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복강경 보조하 질식 자궁절제술을 받은 환자에서 Remifentanil을 이용한 술 후 자가통증조절에 대한 연구
김윤홍 ( Yun Hong Kim ),문성하 ( Sung Ha Mun ),김현수 ( Hyun Su Kim ),우철호 ( Chul Ho Woo ),김용찬 ( Yong Chan Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Background: This randomized, double-blinded clinical study was designed to compare the efficacy and safety of three regimens of intravenous (IV) patient-controlled analgesia (PCA) with remifentanil for postoperative analgesia after laparoscopic-assisted vaginal hysterectomy during the first 24 postoperative hours. Methods: Thirty-four patients were randomly allocated into three groups. The first group received IV remifentanil PCA at a basal rate of 0.02 μg/kg/min, a bolus of 0.3 μg/kg, and a lockout time of 15 min. The second group received IV-PCA at a basal rate of 0.025 μg/kg/min, a bolus of 0.375 μg/kg, and a lockout time of 15 min. The third group received IV-PCA at a basal rate of 0.03 μg/kg/min, a bolus of 0.45 μg/kg, and a lockout time of 15 min. Age, weight, height, and duration of surgery and anesthesia were recorded. Heart rate, systolic and diastolic blood pressure (BP) and oxygen saturation by pulse oxymetry were recorded in the recovery room as a base line after the operation. Heart rate, systolic and diastolic BP, sedation score, visual analogue scale (VAS), and postoperative nausea and vomiting (PONV) scores were recorded at 1 h, 3 h, 6 h, 12 h, and 24 h after the initiation of IV-PCA. Results: Thirty two patients were evaluated. The VAS in group 1 at 1, 3 and 6 hours after surgery was significantly higher than in other groups (P<0.05). There were no clinically relevant differences between the groups in PONV, sedation scores, or hemodynamic parameters. Conclusions: This study suggests that IV remifentanil PCA with at a basal rate of 0.025 μg/kg/min (group 2) provided efficacious analgesia after laparoscopic-assisted vaginal hysterectomy. Special attention must be given to respiratory depression during establishment of PCA with remifentanil. (Korean J Anesthesiol 2009;56:54~9)
정일환 ( Il Hwan Jeong ),최원준 ( Won Jun Choi ),이영재 ( Young Jae Yi ),문성하 ( Sung Ha Mun ),김현수 ( Hyun Soo Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6
Poland syndrome is a rare congenital anomaly characterized by unilateral chest wall hypoplasia and ipsilateral upper extremity abnormalities, usually on the right side. It can be combined with other anomalies such as scapular deformity of the affected side, and hypoplasia or absence of nipple. Typical surgery for a Poland syndrome patient aims to correct the chest wall defect and/or other abnormalities. Ventilation problem such as paradoxical chest movement can occur during anesthesia. We report management of general anesthesia of a Poland syndrome patient with right chest wall defect undergoing inframammary fold reposition and liposuction. (Korean J Anesthesiol 2009; 57: 773∼5)
화상 후 흉골-턱끝 반흔구축이 동반된 환자에서 어려운 기관내삽관의 예측에 대한 연구: 변형 Onah 분류법
정일만 ( Il Man Jeong ),서원구 ( Won Goo Seo ),우철호 ( Chul Ho Woo ),배지영 ( Ji Young Bae ),문성하 ( Sung Ha Mun ),김광민 ( Kwang Min Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
Background: Postburn sternomental contractures cause various changes in mouth, oral cavity, pharynx, larynx and related structures. Although there are many methods to predict difficult intubation, the modified Mallampati test (mMT) and the El-Ganzouri multivariate risk index (EGRI) are popular tests. The authors wanted to compare modified Onah class with these 2 tests and also explored the possibility that Onah class could be an adequate independent predictor for difficult intubation. Methods: One hundred and nine patients, aged 18 to 60 years of age, scheduled for elective surgery for reconstruction of postburn sternomental contractures were divided according to the modified Onah class. We made assessments prior to general anesthesia with respect to mouth opening, thyromental distance, mMT, neck movement, ability to prognath, body weight, and history of difficult tracheal intubation. The accuracy, specificity, positive and negative predictive values were calculated from the data of the 3 tests, and as the 3 tests were compared with patient`s laryngoscopic view grade according to Cormack and Lehane criteria by using the Chi-square test. Results: The incidence of Cormack and Lehane grade III, IV was 39.4%. Onah class showed significantly higher accuracy, specificity, and positive predictive value than mMT and EGRI. There were significant correlations between modified Onah class 2b, 3 and the Cormack and Lehane grade III, IV. Conclusions: Application of modified Onah class for preoperative prediction of the degree of difficulty with laryngeal visualization can reduce the frequency of both an unanticipated failure to visualize laryngeal structures as well as potential unnecessary interventions related to over-prediction of airway difficulty in patients with postburn sternomental contractures. (Korean J Anesthesiol 2009;57:290∼5)
증례보고 : 대뇌 전두엽에 재발한 악성 수막종 환자의 뇌종양 절제술 중 발생한 간대성근경력 발작
김윤홍 ( Yun Hong Kim ),이영재 ( Young Jae Yi ),경문기 ( Moon Ki Kyoung ),김현수 ( Hyun Soo Kim ),문성하 ( Sung Ha Mun ),최원준 ( Won Joon Choi ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2
Several suspected etiologies can cause seizures during the resection of a brain tumor via a craniotomy: the tumor itself, intracranial hypertension or the anesthetic agents used, etc. Generalized myoclonic seizures, during general anesthesia in a 44 year old man, who underwent a resection for a relapsed frontal meningioma, were experienced. Anesthesia was induced and maintained using propofol and remifentanil. The myoclonic seizures began 30 minutes after the induction of anesthesia. The administration of rocuronium was unable to stop the involuntary movement. Midazolam was given to cease the seizures, but they continued for a further 105 minutes. After opening the dura mater, the seizures immediately disappeared and did not recur thereafter. (Korean J Anesthesiol 2007; 52: 241~4)