經鼻的 酸素投與法의 比較硏究

卞達燮,吳興根 한국의 현대의학사 1971 한국의 현대의학 Vol.4 No.1

Diaphragmatic Eventration을 가진 患者에 對한 全身麻醉

卞達燮,鄭華星,吳興根 한국의 현대의학사 1975 한국의 현대의학 Vol.8 No.2

胸部大動脈狹窄症에 對한 全身麻醉例 報告

卞達燮,陳亮華,吳興根 한국의 현대의학사 1975 한국의 현대의학 Vol.8 No.1

흉부대동맥협착증에 대한 전신마취례 보고

오흥근,변달섭,진양화 대한마취과학회 1975 Korean Journal of Anesthesiology Vol.8 No.1

Special problems face the anesthesiologist in anesthetizing patients with coarctation of aorta. Two patients each 7 years old, a boy and a girl were admitted for surgical correction of coarctation of the thoracic aorta. These patients were premedicated with secobarbital and atropine. One to 1½ hours later, anestllesia was induced with sodium thiopental and succinylcholine followed by intubation. Anesthesia was maintained with nitrous oxide, oxygen and halothane. A radial artery was cannulated for blood gas sampling and direct arterial pressure, E.K.G., C.V.P. and rectal temperature were monitored continuously. Mild hypothermia (about 34℃) was induced by surface cooling technique with mattress. In each case, in order to repair of coarctation by dacron graft and prosthesis, left atrio-femoral by pass was used. Acute hemodynamic changes, such as suddn hypertension of the upper extremity and head following cross clamping of the aorta or profound hypotension following declamping, did not develop with this technie. Possible causes and prevention of hemodynamic changes are discussed.

Droperidol-Pentazocine 마취의 임상적 연구

오흥근,변달섭,박오 대한마취과학회 1973 Korean Journal of Anesthesiology Vol.6 No.2

Since 1959 neuroleptanalgesia has been used for poor risk patients and open heart surgery. From august 1973 we have used a modified neuroleptanalgesia and anesthesia with droperidol-pentazocine- N2O in 40 cases. Age ranged 10 to 69 years; 22 were male and 18 female. Physical status was. Class I and II except for 4 patients in Class III and IV. In Group I (20 patients) for induction of neuroleptanalgesia, a mixture combining droperidol, 0.25mg/kg, and pentaocine, 1.0~1.2 mg/kg, was administered intravenously. In Group II (20 patients) for induction initially droperidol only, 0.25 mg/kg, was injected intravenously and 5~10 minutes later pentazocine, 1.0~1.2mg/kg, was given intravenously. Endotracheal intubation following a sleep dose of thiopental, 75~100 mg, and succinycholine, 40~60 mg, was performed in 36 cases. During the operation anesthesia was maintained with N2O-O₂, supplemented with muscle relaxants. Neuroleptanalgesia without thiopentaJ, relaxants, intubat- ion or N2O, to four patients (laryngeal supension-2 cases, and percutaneous cordotomy 2 cases). An additional quarter of the initial dose of droperidol was given,if anesthesia time exceeded .3 4 hours. Pentazocine, half the initial dose was also repeated when the patient showed signs of inadequate anesthesia, as body movement, tachycardia, increased blood pressure and lacrimation. The patients were deeply tranquilized but did not sleep with only droperidol and pentazocine. However when N2O inhalation was given, the corneal reflex was lost and the patient quickly went to sleep. The pupils persisted in miosis after pentazocine was given. The course of induction was smooth and there was no sweating, bradycardia or generalized muscular contractions seen at that time. Nausea and vomiting 12 hrs after anesthesia appeared in only 10% of cases. Blood pressure in Group I remained stable after the mixture but in Group II fell somewhat after the droperidol injection. Pulse rates was stable in both groups. Moderate respiratory depression was observed in Group I as soon as the mixture was administered, however during anesthesia and operation, the respiratory rate, tidal volume and minute volume gradually increased and were normal postoperatively. In Group II after pentazocine administration, respiratory depression increased significantly to about the same level in Group I but persisted after the end of the operation. In neither group was there any statistically significant change in pH and Base-Excess values. Recovery from anesthesia was very rapid and patients opened their eyes on command in 2~3 minutes after N2O was stopped and awakened within 5~6 minutes. The analgesic effect of pentazocine as excellent, persisting for 12 hours postoperatively. In conclusion the circulatory and respiratory response to the administration of the droperidol and pentazocine mixture were more stable than when they were administered seperatedly.

기관협착증에 대한 전신마취례 보고

홍승록,변달섭,오흥근 대한마취과학회 1973 Korean Journal of Anesthesiology Vol.6 No.1

A 32 year-old man was scheduled for tracheal reconstruction after having spial radiological studies and pulmonary function tests. Atropine was given preoperatively. A radial artery cannula was inserted for blood gas sampling and direct arterial pressure monitoring. The E,K.G. was monitored continuously. With the patient breathing a high concentration of oxygen from a mask, halothane was added to the inspired gas. After intramuscular injection of ketamine, halothane was discontinued. Spontaneous respiration was preserved with assistance when necessary. The larynx, pharynx and trachea were topically anesthetized and then a large-bore rubben orotracheal tube was placed in the trachea above the lesion. Anesthesia was maintained with additional ketamine injection. The trachea was explored through an anterior transverse cervical incision with a median sternotomy. The segment distal to the obstruction as dissected and found to be maligant tissue extending down to near the carina and behind the aortic arch. So, it was imperative to postpone further the surgery. Immediately after skin closure, the trachea was almost completely obstructed and PaCO₂ value was above 150 mmHg. Therefore the airway was preserved by a pediatric bronchoscope, which was replaced by a pediatric endotracheal tube. Anesthetic management and tracheal resection and reconstruetion have been reviewed problems of induction in a patient with tracheal obstruction are discussed, and the technics for retaining control of the airway and reducing the hazards of hypoxia and hypercarbia are also stressed.

경비적 산소투여법의 비교연구

오흥근,변달섭 대한마취과학회 1971 Korean Journal of Anesthesiology Vol.4 No.1

Arterial hypoxemia is a frequent occurence in the immediate postoperative period. For this reason many patients are given supplemental oxygen after operation. A common method of delivering oxygen is with a catheter placed through one nostril and extended into the oropharynx. An alternative method is the use of a nasal cathetn inserted 2~3cm into one nostril and wedged in place with a small sponge. We have compared these two methods in two groups of post-surgical patients. Eight patients in each group were selected at random for study during the immediate postoperative period. Each .patient received O₂ at 6L/min. flow by both methods. In the first group of patients the nasopharyngeal catheter was placed first, and in the other group the nasal catheter with a sponge was placed first. Previously blood from the femoral artery was drawn into aheparinized syringe after 15 to 20 minutes of breathing room air. Two subsequent samples of arterial blood were obtained from each patient. In the first group one sample wasdrawn after 15-20 minutes of oxygen administration via the nasopharyngel catheter and the other sample after 15-20 minutes of oxygen administration via the nasal catheter with a sponge. In the second group similar samples were taken with the order reversed. Arterial gas tensions were measured with a radiometer apparatus. A majority of patients did have low arterial oxygen tensions when breathing air in the immediate postoperative period. The average PaO₂ during breathing of room air was 73.7mmHg. With the 6L/min. O₂ flow via the nasopharyngeal catheter, the average PaO₂ was 155. 9mmHg while the catheter with a sponge resulted in an average PaO₂ of 144. 8mmHg in both groups. Thus the PaO₂ of the former is slightly higher than the that of later. However both gave adequate PaO₂ values with 6L/min O₂ flow. Therefore, the nasal catheter with a sponge compares favorably with the nesopharyngeal catheter because of comfort, convenience, natural humidifying effect and elemination of the possibility of gastric don or mediasinal emphysema.

전신마취후의 악심 및 구토에 대한 임상적 고찰

박광원,남용택,변달섭 대한마취과학회 1976 Korean Journal of Anesthesiology Vol.9 No.1

There are many reports about post-anesthetic nausea and vomiting. Pst-anesthetic nausea and vomiting can cause not only severe discomfort but also many complications. McKie (1970) said that the incidence varies from 23% 82%. But nowadays, the incidence seems greatly decreased due to the development of anesthetic techniques and anesthetic agents. We studied the incidence and factors affecting nausea and vomiting in 564 patients under general anesthesia from July 1, 1975. to September 30, 1975. at Severance Hospital, The conclusions are as follows; (1) The over all incidence is 34%. (2) It is more common in women. (3) It is less common below 10 years of age. (4) It is more common after prolonged anesthesia. (5) It is most common with ether. (6) It is more common when parasympatholytic agents are used for premedication. (7) It is most common in abdominal operations. We also studied post-anesthetic headache, and the incidence was 15%. Post-anesthetic hea- dache was most common with halothane. There are many different opinions about the effect of the prophylactic use of antiemetics for post-anesthetic nausea and vomiting. So we studied the prophylactic antiemetic effect in ether anesthesia with the use of perphenazine HCI (Trimin). The antiemetic reduced the incidence from 42% to 3% in cases using ether.

Diaphragmatic Eventration 을 환자에 대한 전신마취

오흥근,정화성,변달섭 대한마취과학회 1975 Korean Journal of Anesthesiology Vol.8 No.2

Special problems face the anesthesiologist in anesthetizing patients with left diaphragmatic eventration. A 59 year old man was admitted for surgical repair of diaphragmatic eventration with cyanosis, dyspnea and abdominal discomfort. The patient was scheduled for operation after chest phyaiotherapy and I.P.P.B. for 15 minutes, 3 times a day, for a week. After this preoperative treatment, the patient's pulmonary function was slightly improved. He was premedicated with atropine. Induction of anesthesria was planed to give intravenous ketamine with lidocain spray, but the patient had discomfort and was iritable during preanesthetic oxygen inhalation. Therefore anesthesia was induced by thiopentothal and succinylcholine, and maintained with oxygen, N2O and methoxyflurane. After anesthesia, the patient was given intensive care with Bennett respirator Model P-R2. Both anesthetic management for surgical repair of diaphragmatic eventration is reviewed and the problem of respiratory care is discussed.

상위척수손상 환자에서 발생한 자율신경 과반사 증례보고

이성호,이원경,박현혜,변달섭 대한마취과학회 1983 Korean Journal of Anesthesiology Vol.16 No.2

Autonomic hyperreflexia in spinal cord lesion is due to interruption of inhbitory im from higher centers. Especially, dramatic disturbance is seen in cord lesions above the fifth thoracic se and consist of hypertension, bradycardia and sweating. Sometimes marked hypert results in fatal cerebral hemorrhage or subarachnoid hemorrhage ao that the anesthesic gets used to its control and treatment. In current methods of control of hypertension, there are general anesthesia with halothane or enflurane, spinal anesthesia and ganglionic blockers. Ganglionic blockers, such as hexamethonium, drsmatically suppress marked arterial hypertension, also. We have experienced 3 cases of tetraplegic patients. Two cases given local anesthesia developed autonomic hyperreflexia but one case given general anesthesia did not have the hyperreflexia.