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전신 마취후 발생한 전율현상에 대한 Meperidine, Doxapram, Fentanyl 의 치료 효과
곽미숙,강양자,최윤정,염광원 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2
Background : Shivering is a common postanesthetic complication. Because all shivering patients feel uncomfortable and increase oxygen consumption, various attempts have been made to prevent its occurrence or to control it. Among the pharmacological methods of treating shivering, meperidine has been known to be the most effective. This study was designed to evaluate whether there was any difference among meperidine, fentanyl, doxapram and normal saline in the treatment of post-anesthetic shivering. Methods : Forty patients (ASA class I or II) who showed postoperative shivering were randomly assigned into four groups(n=10): Normal saline group: normal saline 5 ml, Doxapram group: doxapram 1.5 mg/kg, Meperidine group: meperidine 25 mg, Fentanyl group: fentanyl 25 g. And all patients received routine care: oxygen by T-piece and heat-reflective blanketrol (cincinati Subzero, U.S.A.). Evaluation of the state of shivering was done every 5 minutes from the beginning of the treatment by the same investigator who had injected the drugs intravenously for treatment of shivering. The age, sex, weight and duration of surgery were recorded. Results: There were no significant statistical differences in age, sex, weight and duration of surgery among the four groups. By 5 minutes, 90% of doxapram group and 30% of meperidine group had stopped shivering. By 10 minutes, 90% of doxapram group and 70% of meperidine group had stopped shivering. But in fentanyl and normal saline group, only 20% had stoppd shivering by 10 minutes. Conclusions: We conclude that both meperidine and doxapram are effective on post-anesthetic shivering. In cases of patient with respiratory depression, doxapram is especially effective because it stimulates the respiratory center. (Korean J Anesthesiol 1998; 34: 389∼393)
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Bullard 후두경과 직접후두경을 이용한 기관내 삽관시 경부신전의 방사선학적 측정
이상민,한태형,황원균,이정진,강양자,신백호 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5
Background: Conventional laryngoscopy with Macintosh blade requires a movement of the head, neck and cervical spine. The Bullard laryngoscope is an anatomically shaped, potentially eliminating the need for cervical spine extension. Bullard and Macintosh laryngoscopes were compared by measuring the degree of cervical spine extension by radiological measurement. Methods: Eighteen patients requiring endotracheal intubation were studied. Anesthesia was induced in neutral head position followed by laryngoscopy. Each patients was intubated two times by Macintosh and Bullard laryngoscope in random order. Radiographic evaluation was performed to determine the degree of cervical spine extension on four occasions; before induction, during facial mask ventilation, and during Bullard and Macintosh laryngoscopy. Results: The extension of cervical spine was significantly less following Bullard laryngoscopy than Macintosh laryngoscopy for best view (p<0.05). Conclusions: The Bullard laryngoscope can be used with less cervical spine extension than Macintosh laryngoscope. It may be useful in patients in whom cervical spine movement is limited or undesirable. (Korean J Anesthesiol 1998; 35: 890∼894)
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가토를 대상으로 Oleic Acid로 유발한 급성 호흡부전증에서 기관내 폐환기법이 사강과 기도내 압력에 미치는 효과
이국현,이가영,김광우,정성량,강양자 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.3
Background : Intratracheal pulmonary ventilation (ITPV) was developed to allow a decrease in physiological dead space during mechanical ventilation. To reduce anatomic dead space, a reverse thrust catheter (RTC) is introduced into an endotracheal tube (ETT) through an adapter and positioned just above the carina inside the ETT. ITPV can be combined with pressure control mode of mechanical ventilation to make hybrid ventilation(HV). The effect of HV on the reduction of dead space was compared with that of conventional mechanical ventilation(CMV) in rabbits with acute respiratory failure. Methods : Oleic acid of 0.06 ml/kg was injected to induce acute respiratory failure in 7 rabbits. PaO2 and PaCO2 were measured 30 minutes after the injection. Oleic acid was injected in another 7 rabbits to compare CMV with HV while increasing the respiratory rate(RR). Tidal volume, dead space(VD) and peak inspiratory pressure(PIP) were measured at the same RR. Results : PaO2 decreased significantly from 467± 68 mmHg to 156 6 mmHg at FIO2 1.0 after the injection of oleic acid. In another 7 rabbits, the VD's of CMV were 34± 10 ml, 27 ±10 ml, 20± 6 ml, and 18± 3 ml at respiratory rate of 20/min, 40/min, 80/min and 120/min, respectively. The VD's of HV were 28 ±11 ml, 16± 8 ml, 9± 4 ml, and 7± 3 ml at the same respiratory rates as in CMV. The VD's of HV were lower than those of CMV. The PIP's were lower in HV than in CMV. Conclusion: We conclude that HV, as the modification of ITPV, can be applied to acute respiratory failure to minimize the airway pressures and dead space of CMV. (Korean J Anesthesiol 1997; 32: 360∼365)
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조현성,이국현,김정수,강양자 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.5
Background : Brain death is irreversible coma due to injury of brain hemisphere and brain stem regardless of any treatment. In brain-dead patients, diabetes insipidus, hypothermia, acute respiratory failure, and multiorgan failure occur due to brain stem compression injury. The primary goal of organ donor management is maintenance of optimal physiologic environment for organs prior to donation. This study is performed for suggesting the guideline of the prediction and management of multiorgan failure in the brain-dead patient. Methods : We analyzed 16 brain-dead patients waiting for organ donation in the intensive care unit. The causes of brain death among the donors consisted of closed head injury in 8 patients, subarachnoid hemorrhage in 4, drowning in 1, aplastic anemia in 1, asthmatic attack in 1 and falling-down injury in 1. PaO2/FIO2 (arterial oxygen tension/fractional inspired O2 concentration) was analyzed to demonstrate the progress of respiratory failure. Body temperature, vital signs, urine output, serum osmolarity, urine osmolarity, serum K+, serum Na+, AST(aspartate aminotransferase), ALT(alanine aminotransferase), total bilirubin, BUN(blood urea nitrogen) and creatinine were also analyzed in all patients. Results : Diabetes insipidus were found in 15 patients, hypothermia in 8, renal dysfunction in 2, hepatic dysfunction in 0, and acute respiratory failure in 2 at the time of arrival to intensive care unit. Diabetes insipidus was found in 16patients, hypothermia in 0, renal dysfunction in 0, hepatic dysfunction in 0, and acute respiratory failure in 9 at 16 hours after arrival to intensive care unit. Conclusions : We concluded that hepatic and renal functions were well preserved for long time after brain death and brain-dead patients rapidly progressed to acute respiratory failure. It can be suggested that organ procurement should be performed as soon as possible after brain death was confirmed for successeful organ transplantation. (Korean J Anesthesiol 1997; 32: 787∼792)
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