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임상연구 : 두부 외회전이 우측 내경정맥과 경동맥의 해부학적 위치관계에 미치는 영향
김순임 ( Soon Im Kim ),강제현 ( Je Hyun Kang ),백영희 ( Young Hee Baek ),김상호 ( Sang Ho Kim ),옥시영 ( Si Young Ok ),김선종 ( Sun Chong Kim ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5
Background: The purpose of this study was to evaluate the effect of head rotation on the anatomical relationship of the right internal jugular vein (RIJV) and the carotid artery (CA) with using ultrasound images in Korean patients. Methods: We investigated 117 patients (age range: 16-87 years old) who were placed in the supine position, but not in the Trendelenburg position. An ultrasound probe was placed on the right neck at the apex of the triangle formed by the head of the sternocleidomastoid muscle and the clavicle, and it was directed toward the ipsilateral nipple at a 30 degree angle to the coronal plane. For each head rotation (0, 30, 60 degrees), we measured the horizontal diameter of the RIJV and CA, and the percentage of overlap of the CA and the RIJV with using an ultrasound system. Results: The mean RIJV diameter was 18.4±4.3 mm and the mean CA diameter was 7.5±1.2 mm at the neutral head position. Following head rotation, the percentage overlap of the CA and RIJV increased significantly (0°: 32.7%, 30°: 45.4%, 60°: 57.0%) (P<0.05). The percentage overlap of the CA and RIJV in the neutral head position increased more in the patients with a BMI over 25. However, age did not have any effect on the percentage of overlap. Conclusions: Head rotation toward the contralateral side increases the percentage of overlap of the CA and RIJV. To decrease the risk of CA puncture, rotate the head from the neutral position as little as possible when performing RIJV catheterization. (Korean J Anesthesiol 2008;55:538~42)
실험연구 : 흰쥐 횡격막 신경근 표본에서 Vancomycin이 비탈분극성 근이완제의 신경근 차단에 미치는 영향
김순임 ( Soon Im Kim ),한창윤 ( Chang Yoon Han ),정호순 ( Ho Soon Jung ),이정석 ( Jeong Seok Lee ),옥시영 ( Si Young Ok ),김선종 ( Sun Chong Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6
Background: Vancomycin is frequently used as a prophylactic antibiotic in patients undergoing cardiac and orthopedic surgical procedures. However, the interactions of vancomycin with non-depolarizing muscle relaxant have not yet been reported on. Therefore, we studied the effects of vancomycin on the neuromuscular block of vecuronium, rocuronium and atracurium in vitro. Methods: Square wave, 0.1 Hz supramaximal stimuli were applied to the phrenic nerve-hemidiaphragm preparation of the rat and the twitch height response was recorded. We measured cumulative concentration response curves of vecuronium, rocuronium or atracurium, respectively, and also those of the rats that were pretreated with vancomycin (20μg/ml). The EC50 and EC95 of these muscle relaxants alone and those of the rats pretreated with vancomycin were calculated with using an inhibitory sigmoid Emax model. Results: Vancomycin alone did not depress the twitch height. The pretreated vancomycin (20μg/ml) did not affect the EC50 and EC95 of vecuronium or rocuronium, but it significantly reduced the EC50 and EC95 of atracurium (P < 0.05). Conclusions: Vancomycin itself does not have neuromuscular blocking properties. Vancomycin does not affect the neuromuscular blockade induced by vecuronium or rocuronium, but it significantly enhances the neuromuscular blockade induced by atracurium. (Korean J Anesthesiol 2006; 51: 727~32)
임상연구 : 소아에서 사시 교정 수술 후 Ondansetron과 Dexamethasone의 병용투여가 구토 예방에 미치는 효과
김순임 ( Soon Im Kim ),이정석 ( Jeong Seok Lee ),김수현 ( Soo Hyun Kim ),옥시영 ( Si Young Ok ),김선종 ( Sun Chong Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: Postoperative vomiting (POV) is a common complication after pediatric strabismus surgery. The aim of this study was to evaluate the prophylactic antiemetic effects of a combination of ondansetron with dexamethasone after strabismus surgery in children. Methods: In this prospective, randomized, double-blind, placebo-controlled study, 126 healthy children, aged 3-10 years, who underwent strabismus surgery under general anesthesia using sevoflurane were examined. The patients were divided randomly into three groups: Patients who received 100μg/kg ondansetron with 100 μg/kg dexamethasone (OD group, n = 42); 100μg/kg ondansetron (O group, n = 42); and saline as placebo (P group, n = 42) after the induction of anesthesia. The incidence of vomiting, the patient`s distress due to vomiting, the need for rescue antiemetics and parental satisfaction during the first 24 h after surgery were evaluated. Results: The incidence of vomiting in group OD (5%) and group O (17%) during the first 24 h after surgery were significantly lower than in group P (40%) (P < 0.001, P < 0.05, respectively). The level of distress of the patients in group OD during the first 6 h after surgery was significantly lower than in group P (P < 0.05). The parents in group OD were more satisfied than those in group P (P < 0.05). However, the incidence of vomiting, patient`s distress, need for rescue antiemetics, and parental satisfaction were comparable between groups OD and group D. Conclusions: A combination of ondansetron with dexamethasone and ondansetron alone were equally effective in preventing vomiting after strabismus surgery in children. However the combination of ondansetron with dexamerhasone, but not ondamsetrone alone, is more effective in reducing the level of patient`s distress and incresing the level of parental satisfaction than the placebo. (Korean J Anesthesiol 2006; 51: 324~9)
임상연구 : Propofol을 이용한 완전 정맥 마취에서 기관내 삽관 시 Remifentanil이 Bispectral Index에 미치는 영향
이준호 ( Joon Ho Lee ),김순임 ( Soon Im Kim ),김문규 ( Mun Gyu Kim ),김선종 ( Sun Chong Kim ),옥시영 ( Si Young Ok ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: The present study was undertaken to determine the effect of remifentanil on the bispectral index (BIS) during intubation under TIVA (total intravenous anesthesia) using propofol. Methods: In this prospective, randomized, double-blind study, 80 healthy patients aged 18-60 years undergoing elective surgery were investigated. Anesthesia was induced using propofol (target effect-site concentration 4μg/ml). After the loss of consciousness, rocuronium (0.9 mg/kg) and remifentanil was infused. The patients in the R group were infused with remifentanil using a target effect-site concentration of 4μg/ml, and patients in the P group were infused with saline. The BIS value, mean arterial pressure (MAP) and heart rate (HR) were measured before induction, before remifentanil infusion and before and after tracheal intubation. Results: The BIS value remained constant after intubation in the two groups. The MAP and HR increased significantly after intubation in the two groups, but the degree of increase of MAP and HR was less in group R than in group P significantly. Conclusions: We suggest that the BIS value is not affected by the administration of remifentanil during intubation under TIVA using propofol. (Korean J Anesthesiol 2007; 53: 695∼9)
임상연구 : Propofol을 이용한 완전 정맥마취 시 기관내 삽관으로 인한 혈역학적 변화를 억제하는 Remifentanil의 효과처 농도
이준호 ( Joon Ho Lee ),김순임 ( Soon Im Kim ),옥시영 ( Si Young Ok ),김선종 ( Sun Chong Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3
Background: The present study was undertaken to determine the effect-site concentration of remifentanil for blunting hemodynamic responses to tracheal intubation during total intravenous anesthesia (TIVA) using propofol. Methods: In this prospective, randomized, double-blind study, a total of 126 patients, aged 18-60 (ASA I or II), having undergone elective surgery under TIVA using propofol were investigated. Anesthesia was induced using propofol (target effect-site concentration 4μg/ml) and rocuronium (0.9 mg/kg). Remifentanil was infused at target effect-site concentrations of 0, 2, 4, 6 ng/ml: groups R1, R2, R3 and R4, respectively. The systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and heart rate (HR) were measured pre-induction, and before and after tracheal intubation. Results: After intubation, the SAP, DAP and HR increased significantly (P < 0.05) in all groups compared to the pre-intubation values. Compared with pre-induction values, the SAP and DAP in groups R1 and R2 increased significantly after intubation (P < 0.05), but those in group R3 remained constant until 1 min after intubation. The SAP and DAP in group 4 however, decreased significantly (P < 0.05) for 3 min after intubation. The HR increased significantly after intubation in groups R1, R2 and R3 compared to the values before intubation (P < 0.05), but that in group R4 being remained constant. Conclusions: We suggest that the optimal target effect-site concentrations of remifentanil for blunting hemodynamic responses to tracheal intubation were 4 or 6 ng/ml during TIVA using propofol. (Korean J Anesthesiol 2007; 52: 269~74)
임상연구 : 심박출량 측정 시 경식도초음파도플러(Hemosonic 100TM)와 열희석법의 비교
옥시영 ( Si Young Ok ),박현준 ( Hyun Jun Park ),김순임 ( Soon Im Kim ),김선종 ( Sun Chong Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: The measurement of cardiac output (CO) is an important part of anesthetic practice in patients undergoing major surgery. The thermodilution method (TDM), using a pulmonary artery catheter, is still accepted as the standard procedure. However, the use of the method is associated with several limitations and severe complications. The use of a transesophageal Doppler ultrasound monitor (EDUM; Hemosonic 100TM) is less invasive and calculates CO from a simultaneous measurement of blood flow velocity and diameter of the descending aorta. The aim of this study was to compare the cardiac output measured by the use of the TDM and an EDUM. Methods:In 20 patients undergoing major abdominal surgery, CO and other hemodynamic profiles were measured simultaneously by the use of the TDM and an EDUM. Results: The cardiac output, cardiac index, and the systemic vascular resistance monitored by both devices were highly correlated (correlation coefficients range from 0.63 to 0.88). Bland and Altman analysis showed a consistently negative mean bias for an EDUM and the TDM. This finding indicates an overestimation of the hemodynamic profile by the use of an EDUM. Conclusions: Although Bland and Altman analysis showed a significant bias, the use of an EDUM results in cardiac output, cardiac index, and total systemic vascular resistance measurements that are considerably similar to those obtained using the TDM, and a strong correlation exists for the use of the two methods. (Korean J Anesthesiol 2007; 53: 689∼94)