Alfentanil과 remifentanil 정주 후 나타나는 기침의 발생 빈도와 정도 비교

Introduction: Intravenous administration of fentanyl derivatives can induce cough paradoxically. This study examined the incidence and severity of cough after a bolus of alfentanil and remifentanil. Methods: Four-hundred sixty five patients, aged 18-70 years, were allocated randomly to three groups to receive alfentanil 10 μg/kg, remifentanil 1 μg/kg, or an equal volume of 0.9% saline intravenously over 10 s. Any episode of cough was classified as coughing and graded as mild (1-2), moderate (3-4) or severe (5 or more). Results: The overall incidence of cough was higher in the opioid groups than the saline group. The remifentanil group [39/150 patients; 26.0%, (95% CI, 19.6-33.6%)] showed a higher incidence than the alfentanil group [11/152 patients; 7.2%, (95% CI, 0.4-12.6%)] (P < 0.001). There was no significant difference in the severity of cough between alfentanil and remifentanil group. Conclusion: This study demonstrated that the equipotent boluses of alfentanil and remifentanil induced coughing, even though the incidence of cough after alfentanil administration was lower than that after remifentanil administration.ABSTRACT i TABLE OF CONTENTS ii LIST OF TABLES iii LIST OF FIGURE iv ABBREVIATIONS v I. INTRODUCTION 1 II. PATIENTS AND METHODS 3 III. RESULTS 5 IV. DISCUSSION 12 REFERENCES 17 국문요약 21Docto

삼차신경통과 비정형 안면통 환자에서 MMPI를 이용한 성격 비교

PURPOSE: Trigeminal neuralgia and atypical facial pain are representative disease entities of chronic facial pain. Most patients of these disaeses could be accompanied with psychological, emotional problems as their pain become chronic. These diseases actually have many differences in pathophysiology, symptom, treatment, and prognosis each other. Atypical facial pain shows a tendency to coexist particular characteristics of personality disorders. The purpose of this study is to investigate whether different types of chronic facial pain lead to alteration in personality disorder or they are associated with particular characteristics of personality disorders using Minnesota multiphasic personality inventory (MMPI). MATERIALS AND METHODS: 40 patients of trigeminal neuralgia and 21 patients of atypical facial pain who had responded MMPI were enrolled in this study. Two groups were compared for age, sex, pain intensity (Visual analogue scale, VAS), duration of pain, MMPI scores and psychological impression from MMPI results. The relationship between MMPI　scores and pain intensity as well as duration of pain in each group were analysed. RESULT: Pain intensity and chronicity were more severe and longer in trigeminal neuralgia group than atypical facial pain. However, some MMPI profiles such as hypochondriasis and hysteria were significantly elevated in atypical facial pain. Pain intensity and duration did not correlate with MMPI profiles in each group. Meaningful psychological impression from MMPI results which were interpreted by one psychologist were shown in 13 patients of trigeminal neuralgia (32.5%) and 14 patients of atypical facial pain (66.7%). Especially, psychosomatic disorder was most frequently impressed in atypical facial pain patients (47.6%). CONCLUSION: Atypical facial pain patients have psychologic and emotional problems more frequently than trigeminal neuralgia patients independent of pain intensity and chronicity. It suggests that careful consideration about possible existence of personality disturbances in the atypical facial pain patients is needed, and it would be helpful to consider psychologic consultation and treatment as well as pain control.목적: 삼차신경통과 비정형 안면통은 얼굴에 만성적인 통증을 일으키는 대표적인 질환이다. 일반적으로 만성적 통증 질환을 갖고 있는 환자는 통증의 만성화에 따른 우울, 불안 등의 정신적, 정서적 문제점을 동반하는 경향이 있는 것으로 알려져 있다. 두 질환은 치료 및 예후에 큰 차이를 갖고 있지만 진단을 하는데 있어서는 특별한 혈액검사나 방사선학적인 검사 등의 객관적인 검사에 따르는 것이 아니라 환자의 과거력, 통증의 양상 및 그 동안의 치료에 대한 반응 등을 고려하여 임상 진단기준에 맞추어 진단을 내리게 되는 질환이다. 삼차신경통은 특유의 통증을 나타내나 비정형 안면통인 경우에는 통증의 양상이 다양하며 두 질환 모두 임상증상을 기준으로 진단을 내리는 데 있어 모호성을 주는 경우가 있으며, 비정형 안면통 환자의 경우 정서적인 요소가 질환 발생과 연관이 있다고 주장되어지고 있다. 본 연구에서는 다면적 인성검사(Minnesota Multiphasic Personality Inventory, MMPI)를 이용하여 두 질환 환자군에서 통증의 만성화가 환자들의 정서적 이상을 초래하는지 또는 이러한 질환을 일으키는 특유의 정서적 이상이 질환 발생과 연관이 되는지를 알아보고자 하였다. 대상 및 방법: 삼차신경통 환자 40명, 비정형 안면통 환자 21명을 대상으로 두 군간에 나이, 성별, 시각 통증 등급(Visual Analogue Scale, VAS)을 이용한 통증 정도, 이환 기간과 MMPI의 임상척도를 각 군간 비교하였고, 각 군내에서 통증 정도와 이환 기간에 따른 MMPI의 임상척도와의 상관관계를 분석하였으며, MMPI 결과에 따른 추정 진단을 양 군간에 비교하였다. 결과: 삼차신경통 환자군에서 비정형 안면통군에 비하여 통증의 강도가 심하게 나타났으며, 이환 기간도 유의하게 길게 나타났으나 MMPI 임상척도는 비정형 안면통 환자군에서 건강염려증(Hypochondriasis, Hs)과 히스테리(Hysteria, Hy)의 수치가 높게 나타났다. 두 군 모두에서 통증강도 및 이환 기간은 MMPI 임상척도와 상관관계가 없는 것으로 나타났다. MMPI에 의한 심리학적 추정 진단의 비교에서는 정상범주를 벗어난 의미 있는 해석이 나온 경우가 삼차신경통에서는 40명 중 13명으로 32.5%, 비정형 안면통에서는 21명 중 14명으로 66.7%를 차지하였고, 이러한 추정 진단 중 비정형 안면통 환자군의 47.6%에서 정신신체장애(Psychosomatic disorder) 소견을 보였다. 결론: 비정형 안면통 환자군에서 보이는 MMPI 결과의 이상소견은 질환의 만성화에 의한 것이라기보다는 질환자체의 병태생리로 생각할 수 있으며, 이러한 객관적인 검사 결과를 만성 안면통 환자의 진단 및 치료에 반영하여 좀더 정확한 진단 및 적정한 치료에 도움이 될 것으로 생각된다."차례 국문요약 = i 차례 = iii 표차례 = iv 약어 = v Ⅰ. 서론 = 1 Ⅱ. 대상 및 방법 = 2 Ⅲ. 결과 = 4 Ⅳ. 고찰 = 7 Ⅴ. 결론 = 10 참고문헌 = 11 ABSTRACT = 14"Maste

예방적으로 투여한 Dolasetron과 마취 유도제로 사용한 Propofol이 갑상선 절제술 후 오심과 구토에 미치는 영향

Background: Postoperative nausea and vomiting (PONV) is a common problem in patients undergoing thyroidectomy. In this study we evaluated the effects of prophylactic dolasetron and/or induction with propofol on PONV. 　 Methods: Two hundred three patients scheduled thyroidectomy under general anesthesia with sevoflurane were included and were randomly allocated to one of four groups. In control (group C) and dolasetron groups (group D), the patients received thiopental sodium 4?5 mg/kg intravenously for the induction of anesthesia, and the patients in group D received prophylactic intravenous dolasetron 210?g/kg. In propofol (group P) and dolasetron ＋ propofol groups (group D ＋ P), the patients received propofol 2 mg/kg intravenously for the induction of anesthesia, and the patients in group D ＋ P received prophylactic intravenous dolasetron 210?g/kg. The incidence and severity of PONV, the need for rescue antiemetics, adverse events were assessed during 0 to 1 hour and 1 to 24 hours postoperatively. 　 Results: During the first 24 hours after anesthesia, the incidences of PONV and postoperative vomiting were significantly reduced in group D ＋ P compared with group C (P ＜ 0.05, respectively). There were no significant differences in postoperative nausea, need for rescue antiemetics, severity of PONV, and adverse events of antiemetics among the four groups. 　 Conclusions: In patients with thyroidectomy, combination of prophylactic dolasetron administration and induction with propofol was found to reduce the incidence of PONV during the first 24 hours after anesthesia, compared with that of routine induction with thiopental sodium