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염종훈,안대웅,김경헌 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.4
Background: Many clinicians have probably used subjective, unscientific methods for dose reduction to avoid overdose in elderly patients. The aim of this study was to compare several dosing schedules of intravenous dexmedetomidine (DEX) to identify the appropriate dosing schedule within the therapeutic dose range for adequate sedation of elderly patients under spinal anesthesia. Methods: After administration of spinal anesthesia, a loading dose of DEX was injected over 10 min in three groups with the following dosages: group A, 1.0 mg/kg of actual body weight; group B, 1.0 mg/kg of ideal body weight (IBW); and group C, 0.8 mg/kg of IBW. Then, a maintenance infusion (0.5 mg/kg of each BW/h) was administered. The bispectral index score (BIS), the time required to reach BIS 80, airway obstruction score, and the occurrence of bradycardia were recorded. Results: The changes in the BIS among the groups over time were found to have statistically significant differences (P < 0.001). The times required to reach BIS 80 were 6.1 ± 5.3 min, 5.0 ± 3.6 min, and 11.0 ± 8.6 min in groups A, B, and C, respectively (P < 0.001). The airway obstruction score and the frequency of bradycardia did not have statistically significant differences among the groups. Conclusions: An initial loading dose of DEX that is 0.8 mg/kg of IBW over 10 min, followed by an infusion rate of less than 0.5 mg/kg of IBW/h may be adequate for sedation in elderly patients receiving spinal anesthesia.
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염종훈,오미경,안대웅,박수인 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.3
Background: For many drugs, dosing scalars such as ideal body weight (IBW) and lean body mass are recommended over the use of total body weight (TBW) during weight-based dose calculations. Doses based on TBW are frequently used, and this may cause under- or over-dosing. Because dexmedetomidine (DEX) overdosing could increase the incidence of side effects, and spinal anesthesia may increase sensitivity to a sedative agent, determining an appropriate dose is critical. Methods: Eighty patients were randomly divided into 2 groups, the IBW and TBW groups. Patients received a loading dose of DEX 1 μg/kg IBW or TBW for 10 min, followed by a continuous infusion at 0.5 μg/kg/h IBW or TBW after the induction of spinal anesthesia. The patients’ vital signs, bispectral index (BIS), peripheral capillary oxygen saturation, time to reach a BIS of 80, airway obstruction score, and coughing were monitored and recorded at 0, 10, 30, and 50 min after the start of the loading dose injection. Results: The changes in BIS, airway obstruction score, the incidence of side effects, and time to reach a BIS of 80 did not show statistically significant differences between the two groups. However, airway obstruction and/or coughing occurred in both groups, and the average BIS in both groups was lower than the target BIS of 60?80 at 30 and 50 min. Conclusions: A loading dose of DEX 1 μg/kg for 10 min, and a maintenance dose of DEX 0.5 μg/kg/h of either IBW or TBW, may induce excessive sedation, airway obstruction, and/or coughing under spinal anesthesia.
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염종훈,김경헌,최규호,이재민 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.66 No.6
Background: In this study, we assessed the 50% effective concentration (EC50) of sevoflurane for reducing a rocuronium-induced reaction, based on the Dixon’s up-and-down method. We also assessed the 50 and 95% effective end-tidal concentration of sevoflurane (ETsev), based on the probit regression curve of the probability of nonwithdrawal reaction. Methods: We conducted a prospective, double-blind study in 23 males and 24 females. After using 2.5% thiopental sodium (4 mg/kg), anesthesia was induced in the patients. The patients then inhaled sevoflurane with 5 vol% in 6 L/min of oxygen. When the target ETsev was achieved, a nurse injected the intubating dose of rocuronium (0.6 mg/kg) for 5-10 s under the free flow of intravenous fluid. After the nurse evaluated the response, the nurse recorded the maximum heart rate during 30 s and the mean arterial pressure after rocuronium injection. Results: Based on Dixon’s up-and-down method, the EC50 of sevoflurane was 2.5 ± 0.5 vol% in males and 2.5 ± 0.3 vol% in females. The probit regression curve of the probability of nonwithdrawal reaction showed that in males the 50% effective ETsev was 2.4 vol% (95% confidence interval [CI], 1.5-3.1 vol%) and the 95% effective ETsev was 3.5 vol% (95% CI, 2.9-11.0 vol%); in females, the 50% effective ETsev was 2.4 vol% (95% CI, 2.1-2.7 vol%) and the 95% effective ETsev was 3.0 vol% (95% CI, 2.7-4.5 vol%). Conclusions: The inhalation of sevoflurane during the induction period may provide a simple and reliable means of reducing rocuronium-induced reactions without adverse hemodynamic changes. There was no significant difference between males and females.
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염종훈,김경헌,전명수,변장원,조상윤 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.2
Background: Although acute tolerance to opioids, especially to remifentanil, has been demonstrated consistently in animal studies, the results of clinical trials in humans are controversial. The aim of this study was to determine whether intraoperative infusions of remifentanil used as an adjuvant in general anesthesia result in acute tolerance, an event manifested by increased postoperative pain and a higher opioid requirement than usual. Methods: Sixty patients who underwent surgery under general anesthesia for spinal fusion were randomly assigned to receive sevoflurane-nitrous oxide-oxygen (group SO, n = 20), sevoflurane-remifentanil-nitrous oxide-oxygen (group SR, n = 20), or propofol-remifentanil-oxygen (group PR, n = 20) in a double-blinded manner. All patients within 1 hour after induction received PCA (fentanyl 0.4 μg/kg/ml and ondansetron 16 mg) administered intravenously at a basal infusion rate of 1 ml/h, after being intravenously injected with a loading dose of fentanyl (1 μg/kg). Data for fentanyl requirement, verbal Numerical Rating Scale (NRS) pain score at rest, and presence of nausea or vomiting were collected at 1, 24, and 48 hours after surgery. Results: We did not find any significant difference in postoperative PCA fentanyl requirements, NRS or side effects among the groups. Conclusions: Remifentanil as an adjuvant to sevoflurane or propofol in general anesthesia for adults having surgery for spinal fusion does not appear to cause acute opioid tolerance or hyperalgesia in patients. However, further studies are needed to elucidate whether sevoflurane and propofol exert a clinically significant effect on opioid-induced tolerance or hyperalgesia and whether this effect is related to the age of the patient, the dose and duration of remifentanil given and the intensity of pain experienced postoperatively.
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염종훈,전명수,전우재,심재항 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.1
Background: In this study, we assessed the effectiveness of ketamine as an alternative to non-steroidal antiinflammatory drugs (NSAID), to manage acute postoperative pain after spinal fusion when given intravenously via a patient-controlled analgesia (PCA) pump in which the dose was proportional to that of fentanyl. Methods: Forty patients undergoing 1-2 level spinal fusion were enrolled in this study. Patients were intraoperatively randomized into two groups to receive intravenous PCA consisting either of fentanyl 0.4 μg/ml/kg (control group) or fentanyl 0.4 μg/ml/kg with ketamine 30 μg/ml/kg (ketamine group) after intravenous injection of a loading dose. The loading dose in the control group was fentanyl 1 μg/kg with normal saline equal to ketamine volume and in the ketamine group it was fentanyl 1 μg/kg with ketamine 0.2 mg/kg. The verbal numerical rating scale (NRS),fentanyl and ketamine infusion rate, and side effects were evaluated at 1, 24, and 48 hours after surgery. Results: There were no significant differences in patient demographics, duration of surgery and anesthesia or intra-operative opioids administration. We did not find any significant differences in the mean infusion rate of intraoperative remifentanil or postoperative fentanyl or in the side effects between the groups, but we did find a significant difference in the NRS between the groups. Conclusions: Based on our results, we conclude that a small dose of ketamine (0.5-2.5 μg/kg/min) proportional to fentanyl is not only safe, but also lowers postoperative pain intensity in patients undergoing spinal fusion, although the opioid-sparing effects of ketamine were not demonstrated. Background: In this study, we assessed the effectiveness of ketamine as an alternative to non-steroidal antiinflammatory drugs (NSAID), to manage acute postoperative pain after spinal fusion when given intravenously via a patient-controlled analgesia (PCA) pump in which the dose was proportional to that of fentanyl. Methods: Forty patients undergoing 1-2 level spinal fusion were enrolled in this study. Patients were intraoperatively randomized into two groups to receive intravenous PCA consisting either of fentanyl 0.4 μg/ml/kg (control group) or fentanyl 0.4 μg/ml/kg with ketamine 30 μg/ml/kg (ketamine group) after intravenous injection of a loading dose. The loading dose in the control group was fentanyl 1 μg/kg with normal saline equal to ketamine volume and in the ketamine group it was fentanyl 1 μg/kg with ketamine 0.2 mg/kg. The verbal numerical rating scale (NRS),fentanyl and ketamine infusion rate, and side effects were evaluated at 1, 24, and 48 hours after surgery. Results: There were no significant differences in patient demographics, duration of surgery and anesthesia or intra-operative opioids administration. We did not find any significant differences in the mean infusion rate of intraoperative remifentanil or postoperative fentanyl or in the side effects between the groups, but we did find a significant difference in the NRS between the groups. Conclusions: Based on our results, we conclude that a small dose of ketamine (0.5-2.5 μg/kg/min) proportional to fentanyl is not only safe, but also lowers postoperative pain intensity in patients undergoing spinal fusion, although the opioid-sparing effects of ketamine were not demonstrated.
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염종훈,김용오,이재민,전우재 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.66 No.4
Background: During induction of general anesthesia, the intravenous injection of rocuronium is often associated with withdrawal movement of the arm due to pain, and this abrupt withdrawal may result in dislodgement of the venous catheter, injury, or inadequate injection of rocuronium. We performed this study to evaluate the 50 and 95% effective end-tidal concentrations of sevoflurane (ETsev) for preventing rocuronium-induced withdrawal of the arm. Methods: We conducted a prospective double-blind study in 31 pediatric patients. After free flow of lactated Ringer’s IV fluid was confirmed, anesthesia was induced in the patients by using 2.5% thiopental sodium (4 mg/kg) and sevoflurane (4 vol%) with 6 L/min of oxygen. When the target ETsev was reached, preservative-free 1% lidocaine (1.5 mg/kg) was intravenously injected during manual venous occlusion and rocuronium (0.6 mg/kg) was injected after lidocaine injection under free-flow intravenous fluid. A nurse who was an investigator and was blinded to the ETsev injected the rocuronium. The nurse evaluated the response. Results: Non-withdrawal movement was observed in 5 out of 11 patients with ETsev 3.0 vol% and in 5 out of 6 patients with ETsev 3.5 vol%. By Dixon’s up-and-down method, the 50% effective concentration (EC50) of sevoflurane for non-withdrawal movement at rocuronium injection was 3.1 ± 0.4 vol%. A logistic regression curve of the probability of non-withdrawal movements showed that the 50% effective ETsev for abolishing withdrawal movement at rocuronium injection was 2.9 vol% (95% confidence interval [CI] 2.4-3.8 vol%) and the 95% effective ETsev was 4.3 vol% (95% CI 3.6-9.8 vol%). Conclusions: This study showed that the 50 and 95% effective ETsev that prevent withdrawal movement at rocuronium injection are 2.9 and 4.3 vol%, respectively.
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향부자(香附子)가 천식 관련 Th1/Th2 세포 관련 cytokine 분비에 미치는 영향
염종훈,이형구,정승기,정희재,Yom, David Jong-Hoon,Rhee, Hyung-Koo,Jung, Sung-Ki,Jung, Hee-Jae 대한한방내과학회 2009 大韓韓方內科學會誌 Vol.30 No.3
Background and Objective : Cyperus rotundus L. (CR) is a commonly used herbal medicine in Asian countries such as Korea, China and Japan. The present study was designated to evaluate the direct effects of CR on helper T cell activities and on Th1/Th2 lineage development in vitro. Materials and Methods : Spleen cells from 8 week BALB/c mice were cultured in CR extracts containing medium without activation for 24 hours and with activation for 48 hours. CD4+ T cells were isolated and analyzed for mRNA expression levels of INF-$\gamma$, IL-4, T-bet and GATA-3 by RT-PCR and secretion cytokines levels of INF-$\gamma$, IL-4, IL-5 and IL-10 by ELISA. Results : The results demonstrated that CR had no mitogenic effects on unstimulated CD4+ T cells, but augmented CD4+ T-cell proliferation upon activation with anti-CD3/anti-CD28 antibodies in a dose-dependent manner. CR treatment significantly increased CD4+ T cell population and the IFN-$\gamma$ expression was significantly enhanced, while IL-4 expression was significantly decreased. In addition, in vitro Th1/Th2 polarization experiments revealed that CR enhanced IFN-$\gamma$ secretion in Th1 cells, but reduced the IL-4 in Th2 cells in a dose-dependent manner. Conclusion : These results suggest that CR treatment could be a desirable alternative therapy for the prevention or correction of Th2 dominant pathological disorders, such as allergy and asthma.
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