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이상영,김인세,성장호 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.1
Temperature changes after cardiopulmonary bypass surgery(CPV) markedly affect postoperative ventilation. Despite core rewarming after CPB on admission to the intensive care unit the rectal temperature is about 34∼35℃ over the next 12 hours, the temperature rises to 38∼39℃. Unless minute ventilation is increased. hupercarbia occurs presumably becarse dead space and/or CO_2 production are increased. This prospective review was designed to confirm these clinical impressions and to provide direction for future sutdies. Themperature changes, PaCO_2, pH, sodium and potassium values of 42 patients who had undergone cardiac valvular replacement surgery with hypothermic cardiopulmonary bypass were observed during surgery and during the first 12 postoperative hours in the intensive care unit. The results are as follows: 1. The mean nasopharyngeal temperature was 26.3℃, 34.4℃, 34.9℃, and 36.4℃ during bypass rewarming, admission to the intensive car unit, and after 4 hours, respectively. The temperature curve was sigmoid rather than linear. 2. During rewarming, the most common abnormality of PaCO_2 on anesthectic mechanical ventilation was acute respiratory acidosis(PaCO_2 45 mmHg. pH 7.35) which occurred in 48% of the patients. After bypass and in the intensive are unit, respiratory alkalosis occurred in 36% and 45% of the patients, respectively. 3. The serum sodium value decreased in 19% of the patrents during bypass but not significantly. 4. The serum potassium value increased in 21% of the pathients during bypass surgery, but not significantly, and after surgery it returned to normal limits. This suggests that ventillatory management in the early postoperative period after hypothermic cardiopulmonary bypass surgery should be carefull monitered and adjusted as necessary to the increased metabloic rate during rapid rewarming.
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경요도적 전립선 절제술 환자에 있어 혈청전해질 및 삼투질 농도의 변화에 관한 고찰
김해규,정규섭,김인세,성장호 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.5
Dilutional hyponatremia and serum hypoosmolality are commonly observed during transurethral resection of the prostate in association with the systemic absorption of the irrigating solution. To assess these sequential changes following surgery, 26 patients were studies who underwent transurethral resection of the prostate because of prostatic tumors at Pusan National University Hospital, where 4% Dextrose in Water is Still used as irrigating solution. 0.9% NaCl and furosemide were administered to all 26 patients in the recovery room after surgery. Blood samples were examined for serum electrolytes and osmolality before induction of anesthesia, immediate-postoperatively, and at postoperative 1 hour, 6 hours and 24 hours respectively, The results are as fellows : 1) Of the 26 Patients, 19 Patients shoved abnormalities in serum electrolytes, especially serum sodium, in the immediate postoperative period, while 7 patients showed a slight decrease in serum sodium but within normal limits. Mean changes in serum sodium was 10.9 mEq/l in the immediate postoperative period, but after administration of 0.9% NaCl and furosemide, the level of serum sodium returned to normal limits within 1∼3 hours. Serum calcium decreased approximately 0.8 mg/dl but returned to normal levels 3 hoers after surgery. But no symptoms of hyponatremia or hypocalcemia were not observed. 2) Serum osmolality decreased to about 8.4 mOsm/kg below the preoperative level in accordiance with hyponatremia, but returned to normal levels 24 hours postoperatively. 3) Blood glucose levels increased about 231.5 mg% but returned to normal levels 24 hours postoperatively.
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정규섭,김인세,김성수,성장호,하영천 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.2
This study was undertaken to evaluate the result of intensive respiratery care for 36 patients who developed acute respiratory insufficiency and pulmonary comlications after operation in Busan National University Hospital, and to compare the any difference between the survivors and nonsurvivors. The results were as follows : 1) 20 patients survived (55.6%) . 2) In 19 patients(52.8%), were received prolonged cancer operation and upper abdominal surgery. 3) 30 patients had abnormal physilogic conditions before operation, in which the COPD was the most common problems. 4) 55% of aurvirors had mean operation time less than 5 hrs and 75% of non survivers had mean operation time greater than 5 hrs. 5) In 83.3% of patients, acute respiratory compiication was developed within 10 hours from the opration, 6) Majority of the patients (25/69.4%) required less than 24 hrs of ventilatory support. 7) 29 patients, receive the PEEP therapy and the level of PEEP was 6∼15 cmH_2O. 8) The survivors showed fair general conditios during respiratory care, such as normal range of blood preasure, more improved pulmonary function, more improved atterial blood gases and CVP, and adequate hourly urine output. But the nonsurvlvors had poor general conditions, such as unstable blood pressure, poor pulmonary function, abnormal arterial blood gases in spite of ventilatory support, low urine output, high CVP, and elctrolyte i mbalances.
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