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유아 및 소아에서 후두마스크 크기의 선택 기준 : 체중과 나이의 비교 Comparison between Body Weight and Age
박종두,박재현 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.2
Background : In children, laryngeal mask airways (LMA) almost always show a tendency to come out of the mouth too much before and during inflating the cuff. We hypothesized that the selection criteria based on body weight seemed to be set too low or unappropriate in children. Methods : After IRB approval and informed consent from parents, pediatric patients (n = 63; 42 male, 21 female) weighing less than 20 ㎏, of ASA physical starus 1 or 2, and in whom the use of an LMA was not contraindicated, were studied. LMAs were inserted by an experienced investigator and connected to a volume ventilator, and positive pressure ventilantion was initiated. Inspiratory and expiratory tidal volume (V_T) were measured to calculate the fraction of leakage (F_L, %) as ([inspiratory V_T-expiratory V_T]/inspiratory V_T) × 100. The larynx was inspected with a fiberoscope (FOB) located just proximal to the aperture bar. For each size of LMA, we divided each group into two subgroups depending on the body weight (4, 7 or 12 ㎏) and age (2, 9 or 30 months) and compared the FOB finding and F_L between the two subgroups. In the other 16 patients, LMAs of two different sizes were applied successively to a patient, and its FOB grades were compared. Results : For size 1 LMAs (n = 22), the FOB finding and F_L were not different between the subgroups. For size 1.5 LMAs (n = 20), patients weighing 7 to 10 ㎏ or aged < 9 months had a better FOB finding (P = 0.007 and 0.0003) than patients weighing 5 to 7 ㎏ or aged > 9 months. For size 2 LMAs (n = 21), F_L was correlated with body weight (P<0.001, r^2 = 0.448) and age (P < 0.001, r^2 = 0.424). In 8 patients of 5 to 7 ㎏, use of size 1 LMAs had a better FOB grade than that of size 1.5 LMAs (P = 0.031). In the other 8 patients of 10 to 12 ㎏, there was no difference of FOB grades between the size 1.5 and 2 LMAs. Conclusions : For patients weighing 5 to 7 ㎏, the use of size 1 LMAs is recommended. Contrary to adults, a smaller LMA may have to be tried if an LMA size turns out to be inappropriate. (Korean J Anesthesiol 2002; 42: 148~153)
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김성덕,박종두,김종성 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.4
We examined the causes of delaying or cancellation of the elective surgery at Seoul National University Children's Hospital. The total numbers of pediatric patient for the elective surgery during September 1, 1994, to November 30, 1994, were 1287 and that of delaying or cancellation of surgery were 135. The fraction of medical causes of delaying of the elective surgery was 62.2%, and that of non-medical causes of the elective surgery was 36.3%, and 1.5% was unknown. The single most frequent cause was upper respiratory infection, 42.2% of total delays, and the second was that patient had not be admitted as 16.3%o of total delays. The third frequent cause was no indication for surgery as 6.7%, the fourths were fever and inadequate preparation for surgery (5.2%), and the sixth was that the patient had refused to give an informed consent (3.7%), etc.
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Esmolol 혹은 Sodium Nitroprusside 를 이용한 유도저혈압 견에서 혈액 희석이 임꼐 산소 운반에 미치는 영향
김종수,고홍,박종두 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.5
Background : Acute normovolemic hemodilution (ANH) and deliberate hypotension (DH) are methods used for reducing homologous transfusions in cases of massive intraoperative bleeding. Using the technique of combining ANH and DH, we can save more homologous blood than a single use of ANH or DH, but the risk of tissue hypoxia may increase. Methods : Fourteen male dogs were used for this study and divided into two groups. After performing ANH by 25 ml/kg, mean arterial pressures were reduced to 60 mmHg by sodium nitroprusside (S group) or esmolol (E group). The critical oxygen delivery and the hemoglobin concentration at the critical oxygen delivery were determined by measurements of hemodynamic change, systemic oxygen delivery and systemic oxygen consumption during subsequent hemodilution. Results : After performing ANH by 25 ml/kg, the cardiac output was significantly increased, and systemic vascular resistance and hemoglobin concentration were significantly decreased compared with control values. The critical oxygen deliveries were 179.6 ml/min in the S group and 169.1 ml/min in the E group. There was a difference in mean systemic oxygen consumption between the S group (123.4±16.7 ml/min) and E group (112.9±15.4 ml/min) above the critical oxygen delivery point (mean±SD). The hemoglobin concentrations at the critical oxygen delivery were 2.6±0.7 g/dl in S group and 4.0±1.3 g/dl in E group (mean±SD). Conclusions : The critical oxygen delivery during hemodilution under DH by sodium nitroprusside was 179.6 ml/min and by esmolol was 169.1 ml/min. However, esmolol was higher in hemoglobin concentrations at the critical oxygen delivery than sodium nitroprusside. These results suggest that hemodilution under DH by esmolol rather than sodium nitroprusside requires more careful monitoring of systemic oxygen delivery for prevention of tissue hypoxia. (Korean J Anesthesiol 2000; 39: 713-725)
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오용석,박종두,전영태 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.1
An endotracheal tube provides patent airway during general anesthesia. We experienced the cutting of an endotracheal tube during surgical procedure. The patient with bimaxillary protrusion was operated for cosmetic bimaxillary surgery. The patient was intubated via nasotracheal route with a reinforced endotracheal tube. During surgical procedure, we found air bubbles from the nostril in which the entotracheal tube was inserted. Several milliliters of air was infused into the pilot balloon to inflate the cuff, but air bubbles was noticed continuously. We exchanged the endotracheal tube using a tube exchanger. The removed endotracheal tube was partially cut at 22cm from the tip, probably due to the air-driven saw.
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파열되지 않은 뇌동맥류를 가진 산모의 제왕절개술과 뇌동맥류 결찰술의 동시 마취경험
김종수,한승문,박종두 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.4
Intracranial aneurysm in pregnancy imposes special consideration for both mother and fetus. During newborn delivery, the risk of aneurysmal rupture should be avoided by careful management. We experienced a case of cesarean section and the clipping of aneurysm in 37 years old pregnant woman at the gestational age of 35 weeks. She had suffered from headache since 30 weeks of gestational age and the ptosis of left eye since 33 weeks of gestational age. Ten millimeter-sized aneurysm of posterior communicating artery was found on the cerebral angiogram. After radial artery cannulation, we anesthetized the woman with nitroprusside infusion, thiopental, succinylchoine and nitrous oxide-oxygen- isoflurane gas mixture. Soon after intubation, systolic blood pressure increased from 140 to 150 mmHg during the infusion of sodium nitroprusside. The delivery of a newborn was done 8 min after induction and clipping of aneurysm was done successfully after the end of cesarean section. (Korean J Anesthesiol 1999; 36: 736∼739)
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제왕절개시 전신마취 및 경막외마취가 심박수 변이도(Heart Rate Variability)의 Power Spectral Components 에 미치는 영향
고홍,곽일용,박종두 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.2
Background: The analysis of beat-to-beat heart rate variability has become a method of assessing the state and health of the autonomic nervous system. Power spectral analysis(PSA) has become one of the most widely used techniques to describe heart rate variability. Methods: We analyzed the heart rate variability using PSA before and during general and epidural anesthesia in cesarean section. We anesthetized 12 patients by enflurane, and 15 patients by 2% lidocaine via epidural catheter. Automatic computer analysis provided PSA. The PSA contained two major components, a low frequency(LF) at 0.04∼0.15 Hz, and a high frequency(HF) at 0.15-0.50 Hz. Results: Before anesthesia, P_(LF)(spectral power of LF-unit; sec² /Hz) is 0.06(0.03, 0.34) { median(5 percentile, 95 percentile) }, P_(HF), 0.83(0.22, 1.68), total spectral power(Ps), 1.98(O.86, 3.88), and P_(LF)/P_(HF), 0.67(0.17,1.67) in general anesthesia group. During anesthesia, P_(LF) is 0.06(0.03, 0.34), P_(HF), 0.12(0.04, 0.76), Ps, 0.43(0.24, 1.71), P_(LF)/P_(HF), 0.70(0.24, 2.59). In epidural group, before anesthesia, P(LF) is 0.30(0.11, 1.94), P_(HF), 0.78(0.14, 1.94), Ps, 1.81(0.58, 5.23), P_(LF)/P_(HF) 0.47(0.25, 1.34). During anesthesia, P_(LF). is 0.14(0.05, 0.41), P_(HF), 0.33(0.07, 0.80), Ps, 0.81(0.34, 1.58), P_(LF)/P_(HF), 0.58(0.22, 1.08). Conclusions: In general anesthesia, P_(LF) P_(HF) and Ps during anesthesia showed significant decrease than pre-anesthetic period, but P(LF)/P(HF) did not change. In epidural anesthesia, P_(LF)/P_(HF) and Ps during anesthesia also decreased, but P_(LF)/P_(HF) did not change. There were significant differences in degree of decrease in Ps and P_(HF) between general and epidural anesthesia, but no differences in and P_(LF)/P_(HF)
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김대현,김지희,이순애,장성호,박종두 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.2
Background : This study was designed to identify overtransfusion- triggering clinical factors in patients undergoing total hip replacement surgery. Methods : The discharge hematocrit was chosen for evaluation. Estimated red cell loss for each patient during the admission was calculated by the differences between admission and discharge hematocrit, multiplied by patient whole blood volume. Total RBC lost was then determined by the sum of RBC volume lost plus the RBC volume transfused. RBC volume in each patient at admission. Comparison of transfusion practice was done on the basis of sex, age, preoperative hematocrit, surgical procedure and anesthetic method. Results : Forty-six (37.7%) of 122 patients were identified to have been transfused with red cell volumes in excess of red cell volumes lost. Significant differences for patients transfused in excess of needs were found by sex (52.4% of women vs. 22.0% of men, P = 0.001) and by preoperative hematocrit (71.4% of patients with lower hematocrit vs. 24.1% of patients with higher hematocrit, P = 0.001). Conclusions : Preoperative hematocrit and sex can be a overtransfusion-triggering index. (Korean J Anesthesiol 2002; 42: 167~171)
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