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Background: Propofol is a good choice for elderly patents because it produces rapid onset and quick recovery with few side effects. Propofol produces dose-dependent cardiovascular depression. This effect is more pronounced in elderly patients during induction and can be minimized by a slow injection. The aim of this study was to determine the appropriate induction dose of propofol using a slower infusion rate for elderly patients to obtain desirable sedation and hypnotic conditions with minimal hemodynamic changes. Methods: Thirty-nine patients aged over 70 years were assigned to receive a propofol infusion of either 1.5 mg/kg (n = 21, Group 1) or 2.0 mg/kg (n = 18, group 2). The infusion rate was 20 mg/kg/hr. The systolic and diastolic pressure, heart rate, BIS and modified observers assessment of the alertness/sedation scale (OAA/S) were measured before the induction (baseline), after the propofol infusion, as well as immediately, 3 and 5 minutes after intubation. Results: The systolic pressure decreased significantly after the propofol infusion in both groups (group 1: 17%, group 2: 25%) but there were no significant differences between them. The BIS values after the propofol infusion and intubation were 67.1 ± 12.6 and 62.3 ± 12.7 in group 1, 49.6 ± 11.1 and 51.7 ± 11.7 in group 2, respectively which showed significant differences between the groups. Conclusions: When 2.0 mg/kg of propofol is administrated to elderly patients, a slower infusion rate is more appropriate for maintaining the desirable sedation and hypnotic conditions and cause no significant hemodynamic changes. (Korean J Anesthesiol 2006; 50: 417~21)
Background: Both ketorolac and propacetamol have been used to control mild to moderate pain after operation. Ketorolac is a non-steroid anti-inflammatory drug (NSAID) with strong analgesic activity, but should be avoided in patients with renal dysfunction or bleeding complications. Propacetamol is a prodrug of paracetamol and can be delivered intravenously. Importantly, it has fewer side effects and therefore generally considered safe. The purpose of this study is to compare the analgesic efficacy of ketorolac and propacetamol for pain control after tonsillectomy in pediatric patients. Methods: The pediatric patients were randomly divided into three groups. All patients were given propofol and fentanyl for induction. During induction, one group received ketorolac 1 mg/kg (group K), another group received propacetamol 30 mg/kg (group P), and the other group received saline (group C). Postoperative pain was assessed by Visual Analogue Scale (VAS) and Faces Pain Scale (FPS) at 15, 30 and 60 min after arrival at the recovery room. Results: VAS and FPS at 30 and 60 min after arrival were significantly lower in group K and P than in group C (P < 0.05). No adverse side effect was observed in all groups after tonsillectomy. Conclusions: Propacetamol can be used as a safe alternative to ketorolac for pain control after tonsillectomy in pediatric patients. (Korean J Anesthesiol 2008; 55: 704~8)
산림내 희귀 및 멸종위기식물이며 밀원식물로도 중요한 망개나무 자생지의 환경적 특성과 개체군 및 군집의 구조적 특성을 이해하기 위하여 군자산의 망개나무 임분을 조사하였다. 이 조사지는 중부기후구 낙엽활엽수림이고, 경사도는 5-25˚, 암석노출율은 30-90%, 토양 pH는 6.37였다. 본 조사 임분 36 ha에서 망개나무는 ha당 18.2본, 총 656개체가 있었으며, 평균수고 11.8m, 평균흉고직경 22.6 cm, 임령은 최고 56년, 맹아발생 개체비율은 32.9%, 그루당 맹아발생은 최고 8개였다. 이 망개나무 임분은 당단풍나무군락-고로쇠나무군, 당단풍나무군락-갈참나무군, 그리고 망개누무군락군-졸참나무군락의 3개의 식생단위로 분류되었다. 이들 식생단위에서 망개나무의 평균중요치(MIV)는 10.9%, 종다양도는 0.77-1.31, 종내경쟁은 0.78-0.94, 우점도는 0.07-0.29, 균재도는 0.71-0.93이었다. 현재 군자산의 망개나무 임분에서는 망개나무가 우점이지만. 하충목은 충충나무와 느릅나무 등오로 자연천이가 일어나고 있었다. Berchemia berchemiaefolia is a rare and endangered species and important as a honey resource. The purposes of this study were to investigate physical environmental factors and the population and community structure of Berchemia berchemiaefolia stands at Mt.Gunja in Sogrisan National Park in Chungcheongbuk-do. The B berchemiaefolia stands belonged to deciduous forests in mid-temperate zone and were 5~25˚ in slope 30~90% in rock ratio and 6.37 in soil pH. They had 656 trees within the area of 36 ha and their average density was 18.2 trees per ha. The trees within the stands were 11.8m in tree height 22.6 cm in DBH and 56 years old. The number of branched stems was the maximum 8 and 32.9% of the trees were branched. B. berchemiaefolia trees over 12cm diameter occupied 89.9% but young B. berchemiaefolia did only 11%. The structure of B. berchemiaefolia stands were classified into three groups as Acer pseudo-sieboldianum & A. mono community group A. pseudo-sieboldianum & Quercus aliena community group and B. berchemiaefolia & Quercus serata community group. The mean importance value of B. berchemiaefolia was 10.9% while species diversity of the community ranged 0.77~1.31 and interspecific competition ranged 0.78~0.94. The dominance of the community ranged of 0.07~0.29 and the evenness ranged 0.71~0.93. Although B. berchemiaefolia was dominant in the habitat but the species was already in natural successional stage to cornus controversa or Ulmus davidiana var. japonica.
최주연 ( Ju Yeon Choi ),이귀용 ( Guie Yong Lee ),김동연 ( Dong Yeon Kim ),한종인 ( Jong In Han ),정락경 ( Rack Kyoung Chung ),김치효 ( Chi Hyo Kim ),백희정 ( Hee Jung Baik ),김종학 ( Jong Hak Kim ),이춘희 ( Choon Hi Lee ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.2
Background: The elderly have increased sensitivity to opioids and anesthetics. The hemodynamic effects of propofolremifentanil during induction are not known in the elderly. This study was designed to compare two different remifentanil administration methods during propofol-remifentanil induction and tracheal intubation in the elderly. Methods: Forty patients, ages over 65 years were enrolled. Anesthesia was induced with propofol 1 mg/kg and remifentanil. In Group T (TCI : target controlled infusion), remifentanil 3.5 ng/ml were infused until laryngoscopy and tracheal intubation. In Group R (rapid infusion), infusion were stopped when effect-site concentration reaches 5.0 ng/ml. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction (baseline), after remifentanil reaches its target effect-site concentration, after administration of propofol, 1 minute before intubation, 1 minute after intubation and 3 minute after intubation. Results: In both groups, MAP decreased significantly after induction and then increases significantly after intubation (P < 0.05). In Group R, MAP decreased earlier and was significantly lower than that of Group T (P < 0.05) before intubation. HR shows no significant changes between groups. Conclusions: In these two methods, there are no severe hemodynamic compromise during induction and tracheal intubation in the elderly. However, lesser degree of hypotension occurs in Group T. So we conclude that TCI method can provide better hemodynamic stability than rapid infusion method. (Korean J Anesthesiol 2007; 53: 714∼9)
Background: The combined induction using two or more agents has a potential benefit that anesthesia could be induced with smaller anesthetic agents with fewer side effects. We studied the effects of co-administration with midazolam and remifentanil on the dose of propofol, the time to loss of consciousness (LOC) and hemodynamics during tracheal intubation. Methods: Sixty patients were randomly assigned to three groups. Group 1 was induced with target-controlled propofol alone. Group 2 received midazolam (0.05 mg/kg) and target-controlled propofol. Group 3 received midazolam (0.025 mg/kg), remifentanil (2 ng/ml) and target-controlled propofol. The time to LOC, the infused propofol dose and the effect site concentration at LOC were recorded. After LOC, rocuronium (0.6 mg/kg) was given and tracheal intubation was performed. The noninvasive blood pressure, heart rate (HR) and bispectral index were recorded. Results: The time and the dose of propofol to LOC were significantly reduced in group 2, 3 than in group 1 (P<0.05). Compared with pre-induction values, mean blood pressure at immediately after intubation was increased in group 1, 2 with no change in group 3. The HR immediately after intubation was significantly increased in all groups compared to the pre-induction values, but the rate of increase of HR in group 3 were significantly lower than those group 1, 2 (P<0.05). Conclusions: The co-administration with midazolam and remifentanil reduces the time to LOC and the dose of propofol. That also attenuates hemodynamics during tracheal intubation under target-controlled infusion of propofol. (Korean J Anesthesiol 2009: 56: 619~23)
Background: Postoperative urinary retention is a common postoperative complication. Persistent distention of the bladder may affect the function of the detrusor, resulting in impairment of micturition. This study examined the risk factors and incidence of early postoperative urinary retention and distention in PACU (postanesthesia care unit) using an ultrasound scanner. Methods: The bladder volume was measured in 228 surgical patients before discharge from the PACU using an ultrasound scanner. The postoperative urinary retention was defined as the inability to void at a bladder volume exceeding 500 ml within 30 min. The potential variables of urinary retention were collected including age, gender, type of surgery and anesthesia, duration of anesthesia, amount of perioperative fluid, post operative patient-controlled analgesia, and anticholinergics. The independent risk factors for postoperative urinary retention were identified by multivariate analysis. Results: The incidence of postoperative urinary retention in the PACU was 14.0%. Risk factors of the early postoperative urinary retention in the PACU detected by the ultrasound scanner were age (50 yr, odds ratio = 3.3), spinal anesthesia (odds ratio = 2.6) and the amount of perioperative fluid (700 ml, odds ratio = 4). Conclusions: It is recommended that early postoperative urinary retention be evaluated routinely using an ultrasound scanner in the PACU, particularly in older patients and patients given a large amount of perioperative fluid after spinal anesthesia. (Korean J Anesthesiol 2006; 50: 674~8)