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장영진,이동철,오영준,하동훈,이미금 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.4
Background: The authors sought to determine whether a shallow needle approach to the axillary artery would improve complete sensory blocks of median, radial, and ulnar nerves as compared with a perpendicular approach when transarterial axillary block is performed using a scalp vein needle (23G, 3/4’). Methods: Fifty-four patients were allocated equally to a perpendicular group (the PA group) or a shallow approach group (SA group). Sensory and motor scores were evaluated and compared in the two groups at 5-minute intervals for 20 minutes after block. The main outcome variables were rates of blockage of median, radial, and ulnar nerves. Results: Excellent block rates (defined as completion of surgery using brachial plexus block alone) were obtained in both groups (SA group 77.8% vs. PA group 70.3%, P = 0.755). However, the rate of blockage of all three nerves was significantly higher in the SA group (74% vs. 40.7%, P = 0.013). Furthermore, the rate of complete sensory block of the radial nerve at 20 minutes was significantly greater in the SA group (85.2% vs. 59.3%, P = 0.033). Conclusions: A shallow needle approach to the axillary artery resulted in a significantly higher median, radial, and ulnar nerve block rate at 20 minutes after LA injection than a perpendicular approach.
마취유도에서 저삽관용량 사용시 Rocuronium 의 보관온도가 삽관상태 및 작용시간에 미치는 영향
장영진,김용범,이원상,이경천,김대희,곽현정 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.4
Rocuronium bromide is a monoquaternary amino steroidal muscle relaxant. Rocuronium is structurally stable and no metabolites of rocuronium have not been observed in humans. The manufacturer recommends that rocuronium can be stored in room temperature for 12 weeks. The aim of this study was to determine if the storage temperature of rocuronium could influence the pharmacodynamics of rocuronium. Methods: One hundred of patients with a class I or II ASA physical status were enrolled in this study. It was divided to two groups. One (Group ‘0', n = 50) consists of those who had intravenously administered the rocuronium which had been stored in refrigerator and the other (Group ‘14', n = 50) consists of those who had intravenously administered the rocuronium which had been stored in room temperature (20-29oC, median 25.1oC) for 14 days. Before an anesthesia was induced, TOF-WatchⓇ was attached and calibrated. The anesthesia was induced with 1μg/kg of fentanyl and 1.5 mg/kg of propofol intravenously. While the 0.1 Hz of single twitch was applied, 0.45 mg/kg of rocuronium, which is appointed to each group, was injected. Intubation is performed 90 seconds after injection of rocuronium and evaluated the intubating condition as excellent, good, poor, and impossible. Results: There was a statistically significant difference in intubating condition at 90 seconds between two groups. The onset time to twitch depression of 0% in group ‘14' was prolonged compared to group ‘0' (P < 0.05). Clinical duration was also shortened in group ‘14' (P < 0.05). Conclusions: Compared with the use of rocuronium stored in refrigerator, that stored at room temperature can be expected to have unfavorable intubating condition at 90 seconds after rocuronium injection. Therefore, the storage temperature has some influences on the efficacy of rocuronium.