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뇌압이 증가된 환자에서 마취유도 용량의 Etomidate와 Propofol 일회량 정주가 뇌관류압에 미치는 효과의 비교
안우용,연준흠,김계민,이윤석,김정원,홍기혁 대한정맥마취학회 2000 정맥마취 Vol.4 No.2
서론: 두개내압 항진은 두부 외상 후에 자주 발생하고 치명적인 합병증이다. 이 연구는 두개내압이 항진되어 있는 중환자실 환자들에서 etomidate 일회 정주가 동맥혈압, 두개내압, 뇌관류압에 미치는 효과를 알아보고 propofol과 비교하기 위해서 고안되었다. 방법: 1998년 7월부터 12월까지 상계 백병원 중환자실에 두부외상으로 입원한 성인 환자 일곱명을 대상으로 하였다. 일차수술을 통해 혈종을 제거한 후 혼수상태로서 기계환기를 받고 있으면서 두개내 탐침으로 두개내압을 감시하고 있었다. 이미 시행되고 있는 신경외과적 치료는 별도로 통제하지 않았다. 평균 동맥혈압과 두개내압의기본값을 측정한 뒤 etomidate 0.3 ㎎/㎏과 propofol 2 ㎎/㎏ 중에서 무작위로 한가지 약물을 선택하여 말초혈관을 통해 서서히 정주하였다. 투여 후 2, 4, 6, 8, 10분에 평균 동맥혈압과 두개내압을 측정하여 뇌관류압을 계산하였다. 48시간이 지난 뒤 나머지 약물에 대한 연구를 같은 방법으로 시행하였다. 모든 측정치는 반복측정 분산분석으로 약물 내, 약물 간에 비교하였다. 결과: Etomidate와 propofol 투여로 인한 평균 동맥 혈압의감소는 etomidate에서 5 ㎜Hg, propofol에서 6 ㎜Hg로서 기본값에 비해서 투여 후 2분 동안 유의한 차이가 있었지만(P < 0.05) 약물간에는 차이가 없었다. 두개내압은 etomidate 투여 후 2분부터 10분까지 5 ㎜Hg, propofol 투여 후 2 ㎜Hg의 유의한 감소폭을 유지하였지만(P < 0.05) 약물 간의 차이는 없었다. 계산된 뇌관류압은 두 약제 모두에서 의미있는 변화를 보이지 않았다. 결론: 두개내압 항진에 대해서 이미 고식적인 치료가 시작된 두부외상 환자에서 마취유도 용량의 etomidate와 propofol 일회정주로는 뇌관류압 개선을 얻을 수 없었다. Background: Increased intracranial pressure (ICP) is one of life-threatening complications after head injury. This study was conducted to evaluate the effectiveness of etomidate single bolus on mean arterial pressure (MAP), ICP and cerebral perfusion pressure (CPP) compared to that of propofol in postoperative patients with increased ICP. Methods: Seven patients with increased ICP after head injury were randomly selected. ICP was monitored continuously in intensive care unit. Managements already given for lowering ICP, such as hyperventilation, barbiturate and mannitol, were not controlled. Study was done in 2 steps. Baseline measurements of MAP and ICP were obtained for 5 minutes. In the first step, etomidate 0.3 ㎎/㎏ in three patients and propofol 2 ㎎/㎏ in four patients were given slowly through peripheral vein. MAP and ICP were recorded at 2, 4, 6, 8 and 10 minutes after drug administration. In the second step, performed 48 hours later, study drug was swapped in each patient. Details were same with the first step. CPP was calculated by difference of MAP and ICP. All measurements were analyzed within and between drugs by repeated measures ANOVA & multiple comparison. Results: MAP reduced were 5 ㎜Hg by etomidate and 6 ㎜Hg by propofol, which were not significant between drugs and confined to 2 minutes after drug administration (P < 0.05). ICP reduced by 5 ㎜Hg by etomidate and 2 ㎜Hg by propofol, which such reductions were sustained for 10 minutes (P < 0.05), however, there was no statistical difference between drugs. CPP were not changed significantly by both drugs. Conclusions: Etomidate and propofol single boluses cannot improve CPP in patients with increased ICP.
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TCI(Target Controlled Infusion)를 이용한 Propofol 의 수면 상태하 신경차단술
오완수,홍기혁,안우용 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.1
Background : The use of sedative and analgesic adjuncts during local and regional anesthesia can enhance patieet comfort and improve operative conditions. Because propofol has well-known rapid recovery characterized by clear-headedness$quot;, its use intraoperatively may result in less postoperative sedation and thus shorten the time for discharge from the hospital. The purpose of this study was designed to evaluate the patients satisfaction of hypnotic neural blockade using target controlled infusion (TCI) of propofol. Methods: Sixty-two patients scheduled to undergo elective neural blockade in the operating room were selected for this study. They had taken previous neural blockade in the awakening state. Without premedication, they amved at the operating room via pain clinic. After proper positianing, vital signs, pulse oximetry and respiratory rate were monitored. TCI of propofol was started at a target concentration of 3.0 μg/ml and an induction time of 3 minutes. We regarded loss of hand grasping power as iduction of hypnosis. Subsequently, target concentration was adjusted to a range of 0.8-1.6 times the effector site concentration at induction. Propofol infusion was stopped when the procedure was finished and the patients were transported to the recovery room and discharged. The satisfaction of patients conceming hypnotic neural blockade were evaluated by a six point numerical rating scale (6: best-1: worst). Results : Patient withdrawal movement during local anesthetic infiltration occured in 17 patients. Recovery time was 4.7 ± 3.0 min (mean ± S.D.). Patient's satisfaction for hypnotic neural blockade was 5 [3-6] (median [rangeJ]. Conclusion : Patient's satisfaction for hypnatic neural blockade was high. TCI of propofol serves as a safe sedation model during neural blockade without any residual sequelae. (Korean J Anesthesiol 2000; 39: 56~60)
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