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정배희,원임수,정인선,정미화,노성숙,손두식 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.1
Tracheal intubation for general anesthesia is usually performed using a rigid laryngoscope and reguires the mandible to be opened with forward and upward traction of the patient's jaw which may at times result in the inadvertant injury to temporomandibular joint(TMJ). The injury may include internal derangement, dislocation and hematoma of TMJ; subsequent intraarticular adhesion formation ; dislocation of the meniscus, and rarely auriculotemporal nerve damage from traumatic TMJ dislocation. We studied in 200 patients the size of mouth opening during intubation, the change of mouth opening by tracheal intubation evaluated after operation, and any TMJ disorder arising after tracheal intubation. The results were as follows; 1) The mean size of mouth opening before operation was 42.7±7.0 and 40.6±6.2mm in male and female patients, respectively. 2) The mean size of mouth opening during intubation was 24.7±2.6 and 23.4±2.7mm in male and female patients, respectively. When vecuronium was used to prevent fasciculn, the mean was 24.3±3.1 and 25.2±2.0mm in male and female patients, respectively. 3) One week following operation The mean size of mouth opening one week postoperation was 48.3±8.9 and 42.2±6.3mm in male and female patients, respectively. When vecuronium was used to prevent fasciculation, the mean size of mouth opening was 55.5±5.3 and 43.2±6.2mm in male and female patients, respectively. 4) Five patients complained of discomfort around TMJ after tracheal intubation. It seems that upward 45 mandibule lifting by laryngoscope caused trauma to TMJs.
이성우,정배희,정미화,원임수 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.3
A 4year old female admitted for the management of degloving injury of popliteal area. The patient was injuried by traffic accident, and underwent emergency sugery for irrigation and debriment of wound area under halothane anesthesia. She has the 2nd administration of halothane in a period of 18days Two days after the 2nd anesthesia, the patient began to suffer from acute hepatitis with increasing SGOT/SGPT. The patient was cared for at the department of pediatrics and had 3rd operation after 38days and was discharged after 71 days hospitalization.
직선 및 곡선 전극(Straight or Curved Electrode)을 사용하여 달걀 흰자에서 시행한 고주파열응고술에서 온도에 따른 병소의 양상 및 크기의 비교
임소영,정배희,김현주,이기헌,윤선혜,신근만,홍순용 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.2
Background: Understanding the electrophysiology of radiofrequency (RF) lesions and determining the size and shape of RF lesions is important for reducing side effects when applied to patients in a clinical setting. We compared the shape and size of RF thermocoagulation produced by straight and curved 20-gauge electrodes and considered its application in clinical settings. Methods: The white from a hesh hens egg was warmed to 37℃ and placed in a rectangular glass container. Straight and curved 20-gauge electrodes were immersed. The transparency of the egg white and the glass container made it possible to photograph the changes in size of the RF lesions over time. We applied thermocoagulation for 60 seconds at 70, 80, and 90℃. Photographs were taken at 60 seconds. We measured the maximal size of the lesions. A two-way statistical analysis of variance was performed. Results: The thermocoagulations were started at the junction of the insulated and uninsulated portion of the electrode and did not extended beyond e tip. The thermocoagulation size was 4.2 ±0.8 at 70℃, 6.1 ±2.9 at 80℃ and 6.1 ±1.9 at 90℃ using the 20-gauge, 10 mm active tip, straight electrode and 4.5 ±1.1 at 70℃, 7.2 ±1.9 at 80℃ and 7.9 ±2.7 at 90℃ using the 20-gauge, 10 mm active tip, curved electrode. There was no observable difference in the size of the lesions produced by the straight and curved electrodes. Conclusions: We found that temperature was the more important factor in determining lesion size. When the temperature setting is the same, lesions produced by straight and curved electrode of the same gauge are also same size. Therefore the choice of straight or curved electrode should be made to optimize ease of handling and ensure proper location of the electrode tip.
중증 폐기종 환자의 수술적 치료법인 폐용적 감소술(Lung Volume Reduction Surgery)의 치험 3예
김태성,김현주,정배희,원임수 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.1
We have recently experienced with 3 cases of bilateral lung volume reduction surgery (LVRS) in patients with severe emphysematous disease in an effort to improve pulmonary mechanics. We compared intraoperative total dynamic lung compliance (CT) and % of breath exhaled in one second (Vl.0%) obtained immediately pre-lung reduction and immediate post-lung reduction. In addition we also compared preoperative pulmonary function test (PFT) [FEV1 , TLC, TG (trapped gds) and FRC] with 3 month postoperative values. Two of the three patients demonstrated post-reduction improvement in dynamic CT while only one patient demonstrated post-reduction improvement in Vl.0%. All three patients demonstrated an increase in FEV1 and a decrease in TLC, TG and FRC with the greatest change in one patient who also had a significant reduction in CT and an improvement in Vl.0% intraoperatively, and post-lung reduction. Although our results of the 3 cases are preliminary, it appears that side stream spirometry with immediate intraoperative measurement of dynamic CT and Vl.0% could play a role in predicting expected follow-up objective pulmonary function tests; improvement in both CT and Vl .0% may predict significant improvements in PFT. (Korean J Anesthesiol 2001; 40: 111 ~ 116)
마취유도를 위한 Midazolam 과 Propofol 의 상승 효과
이승준,윤영준,길호영,김병중,정배희,최현,최원주,강재익 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.4
The mechanism by which propofol exerts its action is poorly understood, but may involve a non-specific effect on lipid membrane and has been shown to potentiate GABA-mediated synaptic inhibition. And, midazolam also acts through GABA receptor mediated increased chloride conductance. The aim of this study was to evaluate the dose response of midazolam, propofol and combination of these drugs, and determine possible interaction between two drugs in patients. The effect of propofol on the dose response curve for midazolam was studied in 260 nonpremedicated ASA physical status I or II female patients who were scheduled for elective operation. The response to the verbal command was used as an end-point of hypnosis. Dose response curves for midazolam, propofol, and their type of interaction was determined using Instat software package, nonlinear regression analysis, and algebraic(fractional) analysis of interaction. ED_(50) of midazolam and propofol was 0.11 mg/kg, 1.13 mg/kg and ED_(95) was 0.18 mg/kg, 1.67 mg/kg respectively. ED_(50) of combined drug(midazolam+propofol) in comhined dose response curve was 29% of each drug and the type of interaction between two drugs was found to be synergistic.