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Ketamine 에 의한 Vencuronium 의 근이완 효과에 미치는 영향
신양식,고신옥,전명숙,길혜금 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.1
Comflicting results have been reported on whether ketamine potentiates the neuromuscular effect of succinylcholine or other non-depolarizing agents. Notably, there has been no reported clinical evatustion of the influence of ketamine upon the neuromuscular action of vecuronium, a new muscle relaxant. The present study was undertaken to estimate the influence of ketamine upon the neuromuscular action of vecuronium with a single bolus injection of ED_95. Forty-five ASA class ⅠorⅡ surgical patients were divided into three groups:Ⅰ,Ⅱ and Ⅲ, and were given thiopental sodium(5 mg/kg). ketamine 3mg/kg and ketamine 5 mg/kg as induction agents, repectively. The duration and recovery index of groups Ⅱ and Ⅲ (35.20±2.30 and 16.20±1.37 min., 52.60±3.98 and 25.47±3.78 min., respectively) were longer than those in group Ⅰ (24.87±1.59 and 10.66±1.23 min.). But group I had a lower TOF ratio(27.40±3.09%) at 75% single twitch recovery than groups Ⅱ and Ⅲ (41.87±3.25 and 45.27±3.67%, respectively). The increase in duration and the recovery index of group Ⅲ were greater than that of group Ⅱ. It was concluded that ketamine would potentiate the neuromuscular action of vecuronium in a dose-dependent manner. We suggest that combination of ketamine and mecuronium requires careful postorperative neuromuscular monitoring for the recovery from a vecuroniuminduced neuromuscular block.
뇌피질 전기자극하에서 여러가지 마취제에 의한 복합근육 운동 유발전위 양상
신양식,민경태,강상화 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.1
Motor evoked potentials(MEP) have been recently introduced as intraoperative monitoring of descending motor pathways. Transcranial electrical or magnetic MEP have been using clinically, but there are still some limitations of using in operating room. Furthermore, according to anesthetic regimens, MEP responses vary significantly. The authors observed the effects of the various anesthetics (thiopental, fentanyl, ketamine, nitrous oxide and isoflurane) on electocortical MEP in a patient who had been previously undertaken electrocortico-graphic grid insertion operation for seizure monitoring. Electromyographic responses were recorded from contralateral arm flexor and extensor using needle type electrode. Most anesthetics except ketamine decreased the amplitude of MEPs reversibly and there were differences in electromyographic responses according to measuring compound muscles.
신속한 기관내삽관을 위한 Rocuronium의 Timing Principle 도입의 적절성
신양식,이수경 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.2
Background: The timing principle utilises a single bolus of nondepolarizing neuromuscular blocking drug followed by an induction drug at the onset of clinical weakness. The purpose of this study was to compare the intubating conditions after succinylcholine or rocuronium and after rocuronium using the timing principle. Methods: Forty patients were randomly allocated into four groups. Patients in group I received rocuronium 0.6 mg/kg using the timing principle, At the onset of clinical weakness, anesthesia was induced with the thiopental 4 - 5 mg/kg. Patients in group II, III, and IV received rocuronium 0.6, 0.9 mg/kg, and succinylcholine 1.5 mg/kg respectively using the usual technique. The trachea were intubated 60 s after thiopental induction. Accelerographic response to train-of-four (TOF) stimulation of the ulnar nerve was used for neuromuscular monitoring. Intubating conditions were assessed according to a grading scale. Results: The twitch depression immediately before tracheal intubation in group I, II, III, and IV were 14.5, 28.2, 11.1, and 6.8%, respectively. The TOF count showed no significant differences between groups. The duration of action in group III (45.3 ± 12.1 min) was significantly prolonged compared to that in group I (31.2 ± 6.4 min). Intubation conditions were either good or exellent in all patients except one in group II. In group I, three patients recalled shortness of breath or general weakness. Conclusions: It is coneluded that the use of rocuronium 2×ED_(95) using the timing pri#nciple did not provide additional benefits compared to rocuronium 3×ED_(95) using the usual technique except in duration.
신양식,박광원,남순호,조범준 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.2
For the rapid endotracheal intubation, the ideal neuromuscular blocking drug with short onset time, short duration and few side effects has so far not been found. Succinylcholine is still, inspite of its side-effects and contraindications, the standard drug of choice for rapid intubation. But, high-dose vecuronium as an alternative to succinylcholine for rapid intubation may be recommended. To compare the intubating conditions with that in succinylcholine, the onset and cardiovascular effects of high-dose vecuronium(0.3 mg/kg) were evaluated clinically with a scoring system. The results are as follows ; 1) High-dose vecuronium may provide an alternative means of achieving a rapid onset of neuromuscular blockade. 2) High-dose vecuronium shows minimal effects on cardiovascular system. In concluson, high-dose vecuronium as an alternative method for rapid endotracheal intubation may be recommended without any significant cardiovascular change if succinylcholine is contraindicated.