뇌동맥류 결찰시 간헐적 Labetalol 정주에 의한 저혈압 유도 마취 경험 4예

박평환,최종무,황재현 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.2

Hypotensive anesthesia is still widely employed during neurosurgery in spite of the development of microsurgical techniques. There have been a few reports regarding cerebral blood flow during injections of labetalol, a non-selective beta and selective alpha 1-blocker, to control blood pressure during or after craniotomy and results were favorable. In 4 cases, intermittent labetalol injections were given for hypotensive anesthesia during clipping of a cerebral aneurysm and the results were as follows: 1) The onset was within 1-2 minutes after injection. 2) Hypotensive anesthesia was well maintained by repeated injections during surgery. 3) Systolic and mean arterial blood pressure were decreased as much as 35.7 mmHg and 24.3 mmHg respectively. 4) Heart rate did not change significantly. 5) After clipping, blood pressure returned to the previous level with atorpine or ephedrine. 6) We conclude that labetalol can be an excellent choice for hypotensive anesthesia.

고양이에서 출혈성 쇽후 수액소생시 수액 종류가 소화관 점막 산소화에 미치는 효과

박평환,백종화,최종무 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.6

Recently, much attention has been paid to the gut mucosal oxygenation in shock resuscitation, because many studies has been reported that the ultimate etiologies of death due to shock are mainly due to multiple organ failure caused by translocation of endotoxins and microorganisms from the ischemic gut mucosa. As there has been persistent controvesies over the relative merits of various kinds of resuscitation fluids in regard to the tissue oxygenation during management of shock, we studied the effects of various kinds of resuscitation fluids on the gut mucosal oxygenation with cats which were in hemorrhagic shcok 24 anesthetized cats were subjected to ge to decrease the mean arterial blood pressure to 40∼45 mmHg and this pressure was maintained for 120 minutes (oligemic period). After this period, normal saline, hydroxyethyl starch and hypertonic saline/dextran mixture were administered respectively to raise systolic blood pressure up to 85 mmHg over 30 minutes and this level was maintained for another 120 minutes (post-oligemic period). Mesenteric venous oxygen tension, mesenteric venous-arterial lactate difference, carbon dioxide tension difference and arterial-venous pH difference were measured far evaluating the effects of three groups of resucitation fluids in regard to the gut mucosal oxygenation. There were no statistical significances among three groups by measuring the venous oxygen tension, venous-arterial carbon dioxide difference, arterial-venous pH difference. But venousarterial lactate difference in normal saline resuscitation group was significantly elevated from 5.0 ±l.l mg/dl immediately after fluid resuscitation to 8.4±1.8 mg/dl 1 hour after fluid resuscitation (p$lt;0.05). The difference in normal saline group was significantly high compared to the hydroxyethyl starch group which was 4.4±0.5 mg/dl and also compared to the hypertonic saline/dextran mixture group which was 4.1±0.9 mg/dl (p$lt;0.05). Hydroxyethly starch and hypertonic saline/dextran mixture are more effective than normal saline in rd to the gut mucosal oxygenation in shock resuscitation, based on changes in venous-arterial lactate difference in each group. Further clinical studies may be needad

올레인산 유발 급성폐손상시 Prostaglandin E1 및 Hydralazine 이 혈역학과 가스교환능에 대한 효과에 관한 실험적 연구

박평환,김용락 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.3

Prostaglandin E_1(PGE_1) is a potent vasodilator of the systemic and coronary circulatory system, and when used in adult respiratory distress syndrome, PGE_1 produces a decrease in pulmonary arterial pressure(PAP) and pulmonary vascular resistance(PVR), and increases cardiac output(CO) and arterial oxygen tension(PaO_2). Another vasodilator hydralazine in patients with pulmonary hypertension and heart failure produces a decrease in PVR, and an increase in CO and inspite of an increase in CO, hydralazine maintains or increases the PaO_2. The authors made a comparative studies on the effects of PGE_1 and hydralazine on hemodynamics and gas exchange in experimentally induced acut lung injury. Oleic acid was infused in 8 dogs in order to induce acute lung injury and the effects on hemodynamics and gas exchange were measured every 30 minutes for 2 hrs. After measuring Pre-PGE_1 and Prehydralazine values, PGE_1 and hydralazine were administerd intravenously in order to evaluate and compare their effects. Doses for PGE_1 and hydralazine were titrated until CO increased by 25%, heart rate(HR) increased by 15%, or mean arterial pessure(MAP) decrased by more than 20% from Pre-PEG_1 and Prehydralazine values. In PGE_1 group, CO increased by 21%(P<0.01), MAP decreased by 14%(P<0.01), PVR decreased by 19%(P<0.01) and systemic vascular resistance(SVR) decreased by 29%(P<0.01). As CO increased with PGE_1, intrapulmonary shunt(Q's/Q't) increased from 37% to 49%(P<0.01) and PaO_2 fell from 109 mmHg to 88 mmHg(P<0.01). In hudralazine group, MAP, PVR, SVR and pulmonary capillary wedge pressure(PCWP) all decreased by 9%(P<0101), 10%(P<0.05), 30%(P<0.01), 28%(P<0.01), respectively. CO increased by 41%(P<0.01) but the increase in A's/A't was only 5% inspite of a remarkable increase in CO, consequently PaO_2 increased by 10% rising from 86 mmHg to 94 mmHg(P<0.01). Comparing the two groups, hydralazine resulted in a mainor increase in Q's/Q't, while there was a remarkable increase in CO. Moreover, it caused an increase in PaO_2 and decrease in PCWP. THe avove results suggest that the effects of hydralazine are superior to those of PGE_1 on the effects of hemodynamics and gas exchange in acute lung injury in dogs.

Caking Coal을 이용한 활성탄 제조

박평환,장동순,김춘호,백일현,서지미 대한환경공학회 1997 대한환경공학회 학술발표논문집 Vol.1997 No.12

석탄 비산회재 미연탄소 저감을 위한 싸이클론 연소로 주요변수 연구

박평환,장동순,김경미,현주수,손응권 대한환경공학회 1998 대한환경공학회 학술발표논문집 Vol.1998 No.12

Thiopental 로 인한 면역성 용혈반응 1 예

박평환,서병태 대한마취과학회 1986 Korean Journal of Anesthesiology Vol.19 No.4

Epinephrine 의 우발적 과용량 투여 후 발생한 가역적인 심근병증

박평환,김종욱,임민성 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.4

There is increasing tendency to use epinephrine injection or topical application to obtain clear operative field and hemostasis under general anesthesia. But excessive catecholamines due to inadvertent administration are known to cause a wide spectrum of cardiotoxicity. The authors have experienced a case of reversible cardiomyopathy due to accidental epinephrine overdose during mastoidectomy. This report is the first recorded case of the nearly fatal conseguences of inadvertent administration of a very large dose of epinephrine, with the subsequent development of a severe catecholamine induced $quot;cardiomyopathy$quot;. After the initial phase of massive catecholamine excess, this patient required exogenous catecholamines to support the injured, dysfunctional myocardium and maintain adequate perfusion pressure to vital organs. These abnormalities are also transient in nature with complete recovery documented. The case suggests the need for aggressive support of patients received accidental epinephrine overdose with the expectation that, while cardiar. function may be extremely impaired early in the course of the illness, recovery is virtually complete over time.

고양이에서 Vecuronium 이 혈역학 및 두개강 내압에 미치는 영향

박평환,서병태,이경천 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.6

We studied the cardiovasuclar and intracranial pressure (ICP) effects of Vecuronium in cats with normal and artificially increased ICP. Under pentobarbital and nitrous oxide anesthesia, monitors for ICP, Mean Arterial Pressure (MAP), Heart Rate (HR), and Central Venous Pressure (CVP) were placed in the cats. The cats were then divided into two groups; one with normal ICP (N-ICP) (n=8) and the other with artificially increased ICP (AI-ICP) (n=8). In the AI-ICP group, a size 8F Foley catheter was placed in the epidural space through a 5 mm trephined hole on the right parietal area. In each group, ICP, MAP, HR, CVP, and Cerebral Perfusion Pressure (CPP) were measured after Vecuronium injection (80 mg/kg)(CPP=MAP-ICP). Results showed no statisitically significant changes in cats with N-ICP and AI-ICP.

개심술마취 22 례 보고

박평환 대한마취과학회 1984 Korean Journal of Anesthesiology Vol.17 No.2

This report is concerned to out clinical expenence of 22 cases of open beart anesthesia at the Department of Anesthesiology, Capital Armed Force General Hospital during the period between May, 1982 and February, 1984. Among 22 cases male were 20, female were 2 cases. Age was varied from 21 years to 50 years and mean was 25.8 years. Morphine & demerol were used as premedicants in most cases in conjunction with valium or alone, and thiopental in 2.5~6 mg/kg dosage as in duction agent for 20 cases. We used halothane for 21 cases, enflurane for 1 case in concentration of 0.3~1%, 0.7~1.5% respectively. Intravenous anesthetic agents, morphine and thalamonal, were used as supplementary to reduce the required dosage of inhalation agents, halothane and enflurane, to maintain the anesthesia. Succinylcholine for intubation of trachea and pancuronium for maintenance of muscle relaxation were used in dosage of 1~1.6 mg/kg, 0.1~0.3 mg/kg respectively.

판막질환의 개심술시 Creatine Kinase MB Isoenzyme 측정에 의한 심근손상 평가에 대한 소고

박평환,서병태 대한마취과학회 1985 Korean Journal of Anesthesiology Vol.18 No.3

During a 3-month period in 1984, 12 patients undergoing scheduled valvular replacement were Studied by CK and CK-MB isoenzyme to evaluate the myocardial damage during open heart operation. Total creatine kinase value was 58.3±25.6 u/L at control, 59.8±23.5 U/L at prebypass period, 85.5±49.6 U/L at during bypass period, 20.2±87.6 at poatbypass period respectively. It began to rise in prebypass period and showed higbest level in postbypass period. CK-MB value was low in most cases below 20U/L but in 2 patients postbypass period showed high level which above 40U/L. Initial isoenzyme activity was detected in 2 patients prior to anesthesia, in 2 patients prior to bypass, in 5 patients during bypass, and in all others after termination of bypass. Considering above data we concluded that anesthetic manage-ment during prebypass period and myocardial preservation during bypass period required more proper and aggressive management despite of good operation results.