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임상연구 : 기관내 삽관 시 Bispectral Index와 Auditory Evoked Potential Index 변화와 비교
이윤숙 ( Yoon Sook Lee ),강상수 ( Sang Soo Kang ),이규호 ( Kyu Ho Lee ),김영미 ( Young Mi Kim ),신근만 ( Keun Man Shin ),윤영준 ( Young Joon Yoon ),길호영 ( Ho Young Kil ),김광민 ( Kwang Min Kim ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.45 No.2
임상연구 : 비선형 혼합효과 모델을 이용한 Etomidate의 집단 약동학 및 약역학
한태형 ( Tae Hyung Han ),이수경 ( Soo Kyung Lee ),이현철 ( Hyun Chul Lee ),이진영 ( Jin Young Lee ),곽인숙 ( In Suk Kwak ),정미화 ( Mi Hwa Jung ),길호영 ( Ho Yeong Kil ),박경수 ( Kyung Soo Park ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Background: Etomidate is used as a fast-acting hypnotic with few cardiovascular effects to induce anesthesia in patients with a poor cardiovascular reserve. The bispectral index (BIS) has been suggested to be a measure of the depth of anesthesia and correlates well with the level of consciousness. This study examined the population pharmacokinetics and pharmacodynamics of etomidate using nonlinear mixed effect (NONMEM) modeling and sigmoid Emax modeling. Methods: Eighteen middle aged adults, with ASA physical status I or II, who were scheduled for elective surgery, were included. 0.2% etomidate was administerd at 150 ml/h until the patients lost consciousness. The patient recovered spontaneously until they regained consciousness, as determined by a verbal response. The BIS was determined and arterial blood samples were collected. The plasma concentrations were measured with high performance liquid chromatograhy (HPLC). NONMEM was used for population pharmacokinetic and sigmoid Emax model for pharmacodynamic analysis. Results: The induction dose for the loss of eyelid reflexes was 0.38 mg/kg. The induction time from drug infusion to the loss of eyelash reflexes was approximately 3.5 minutes. This study took approximately 8.5 minutes from the start of drug infusion to the recovery of consciousness. The pharmacokinetic parameters were t1/2α = 1.1 min, t1/2β = 1.9 min, t1/2γ = 106.5 min, k21 = 0.36 L/min, k31 = 0.009 L/min, V1 = 6.43 L, Varea = 426 L, Cl = 2.77 L/min. The pharmacodynamics were keo = 0.40 L/min, CE50 = 1.0 ug/mL, E0 = 94, Emax = 94 and γ = 1.2. The performance error for the etomidate concentration was 0.14 ± 0.99 (typical prediction) and -0.03 ± 0.40 (individual prediction) and -0.09 ± 1.00 and -0.001 ± 0.13 for the BIS score. Conclusions: When compared with other previously published data, our pharmacokinetic parameters demonstrated a shorter half lives, a larger volume of distribution, and an increased clearance with significant interindividual differences. The pharmacodynamics showed a large interindividual variability. The reason for discrepancy might be the relatively short sampling time. However, further study will be warranted to improve the model performance in the future. (Korean J Anesthesiol 2006; 51: 271~7)
Ketamine 전투여가 Propofol 마취유도시 정주통과 평균동맥압 및 심박수에 미치는 영향
길호영,최영환,이승준,박영주 대한정맥마취학회 1999 정맥마취 Vol.3 No.4
서론: Propofol은 마취의 유도와 유지에 유용한 약제이지만 정주통과 혈압감소가 문제가 되고있다. 한편 ketamine은 강력한 진통작용과 교감신경 항진효과를 가지고 있다. 이에 저자들은 propofol 마취유도시 다양한 용량의 ketamine 전투여로 정주통과 혈압감소 예방에 유용성을 알바보고자 하였다. 방법: 계획 수술이 예정된 미국마취과학회 신체분류 등급상 1, 2에 속하는 120명의 환자를 대상으로 ketamine 전투여 유무에 따라 임의로 1군은 propofol만을 투여받은 환자(n=60), ketamine의 진정 용량의 ED_50의 25%, 50%, 75%를 투여받은 환자를 각각 2, 3, 4군(n=20)으로 나누었다. 각 군에서 정주통의빈도 및 정도는 각각 발생빈도 및 통증점수로, 평균동맥압 및 심박수는 약물 투여시점을 대조치로 투여 후 2분, 4분 삽관 후 1분, 3분에 측정하였다. 결과: 정주통의 발생빈도는 1군에 비해 2, 3, 4군에서 유의하게 감소하였으며 (P<0.05) 평균동맥압 및 심박수는 약물주입후 4분에 2, 3, 4군에서 안정적 변화를 관찰하였다. 결론: Propofol 마취유도시 ketamine의 hypnotic ED_50의 25-50% (0.17 - 0.33 ㎎/㎏)의 사전정주는 정주통의 빈도와 정도 및 혈역학적 변화를 유의하게 감소시킬 수 있었다. Background: Propofol is useful agents for anesthesia induction and maintenance, but pain on injection and possible hypotension are commonly encountered problems during induction. Meanwhile, ketamine has potent analgesic and sympathomimetic effect. Therefore, we evaluated the effect of ketamine pretreatment on injection pain and hemodynamic changes during induction with propofol. Methods: Premedicated one hundred and twenty ASA physical status Ⅰ or Ⅱ patients scheduled for elective surgery were randomly allocated into one of four groups (group 1; propofol only, group 2, 3, 4; pretreatment with 25%, 50%, 75% dose of hypnotic ED_50 of ketamine, respectively) groups. Intensity and frequency of injection pain, mean arterial pressure and pulse rate were checked for evaluation of ketamine pretreatment on injection pain and hemodynamic changes during induction with propofol. Results: Incidence or pain on injection was significantly reduced in group 2, 3 and 4 compared with group 1. Group 2 and 3 showed more stable hemodynamic changes than Group 1 and 4. Conclusions: 25-50% of hypnotic ED_50 of ketamine (0.17-0.33 ㎎/㎏) pretreatment reduced pain on injection and hemodynamic changes during propofol induction significantly.
길호영,이현화,한태현,박훈,이정은,이종희,최국영,안재목 대한정맥마취학회 2002 정맥마취 Vol.6 No.1
Background: The objectives of the present study were to assess the mechanical performance error of the three commercially available target controlled infusion devices incorporating the pharmacokinetic parameters proposed by Marsh et al. for the administration of propofol. Methods: After institutional review board approval and informed consent, forty-five ASA 1 or 2 adult patients undergoing elective orthopedic surgery were participated in this study. Atropine 0.5 mg was injected for premedication. Subjected TCI devices were "A", "B", "C" devices. Anesthesia was induced by a TCI of propofol with a target concentration of 6 ㎍/㎖ and maintained around 3-5 ㎍/㎖ according to the bispectral index (35-45). In he middle of surgery, target concentrations were increased to 6 ㎍/㎖ and maintained until pseudo-steady state with the effect site concentration. Three minutes after equilibration, 3 ml of blood was drawn from the radial artery for measuring blood concentration using HPLC. Target concentrations were gradually decreased at the interval of 1 ㎍/㎖ until the end of surgery and a blood sample was drawn as described in the above. A sample for every 1 ㎍/㎖ was collected in the recovery room. Performance error of the predicted concentration of blood was calculated as measured-predicted concentration/predicted concentration × 100. Results: "A" and "C" TCI showed acceptable performance error within 30%, however the degree of error was higher in "B". And "B" TCI showed more than acceptable performance error in low target concentration and showed transition of error at higher concentration (5-6 ㎍/㎖) compared to "A" and "C" TCI. Conclusions: "A" and "C" TCI showed more acceptable mechanical performance error than "B" TCI device.
Propofol 의 주입속도 변화가 동맥압반사 민감도에 미치는 영향
길호영,이기헌,양정화,이승준,오완수,박영주 대한정맥마취학회 1999 정맥마취 Vol.3 No.4
서론: Propofol 마취유도는 혈압하강을 보이며 이의 기전으로 심근 억제, 후부하 감소, 전부하의 감소, 전신혈관저항의 감소 등이 있다. 본 연구는 propofol을 3, 6, 12 ㎎/㎏/hr로 주입하면서 각성시와 propofol 주입 30분 후에 phenylephrine 정주에 의한 혈압변화에 따른 R-R 간격의 변화를 관찰함으로써 propofol 주입 속도에 따른 압반사 민감도의 변화를 관찰하였다. 방법: 20-55세, 체중 50-80 ㎏의 미국마취과학회 신체분류 등급상 1 및 2에 해당되는 남녀환자 80명을 대상으로 심전도, 맥박산소계측기, 지속적 동맥압을 측정하였고 propofol을 투여하지 않은군은 1군, propofol 3, 6, 12 ㎎/㎏/hr로 투여한 군을 각각 2, 3, 4군으로 분류하였다. 안정 상태에서 수축기 및 이완기 혈압, 맥박, 말초산소포화도를 3분 간격으로 3회 측정하여 평균치를 phenylephrine 100 ㎍을 정주한 후 혈압 및 맥박수(R-R 간격)을 20초 간격으로 기록하였다. 결과: 수축기 혈압에 대한 R-R 간격의 비율로 나타낸 압반사의 기울기는 1군 8.4 ± 0.7, 2군 8.9 ± 1.7, 3군 8.0 ± 1.3, 4군 7.2 ± 1.0으로 유의한 차이를 보이지 않아 propofol 주입속도 3-12 ㎎/㎏/hr에서 각 군간에 압반사 민감도의 차이는 없었다. 또한 2, 3, 4군에서 propofol 주입속도 증가에 따른 혈압하강에 따라 동시에 맥박이 증가하는 대신 감소된 상태를 유지함으로서 반사의 재조정 현상을 보여주었다. 결론: Propofol을 이용한 마취시 3, 6 및 12 ㎎/㎏/hr의 주입속도의 변화는 압반사 활성도에 유의한 변화를 보이지 않았고 압반사의 재조정 현상이 나타남을 알 수 있었다. Background: Induction of anesthesia with propofol caused a decrease in arterial blood pressure and systemic vascular resistance. This effects of propofol on the circulation can be more clarified by studying cardiovascular control mechanism such as baroreflex sensitivity during variable rate infusion of propofol. Methods: The effects of three infusion rates of propofol (3, 6, 12 ㎎/㎏/hr) to supplement 66% nitrous oxide in oxygen anesthesia on baroreflex sensitivity were studied and compared with awake value in 80 ASA Ⅰ or Ⅱ patients (20-55 years old, n=20 in each group). Batoreflex control of heat rate was studied by pertubing the patients' arterial pressure with 100 ㎍ of phenylephrine in each three infusion rates of propofol which was maintained at least 30 min without any surgical stimulation. Results: Baroreflex slope representing baroreflex sensitivity among three infusion rates of propofol did not show any significant differences. The slope of each infusion rate was 8.4 ± 0.7 at awake, 8.9 ± 1.7 at 3 ㎎/㎏/hr, 8.0 ± 1.3 at 6 ㎎/㎏/hr, 7.2 ± 1.0 at 12 ㎎/㎏/hr, respectively. But, resetting of the reflex occured at low heart rates. Conclusions: Usual propofol-nitrous oxide-oxygen anesthesia was not associated with impairment of baroreflex sensitivity, but showed reflex resetting at low heart rates.
길호영,김광민,전순영 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.3
Background: Marsh's pharmacokinetic parameter set is the most widely used parameter for target controlled infusion for propofol. However, Marsh's model was derived from a European population, and it is uncertain whether this model is accurate for Koreans. Methods: Thirty ASA 1 or 2 adult patients undergoing orthopedic surgery participated in this study. Atropine 0.5 mg was injected for premedication. Anesthesia was induced by a TCI of propofol with a target concentration of 6㎍/ml and maintained around 3- 5 ㎍/ml according to the bispectral index (35-45). In the middle of surgery, target concentrations were increased to 6 ㎍/ml and maintained until effect site concentration was the same concentration. Three minutes after equilibration. 3 ml of blood was drawn from the radial artery and contralateral antecubital cephalic vein for measuring blood concentration using HPLC. Target concentrations were gradually decreased at the interval of 1 ㎍/ml until the end of surgery and a blood sample was drawn as described in the method. A sample for every 1 ㎍/ml was collected in the recovery room. Performance error of the predicted concentration of blood was calculated. Results: The performance error was - 12.86-16.55% for 1-6 ㎍/ml of predicted concentration. Measured concentrations were higher than predicted at higher concentrations, but lower at lower con-centrations. Measured cardiac output and arteriovenous concentration differences at 1-6 ㎍/ml showed no difference. Conclusions: Marsh's pharmacokinetic model was accurate for propofol TCI in Koreans in terms of relatively low performance error (< 20%) in the concentration range of 1-6 ㎍/ml. (Korean J Anesthesiol 2001; 40: 282 ~ 292)