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수술후 통증조절을 위한 지주막하강내 몰핀투여시 Epinephrine 첨가효과
송민엽,송경준,정종달,소금영,김용일 朝鮮大學校 附設 醫學硏究所 1996 The Medical Journal of Chosun University Vol.21 No.2
To investigate whether the addition of epinephrine would enhance postoperative pain relief by intrathecal morphine, we studied 30 patients scheduled to have spinal anesthesia for low extremities surgery, Patients were randomly allocated to one of two groups: the first group received 0.5% bupivacaine and morphine 0.15㎎ intrathecally: the second group received 0,5% bupivacaine. morphine 0.15㎎ and epinephrine 0.15㎎ intrathecally. There were differences among groups in the incidence of nausea and pruritus and no evidence of respiratory depression. The addition of epinephrine enhances intra-and postoperative analgesia by intrathecal morphine without increasing the incidence of adverse effects as compared with intrathecal morphine alone.
Ranitidine 의 마취전투약 방법에 따른 수술환자의 위액 pH 의 변화
유병식,송민엽 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.4
Background: Aspiration pneumonia remains a serious result associated with general anesthesia. Therefore, we studied the effectiveness of preanesthetic ranitidine in increasing gastric pH to prevent aspiration pneumonia. Methods: Eighty patients scheduled for elective surgery were randomly divided into four groups with twenty patients in each group. Patients in control group were not given preanesthetic ranitidine; patients in group I received 300 mg of ranitidine orally at night before surgery, patients in group II received 150 mg of ranitidine orally both the night before surgery and one hour before surgery respecvtively and patients in group III recieved 150mg of ranitidine orally one hour before surgery. Results: Compared with control group, the mean gastric pH of preanesthesia and 1 hour after anesthetic induction increased significantly in the group I, II, III (P$lt;0.0001). There was significant increased gastric pH in the group II compared with group I and III. Conclusions: These results demonstrate that ranitidine markedly increase the gastric pH. So, we recommend that patients receiving general anesthesia would be taken Hz-antagonist such as ranitidine preoperatively.
성인 남자에서 척추경막외 천자침을 사용시 피부에서 경막외강과 지주막하강까지의 거리
송광수,송민엽,임경준,정종달,김용일,송성용 朝鮮大學校 附設 醫學硏究所 1996 The Medical Journal of Chosun University Vol.21 No.1
The purpose of the present study was to examine and evaluate the distance from the skin to the epidural space, to the subarachnoid space and the epidural width using a combined spinal-epidural technique. And to evaluate the correlation with age, height, weight and the ponderal index (PI= weight/height ratio). Combined spinal-epidural anesthesia was performed on 30 males in the ASA class I-II patients scheduled for lower extremity surgery. The age, height, weight and PI were recorded. The epidural space was identified using midline approach at the L_(3-4) interspace with an 18G Tuohy needle and the spinal needle was introduced through the Tuohy needle. After free flow of cerebrospinal fluid. 3ml of 0.5% heavy bupivacaine was injected into the subarachnoid space. We used following parameters : the distance from the skin to the tip of the Tuohy needle (skin to epidural space : SE) and to the distal aperture of the spinal needIe (skin to subarachnoid space : SS) and the distance from recognition of negative pressure to free flow of cerebrospinal fluid (epidural width : EW) were measured. Afber measurement, the spinal needle was withdrawn and the epidural catheter was inserted. The mean SE, EW and SS were found to be 4.74 cm, 0.79 cm and 5.53 cm respectively, which significantly correlated with the weight and PI, but not with age and height. It is concluded that if the SE, SS and EW are predictable after weight and the PI are measured, an accurate placement of the epidural needle into epidural space may reduce the complications of spinal or epidual anesthesia as well as providing a safe anesthetic management.
임경준,정종달,송광수,송민엽 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.3
A thirty nine year-old male patient was scheduled for emergent craniotomy and epidural hematoma evacuation under general anesthesia. All data of the preoperative check lists for emergent operation were within normal limits and vital signs of the patient were stable. During the induction of anesthesia an armored tube was inserted into the trachea for this operation. Approximately 110 minutes after the induction of anesthesia, signs of complete airway obstruction developed abruptly. At that time we deflated the cuff balloon to exchange the tube. Then, the signs of airway obstruction disappeared completely. Therefore the deflation of cuff balloon is recommended in order to exclude the obstruction by the displaced cuff.
조남수,김용배,조수형,송민엽,송성용 大韓應急醫學會 1996 대한응급의학회지 Vol.7 No.1
Endotracheal intubation has been used widely for the maintenance of airway in the emergency patient and CPR in the acute airway obstruction patient and to treat respiratory insufficiency. Endotracheal intubation has many advantages but it may cause several complications which rate about 4% of endotracheal intubation patient. Among these complications, laryngeal granuloma is a relatively rare complication arising about 1 case per 10,000∼20,000 cases. Authors report a case of laryngeal granuloma which developed after endotracheal intubation required during emergency treatment. Case: A 55-year old female patient visited Chosun University Hospital Emergency Room complaining of dyspnea, cyanosis and sweating on Feb. 8th 1995. According to past history, she had a little obesity, dyspnea on exercise and mild hypertension. At arrival, blood pressure was 240/110mmHg, pulse rate 150 rates/min, respiratory rate 12/min, body temperature 36.5℃ and cyanosis with sweating on whole body was observed. And the mental state was semicoma. At 5 minutes after arrival, sudden respiratory arrest developed and immediate endotracheal intubation which emergency treatment was performed it was difficult to intubate endotracheally due to short neck and obesity. At 1 hour after arrival, general condition of the patient recovered well and extubation was done. The patient was transferred to internal medicine department and discharged after 12 days of medical treatment. At 2 months after discharge, the patient felt a progressive hoarseness and foreign body sensation of larynx. She was diagnosed as laryngeal granuloma at ENT department of Chosun University. She underwent the surgical operation and discharged in good health after 7 days of admission.