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척추마취시 차단부위별 및 Epinephrine, Morphine 혼합 사용에 따른 혈당량의 변화
이호정,김봉일,윤만모 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.6
The purpose of this study was to observe the effect of spinal anesthesia on serum glucose which is still controversial and to observe the changes of serum glucose according to the blocked level and intrathecal morphine and epinephrine mixed with local anesthetic(tetracaine). 67 patients(age; 16-83, ASA. ps. 1-3) for lower abdominal or lower extremity operation, had no disease affecting serum glucose level and were not contraindicated for spinal anesthesia, were selected randomly and divided them into each 3 group depending on the sensory block level and with or without intrathecal morphine and epinephrine mixed with local anesthetic (tetracaine) as fo11ows; Ggroup l (N =8); high spinal anesthesia(above T4) Group 2(N=23); middle spinal anesthesia(T5~T9) Group 3(N=26); low spinal anesthesia(below T10) Group A(N=18): tetracaine only Group B(N=17); tetracaine+epinephrine(0.2 mg) Group C(N = 32); tetracaine+ epinephrine(0.2 mg)+ morphine(0.2 mg) All patients except emergency cases were premedicated with nalbuphine(5 mg) and droperidol(2.5mg) or hydroxyzine(1 mg/kg) and were kept NPO 6-12hr. Hartman's solution were used for the maintenance fluid. Serum glucose were measured before operation, just immediate before and after spinal anesthesia and at 30 min. after starting operation with Glucometer-2(Miles inc, Indiana, USA). The results were as follows; 1) The values of serum glucose after spinal anesthesia were not changed significantly compared with those of the immediate before anesthesia(P$gt; 0.05). 2) The values of serum glucose according to sensory block level were not changed significanly compared with each group(P$gt;0.05). 3) The values of serum glucose when using mixed epinephrine and morphine with tetracaine intrathecally were not changed significantly compared with using tetracaine only(P$gt;0.05). These results suggested that spinal anesthesia itself did not affect serum glucose level, and neither the sensory block level nor iatrathecal epinephrine and morphine affect serum glucose level. Increased serum glucose caused by surgical stress might be attenuated by spinal anesthesis when lower extremity and lower abdominal operation.
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경요도 전립선 절제술시 투여한 Furosemide 가 수술중, 후 혈청 전해질 및 삼투질농도에 미치는 영향
이상화,박대팔,김봉일,노운석,윤만모,진선미 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.2
The purpose of this study was to prevent the dilutional effect of excessive absorption of irrigating solution by using furosemide intraoperatively during transurethral resection of the prostate. Thirty patients, classified as ASA ps 2 or 3, were selected randomly and divided them into two groups as follows: Group l(N=15); Not-administrated furosemide(control group) Group 2(N=15); Administrated furosemide(Experimental group) All patients were premedicated with hydroxyzine(1 mg/kg, IM) and were performed continuous epidural anesthesia with 2/ lidocaine(1-1.5 mg/segment). 5% D-sorbitols were used for irrigating solution, and Hartmans solutions were given for maintenance fluid. And fixed the irrigating container to 60 cm in height from symphysis pubis. With the starting of operation, 20 mg furosemide was administrated to experimental group. The blood samples for serum Na^+, K^+, glucose and BUN were obtained at preoperation, 10 min, 20 min, 30 min after the stating of operation and immediate postoperative period, and serum osmolality and effective osmolality were calculated. The results were as follows: 1) The values of sodium concentration of control group were decreased significantly at 10 min, 20 min, 30 min after the starting of operation and immediate postoperative period as compared with the preoperative value(p$lt;0.05). But those of experimental group were not changed significantly. 2) The values of serum osmolality and effective osmolality were decreased significantly at 30 min after the starting of operation and immediate postoperative period as compared with the preoperative value(p$lt;0.05). But those of experimenta1 group were not changed significantly. These results show that the dilutional effect of excessive absorption of irrigating solution might be prevented by using furosemide intraopertively. So we would like to recommend the use of furosemide during TURP, especially in patients with congestive heart failure or renal failure.
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수술실내의 Halothane 오염방지에 대한 중앙집중식 흡인배기장치의 효과
이상화,예민해,이선행,조성경,김봉일,윤만모 대한마취과학회 1985 Korean Journal of Anesthesiology Vol.18 No.3
A central vacuum scavenger modified by the authors, was used to control the atmospheric contamination of the operating room by anesthetic gases and vapours. Air pollution was monitored by measuring the concentrations of balothane vapour in the air of the operating room with the gas chromatograph. Under endotrachal intubation, the semi-closed circle absorber system was used for anesthetic admistration and maintained with 0.8∼1.2% Halothane. Total gas flow rates were 4 liter/min with 50% oxygen in nitrous oxide for daily work. Air sampling was taken early in the morning at 10㎝ high from the floor before anesthesia. After daily work, they were also done at 10㎝, 120㎝, and 140㎝ high from the floor and at the corrkdor of the operating room. We investigated the differences of halothane concentration according to each site by the changing central vacuum pressure. Results are as followings: The atmospheric halothane concentrations of the operating room before anesthesia were 0.27±0.12, 0.22±0.11 and 0.15±0.06 ppm. The atmospheric halothane concentrations of the operating room after daily work were 7.94±1.30 ppm without the active central vacuum pressure. The atmospheric halothane concentrations of the operating room after daily work were 1.41±0.48 ppm of 20 mmHg of central vacuum pressure. The atmospheric halothane concentrations of the operating room after daily work were 0.49±0.18 ppm of 40 mmHg of central vacuum pressure. The atmospheric halothane concentrations at the corridor of the operating room after daily work were 1.09±0.19, 0.77±0.11, and 0.36±0.17 ppm when ench bacuum pressure was 0 mmHg, 20 mmHg and 40 mmHg. A significant reduction (P<0.01) in atmospheric halothane concentration of the operating room was obtained by the use of the central vacuum pressure with the scavenger. The higher the vacuum pressure, the greater reduction of the operating room air pollution was observed.
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