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중증 자가전증 환자에서 경막외 마취전 중심정맥압 측정의 필요성
김애라,김홍란 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.6
Most obstetric anesthesiologist now consider epidural anesthesia to be the preferred anesthetic technique for patients with preeclampsia. In the severe preeclampsia effective ciirculatory volume is usually low, so appropriate preanesthetic hydration is essential feature of safe management. We performed CVP monitoring before epidural anesthesia in nine severe preeclamptic patients undergoing cesarean section. Mean CVP of them was 2±1 mm Hg which was not significantly different from normal term parturient. In four patients whose CVP was less than 2 mmHg, preanesthetic hydration with Hartman's solution 500~700 rrd was performed under the monitoring of CVP until it became to rise 2~3 mmHg. Five patients out of nine whose systolic blood pressure dropped below 100 mmHg during anesthesia were IV injected ephedrine 4 mg immmediately and three of them needed repeat injection of ephedrine 4 mg. With the monitoring of CVP, the operations of all the nine severe preeclamptic patients were completed successfully without ay problem during and after anesthesia. lt is important to reaUze the limitation of central venous pressure monitoring : but if used with caution in proper circumstance it can provide clinically useful information with minimal risk to the patient.
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제왕절개술을 위한 경막외 2 % Lidocaine 용액의 알카리화
김애라,김홍란 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.10
Sixty parturients scheduled for elective cesarean section at term under epidural anesthesia were randomly divided into one of two groups. Group 1 patients were given a prepared 2% lidocaine solution with 1:200,000 epinephrine plus 1ml of normal saline per 10ml of lidocaine; the solution pH was 2.45. Group 2 patients were given a prepared 2% lidocaine solution with 1:200,000 epinephrine plus 1ml(lmEq) NaHCO3 per 10ml of lidocaine; the solution pH was 7.20. Just before injection, either 2ml normal saline(group 1)or 2ml(2mEq) 8.4 % NaHCO3 solution(group 2) was added to 20ml 2% lidocaine hydrochloride with 1:200, 000 epinephrine. The time to onset of the T5 sensory block (time between completion of injection and loss of cold sensation at T5 dermatome) was significantly more rapid in the group 2 that received the pH adjusted solution. The mean onset time was 4.9±1.3 min in the group 2 and 6.4±2.0 min in the group 1. The time to peak level was also significantly more rapid in the group 2 at 10.5±2.7 min and gro1 at 13.3±4.0 min. But the peak level was not statistically signifieant between the two groups. The spread of sensory blockade was significantly more rapid in the pH-adjusted group at 5, 10 and 15 min after epi- dural injection. Incidence of maternal hypotension during the operation did not differ signifi- cantly between the two groups. The time from end of injection to Bromage scale 0 did not differ significantly between the two groups.
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전자궁적출술 후 통증자가조절장치 사용약제에 따른 통증점수 비교
이정구,김홍란 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.4
Background : The purpose of this study was to compare meperidine and meperidine with ketamine for postoperative analgesia after total abdominal hysterectomy (TAH) and to establish a correlation between three types of pain; pain at rest, pain with movement and pain with coughing (maximal pain). Methods: This present study eompared the quality of pain during pain management in 65 patients undergoing TAH. Patients received i.v. meperidine as the loading dose in the recovery room and PCA with meperidine 600 mg, droperidol 5 mg, normal saline 35 ml for three days (Group 1, n =36), or with meperidine 600 mg, ketamine 200 mg, droperidol 5 mg, normal saline 16 ml for three days (Group 2, n = 29). Patients were then interviewed on postoperative day 1, 2 and 3 (POD1, 2 and 3) to assess their pain on a visual analogue scale (VAS) of 0 (none) to 10 (worst imaginable) and to compare meperidine and meperidine with ketamine for postoperative analgesia. Results : The rnean VAS of pain at rest was 4.5 on POD and decreased to 1.8 on POD 3 for patients receiving meperidine with ketamine was lower than the VAS scores of patients receiving meperidine 5.4 to 2.5. Patients receiving meperidine with ketamine also had less difficulty with side effects, less headache, nausea and vomiting. Conclusions : IVPCA ketamine in combination with meperidine provides superior postsurgical pain relief, especially at rest and with movement and has fewer side effects than meperidine alone. (Korean J Anesthesiol 2000: 38: 679~687)
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장영호,이정구,전재규,김홍란 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.6
Laparoscopic cholecystectomy, a surgical technique first performed in France, which has gained widespread acceptance among surgeons in Korea. The advantages of the laparoscopic technique include lesser patient discomfort, shorter hospitalization, and a shorter return interval to full activities after operation. It has been postulated that due to the minimal incisional discomfort of laparoscopic cholecystectomy, the postoperative pulmonary function following this procedure would be improved as compared to open cholecystectomy. Laparoscopic cholecystectomy uses carbon dioxide, a highly diffusable gas, for insufflation. With extended periods of insufflation, a patient's arterial carbon dioxide levels may be adversely altered. We performed 44 laparoscopic cholecystectomy in 1993. There were 22 women and 22 men, with a mean age of 50.0±11.9 years. The mean operative time was 86.7±24.3 minutes, reflecting a 62 percent decrease in operative time compared to the open cholecystectomy. The mean hospital stay was 4.60 days. To analyze the hemodynamic effects of carbon dioxide during laparoscopic cholecystectomy, the changes of pH, PaCO_2, PaO_2, and SaO_2 were studied. The measurement showed significant increase of arterial carbon dioxide. Finally, during laparoscopic cholecystectomy patients may require careful intraopererative arterial blood gas monitoring of the absorbed carbon dioxide.
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