The effect of combination treatment using palonosetron and dexamethasone for the prevention of postoperative nausea and vomiting versus dexamethasone alone in women receiving intravenous patient-controlled analgesia

유재화,유재화,김문규,이기훈,김순임 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.3

Background: The purpose of this study was to evaluate the effect of palonosetron combined with dexamethasone for the prevention of PONV compared to dexamethasone alone in women who received intravenous patient-controlled analgesia (IV-PCA) using fentanyl. Methods: In this randomized, double-blinded, placebo-controlled study, 204 healthy female patients who were scheduled to undergo elective surgery under general anesthesia followed by IV-PCA for postoperative pain control were enrolled. Patients were divided into two groups: the PD group (palonosetron 0.075 mg and dexamethasone 5 mg IV; n = 102) and the D group (dexamethasone 5 mg IV; n = 102). The treatments were given after the induction of anesthesia. The incidence of nausea, vomiting, severity of nausea, and the use of rescue anti-emetics during the first 48 hours after surgery were evaluated. Results: The incidence of PONV was significantly lower in the PD group compared with the D group during the 0–24 hours (43 vs. 59%) and 0–48 hours after surgery (45 vs. 63%) (P < 0.05). The severity of nausea during the 6–24 hours after surgery was significantly less in the PD group compared with the D group (P < 0.05). The incidence of rescue antiemetic used was significantly lower in the PD group than in the D group during the 0–6 hours after surgery (13.1 vs. 24.5%) (P < 0.05). Conclusions: Palonosetron combined with dexamethasone was more effective in preventing PONV compared to dexamethasone alone in women receiving IV-PCA using fentanyl.

근육위축측삭경화증 환자에서 근 이완 없이 시행한 전정맥마취 1예

유재화,김순임,조아나,김호준,박아연 순천향대학교 순천향의학연구소 2016 Journal of Soonchunhyang Medical Science Vol.22 No.2

A 66-year-old woman with amyotrophic lateral sclerosis was scheduled for closed reduction and external fixation of left tibio-fibula. Total intravenous anesthesia using 2% propofol and remifentanil was done without muscle relaxant to avoid possible postoperative respiratory complication and pulmonary aspiration. The surgery had done without difficulty and she recovered from anesthesia promptly without respiratory complication and pulmonary aspitation. She discharged satisfactorily 15 days after surgery.

파스칼 키냐르 사유에 나타난 문학과 회화의 “공(共)동요성” -『성적인 밤 La nuit sexuelle』을 중심으로

유재화 프랑스문화예술학회 2024 프랑스문화예술연구 Vol.87 No.-

티베리우스 황제가 외설적인 그림을 수집했듯, 파스칼 키냐르의 『성적인 밤 La nuit sexuelle』은 그가 수집한 거의 포르노그래피에 가까운 그림 모음 집이다. 이 작품은 에로티시즘과 성을 탐색하면서, 특히 우리 존재의 기원 과 회화의 기원을 질문한다. 키냐르를 매혹하는 화두는 예술과 우리 존재라 는 극명한 시각적, 실체적 형상이 결코 알 수 없는 비가시적이고 비형상적 인 세계를 기원으로 파생했다는 점이다. 이건 아포리아일까? 아니면 이론의 여지 없는 진리일까? 호라티우스의 명구 Ut pictura poesis처럼 고대부터 쟁점이 되어 온 회화 와 문학에 관한 키냐르의 사유를 연구하는 이 논문에서, 우리는 키냐르가 제안한 “공(共)동요성(coagitation)”에 집중할 것이다. 이것은 그림과 시가 단 순히 비유되는 것이 아니라, 공시적 또는 연기적(緣起的)으로 작용한다는 말일 수 있다. 회화에 이미지로 응축된 “시선” 속에서, 키냐르는 예술의 아름다움을 발 견한다. 예술의 관건은 이미지를 응축하는 힘이다. 키냐르는 특히 이 시선 속에 결코 알 수 없는 기원으로서의 잃어버린 과거와 우리 운명과도 같은 결말 직전의 “바로 앞 순간” 또는 임박한 전미래라는 두 시간성이 함께 응 축되어 있음을 간파한다. 이 극한 순간은 삶과 죽음이 마주치는 순간이며, 예술가가 포착해내야 하는 것은 바로 이것일지 모른다. Comme l’empereur Tibère collectionna des peintures obscènes, Pascal Quignard a rassemblé dans La nuit sexuelle des peintures presque pornographiques qu’il a collectionné. La nuit sexuelle n’est pas seulement une exploration de l’érotisme et de la sexualité, mais aussi une interrogation sur l’origine de notre être et celle de la peinture. Or, ce qui le fascine le plus, l’invisible, l’infigurable, et l’inconnaissable est l’origine de notre corps et de notre art visible et figurable. Est-ce l’aporie ou la vérité incontestable? Dans cette étude qui va suivre la pensée très quignardienne sur les liens entre peinture et littérature, qui sont problématiques depuis l’Antiquité, comme la formule d’Horace Ut pictura poesis, nous serons intéressés par la “coagitation” suggérée par Quignard. Il s’agit d’un double mouvement où pictura et poesis se meuvent dans un entre-deux. Il ne s’agirait pas de comparer simplement les deux arts. En fin de compte, par le “regard” condensé en image dans la peinture, Quignard découvre une beauté de l’art, peinture ou littérature: l’enjeu, c’est le pouvoir de condenser l’image. Puisque, dans ce regard, sont condensées également deux temporalités: le passé perdu comme l’origine inconnaissable et l’“instant d’avant” ou le futur antérieur et imminent comme notre destin. C’est ce moment extrême où la vie et la mort se font face, que l’artiste veut saisir.

Evaluation of palonosetron for the prevention of pain on injection of LCT/MCT propofol: Randomized controlled comparison with lidocaine

유재화,김용익,김순임,이세진,한유미 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.3

Background: Long-chain triglyceride/medium-chain triglyceride (LCT/MCT) propofol is less painful than standard long chain triglyceride (LCT) propofol; however, there is still a need to reduce severe pain. 5-Hydroxytryptamine type 3 (5-HT3) receptor antagonists have an analgesic effect during the injection of standard LCT propofol. This study compared the incidence of moderate-to-severe injection pain with LCT/MCT propofol using pretreatment with palonosetron versus pretreatment with saline or lidocaine. Methods: This prospective, randomized double-blind study divided 98 patients scheduled for general anesthesia into three groups: control (n = 33), palonosetron (n = 32), and lidocaine (n = 33) groups. An 18-gauge intravenous catheter was inserted into the peripheral vein at the dorsum of the hand. The patient’s vein was occluded by a rubber tourniquet at mid-forearm, and we then administered 2 ml of the pretreatment drug. One minute after venous occlusion, we released the tourniquet and administered LCT/MCT propofol 2 mg/kg for 10–15 seconds. The degree of pain on propofol injection was evaluated using a 4-point scale. Results: The incidence of moderate-to-severe pain in the control, palonosetron, and lidocaine groups was 9.1, 15.6, and 12.1%, respectively. The incidence of overall pain was lower in the lidocaine group than in the control or palonosetron group. Conclusions: Palonosetron and lidocaine pretreatment does not reduce moderate-to-severe pain on injection of 1% LCT/MCT propofol. Lidocaine pretreatment reduced the overall incidence of injection pain.

국내 단일기관에서 시행한 13년간의 무수혈 수술 분석

유재화,조아나,이세진,염욱 순천향대학교 순천향의학연구소 2014 Journal of Soonchunhyang Medical Science Vol.20 No.1

Objective: Patient’ desire of transfusion free surgery has been increasing due to blood transfusion risks. We analyzed the perioperative parameters and perioperative management of transfusion free surgical treatment in Soonchunhyang University Seoul Hospital. Methods: Operation quantity and blood unstoring count from blood bank between 2000 and 2012 were collected from chronological records. Perioperative parameters including preoperative hemoglobin level, postoperative hemoglobin level, and lowest hemoglobin level were collected from medical records. Perioperative blood management such as acute normovolemic hemodilution, intraoperative blood cell salvage, or hematinic agents and complication were assessed. Results: A total of 3,088 patients underwent transfusion free surgery at Soonchunhyang University Seoul Hospital between 2000 and 2012. Postoperative hemoglobin level <5.0 g/dL were 33 patients. Four patients expired at postoperative period with serious perioperative complications. Average of expired patient’s hemoglobin was 3.22 g/dL and overall mortality was 0.12%. Operation was increased as years go by. The amount of blood use bank wasn’t increased in general patients with transfusion. Conclusion: Careful perioperative blood management for transfusion free surgical treatment was responsible for safety and results in good clinical outcomes. Overall transfusion rate was decreased in spite of increasing operation quantity.

Effects of 10-min of pre-warming on inadvertent perioperative hypothermia in intraoperative warming patients: a randomized controlled trial

유재화,Ok Si Young,김상호,정지원,박선영,김문규,조호범,You Gyu Wan 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.3

Background: This study aimed to evaluate the efficacy of 10-min pre-warming in preventing inadvertent perioperative hypothermia, which is defined as a reduction in body temperature to less than 36.0℃ during the perioperative period in intraoperative warming patients. Methods: In this prospective randomized study, 60 patients scheduled for elective surgery under general anesthesia lasting less than 120 min were divided into two groups: the 10-min pre-warming group (n = 30) and the control group (n = 30). Patients in the 10-min pre-warming group were pre-warmed for 10 min in the pre-anesthetic area using a forced-air warmer set at 47ºC. Intraoperatively, we warmed all patients with a forced-air warmer. Body temperature was measured using a tympanic membrane thermometer pre- or postoperatively and a nasopharyngeal temperature probe intraoperatively. Patients were evaluated on the shivering and thermal comfort scale in the pre-anesthetic area and post-anesthesia care unit. Results: The incidences of intraoperative hypothermia and postoperative hypothermia were similar in both groups (10.7% vs. 28.6%, P = 0.177; 10.7% vs. 10.7%, P = 1.000 respectively). Body temperature was higher in the 10-min pre-warming group (P = 0.003). Thermal comfort during the pre-warming period was higher in the 10-min pre-warming group (P < 0.001). However, postoperative thermal comfort and shivering grades of both groups were similar.Conclusions: Ten minutes of pre-warming has no additional effect on the prevention of inadvertent perioperative hypothermia in intraoperative warming patients.

원발성간세포암의 진단에 있어서의 혈청 Ferritin 측정의 의의

유재화,양상호,박요한,구자영,박병채 대한암학회 1986 Cancer Research and Treatment Vol.18 No.1

The effect of dexmedetomidine sedation on patient and surgeon satisfaction during retinal surgery under sub-tenon’s anesthesia : a randomized controlled trial

유재화,김순임,조아나,이성진,선해정,조호범,이동련 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.5

Background: The purpose of this study was to evaluate the effect of intraoperative dexmedetomidine sedation on patient’s and surgeon’s satisfaction during retinal surgery under sub-tenon’s anesthesia. Methods: Forty-four patients scheduled for elective retinal surgery under sub-tenon’s anesthesia were enrolled in this randomized controlled trial. The patients were divided into Dexmedetomidine (n = 22) and Control (n = 22) groups. Intravenous dexmedetomidine or 0.9% saline via infusion pump were administered continuously to the dexmedetomidine or control group, respectively. Ramsay sedation scale with a target level of 3–4 was used to assess adequacy of sedation. Perioperative pain, hemodynamic and respiratory data were collected, while satisfaction from patients and surgeon were assessed post-surgery using a 5-point satisfaction scale. Results: Patient and surgeon satisfaction was higher in the dexmedetomidine group (P < 0.001, P = 0.002, respectively). The pain associated with sub-tenon’s anesthesia and peripheral vitrectomy was lesser in the dexmedetomidine group than in the control group (P = 0.020). There was significant reduction of heart rate in the dexmedetomidine group (P = 0.001), but only one patient needed treatment with atropine. There was no respiratory effect on both groups. Conclusions: Dexmedetomidine sedation during retinal surgery improved satisfaction from both patient and surgeon without respiratory complication. It is a safe and preferable choice of sedation for retinal surgery.

쇄골수술을 위한 마취에서 표재 목신경얼기 차단과 팔신경얼기 차단 병행 마취와 전신마취와의 비교연구

유재화,유재훈,유규완 순천향대학교 순천향의학연구소 2019 Journal of Soonchunhyang Medical Science Vol.25 No.1

Objective: Recently, the cases about successful regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block for clavicle surgery have been reported. The aim of this study was to compare regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block with general anesthesia. Methods: In this prospective randomized study, 26 patients scheduled for elective clavicle surgery were divided into two groups: the first group was general anesthesia group (GA group, n=13) and the second group for peripheral nerve block group (PNB group, n=13). Standardized general anesthesia was done to the patients assigned to the GA group and ultrasonography-guided combined superficial cervical plexus block and interscalene brachial plexus block was done to the patients assigned to the PNB group. Postoperative sedation scale was assessed at post-anesthesia care unit, and pain scale using 10-cm Visual Analog Scale (VAS) was assessed at immediate postoperative, 30 minutes, 1 hour, 6 hours, and 24 hours. Patients needed additional analgesics, and time for first analgesic demand and duration from surgery to discharge was recorded. Results: The pain VAS scales were less in PNB group than GA group from immediate postoperative time to 6 hours. The patients’ immediate postoperative sedation scale less than 4 were significantly less in PNS group than GA group. The duration from surgery to discharge was shorter in PNS group than GA group. Conclusion: Regional anesthesia using combined superficial cervical plexus block and interscalene brachial plexus block is a successful alternative to general anesthesia for clavicle surgery.

Aprepitant in combination with palonosetron for the prevention of postoperative nausea and vomiting in female patients using intravenous patient-controlled analgesia

유재화,김순임,정지원,전미령,한유미,김용직 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.6

Background: The aim of this study was to evaluate aprepitant in combination with palonosetron as compared to palonosetron alone for the prevention of postoperative nausea and vomiting (PONV) in female patients receiving fentanyl- based intravenous patient-controlled analgesia (IV-PCA). Methods: In this randomized single-blinded study, 100 female patients scheduled for elective surgery under general anesthesia were randomized to two groups: Group AP (80 mg aprepitant plus 0.075 mg palonosetron, n = 50) and Group P (0.075 mg palonosetron, n = 50). The patients in group AP received 80 mg aprepitant per oral 1–3 h before surgery, while all patients received 0.075 mg palonosetron after induction of standardized anesthesia. All patients had postoperative access to fentanyl-based IV-PCA. The incidence of nausea and vomiting, use of rescue medication, and severity of nausea were evaluated at 6 and 24 h after surgery. Results: The incidence of nausea (54%) and vomiting (2%) in group AP did not differ significantly from that in group P (48% and 14%, respectively) during the first 24 h after surgery (P > 0.05). Patient requirements for rescue medication in group AP (29%) were similar to those in group P (32%) at 24 h after surgery (P > 0.05). There was no difference between the groups in severity of nausea during the first 24 h after surgery (P > 0.05). Conclusions: Aprepitant combined with palonosetron did not reduce the incidence of PONV as compared to palonosetron alone within 24 h of surgery in women receiving fentanyl-based IV-PCA.