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김진아,민진혜,이홍식,조형래,제의진,백진협 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.6
Background: Glycopyrrolate given as reversing agents of muscle relaxants has been reported to be effective in reducing postoperative catheter-related bladder discomfort (CRBD). However, it remains unclear whether glycopyrrolate as premedication is also effective. This study aims to investigate the effectiveness of glycopyrrolate as premedication on preventing CRBD in the post-anesthesia care unit (PACU). Methods: Eighty-three patients who received elective ureteroscopic removal of ureteral stone were randomly assigned to the control (n = 43) or the glycopyrrolate group (n = 40). The glycopyrrolate group was treated with glycopyrrolate 0.3 mg as premedication while the control group received 0.9% saline 1.5 ml. The incidence and severity of CRBD and pain score using numerical rating scale (NRS) were measured in the PACU. Results: The incidence of CRBD (26 of 40 patients vs. 41 of 43 patients, relative risk [RR] = 0.68, 95% Confidence interval [CI] = 0.53–0.86, P = 0.001) and the moderate to severe CRBD incidence (6 of 40 patients vs. 20 of 43 patients, RR = 0.32, 95% CI = 0.14–0.72, P = 0.002) were lower in the glycopyrrolate group than in the control group. Also, postoperative pain NRS score was found to be lower in the glycopyrrolate group (median = 1 [Q1 = 0, Q3 = 2]) compared to the control group (3 [1, 5], median difference = 1.00, 95% CI = 0.00–2.00, P = 0.002). Conclusions: The use of glycopyrrolate 0.3 mg as premedication in patients receiving ureteroscopic removal of ureteral stone reduced the incidence and severity of CRBD, and decreased postoperative pain in the PACU.
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중재적 통증 시술 후 발생한 심인성 딸꾹질 의증 -증례 보고-
강유,채영근,민진혜,이용경,이홍식,제의진 대한마취통증의학회 2015 Anesthesia and pain medicine Vol.10 No.4
Several cases of the hiccups that occurred after interventional pain procedures have been previously reported. A 34-year-old man had suffered from persistent hiccups that started after epidural and trigger point injection of steroid. His hiccups were stopped during meals and sleep. Furthermore, hiccups did not occur after intravenous or intramuscular steroid injection due to eczema and bronchitis, and after interventional pain procedure that was performed under sedation with midazolam. Hence, we suspected that his hiccups had resulted from a psychogenic cause.
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The correlation between the Trendelenburg position and the stroke volume variation
민진혜,이상은,이홍식,채영근,이용경,강유,제의진 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.6
Background: The stroke volume variation (SVV), based on lung-heart interaction during mechanical ventilation, is auseful dynamic parameter for fluid responsiveness. However, it is affected by many factors. The aim of this study was toevaluate the effects of SVV on Trendelenburg (T) and reverse Trendelenburg (RT) position and to further elaborate onthe patterns of the SVV with position. Methods: Forty-two patients undergoing elective surgery were enrolled in this study. Fifteen minutes after standardizedinduction of anesthesia with propofol, fentanyl, and rocuronium with volume controlled ventilation (tidal volume of8 ml/kg of ideal body weight, inspiration : expiration ratio of 1 : 2, and respiratory rate of 10-13 breaths/min), the patientsunderwent posture changes as follows: supine, T position at slopes of operating table of -5o, -10o, and -15o, andRT position at slopes of operating table of 5o, 10o, and 15o. At each point, SVV, cardiac output (CO), peak airway pressure(PAP), mean blood pressure, and heart rate (HR) were recorded. Results: The SVV was significant decreased with decreased slopes of operating table in T position, and increased withincreased slopes of operating table in RT position (P = 0.000). Schematically, it was increased by 1% when the slope ofoperating table was increased by 5o. But, the CO and PAP were significant increased with decreased slopes of operatingtable in T position, and decreased with increased slopes of operating table in RT position (P = 0.045, 0.027). Conclusions: SVV is subjected to the posture, and we should take these findings into account on reading SVV for fluidtherapy.
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