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제왕절개술시 Propofol-N2O 마취가 술중 산모의 각성과 신생아에 미치는 영향
김정호,박병순,도건호,강훈수 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.4
Background : In anesthesia for cesarean section, there is an increased incidence of maternal awareness because a light plane of general anesthesia is chosen for fetal safety and rapid recovery. Propofol may be the choice if smooth induction and rapid maternal recovery are desired. Authors tried to know that propofol has properties which suggest that it might be useful alternative to thiopental and enflurane. Methods : Forty patients in ASA class I or II scheduled for cesarean section were allocated randomly to either propofol(n=20)(P) or thiopental-enflurane(n=20)(T-E) group. Anesthesia was induced with propofol 2 mg/kg IV and maintained by continuous infusion of propofol 8 mg/kg/hr in P group and was induced with thiopental 4 mg/kg IV and maintained by inhalation of 1 vol% enflurane in T-E group. All patients received vecuronium 0.1 mg/kg and 50% N2O-O2. Blood pressure, heart rate, Apgar score, umbilical arterial blood gas analysis and the incidence of maternal awareness using the isolated forearm technique(IFT) were evaluated Results : Diastolic pressure was decreased in P group than T-E group at 10 min after delivery. Heart rate was increased in P group than T-E group at immediate after extubation(P<0.05). For apgar score, umbilical artery gas analysis and maternal awareness there were not significant differences between two groups. Conclusions : In comparison with thiopental-enflurane, propofol infusion(8 mg/kg/hr) coupled with N2O was proved to be clinically satisfactory anesthesia for cesarean section with no adverse effects on both mother and neonate. (Korean J Anesthesiol 1998; 34: 814∼820)
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제왕절개술후 Morphine을 이용한 지속적 정맥내 통증조절시 Tenoxicam의 불완전한 선행진통 효과
김정호,노만석,강훈수,도건호 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.6
Background : The analgesic properties of the nonsteroidal antiinflammatory drugs(NSAIDs) have been attributed to their effects on the peripheral synthesis of prostaglandins. Although the preoperative use of NSAIDs has been increasing because of concerns regarding the side effects of opioid analgesics but results of clinical preemptive analgesia studies remain inconclusive. So, we studied the efficacy of preemptive analgesic effects of tenoxicam, new NSAID, on postoperative continuous intravenous analgesia with morphine. Methods : We studied 40 parturients, undergoing cesarean section, ASA class I or II, randomly divided into two groups. Tenoxicam group were injected tenoxicam 0.3 mg/kg and control group were injected normal saline 3 ml at ten min. before induction. For both groups morphine 0.1 mg/kg was administered as loading dose and 0.015 mg/kg/hr as maintenance dose. We examined verbal quantitative score(VQS) at postoperative 30 min, 1, 6, 12, 24 and 48 hr. Maternal satisfaction, side effects, hepatic and renal function also evaluated after pain control. Results : The values of VQS showed no significant differences between two groups 30 min, 1 and 6hr after start of morphine infusion, but there was significant decrease in tenoxicam group compared to control group 12, 24 and 48 hr after start of morphine infusion(p<0.05). There was no significant difference in maternal satisfaction between two groups and also there were no significant differences in the overall incidences of side effects between two groups. Conclusions : Preoperative single injection of tenoxicam showed incomplete preemptive analgesic effects on postoperative pain control after cesarean section. (Korean J Anesthesiol 1997; 33: 1154∼1158)
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체외순환을 위한 냉각과 재가온시 이산화탄소가스의 첨가에 따른 체온변화
백운이,김시오,손현호,도건호 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5
Background : It is well known that the addition of CO2 gas during cardiopulmonary bypass (CPB) can increase cerebral blood flow (CBF). In this study, we tried to find whether the increase of CBF by CO2 gas could be expressed on the measurement of body temperatures. Methods : This study included 22 adult patients who underwent CPB with moderate hypothermia and were assigned randomly to two groups by adding CO2 gas (CO2 group and Air group). We measured each tympanic (TM), nasopharyngeal (NP), oral, forehead, finger, rectal and CPB arterial line temperatures of CPB circuit for 20 times during cooling in every one minute for 20 minutes and during rewarming every two minutes for 40 minutes. Results : During cooling and rewarming, the TM, NP and oral temperatures changed more rapidly than the rectal and finger temperatures. In TM temperature, as time changed, the percent changes of temperature varied more prominently in the CO2 gas group than in the Air group. The statistical differences were significant especially during 13 minutes to 20 minutes in cooling and 8 minutes to 20 minutes during rewarming. Conclusion : From this data, we can postulate the effect of CO2 gas on CBF indirectly by measuring several sites of body temperatures. (Korean J Anesthesiol 1998; 35: 958∼964)
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