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개심술시 체외순환에 따른 혈소판수와 혈장섬유소원치의 변화
김흥대,윤문한 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.5
In order to evaluate causes and the effective treatment of postoperative bleeding after open heart surgery, we measured platelet count and plasma fibrinogen levels before, during a 30 and 60-minute, and after a 30, 60 and 90-minute extracorporeal circulation in 5 patients perfused by a bubble and membrane oxygenator, respectively. The results were as follows: 1) The platelet count was reduced significantly by 57.2±3.04% during a 30-minute extracorporeal circulation using the bubble oxygenator and by 43.8±0.84% using the membrane oxygenator, and these levels were maintained throughout the extracorporeal circulation. 2) The platelet count after a 90-minute extracorporeal circulation increased significantly compared with after a 30-minute extracorporeal circulation (p$lt;0.05) and these effects were more prominent using the bubble oxygenator (p$lt;0.025). 3) The plasma fibrinogen level was reduced by 28.6±7.50% during a 30-minute extracorporeal circulation using the bubble oxygenator and by 33.6±5.77% using the mene oxygenator, and these levels were maintained throughout the extracorporeal circulation. 4) The plasma fibrinogen level after a 90-minute extracorporeal circulation increased significantly compared with after a 30-minute extracorporeal circulation (p$lt;0.05).
김흥대 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.5
During the last decade, nonrebreathing systems have been used most extensively for neonate and small children, but these systems can lead to alveolar hyperventilation when it was used manually because these systems have not volumometer to measure the tidal volume of patients. Therefore, the author devised two modified methods that is able to estimate the tidal volume of patients using the volumometer in the adult circle system for pediatric anesthesia. One method is modified Jackson Rees system. The Y-piece of the adult circle system was removed and the inspiratory gas tube of the Jackson Rees system was connected to the inspiratory corrugated tube of the adult circle system and the expiratory reservoir tube of the Jackson Rees system was connected to the expiratory corrugated tube of the adult circle system, then was ventilated with reservoir bag of the adult circle system. The other method is modified Y-piece system. The deadspace of Y-piece of the adult circle system was reduced by set up of short cannula in the inspiratory side of the Y-piece, then was ventilated with reservoir bag of the adult circle system. Using above two modified methods, study was undertaken in 25 cases to determine whether adequate alveolar ventilation could be maintained for pediatric anesthesia. The ventilation was carried out as the discretionary manual ventilation, and as the estimated tidal volume of patients using the volumometer in the adult circle system, respectively. In the latter method, tidai volume was 8 ml/kg and respiratory rate was 35 breaths/min under 5 kg of body weight, 30 breaths/min weighing 5 kg-10 kg and 20 breaths/min over 10 kg. Total gas flow of these systems was 2.5 times minute volume of patients. Arterial blood gas tension was measured 30 minutes after the induction of anesthesia. The following results were obtained. 1) In the method of the original Jackson Rees system, when it was ventilated manually and discretionary in 5 cases, PaCO₂ level was 21.0±1.65mmHg. 2) In the method of the modified Jackson Reesystem, when it was ventililated manually and discretionary in 5 cases, PaCO₂ level was 25.1±0.52mmHg, and was ventilated as estimated tidal volume of patients in 5 cases, PaCO₂, level was 37.6±0.45 mmHg. 3) In the modified Y-piece system, when it was ventilated manually and discretionary in 5 cases, PaCO₂, level was 21.3±1.37 mm Hg, and was ventilated as estimated tidal volume in 5 cases, PaCO₂ level was 36.2±1.01mmHg. Therefore, it could be assumed that these two modified methods are a good device to maintain an appropriate alveolar ventilation for pediatric anesthesia.
김흥대,정연탁,황영희,유희구,김완식 대한마취과학회 1977 Korean Journal of Anesthesiology Vol.10 No.3
The mechanism of stimulation produced analgesia has been proposed to involve neurophysiologic and neurohumoral inhibitory effect at the level of the spinal cord, brain stem, thalamus and cortex. And yet it was not clear, but will improve the chance of understanding pain mechanism and providing effective method for pain control with improved superstimulation technics. Nevertheless, the low frequency electrical acupuncture therapy was given and found to relieve the pain to the fourty three cases who had not responding to the various methods of cealing with pain at the pain clinic in Han Yang University Hospital from March to September 1977. The technics and procedure of treatment is described. The results of the low frequency electrical acupuncture stimulation therapy are following with short term of one or two period. Twenty three cases(53.49%) showed marked improvedment, 16 cases(37.24%) showed improvement, 4 cases(9.31%) transient improvement and there were no case of fail. The technics and proceduresis easy to learn, apply and can carried out by the residents or staff. It is economical and there are no series of complications except are seen a generalized fatigue in few cases.