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Desflurane 폐포내농도 상승에 따른 뇌산소포화도 반응에 미치는 Remifentanil의 효과와 뇌혈관의 이산화탄소 반응성
이정혁 ( Jeoung Hyuk Lee ),이윤석 ( Youn Suk Lee ),인준용 ( Jun Yong In ),정승현 ( Seung Hyun Chung ),신홍일 ( Hong Il Shin ),이경진 ( Kyoung Jin Lee ),김경옥 ( Kyoung Ok Kim ),조헌 ( Hun Cho ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5
Background: It is known that sympathetic stimulation and increase in cerebral blood flow velocity can be induced by desflurane. Cerebral oxygen balance could be disturbed during desflurane induction. Aim of this study was to elucidate that cerebral oxygen imbalance induced by desflurane mask induction can be reduced by combination of remifentanil and hypocapnia. Methods: Twenty ASA 1-2 subjects were allocated randomly into 5 groups divided by concentration of remifentanil (0.0, 0.5, 1.0, 1.5, and 2.0 ng/ml). After confirmation of attaining proposed concentration of remifentanil, propofol and vecuronium were administered and mechanical ventilation was done with 8% desflurane with facial mask. Subsequently, changes in regional cerebral oxygen saturation (△rSO2), arterial blood pressure, heart rate, cardiac index, estimated alveolar concentration of desflurane (P(DESF)), and end-tidal concentration of carbon dioxide (PET(CO2)) were recorded for the following 10 minutes. According to concentration of desflurane and remifentanil, △rSO2 and hemodynamic factors were checked. Results: During desflurane induction, changes in cerebral oximetry reached up to+10% (6 [first quartile], 13 [third quartile]). Arterial blood pressure, heart rate, and cardiac index were changed within clinical ranges. The △rSO2 showed S-shaped increasing pattern according to increasing P(DESF). Hypocapnia and concentration of remifentanil reduced the maximum △rSO2 (P=0.0046, P=0.0060). Hypocapnia also shifted the curve to left (P=0.0001). Conclusions: During 8% desflurane induction, regional cerebral oxygen saturation (rSO2) increases maximum +25%. Hypocapnia and use of remifentanil can reduce the increase in regional cerebral oxygen saturation. (Korean J Anesthesiol 2009;56:543~51)
조헌일,백병용,한영희,안승운,유원상 충남대학교 의과대학 지역사회의학연구소 1976 충남의대잡지 Vol.3 No.2
Free fatty acid levels in plasma of normal Korean adults consist of 46 males and 9 females were measured by Dole and Meinertz modification at the department of internal medicine, Chungnam university hospital in the period of July to Sep, 1976. The results were as below : 1. Plasma FFA level of normal male adults were 683.6±193.9 μEq/L, of female 806.0±192.2μEq/L and of total were 710.0±207.4μEq/L. 2. Relatively high normal value were compared with other data and the possible causes of difference was discussed.
박영철,이일옥,조헌,서병태 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.3
Twenty cases of laryngeal intubation granuloma were diagnosed during the three year period from July, 1984 to December, 1987 at the Departements of Otolaryngology and Anesthesiology, Guro Hospital, College of Medicine, Korea University. Among the twenty cases, nine had previous operation at the same hospital, where 14,866 cases of endotracheal anesthesia were performed during the period. A clinical analysis of these case was made to obtain observations as follows: 1) Twenty cases were all female. 2) Nineteen case were adults with ages ranging from 19 to 71 years, and one case was an 8 year old who had undergone open heart surgery. 3) In 7 cases which comprises about 30% of all surgery had been performed on the head and neck area. The duration of endotracheal intubation for those cases were variable ranging from 55 minutes to 75 hours. 4) The site of the granuloma was the vocal process of the arytenoid cartilages in 19 patients. In 7 patients the granuloma observed were bilateral, in 7 on the left side, and in 6 on the right side. 5) The chief complaints of the granuloma patients were hoarsness in 18 patients, respiratory difficulty in 10 patients, and foreign body sensation in 4 patients. 6) These proven cases wereall treated by removal of the granuloma under suspension laryngoscopy. The results were excellent except for one case which showed recurrence in 3 months.
정맥내 자가통증조절시 Morphine과 Fentanyl의 혼합사용 효과
김태일,윤석민,조헌,이혜원,장성호,임혜자,윤희동 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5
Background: The highly lipid soluble opioid, fentanyl, has a rapid onset and short duration of action. The present study was designed to examine the analgesic efficacy and side effects of the combination of fentanyl with morphine in patients using intravenous PCA. Methods : Patients were randomly assigned to receive one of three PCA regimens: M4 group (40 mg morphine+90 mg ketorolac+1.5 mg dorperidol), M2F2 group (20 mg morphine+200 ug fentanyl+90 mg ketorolac+1.5 mg dorperidol), or M2F4 group (20 mg morphine+400 ug fentanyl+90 mg ketorolac+1.5 mg dorperidol). All patients were given initial loading dose of 0.1 mg/kg morphine plus 1 mg droperidol at the end of surgery. Pain score, side effects, and overall satisfaction were assessed at 30 min, 1 hr, 8 hr, 24 hr, and 48 hr postoperatively. Results : The pain score was significantly higher in the M2F2 group than in the M4 group and M2F4 group during 1 hr and 8 hr postoperatively. The total opioid consumption was significantly greater in the M2F4 group than in the M4 group. Patient satisfaction was better in the M2F4 than other two groups. There were no differences in the overall incidence of side effects among three groups. Conclusions : The present results suggest that the combination of fentanyl with morphine for intravenous patient-controlled analgesia is a useful method, and the double dose of fentanyl in comparison with the equipotent morphine dose is recommended in the early postoperative period. (Korean J Anesthesiol 1998; 35: 975∼982)