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임상연구 : 소아 사시수술 시 Remifentanil 마취의 혈역학적 반응과 회복 특징
정찬종 ( Chan Jong Chung ),김태균 ( Tae Gyun Kim ),이형창 ( Hyung Chang Lee ),이승철 ( Seung Cheol Lee ),진영준 ( Young Jhoon Chin ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
Background: This study evaluated the hemodynamic response and recovery profile of remifentanil-N2O anesthesia, compared with secoflurane-N2O anesthesia in pediatric surgery. Methods: Fifty-seven healthy children aged 1-9 years undergoing strabismus surgery were randomly assigned to two groups, group R or group S. None of the children was premedicated with an anticholinergic agent. Anesthesia was induced with intravenous ketamine 1.0 mg/kg. A laryngeal mask airway (LMA) was placed with rocuronium 0.4 mg/kg. Anesthesia was maintained with sevoflurane 2.0-3.0 vol% and N2O 66% in group S, and with remifentanil 0.75㎍/kg over 1 min followed by remifentanil 0.5㎍/kg/min and N2O 66% in group R. At the end of surgery, the anesthetic agents were discontinued, and the early emergence, recovery, and side effects were assessed. Results: During anesthesia, the heart rate and blood pressure were lower in group R (P < 0.05). The incidence of an oculocardiac reflex was similar in both groups. The times to spontaneous ventilation and the removal of LMA were similar in the two groups. The times from eye opening to command, orientation and full recovery were faster in group R (P < 0.05). The incidence of postoperative nausea and vomiting was similar in both groups. The incidence of coughing was lower in group R (P < 0.05). Mild pruritus developed in 17.2% of patients in group R. Conclusions: In pediatric strabismus surgery, remifentanil provided similar hemodynamic stability, and an earlier and smoother recovery, compared with sevoflurane anesthesia. (Korean J Anesthesiol 2006; 51: 174~8)
임상연구 : 위절제술 환자에서 술 후 통증 조절 방법이 Cytokine 반응에 미치는 영향
정찬종 ( Chan Jong Chung ),신훈식 ( Hoon Sik Shin ),김태균 ( Tae Gyun Kim ),최소론 ( So Ron Choi ),진영준 ( Young Jhoon Chin ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.4
Background: The postoperative period is associated with the increased production of cytokines, which augments the sensitivity to pain. Epidural analgesia might reduce the postoperative stress response and influence the immune function. This study evaluated the effect of patient-controlled epidural analgesia (PCEA) on the cytokine response, compared with patient-controlled intravenous analgesia (PCTA) in patients undergoing a gastrectomy. Methods: Twenty-nine patients undergoing a gastrectomy were randomly assigned to one of two postoperative pain management techniques: PCTA (fentanyl 15㎍/ml) or PCEA (fentanyl 3㎍/ml in 0.1% ropivacaine). The level of postoperative pain was assessed at rest and during coughing using the visual analog scale (VAS). Blood samples were collected before administering anesthesia and 6, 24, and 48 h after surgery. The plasma concentrations of the tumor necrosis factor (TNF)-α, interleukin (IL)-l β, TL-6, TL-8, TL-lra, TL-l0, and TL-2 were assessed. Results: The patients in the PCEA group showed lower VAS pain scores during the 72 h after surgery, compared with the patients in the PCIA group. There was no change in the levels of TNF-α and IL-2 between the two groups at all times examined. In both groups, the levels of IL-1 β, IL-6, IL-8, IL-1ra, and IL-10 increased after surgery (each group, P < 0.05) but there was no significant differences between the two groups. Conclusions: These results suggest that PCEA has no added influences on the cytokine responses after a gastrectomy. (Korean J Anesthesiol 2006; 51: 443~8)
37권6호 영문부록 : 소아에서 Clonidine 직장 전투약의 효과
정찬종(Chan Jong Chung),여광환(Kwang Hwan Yeo),이수일(Soo Il Lee),진영준(Young Jhoon Chin) 대한마취과학회 1999 연수강좌 Vol.- No.-
Background : Oral clonidine has been shown to be an effective preanesthetic medication for children. Rectal administration of the premedicant would be as effective as oral administration. This study was designed to investigate the efficacy of rectal clondine as a premedicant in children. Methods : Forty-five children aged 3-6 yr undergoing elective surgery in inguinal region received midazolam 0.5 mg/kg, clonidine 2.5μg/kg, or clonidine 5μg/kg rectally 30 min before induction of anesthesia. The level of sedation, the quality of separation from the parent, and the acceptance of mask application during inhalation of halothane were noted. Anesthesia was maintained with continuous infusion of propofol and N20 66% in oxygen. The hemodynamic changes after tracheal intubation and propofol consumption were compared among the three groups. Side effects were evaluated from the premedication to 12 h after surgery. Results : The sedative effect of clonidine was dose related. The clonidine premedication at dose of 2.5μg/kg did not provide adequate preanesthetic sedation. Similar to midazolam 0.5 mg/kg, clonidine 5μg/kg provided effective preanesthetic sedation and good qualities of separation and acceptance of mask. Compared with midazolam 0.5 mg/kg, clonidine 5μg/kg attenuated the increases in blood pressure and heart rate following tracheal intubation, and decreased the maintenance dose of propofol during anesthesia. Bradycardia developed in 2 and 4 patients of the clonidine 2.5 μg/kg and clonidine 5.0μg/kg groups during surgery, respectively. No clinically significant side effects were observed at the preoperative and postoperative periods. Conclusions : These data indicate that rectal clonidine 5μg/kg would be an effective premedication in children. (Korean J Anesthesiol 1999; 37: S 10∼S 16)
임상연구 : 소아 사시 교정술에서 마취제가 각성 섬망에 미치는 영향
이승철 ( Seung Cheol Lee ),정찬종 ( Chan Jong Chung ),진영준 ( Young Jhoon Chin ),이수일 ( Soo Il Lee ),이종환 ( Jong Hwan Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.2
Background: This study was designed to compare the effects of anesthetic methods used recently on emergence delirium in pediatric strabismus surgery. Methods: Two hundred and thirty two children, aged 2-10 years, undergoing strabismus surgery, were randomly assigned to one of eight groups; ketamine-desflurane (n = 30), ketamine-sevoflurane (n = 30), ketamine-propofol (n = 30), ketamine-remifentanil (n = 27), midazolam-desflurane (n = 28), midazolam-sevoflurane (n = 30), midazolam-propofol (n = 27), and midazolam-remifentanil (n = 30). Anesthesia was induced with ketamine 1.0 mg/kg or midazolam 0.15 mg/kg. Laryngeal mask airway (LMA) was placed with rocuronium 0.5 mg/kg. Anesthesia was maintained with desflurane 5-6 vol%, sevoflurane 2-3 vol%, propofol 7-8 mg/kg/hr, and remifentanil 0.5μg/kg/min under N2O 66% in O2. Ventilation was controlled to maintain normocapnia. The status of emergence delirium (ED) was evaluated by a blinded observer until discharge from postanesthetic care unit. Results: There was no differences in age, sex, weight, height, anesthetic time, and recovery time among the eight groups. ED occurred in 54 children (23.3%), but severe ED needed treatment was not occurred. Compared with ketamine group, midazolam group showed less incidence of ED. Propofol and remifentanil groups showed less incidence of ED compared with desflurane and sevoflurane groups. ED group was more younger and more temperamental compared with nonED group. Conclusions: Propofol or remifentanil anesthesia provided less incidence of ED compared with desflurane and sevoflurane in pediatric strabismus surgery. (Korean J Anesthesiol 2007; 52: 138~42)
제 2족지 근위 지골에 발생한 저악성도 골육종 - 증례 보고 -
한정수,정덕환,신동준,임양선,정찬종,Han, Chung-Soo,Chung, Duck-Hwan,Shin, Dong-Jun,Lim, Yang-Sun,Jung, Chan-Jong 대한근골격종양학회 2001 대한골관절종양학회지 Vol.7 No.4
족부에 발생하는 골육종은 전체 골육종의 0.2~2%로 매우 드물며 장관골의 골간단부에 발생하는 저악성도 골육종은 전체 골육종의 약 1.9% 정도를 차지하는 드문 종양이다. 본 교실에서는 제 2족지 근위 지골의 종물과 심한 동통으로 내원한 38세 여자 환자에서 발생한 저악성도 골육종 1례를 경험하였다. 환자는 단순 방사선 검사상 좌측 제 2족지 근위 지골 전체를 침범한 골용해성 병변이 관찰되었으며 피질골은 얇고 팽대된 소견을 보였다. 골주사 검사상 단순 방사선 사진에서 보인 것과 동일한 위치에 흡수 증가의 소견을 보여 양성 골종양으로 판단하고 종양 절제 후 늑골을 이용한 관절 재건술을 시행하였다. 수술 후 조직학적 소견상 저악성도 골육종으로 판정되었고 이차적으로 좌측 제 2족지의 근치적 광범위 절제술을 시행하였다. 제 2족지 근위 지골에 발생한 저악성도의 골육종은 매우 드문 종양으로 광범위 절제술 후 좋은 결과를 얻었기에 문헌 고찰과 함께 보고하는 바이다. The reported incidence of osteosarcoma of the foot varies between 0.2-2% of all osteosarcoma. Low grade osteosarcoma of the long bone represents only 1.9% of all osteosarcoma. A 38-year-old female had suffered painful mass in the proximal phalanx of the second toe for 1 year. Radiographic finding showed enlarged osteloytic mass which had penetrated thin cortex of the second toe and apparent increased uptake in bone scan was seen. Mass resection with autogenous bone graft using rib was performed. Histologically, the tumor was compatible with "low grade osteosarcoma". Second stage wide resection was performed. Because low grade osteosarcoma located in the proximal phalanx of the second toe is very rare, we report this unusual case with review of literature.