부인과 수술을 위한 경막외마취와 술후 통증관리

김애라,전재규 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.6

Epidural anesthesia has been greatly substitued for spinal anetshesia because epidural aneshtesia can eliminate the most common and agonizing problems of headache and other neurologic sequelae resulting from spinal anesthesia. Many anesthetists are reluctant to give spinal anetshesia to the patients for gynecologic surgery because of the high incidence of postspinal headache in the middle age group of women. On the contrary, epidural anesthesia provides several advantages compared to spinal anetshesia such as eliminating complications of dural puncture and easy management of postoperative pain control. This investigation was primarily undertaken to observe the effectiveness of epidural anesthesia as well as postoperative pain controllability in gynecologic surgery. Out of total 526 cases who had gynecologic surgery, We had 275 cases (53%) who received epidural anesthesia during the last year. 2% lidocaine 400-500 mg, with 4 mg of morphine were used epidurally for total abdominal hysterectomies, ovarian cystectomies, and some cases of tuboplasty, and 2% lidocaine 300-400 mg, with 3 mg of morphine was used for vaginal hysterectomies. Continuous epidural anesthesia in association with general anesthesia was used for tubal anastomosis and radical hysterectomy, and 4 mg morphine was given through the catheter at the end of surgery. The results are as follows: 1) The duration of postoperative analgesic effect was 21.1±5.5 hours. 2) The adverse effects from epidural morphine administration showed 42 (15%) patients had nausea and/or vomiting and 58 (21%) patients had itching. 3) Complications of epidural anesthesia were dural puncture-4 cases (1.4%), convulsion-1 case (0.3%), backache-48 cases (17%), and hypotension-44 cases (16%). The results of this study suggest that epidural anesthesia with 3-4 mg of epidural morphine can be satisfactory for gynecologic surgery and postoperative pain control.

제왕절개술 후 통증완화를 위한 지주막하 소량의 Morphine 투여

김애라,김명호 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.5

척추마취 후 발생한 유착성 지주막염 및 척수공동증

김애라,전재규,최경돈 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.6

The popularity of spinal anesthesia has decreased to some extent due to the widespread use of a balanced anesthesia technique, increasing interest in epidural anesthesia and fear of neurologic sequelae resulting from spinal anesthesia. The complication once most feared was adhesive arach- noiditis. However, in many study reports there were no instances of adhesive arachnoiditis, cauda equina syndrome or transverse myelitis. The majority of serious neurological symptoms appearing after spinal anesthesia can be attributed to coincidence or previously unrecognizaed disease. This is a case report in which the patient developed syringomyelia with chronic adhesive arach-noiditis. A 27-year-old patient, known to have adhesive arachnoiditis which developed after spinal anesthesia, was admitted to this institution for treatment of syringomyelia. He had history of a simple appendectomy done under spinal anesthesia on the 24th of November in 1976 and had experienced sensory changes and progressive motor weakness in the lower extremities 4 months after surgery. In January, 1978 he received an adhesiolysis operation after conservative therapy using steroid injections. Afterward, he developed syringomyelia resulting from adhesive arachnoiditis and had shunt surgery. He went home without significant improvement. However, it is unwise to make a final diagnosis and assume that the sequela was attributed only to the spinal anesthesia. It is important to seek other causes rather than to ascribe all to the spinal anesthesia because there are many other causative factors. In this case, it was not certain that adhesive arachnoiditis was a possible cause, but this could not be ruled out either. The prevention of complica-tions and their causative factors must be carefully considered at all times in the practice of spinal anesthesia.

주관협착증 환자의 Beck Depression Inventory 점수와 이와 관련된 요인들의 분석

김애라,김진모,배정인,장영호,강철형,서보병,이용철,정성원,홍지희 대한통증학회 2007 The Korean Journal of Pain Vol.20 No.2

제왕절개술을 위해 고비중 0.5% Bupivacaine/Meperidine 혼합용액을 이용한 척추마취

김애라,김현경,배정인 대한마취과학회 2004 Korean Journal of Anesthesiology Vol.46 No.5

제왕절개술시 수액이 제대혈의 혈당, 전해질 및 인슐린에 미치는 영향

김애라,박정구,전재규 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.5

It is well documented that rapid administration of solution containing dextrose results in marked hyperglycemia and osmotic diuresis. The maternal effect of hyperglycemia caused by rapid administration of dextrose solution may affect the fetus or the newborn baby as well. Therefore, there was a need to ascertain an appropriate IV solution for prehydration in cesarean section. The aim of this study was to determine an appropriate solution for cesarean section based on the results of the effects of matemal IV glucose solution on the newborn's glucose, electrolyte and insulin. 40 parturients scheduled for cesarem section were chosen at random. They were divided into two groups : one group received Hartmann's solution and the other group received 5% D/W. Patients' venous blood was drawn on the operating table prior to starting IV infusion for the measurement of blood sugar and electrolytes(Na, K, Cl) in various conditions of NPO. Then, intra-venous fluid was administered rapidly for prehydration about 20 ml/kg/hr(about 500 ml for 20 minutes) while anesthesia was induced and maintained with an endotracheal tube in place. The second blood samples were taken from matemal vein, umbilical vein and artery immediately after delivery for the measurement of glucose and electrolyte. At the same time insulin levels of umbilical veins were measured. The prehydrative glucose levels were 75.40±20.80 mg/dl in group 1 and 78.60±12.44 mg/dl in group 2. Both values were within normal range without significant hypoglycemia following the various times of NPO. Posthydration values of maternal glucose in group 2 with glucose infusion was 221.30±3.62 mg/dl. This was significantly higher than 72.20±7.11 mg/dl in group 1(p$lt;0.05). At the time of delivery, the values of umbilical venous and arterial blood glucose in group 2 were significantly higher than in group 1(p$lt;0.05). The values of insulin in umbilical venous blood in group 2 was 48.09±25.54 μU/ml. This was significantly higher than 6.06±2.06 μU/ml in group 1(p$lt;0.05). Hydration ther solutions did not affect the value of electrolyte either in the mother or newborn baby. However, the rapid administration of glucose solution increased the maternal and umbilical glucoses as well as umbilical insulin proportionally. As the result of this study, prehydration with the solution containing glucose for cesarean section increased maternal and fetal glucoses as well as fetal insulin levels. Therefore, prehydration with any solution containing glucose is not recommended to prevent maternal and fetal hyperglycemia, and can result in delayed newbom hypoglycemia. It was concluded that prehydration with balanced electrolyte solution without dextrose seems to be safer to babies as well as mothers.

경막외마취에 의한 무통분만

김애라,전재규 대한마취과학회 1985 Korean Journal of Anesthesiology Vol.18 No.3

Continuous epidural analgesia for labor has become a very popular procedure in the United States. However, it has not been introduced enough to the laypeople in Korea because of economic problems, lack of available anesthesiologists and traditional prejudice about anesthesia for delivery. This report is to present our clinical experience of 250 cases of continuous epidural analgesia for labor and delivery which was done at the Dong San Medical Center during the period of January to May 1985. An epidural puncture was made atthe level between L3-4 with the same technique as used for an ordinary epidural anesthesia. The catheter was threaded through an 18 G Tuohy epideral needle. The epidural catheter was fixed and tapped to the patient's right side. During the first stage of labor, 6∼8 ml of 1% lidocaine mixed with opinephrine 1 : 300,000 was injected through the catheter when the cervix was 5∼6 cm dilated in primipara and 4∼5cm dilated in multipara. After the initial injection, the same dose of 1% lidocaine was repeated as needed when the pain recurred. The injections were usually repeated 3 to 4 tlmes in primipara and once or twice in multipara. For the second stage of labor, 10∼12 ml of 1.5% lidocaine was used. As a result of this experience, we have come to the conclusion that continuous epidural analgesia for labor is beneficial to most of the parturients and is highly useful for practice in Korea.

인지하지 못한 심부전이 동반된 자간전증 환자에서 전신마취 유도중 발생된 심정지

김애라,김진모,박은지 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.6

Better medical management, together with a number of newer surgical techniques, has enable more girls with congenital heart disease to reach childbearing age. Congenital heart lesions now constitute at least half of all cases of heart disease encountered during pregnancy. Pregnancy is characterized by marked increase in stroke volume and cardic output during the antepartum period. The hemodynamic demands of pregnancy dangerously stress the impaired cardiovascular reserve. We experienced that a case of cardiac arrest in a preeclamptic patient with unrecognized heart failure during induction of the general anesthesia for cesarean section. We found out later that she had an operation because of patent ductus arteriosus at the age of 15 and then already had mitral valve regurgitation and LVH findings in the echocardiogram. We suggested that heart failure was enhanced by the hyperdynamic cardiovascular changes of normal pregnancy and further aggrevated by preeclampsia and anemia. (Korean J Anesthesiol 1998; 35: 1180∼1184)

Dietary Sodium Effects on Responses of Atrial Natriuretic Peptide, Aldosterone and Renin Release to Acute Volume Expansion in SHR

김애라,이원정,주영은,김선희,조경우,Kim, Ae-Ra,Lee, Won-Jung,Choo, Young-Eun,Kim, Suhn-Hee,Cho, Kyung-Woo The Korean Physiological Society 1989 대한생리학회지 Vol.23 No.2

장기적으로 소금량을 다르게 섭취시킴에 따라서, 체내의 Na 대사에 관여하는 호르몬인 aldosterone, atrial natriuretic peptide (ANP) 및 renin 분비와 신장의 배설 반응에 나타나는 변화를 정상 혈압쥐 Wistar와 spontaneously hypertensive rat (SHR)에서 비교하고자 실험하였다. 생후 7주의 숫쥐인 Wistar와 SHR에게 저염과 고염 식이 (각각 2, 25 mmol Na/100 g diet)를 6주간 먹였다. 그 후 ether 마취하에서 대퇴 동맥과 정맥 및 방광에 관을 삽입한 후, restraining cage에 넣었다. 수술회복 후 안정시 뇨와 혈액을 채취한 후, 0.9% saline을 30분동안 체중의 3%되게 정맥주입(혈장량 증가)하고 뇨와 혈액을 채취하였다. 혈장의 호르몬을 방사면역법으로 측정하였다. Wistar와 SHR의 저염, 고염 식이군의 성장률에는 유의한 차이가 없었다. Wistar 저염과 고염군의 평균 동맥혈압은 각각 113과 110 mmHg로 차이가 없었으며, SHR의 동맥압은 141과 149mmHg로 고염군이 높았다. 저염식이군에서 혈장 aldosterone농도는 고염군보다 월등히 높았고, ANP 농도는 차이가 없었으며, renin은 고염군보다 낮았다. 혈장량 증가 이후 혈장 aldosterone은 모든 군에서 $30{\sim}40%$정도 감소하였고, renin은 $30{\sim}60%$정도 감소하였다. 혈장량 증가 이후 ANP는 증가하였는데 고염군에서의 증가도가 저염군에서보다 월등히 높았다. 혈장량 증가 이전의 Wistar군의 혈장 aldosterone과 renin의 대조치 값은 SHR보다 유의하게 높았고, ANP 농도는 차이가 없었다. 그러나 혈장량 증가 이후의 Wistar와 SHR의 aldosterone과 renin의 감소정도는 유의한 차이가 없었으나, ANP의 증가도는 Wistar가 SHR보다 높은 경향을 보였다. 호르몬들 중에서 혈장 aldosterone과 renin사이에는 양의 대수함수 관계가 있으며, 기울기는 고염군이 저염군보다 유의하게 높았다. 혈장량 증가 이후에 나타나는 뇨량과 소금 배설률의 증가 정도는 고염군과 저염군 사이에 차이가 없었다. 그러나 SHR이 Wistar보다 더 심한 이뇨와 Na 배설항진 반응을 보였다. 이상의 결과는 소금 섭취량에 따라서 aldosterone, ANP 및 renin의 분비 조절이 다르며, 정상 혈압과 고혈압쥐 사이에서도 차이가 있음을 시사해 주고 있다. Responses of atrial natriuretic peptide (ANP), aldosterone and renin release to acute volume expansion were compared in normotensive Wistar and spontaneously hypertensive rat (SHR) fed low or high-sodium diet (2 or 25 mmol Na/100 g diet). Experimental diets were fed for 6 weeks from 7-week-old and the growth rate was similar in all groups. In the morning of the experiment, catheters were inserted under ether anesthesia in femoral artery for pressure recording and blood collection, femoral vein for saline infusion, and bladder for urine collection. Then, the rats were placed in restraining cages. When the rats were recovered from anesthesia and the arterial pressure became stabilized, control urine and blood samples were collected. Then, 0.9% saline was infused for 30 min for volume expansion (3% BW). Arterial pressure was significantly higher in the high-sodium SHR but there was no difference between the two groups of Wistar rats. Control plasma levels of Na, K, ANP, renin activity, and hematocrit were not different among the 4 groups. However, plasma aldosterone level was significantly higher in the low-sodium groups. Wistar low-sodium rats showed approximately two times higher plasma aldosterone level than the SHR counterpart. Volume expansion produced a marked increase in plasma ANP level, especially in the high-sodium groups. The low-sodium groups of both strains showed approximately two-fold increase in plasma ANP level. Following a volume expansion plasma aldosterone level and renin activity decreased in all groups. There was a significant logarithmic positive correlation between plasma renin activity and aldosterone concentration. The low-sodium rats produced a greater increase in aldosterone release by small increase in plasma renin than did the high-sodium rats. The low- and high-sodium rats produced a similar degree of diuresis and natriuresis after volume expansion. However, SHR produced a greater natriuresis than did the Wistar rats. The above results indicate that regulatory mechanisms of ANP, aldosterone and renin release are different between the normotensive and hypertensive rats, and between the low- and high-sodium groups.

복강경을 이용한 갈색세포종 적출수술 시의 마취관리

김애라,정은용,한석호 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.4

Curently-available imaging techniques provide accurate localization of a tumor in patients with pheochromocytoma. The precision of thiis information allows the use of a more selective surgical approach to the tumor, such as by laparoscopy. We describe a case of a 54-year-old female who under-went resection of pheochromocytoma by a laparoscopic approach. Two events resulted in significant hemodynamic changes; the creation of the pneumoperitoneum and adrenal gland manupulation. Preoperative preparation with alpha-adrenergic blocking agents and adequate fluid loading before insufflation attenuated intraoperative cardiovascular changes, while titration of sodium nitroprusside and phentolamine allowed easy and quick control of the hemodynamic aberrances related to these processes. As a result, the operati#on was carried out safely, and the postoperative course was unremarkable. (Korean J Anesthesiol 2000; 3S: 758 ~ 763)