성인 개심술 마취시 Aprotinin과 Tranexamic Acid의 출혈억제 효과의 비교

문현수,성시욱 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.1

Background : Antifibrinolytics such as aprotinin and tranexamic acid have been administered to reduce blood loss of cardiac surgery, but opinions differ regarding the efficacy of each drug. This study was performed to compare the hemostatic effects between aprotinin and tranexamic acid on adult open heart anesthesia and to evaluate their additive effects. Methods : We randomly allocated 73 patients undergoing coronary artery bypass grafting or double valve surgery to 4 groups. Group I was non-medicated control(n=15), group II(n=21)patients were recipients of a high dose of aprotinin, group III(n=16) patients were recipients of a conventional dose of tranexamic acid, and group Ⅳ(n=21) were recipient of both drugs. Cardiopulmonary bypass time, total operation time, hematocrit, platelet count, transfusion amount and 6 hours of postoperative chest tube drainage were measured. Results : The medicated three groups significantly demonstrated less amounts of blood transfusion and blood loss over the first 6 hours atICU compared to the nonmedicated control group. Total operation times were shorter in group II, III, and Ⅳ compared to group Ⅰ. Use of both agents together was more effective in reducing the total operation time and blood loss compared to tranexamic alone. Conclusions : We conclude that the use of aprotinin and tranexamic acid result in significant positive hemostatic effects but superiority of one agent vs. the others is not proved. Use of two agents together yield a more positive effective in reducing the operation time and the blood loss compared to single agent alone but further study would be needed to fully confirm. (Korean J Anesthesiol 1998; 35: 108∼114)

미만성 기관협착을 동반한 폐동맥 sling 으로 인한 불안정한 기도유지

김미운,성시욱,문현수 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.4

Pulmonary artery sling is a rare congenital condition in which the left pulmonary artery arises anomalously fmm the right pulmonary artery extrapericardially and encirdes the right main stem bronchus and passes between the trachea and esophaghus to reach the hilum of the left lung. Respiratory obstruction vesults from compression of the lower area of trachea and right main stem bronchus. It is rare cause of respiratory distress in the new bom and may be associated with significant morbidity and mortality. We experienced the case of pulmonary artery sling with diffuse trachea stenosis and congenital heart disease (pulmonary atresia and PDA) and confirmed the anomaly by bronchogram and MRI. The presumed cause of death was respiratory obsruction due to pulmonary artery sling.

할로탄 마취 후 할로탄의 체외 배출에 관한 연구

김성덕,김광우,성시욱 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.2

Complete consciousness may return very slowly following general anesthesia. Although most patiients appear to approach their preanesthetic state within minutes to hours, but there appears to be some changes in cognitive functions for the next 2 to 4 days after halothane anesthesia. For the evaluation of recovery time from halothane anesthesia, we studied 10 pediatric patients who received N_2O-O_2-halothane anesthesia, During the recovery after cessation of halothane inhalation, we administered N_2O (2 l/min) and O_2 (1 l/min) with Dameca anesth-esia machine. All the patients ware ventilated with Dameca ventilator. The minute ventilation was 145 ml/kg/min. Throughout the experiments, we measured inspired(Ⅰ) and end-tidal (ET) O_2, CO_2, N_2O, N_2, and halothane concentrations with mass spectrometry. Control data were obtained just after cessation of halothane inhalation, and all the data after then were compared with control data and expressed as % response of control. The concentrations of O_2, CO_2, N_2, and N_2O wer net changed significantly during the experiment. The inspired halothane concentration (C_(1 HAL)) in control was 1.14±0.08 vol% and it showed significant progressive decrease by each minute, The most abrupt decrease in C_(1 HAL) was noticed in 3 min and 6 min: 68.8% and 73.0% in 3 min and 6 min respectively. The endtidal halothane concentrations (C_(ET HAL)) were 1.06 vol%, 0.52 vo1%, 0.39 vol% and 0.32 vol% in control, 3 min, 6min and 9 min respectively. The end-tidal halothane concentrations were also significantly decreased progressively. C_(ET HAL)/C_1 HAL ratio was 0.91±0.02 in centrol, but it wag alwayg more than 1.0 after cessation of halothane, which indicates continuous elimination of halothane from the body, The complete disappearance times of inspired and end-tidal halothane calculated from the linear regreasion equations were 60.26 min and 63.10 min, respectively.

인공 심폐기를 사용않는 관상동맥 우회술시 시행한 유도 저혈압과 서맥

문현수,서정무,성시욱 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.3

Coronary artery bypass grafting(CABG) without cardiopulmonary bypass is now an accepted technique of myocardial revasculization in terms of preventive method from various complications of cardiopulmonary bypass. Despite danger of myocardial ischemia, induced hypotension with bradycardia are sometimes necessary for the convenience of operative approach to beating heart. We report a case of induced hypotension with bradycardia during general anesthesia for CABG without cardiopulmonary bypass. After induction and maintenance of balanced anesthesia with fentanyl-midazolam-isofluranepiperocuronium for the 68 kg, 55 years old male stable angina patient, we induced controlled hypotension(systolic blood pressure: 70∼80 mmHg) and bradycardia(heart rate: 50∼60/min.) by bolus injections of verapamil 5 mg and esmolol 30 mg followed by continuous infusion of esmolol 0.1∼0.3 mg/kg/min. during 50 minutes of main graft implantations without bypass. Any significant ischemic changes on EKG were not detected during induced htension and bradycardia. Patient was recovered without any signs of myocardial ischemia postoperativery and discharged 8 days after operation. (Korean J Anesthesiol 1997; 32: 000∼000)

Halothane과 Enflurane 마취가 혈장 Norepinephrine 및 Epinephrine치에 미치는 영향

박종두,이상민,이경령,성시욱,문현수,김광우 世宗醫學硏究所 1993 世宗醫學 Vol.10 No.2

강직성 경부 류마토이드 환자에서 기관 내관 삽관시 발생한 식도천공 1예 보고

문현수,김미운,김용락,성시욱,김성오 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.6

Adverse respiratory events during endotracheal intubation for general anesthesia are variable. These events frequently occur to difficult airway patients. Traumatic endotracheal intubation with poor glottic exposure and blind thrust can perforate the hypopharynx or cervical esophagus. We experienced a case of esophageal perforation during endotracheal intubation for general anesthesia of total hip replacement in a 50 year old female patient. Neck extension was almost impossible due to longstanding ankylosing rheumatoid cervical arthritis. We tried several times of endotracheal intubation but failed. Post-operative esophago-graphy after we found subcutaneous emphysema confirmed esophageal perforation. Emergency tube drainage and general supportive care were done. Fortunately she recovered uneventfully and discharged on post-op. 30th days.

개심술 마취 감시를 위한 경식도 초음파술(Transesophageal echocardiography)의 사용 경험

문현수,서정무,김미운,성시욱 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.5

Echocardiography has been the most widely applicable noninvasive cardiovascular imaging technique. Recent advances in this technique have extended its use into the operating room by development of transesophageal approach. Many anesthesiologists use transesophageal echocardiography (TEE) because it provides a more direct and rapid method of assessing cardiac anatomy and function. Intraoperative TEE done by anesthesiologists or cardiologists makes it possible for operation team to get useful informations such as cardiac filling, valvular function, cardiac contractility, intracardiac shunt, segmental wall motion abnormality and adequacy of coronary blood flow, etc. We analyzed our clinical experiences of forty six cases of TEE (6.0%) in 767 cases of anesthesia for open heart surgery at the Sejong General Hospital during the period from September 1993 to August 1994. 767 open heart surgical cases were divided into 4 groups by disease entity ; 498 cases of group I(congenital), 190 cases of group II(valvular), 63 cases of group III(ischemic) and 16 cases of group IV(miscellaneous). TEE was done for 22 cases of male patients and 24 cases of female patients. 32 cases of TEE were done for the age group between 21 to 30 years old. The number of TEE was 26 cases of group II, 11 cases of group I, 7 cases of group III and 2 cases of group IV, respectively. The main purpose of TEE in descending order was 27 cases for assessment of cardiac contractility, 18 cases for valvular function after valvuloplasty, 7 cases for the evaluation of low cardiac output syndrome(LCOS), and 7 cases for adequacy of coronary blood flow respectively. Two cases of Biopump in group I, 2 cases of Biopump in group II, 3 cases of intraaortic baloon pump(IABP) in group II, III and IV were applied after TEE. Two cases of mitral valvular replacement(MVR) were done immediately after confirmation of valvular insufficiency by TEE. These results have demonstrated that TEE is one of the useful monitoring devices for the anesthesia in open heart surgery by assessment of variable informations about patients' cardiac status.