynamic changes. Results: Airway irritability was not significantly different between the groups. In F group, mean blood pressure at LOC ver and LOC BIS and heart rate at LOC ver, LOC BIS and just before intubation were lower than those of S group (P<0.05). Other results were not significantly different. Conclusions: The results of the study showed that intravenous fentanyl and lidocaine had no beneficial effects to reduce airway irritability, but intravenous fentanyl could significantly reduce hemodynamic stimulation during inhalation induction with desflurane in the patients who were premedicated with midazolam. (Korean J Anesthesiol 2009; 57: 693∼7)
증례보고 : 자발성 두개내 저압 환자에서 전산화 단층촬영 유도하에 시행된 경추 경막외 혈액봉합술에 의한 치료
민진혜 ( Jin Hye Min ),최영순 ( Young Soon Choi ),김용호 ( Yong Ho Kim ),이우경 ( Woo Kyung Lee ),이용경 ( Yong Kyung Lee ),채홍석 ( Hong Seok Chai ),채영근 ( Young Keun Chae ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Spontaneous intracranial hypotension due to spinal cerebrospinal fluid leakage is uncommon, relatively benign and usually self-limiting. However it is being increasingly recognized as a cause of postural headaches. The treatment options range from conservative supportive measures to an pidural blood patch. We report a 40-year-old woman who developed intracranial hypotention without any preceding events such as lumbar puncture, back trauma, surgical procedures or medical illnesses. The site of the cerebrospinal fluid leakage was identified at between the C1 to C2 level using computerized tomographic myelography. Consequently, the patient underwent a CT-guided autologous epidural blood patch at the C3-C4 level. Her symptoms were relieved immediately without recurrence. (Korean J Anesthesiol 2007; 52: 115~8)
김용호 ( Yong Ho Kim ),민진혜 ( Jin Hye Min ),최영순 ( Young Soon Choi ),이우경 ( Woo Kyung Lee ),이용경 ( Yong Kyung Lee ),이현민 ( Hyun Min Lee ),채영근 ( Young Keun Chae ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.1
Background: Many studies have suggested that propofol in combination with remifentanil may provide adequate conditions for tracheal intubation without the use of muscle relaxants. Other hypnotic drugs have not been thoroughly investigated in this regard. The goal of our study was to evaluate the effect of thiopental, propofol or etomidate on tracheal intubating conditions and hemodynamic changes using remifentanil in the absence of muscle relaxants. Methods: A total of 45 healthy adults were divided randomly into three groups. After iv lidocaine 1.5 mg/kg, thiopental 5 mg/kg (thiopental group) or propofol 2.5 mg/kg (propofol group), or etomidate 0.4 mg/kg (etomidate group) were injected. After the injection of study drugs, remifentanil 2 mcg/kg was administered. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubating conditions were assessed and the mean arterial pressure and the heart rate was measured. Results: There were no significant differences in intubating conditions between patients in the three groups. The heart rate was significantly lower in the propofol and etomidate group patients when compared to the thiopental group patients after anesthetic induction. The mean arterial pressure was significantly lower in the propofol group patients when compared to the thiopental and etomidate group patients. Both heart rate and mean arterial pressure after tracheal intubation were significantly elevated in etomidate group patinets when compared to their preintubation value. Conclusions: The use of thiopental 5 mg/kg, propofol 2.5 mg/kg, and etomidate 0.4 mg/kg did not differ in effect under intubating conditions for tracheal intubation using remifentanil in the absence of muscle relaxants. Thiopental provided the best hemodynamic conditions. (Korean J Anesthesiol 2007; 53: 61~6)
이우경 ( Woo Kyung Lee ),김용범 ( Yong Bum Kim ),최승호 ( Seung Ho Choi ),채영근 ( Young Keun Chae ),홍남근 ( Nam Geun Hong ),김종훈 ( Jong Hoon Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.4
Background: Opioids are known to increase the incidence of postoperative nausea and vomiting (PONV). Remifentanil is an ultrashort-acting opioid with a potent analgesic effect and is useful for rapid emergence. This study compared the effect of remifentanil on the incidence and severity of PONV and postoperative pain with that of fentanyl in patients undergoing laparoscopic surgery, which is normally associated with a high incidence of PONV. Methods: Forty-four adult female patients, who were scheduled for laparoscopic ovarian cyst enucleation, were randomly assigned to either the remifentanil or fentanyl group. Anesthesia was induced with propofol after injecting fentanyl 2μg/kg or remifentnail 1μg/kg and was maintained with sevoflurane. Remifentanil and fentanyl was infused continuously in the range of 0.2-0.5μg/kg/min and 0.03-0.05μg/kg/min, respectively. Ketorolac 0.5 mg/kg was injected 30 min before the end of surgery. The incidence and severity of PONV and pain were recorded upon arrival at the recovery room and 2, 6, 12 and 24 hours thereafter. Results: The incidence and severity of PONV and pain were significantly higher in the remifentanil group upon arrival at the recovery room than in the fentanyl group. The incidence and severity of PONV and pain at the other measurement times were similar. Conclusions: Despite the ultrashort action duration of the remifentanil, the incidence and severity of PONV and postoperative pain immediately after awakening was higher in the remifentanil group undergoing laparoscopic ovarian cyst enucleation than in the fentanyl group. However, there were no significant differences after two hours in the recovery phase. (Korean J Anesthesiol 2006; 50: 390~5)
임상연구 : 체외순환 없는 관상동맥우회술을 시행 받는 환자에서 수술 전 안지오텐신 전환효소 억제제 중단이 혈역학에 미치는 영향
이용경 ( Yong Kyung Lee ),나성원 ( Sung Won Na ),남순호 ( Soon Ho Nam ),남성범 ( Sang Boem Nam ),채영근 ( Young Keun Chae ),송하나 ( Ha Na Song ),곽영란 ( Young Lan Kwak ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Background: Angiotensin-converting enzyme inhibitors (ACE-I) have been widely used for cardiac patients. This study investigated the effect of omitting ACE-I medication on hemodynamics during induction of anaesthesia and operation in patients chronically treated with ACE-I undergoing off pump coronary artery bypass graft surgery (OPCAB). Methods: Sixty patients scheduled for OPCAB were included in this study. Patients not treated with ACE-I were included in control group (Group I, n = 20). And then, patients treated with ACE-I more than 4 weeks were randomly divided into two groups: continuing group including patients who continued ACE-I medication until the morning of surgery (Group 2, n = 20) and discontinuing group including patients who discontinued ACE-lone day before the surgery (Group 3, n = 20). Norepinephrine (8㎍/ml) was infused when systolic blood pressure decreased below 90 mmHg during induction and operation. Amount of norepinephrine infused and hemodynamic data were recorded. Results: Significantly larger amount of norepinephrine was infused in Group 2 than in other two groups during obtuse marginal artery anastomosis. Total amount of norepinephrine infused during the all coronary anatsomosis was significantly larger in Group 2 than those values in other two groups. Conclusions: Continuing ACE-I treatment until the morning of surgery significantly increased the use of norepinephrine during the anastomosis. In contrast, there was no significant difference in the use of norepinephrine between Group I and Group 3. Discontinuing ACE-I before the surgery may helpful to maintain hemodynamics stable during coronary anastomosis in OPCAB. (Korean J Anesthesiol 2007; 52: 34~41)
채영근,이용경,최영순,김용호,이우경,민진혜 관동대학교 의과대학 의과학연구소 2005 關東醫大學術誌 Vol.9 No.1
We have analyzed 1158 patients managed in PACU(Postanesthesia care unit) after completion of general anesthesia between January 1, 2005 to June 30, 2005 to obtain better guidance and management in the PACU. The results of analysis were as follows 1) Total number of PACU patients was 1694, but only 1158 patients were analyzed because 478 patients were taken regional anesthesia, 17 patients' records were incomplete and 2 patients went to ICU for close observation. 2) Age distribution was relatively even in each decades except extreme age and mean age was 34.5 years. 3) The number of patients by operation sites was 429 in lower abdomen & pelvis surgery group, 349 in extremities and 199 in head & neck surgery group and 181 in the other group each. 4) Overall PAR(Postanesthetia recovery) score was 8.8±0.7, highest in 30-39age group and in extremities surgery group, least in over 80 group and in thoracic surgery group. 5) Overall PACU staying time was 41.3±19.0min, shortest in 30-39age group and neurosurgery, longest in over 80 and in back surgery group. 6) The overall incidence of complications; 230(19.9%) was cardiovascular, 56(4.8%) was respiratory, 52(4.5%) was postoperative nausea and vomiting(PONV), 17(1.5%) was agitation and 16(1.4%) was shivering.
기관발관 후 발생한 호흡곤란 : 양측 성대마비 1예 A case of bilateral vocal cord paralysis
오영준,정춘근,채영근 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.5
We had a case of respiratory difficulty following tracheal extubation due to bilateral vocal cord paralysis. The patient was a 66-year-old woman undergoing craniotomy for cerebellopontine angle meningioma. Anesthesia was uneventful. Spontaneous respiration resumed after reversal of neuromuscular blockade. Following extubation she showed inspiratory stridor, tachypnea, and chest retraction. Reintubation was done and then tracheostomy was performed. Every factor contributing vocal cord paralysis such as pressure on the nerve by an overexpanded endotracheal tube cuff, unique posture of the neck during the operation, and female gender, long operating time(about 11 hours) were seemed to be possible causes and we considered the interaction of these combinations responsible for the bilateral vocal cord paralysis. Eight weeks later, the patients vocal cord function had returned to normal.
이윤석,정춘근,채영근,오영준,김혜경 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2
Background : Epidural administration of dilute solution of local anesthetic and lipid-soluble opioid provides the best pain relief during labor and delivery. The purpose of this study was to evaluate the safety, efficacy and patient satisfaction of patient-controlled epidural analgesia compared with continuous infusion epidural analgesia. Methods : Forty healthy full-term parturients who requested epidural analgesia were assigned randomly to either patient-controlled epidural analgesia (PCEA) group or continuous infusion epidural analgesia (CIEA) group. All parturients received proper dose of 0.25% bupivacaine with 0.0008% fentanyl to block T10 sensory level. PCEA was programmed as followings; no background infusion, a 4 ml bolus dose and 15min lock-out interval using 0.0625% bupivacaine with 0.0002% fentanyl. CIEA was started with the same solution at 12ml/hr constantly. Results : Hourly requirement of 0.0625% bupivacaine (mean±SD 7.1±5.8 ml/hr, median 7.6 ml/hr in PCEA group and mean±SD 13.2±2.9 ml/hr, an 12 ml/hr in CIEA group) during labor was significantly reduced in PCEA group (p$lt;0.05). Maternal satisfaction, obstetric and neonatal parameters were shown no statistically significant difference. Incidences of postpartum complications such as gait disturbance, urinary difficulty, pruritus, nausea and vomiting were rare in both groups. Conclusions : Patient-controlled epidural analgesia is safe and effective and has 37% sparing effect of bupivacaine dosage used per hour compared with continuous infusion epidural analgesia. (Korean J Anesthesiol 1997; 32: 274∼280)