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임상연구 : 마취유도시 Bispectral Index 감시하에 Remifentanil 지속정주에 따른 Propofol의 용량과 혈역학적 변화
김영재 ( Young Jae Kim ),김명훈 ( Myoung Hun Kim ),김영환 ( Young Hwan Kim ),임세훈 ( Se Hoon Lim ),이정한 ( Jeong Han Lee ),이근무 ( Kun Moo Lee ),정순호 ( Soon Ho Cheong ),최영균 ( Young Kyun Choe ),신치만 ( Chee Mahn Shin ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: Remifentanil combined with propofol is usually used to induce anesthesia. However, remifentanil and propofol depress the cardiovascular system. This study investigated the effects of a continuous infusion of remifentanil on the propofol dose and hemodynamics using the bispectral index (BIS) during anesthetic induction. Methods: Sixty female ASA physical status class I or II patients, who were scheduled to undergo gynecologic surgery were randomly assigned to one of three groups (n = 20). Normal saline 20 ml/hr (Group S), remifentanil 0.25μg/kg/min (Group 0.25), or remifentanil 0.5μg/kg/min (Group 0.5) was infused intravenously. Propofol was administered slowly two minutes after administering remifentanil or normal saline. The heart rate, mean arterial pressure (MAP) and BIS were measured at baseline, preintubation and postintubation. Result: There were no significant differences in the changes in the BIS among the groups. The MAP and heart rate decreased at preintubation compared with baseline (P < 0.05). The MAP of Group 0.5 at postintubation was lower than that in the other groups (P < 0.05). The heart rate in all groups increased at postintubation compared with baseline (P < 0.05). The heart rate of Group 0.5 at postintubation was lower than that of Group S (P < 0.05). The propofol requirement for unconsciousness was lower in Groups 0.25 and 0.5 than in Group S. The propofol requirement in Groups S, 0.25 and 0.5 was 1.56 ± 0.2 mg/kg, 1.07 ± 0.2 mg/kg and 0.9 ± 0.1 mg/kg, respectively. Conclusions: A combined injection of 0.5μg/kg/min remifantanil with 0.9 mg/kg of propofol decreases the heart rate and MAP at preintubation without adverse effects and appropriately prevents the cardiovascular responses to tracheal intubation, and reduces the propofol dose needed for a loss of consciousness. (Korean J Anesthesiol 2006; 51: 297~301)
Remifentanil이 QT dispersion에 미치는 영향
이원진 ( Won Jin Lee ),김영환 ( Young Hwan Kim ),조광래 ( Kwang Rae Cho ),이상은 ( Sang Eun Lee ),이정한 ( Jeong Han Lee ),임세훈 ( Se Hun Lim ),이근무 ( Kun Moo Lee ),정순호 ( Soon Ho Cheong ),최영균 ( Young Kyun Choe ),김영재 ( 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6
Background: QT dispersion (QTd) is an indirect measure of the heterogeneity of ventricular repolarization and can be used as a risk factor for complex ventricular arrhythmias. We measured the effect of remifentanil on QTd and heart-rate corrected QT dispersion (QTcd). Methods: Sixty ASA class I and II patients, who were between 20 and 60 years old, and who were scheduled for general anesthesia, were studied. After the patient entered the operating room, a 12 lead EKG recording was taken and intravenous infusion of remifentanil was started. The infusion rate was 0.1 μg/kg/min in group 1 and 0.2 μg/kg/min in group 2. Another EKG recording was taken 10 minutes after infusion had started. Results: In both groups, QTd following remifentanil infusion was not significantly different than control values (76.6±23.3 ms vs 81.8±34.9 ms, P=0.459 in group 1; 70.7 ms±29.7 ms vs 73.7 ms±37.1 ms, P=0.734 in group 2). Neither was QTcd: (83.2 ms±25.2 ms vs 89.6 ms±36.2 ms, P=0.371 in group 1; 81.0 ms±35.2 ms vs 83.4 ms±40.9 ms, P=0.829 in group 2). Conclusions: Remifentanil infusion at a rate less than 0.2 μg/kg/min does not change QTd or QTcd. (Korean J Anesthesiol 2009; 57: 737∼41)
기관내 튜브 발관 시 발관 전 투여한 Lidocaine과 Remifentanil의 기침반사 억제에 대한 비교
강동화 ( Dong Hwa Kang ),김영환 ( Young Whan Kim ),최석환 ( Suk Whan Choi ),이상은 ( Sang Eun Lee ),임세훈 ( Se Hun Lim ),이정한 ( Jeong Han Lee ),이근무 ( Kun Moo Lee ),정순호 ( Soon Ho Cheong ),최영균 ( Young Kyun Choe ),김영재 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.4
떨림과 경직이 발생한 척추수술후증후군 환자에서 척수자극술에 의한 치료 경험 -증례 보고-
김영재,김명훈,임세훈,이정한,이근무,정순호,최영균,신치만,Kim, Young Jae,Kim, Myoung Hun,Lim, Se Hoon,Lee, Jeong Han,Lee, Kun Moo,Cheong, Soon Ho,Choe, Young Kyun,Shin, Chee Mahn 대한통증학회 2006 The Korean Journal of Pain Vol.19 No.1
Tremor is a rhythmic, involuntary and oscillatory movement of body parts, and it is the most common movement disorder. Spasticity is also one of the movement disorders that is commonly accompanied with Complex Regional Pain Syndrome; however, the basic nature of spasticity has not yet been proved. A 25-year-old male patient had two operations and he was being treated because of a back injury that occurred 4 years ago. He suffered from pain, tremor and spasticity on both his lower legs, and his symptoms were diagnosed as failed back surgery syndrome. The tremor and spasticity were aggravated despite of continuous treatments. We then treated him with spinal cord stimulation. His pain, tremor and spasticity disappeared after spinal cord stimulation.
증례보고 : 상악암 환자의 갓세르 신경절 고주파 열응고술 후 발생한 급성 세균성 수막염
이근무 ( Kun Moo Lee ),안도건 ( Do Gun An ),김영환 ( Young Hwan Kim ),임세훈 ( Se Hun Lim ),이정한 ( Jeong Han Lee ),정순호 ( Soon Ho Cheong ),최영균 ( Young Kyun Choe ),김영재 ( Young Jae Kim ),신치만 ( Chee Mahn Shin ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2
Since 1920, when Harvey Cushing first used radiofrequency in electrosurgery, the procedural technique has developed rapidly. Even though this procedure is minimally invasive and safer than other neurodestructive procedures, it is still not free of complications. A 72-year-old female patient had constant facial pain, despite several operations and radiotherapies for her maxillary cancer. The region innervated ophthalmic branch and maxillary branch of the trigeminal nerve was involved, with radiofrequency procedure of the gasserian ganglion for pain control also performed at the area. After the procedure, her blood pressure became elevated and she complained of a headache, and six hours later, she became irritable and distracted. Bacterial meningitis was diagnosed by a spinal tap, with third-generation cephalosporin administered as the treatment. The following day, her symptoms had improved and the pain was also reduced. She was discharged from hospital after 14 days, without any sequelae. (Korean J Anesthesiol 2007; 52: 249~51)