신속 삽관법을 통한 마취유도시 안압의 증가를 억제하는 Propofol 적정 용량

최영석,류태간 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.1

3384010102-3 Background: Operations for patients with eye injuries frequently require rapid sequence induction of general anesthesia with succinylcholine (Sch), but Sch as well as endotracheal intubation produce increases in intraocular pressure (lOP). The purpose of this study was to examine whether the increase in dosage of propofol from a usual dosage would prevent the increase in IOP due to endotracheal intubation with Sch during a rapid sequence induction of general anesthesia. Methods: Changes in lOP were measured in three groups of 15 patients each. The patients randomly received thiopental 5 mg/kg (group 1, n = 15), propofol 2.5 mg/kg (group 2, n = 15) or propofol 3.0 mg/kg (group 3, n = 15), followed by Sch 1.0 mg/kg and endotracheal intubation. IOP, systolic arterial pressure (SAP) and heart rate (HR) were measured before induction (baseline), Just after intubation, 3 minutes and 10 minutes after intubation. Results: IOP and SAP just after intubation in groups 1 and 2 increased significantly from baseline. but did not increase significantly from baseline in group 3. IOP and SAP at 3 minutes after intubation in group 1 did not decrease significantly from baseline, but decreased significantly from baseline in groups 2 and 3. IOP and SAP at 10 minutes after intubaton in all groups decreased significantly from baseline. HR just after intubaton in groups 1 and 2 increased significantly from baseline but did not increase significantly from baseline in group 3. HR at 3 minutes and 10 minutes after intubation in all groups did not change significantly from baseline. Conclusions: The authors concluded that propofol 3.0 mg/kg could prevent the increase in IOP, systolic arterial pressure and heart rate just after intubation during a rapid sequence induction of general anesthesia. (Korean J Anesthesiol 2001; 40: 5 ∼ 10)

흰쥐 횡경막 신경근 표본에서 Magnesium 이 Pipecuronium 의 근이완 작용과 그 가역에 미치는 영향

윤석민,이미경,공명훈,류태간,김종술 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.2

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Foam Cuff 기관내 튜브를 사용한 기관내삽관후 인후통에 대한 관찰

최영석,김종술,이미경,윤석민,임상호,박영철,류태간 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.4

Background: Sore throat is a common complaint after endotracheal intubation and affected by several factors. The most important causes that affect the incidence and severity of postoperative sore throat is cuff overexpansion. We evaluate the incidence and severity of postoperative sore throat when foam-filled cuff endotracheal tubes and air-filled cuff endotracheal tubes are used. Method: Forty patients undergoing general endotracheal anesthesia were allocated randomly to two groups to receive either foam-filled cuff tubes or air-filled cuff tubes. All patients were interviewed 24 hours postoperatively whether they had experienced a sore throat or not by individuals who did not know which tube was used. Results: Incidence of sore throat was 20% in foam-filled cuff group and 50% in air-filled cuff group. In foam-filled cuff group, sore throat was less severe than air-filled cuff group. In air- filled cuff group, sore throat was more severe as intracuff pressure was increased. Conclusion: The incidence and severity of postoperative sore throat could be significantly reduced using the foam-filled cuff tubes. (Korean J Anesthesiol 1997; 32: 533∼538)

당뇨병 환자에서 경피적 요골동맥도관 거치 후 발생한 가성동맥류

최영석,윤석민,임상호,이미경,박영철,류태간 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2

Insertion of indwelling arterial catheter has become a valuable procedure for blood pressure monitoring and for measurement of blood gas tension during anesthesia. A 34-year-old man with chronic alcoholism and diabetes mellitus was admitted to the hospital because of hyperosm-olar coma. On the first hospital day, percutaneous left radial artery cannulation was carried out for hemodynamic monitoring and arterial blood gas analysis after a modified Allen's test appear-ed to be positive. On the eleventh hospital day, the catheter was removed because of fever and sign of infection at the insertion site. Treatment with vancomycin by sensitivity test was begun on day 13, after continued for 2 weeks. On day 34 a pulsatile mass was noted at the insertion site. During surgery, a pseudoaneurysm of 1×1.2 cm size was found, and liquified hematoma and necrotic material were noted. The aneurysm was removed and end to end anastomosis was successfully completed. We suggest that risk factors for pseudoaneurysm may include abormal state of vessel wall, multiple attempts at cannulation, increased duration of catheterization, adva-nced age, prolonged hospitalization, hematoma and infection at cannulation site. (Korean J Anesthesiol 1997; 32: 320∼323)

성인에서 기관내삽관을 위한 Pipecuronium 일회 정주 적정 용량

최영석,윤석민,임상호,이미경,박영철,류태간 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.3

Background : Studies in animals suggest that pipecuronium dose not induce hemodynamic chan-ges related to histamine release or to an effect on the autonomic nervous system. Therefore the effects of bolus administration of large doses of pipecuronium, up to 0.20 mg/kg, on the intubation condition, onset and duration of neuromuscular blockade, heart rate and blood pressure were studied during fentanyl- nitrous oxide anesthesia. Method : Forty adults were randomly assigned to receive a bolus injection of either 0.05, 0.10, 0.15, 0.20 mg/kg of pipecuronium. Neuromuscular blockade was measured using mechanomyographic activity of the adductor pollicis muscle after supramaximal stimulation of the ulnar nerve. Four subgroups of 10 patients received pipecuronium doses of 0.05, 0.10, 0.15 and 0.20 mg/kg, respectively, as an intubating dose. Results : The times of onset and clinical duration(mean sem) after each dose were as follows: 0.05 mg/kg, 2.98 0.42 and 41.5 2.42 min; 0.10 mg/kg, 1.54 0.06 and 82.9 7.48 min; 0.15 mg/kg, 1.41 0.14 and 124.8 13.1 min; 0.20 mg/kg, 1.12 0.05 and 187.1 12.8 min. The intubation condition, time of onset and duration after doses of 0.05 mg/kg were significantly different from values after the higer doses. The duration was increased with dose-increments. No dose-related changes in heart rate or blood pressure were observed. Conclusion : The authors conclude that dose of 0.10 mg/kg and over has good intubation condition clinically and large bolus dose of pipecuronium can be safely used with a significantly prolonged duration of action without hemodynamic change. (Korean J Anesthesiol 1997; 33: 453∼457)

장기간 Phenytoin을 투여한 흰쥐 횡격막 신경-근 표본에서 Mivacurium의 근 이완효과

최영석,김종술,윤석민,임상호,이미경,박영철,류태간 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.2

Background : Long-term phenytoin therapy induces resistance to the neuromuscular blocking effects of metocurine, atracurium, doxacurium, and pipecuronium. This study examine neuromuscu-lar blocking effect and recovery of mivacurium in isolated rat phrenic-hemidiaphragm with two-weeks phenytoin pretreatment. Method : After the administration of 14 days of phenytoin 40 mg/kg, administered intraperitoneally twice daily(n=10), ED90, antagonism of neostigmine and 4-aminopyridine on the electrically evoked twitch response and train-of-four(TOF) stimulation were compared to control groups in isolated rat phrenic-hemidiaphragm preparation. Results : ED90 was significantly greater in the phenytoin group than in the control group (319±39.5 g vs. 209.5±52.2 g, respectively). After the administration of neostigmine 0.75 M, the recovery of the single twitch and TOF ratio were significantly lesser in the phenytoin group than in the control group (single twitch; 19.6±6.6% vs. 69.2±9.4%, TOF ratio; 0.258±0.149 vs. 0..1, respectively). After the administration of 4-aminopyridine 40uM, the recovery of the single twitch and TOF ratio were no significant differrence between the phenytoin group and the control group(twitch; 118.1±25.3% vs. 122.6±24.8%, TOF ratio; 0.937±0.051 vs. 0.949±0.067, respectively). Conclusion : Long-term phenytoin therapy induces resistance to the neuromuscular blocking effects of mivacurium. (Korean J Anesthesiol 1997; 33: 237∼242)