수술중 발생한 고열증

임용걸,김태관,윤준로 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.2

The fulminant malignant hyperthermia(MH) is now encountered less frequently because of increased awareness of the condition by anesthesiologist and better use of mornitoring facilities. Thus there is also an increase in the number of aborted cases, in which anesthesia is stopped and treatment instituted as soon as MH is thought to be likely. We presented a case of an abortive MH in 18 years old male patient during the discectomy on the third and fourth lumbar intervertebral spaces. Anesthesia was induced with thiopental sodium and succinylcholine and then maintained with nitrous oxide, oxygen and enflurane. After induction, there were persistent tachycardia, elavation of end-tidal CO2 tension on capnography, spontaneous tachypnea, body temperature elevation up to 38.2oC, respiratory acidosis and highly level of CPK, myoglobulin in serum and urine. Under the suspicion of MH, all anesthetics were discontinued and vigorous emergency treatment was attempted including ventilation with high flow of 100% oxygen(8 l/min), changing all anesthetic circuits, and cooling measurements such as chilled intravenous solution infusion, gastric lavage with cold saline, alcohol and ice water pack over the body. Fourtunately, he recovered well and discharged without complications. (Korean J Anesthesiol 1998; 34: 464∼469)

적출관류 토끼신장에서 칼슘이 Amiloride 의 이뇨작용에 미치는 영향

임용걸 가톨릭대학 (가톨릭신학대학) 대학원 1988 가톨릭大學醫學部 論文集 Vol.41 No.2

편도선절제술후 성상신경절 차단이 제통효과에 미치는 영향

임용걸(Yong Gul Lim),김대우(Dae Woo Kim),박용진(Yo 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1

N/A Background: The tonsillar region is innervated by the sensory components of the glossopharyngeal nerve(IX) which communicates with certain part of cervical sympathetic ganglion. Some authors suggest stellate ganglion block(SGB) is effective for treatment of recurrent tonsillitis. The goal of this study was to evaluate the effect of SGB in controlling pain after tonsillectomy. Methods: Forty five patients, evaluated to ASA class 1 and 2, scheduled for tonsillectomy under general anesthesia were randomly assigned to 1 of 3 groups (group I: control; group II: SGB with 1% lidocaine 5 ml; group m: SGB with 2% lidocaine 2.5 ml plus 0.5% bupivacaine 2.5 ml), SGB was performed at the end of surgery. Postoperative pain was assessed with Numeric Rating Scale(NRS) NRS assessment was made 30, 60, 90 min, 2 h, 4 h, 24 h, 48 h after tonsillectomy. Results: Pain scores, after 30 min in group II, III and 60, 90 min in group III were significantly lower than group I(p<0.05). Conclusions: We found SGB was effective in controlling pain after tonsillectomy but further studies are required needs to prolong duration of relief.

Pheochromocytoma 적출수술의 Enflurane 마취 1예

김대우,임용걸,홍성진,정동석,성춘호,진수남 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.5

A 66 year old male with a suprarenal pheochromocytoma on the left side was treated preoperatively with oral phenoxybenzamine 20 mg, b. i. d. for 2 weeks. The night before surgery, phenobarbital 100 mg & diazepam 5 mg were given orally. One hour before induction, diazepam 10 mg i. m. was given. Preinduction BP was 210/140 and HR was 130/min. After diazepam 20 mg i. v, BP lowered to 200/130 and HR lowered to 126/min. With commencement of sodium nitroprusside i. v. dripping, a BP of 160/100 and HR of 118 were maintained. Following Thiopental sodium 250 mg i. v., mask induction was started with N2O-O2-Enflurane and pancuronium 4 mg i. v., after 5 minutes, a #8.5 tube was intubated and pindolol 0.16 mg was injected to prevent tachycardia. We maintained a tolerable BP and pulse by repeatedly adding a bolus i. v. injection of phenoxybenzamine 1 to 2 mg during tumor manipulation and removal. No arrhythmia was noted throughout the procedure, except tachycardia. After removal of the tumor, with rapid blood transfusion and fluid infusion plus dopamine i. v. dripping, a tolerable BP and pulse was maintained.

Apert 증후군 환자의 마취 경험 1 례

이은주,임용걸,강유진,옥광익 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.2

Apert's syndrome is rare autosomal dominant defect characterized by craniosynostosis, midface hypoplasia and symmetrical syndactyly. Multiple surgical procedures will be needed for the child with this syndrome. Especially surgery for craniosynostosis is most often performed between 2 and 6 months of life, a period of physiologic anemia. Perioperative complications can occur from numerous sources-massive blood loss, venous air embolism, cerebral edema, hypothermia and hazardous airway management, thus more monitoring, large bored central venous line and early transfusion are recommended. We report a case of 5 month-old female Apert patient undergoing frontal bone advancement and cranioplasty. At the end of uneventful surgery, we removed endotracheal tube in operating room and permitted early feeding because the procedure was limited above the orbital ridge. As soon as feeding the patient presented cyanosis with generalized seizure. Patient was immediately intubated, sucked out secretions and inhaled with oxygen. Blood gas showed moderate hypoxemia which was improved by oxygen therapy. Suspicious aspiration pneumonia was marked on chest film but disappered I week later. The condition was favorable thereafter and discharged without complication. Keypoints in management of Aperts syndrome are close observation, early detection and preventive treatment of possible complications in perioperative period. (Korean J Anesthesiol 1995; 29: 30D~303)

노인마취레의 임상적 고찰

최성철,임용걸,정운혁,유건희,조성두 대한마취과학회 1982 Korean Journal of Anesthesiology Vol.15 No.3

To evaluate geriatric anesthetic experience, 1,441 cases of patients aged over 60 years, out of 29,692 surgical cases admitted to St. Mary's Hospital from January 1971 to December 1980 were analyzed according to age, sex, surgery, preoperative condition, technique of anesthesia, duration of anesthesia, anesthetics, and mortality. The results were as follows: 1) The percentage of geriatric cases were 4.9% in average which ranged between 3.9% and 6.0% and showed steady numbers in this period. The distribution of the number of patient according to the age were 1,150 cases (79.8%) in the group of 60-69 years, 262 cases (18.2%) in 70-79 years, 29 cases (2.0%) over 80 years. 2) There were 833 male (57.8%) and 608 female (42.2%) cases. 3) 833 cases (57.8%) were in general surgery; the most prevalent diagnosis were empyema of gallbladder and cholelithiasis which amounted to 196 cases (13.6%0 4) The rates of elective to emergency surgery were 75.4% (1086 cases)to 24.6% (355 cases). 5) Premedicants were mainly atropine with sedatives (785 cases, 61.2%) and atropine with analgesics (220 cases, 17.1%). 6) Preoperative hemoglobin level ranged between 10.1 and 12.0 gm/dl in 40.1% of the patients. 7) The techniques of anesthesia were (1.234 cases, 85.6%) general anesthesia, (75 cases, 5.2%) intravenous anesthesia and spinal anesthesia (60 cases, 4.2%). 8) The duration of anesthesia (500 cases, 34.7%) were 1-2 hours in average. 9) The inhalation anesthetics were Halothane (1,110 cases, 90.0%), Methoxyflurane (112 cases, 9.1%), N_2O (6 cases, 0.5%), and Ether (6 cases, 0.5%). 10) The preoperative chest X-ray and clinical signs showed that 963 cases (64.3%) were normal, 159 cases (10.6%) had emphysems, 152 cases (10.1%) had pulmonary tuberculosis and 41 cases (2.7%) had bronchitis. 11) The preoperative EKG and clinical symptom revealed that 952 cases (62.1%) were normal in cardiovascular aspect, 232 cases (15.1%) showed hypertension, 124 cases (8.1%) had arrhythmia, and 79 cases (5.2%) had myocardial ischemia. 12) During the surgical procedure cardiac arrest were experienced in 5 cases (0.3%) and sudden hypotensivee pisods in 18 cases, which successfully resucitated. There were no operative mortalities within 48 hours. In summary, the patients over the 60 to 80 age group had a poor surgical risk but they were able to withstand this risk when properly managed with modern anesthesia.

내독소혈증을 유발한 토끼의 폐에서 염증반응에 대한 스테로이드와 리도카인의 효과

김대우,임용걸,강유진,조원선 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5

Background : It has been reported that steroid and lidocaine reduce inflammatory responses to endotoxin. The aim of this study is to compare the effects of lidocaine with those of steroid on inflammatory responses to Escherichia coli endotoxemia in the rabbit lung. Methods : Twenty four animals were randomly assigned to one of four groups. Group I (endotoxemic group; control, n=6): They were received E. coli endotoxin (500 g/kg) intravenously through the ear vein and followed by saline infusion at 20 ml/kg/hr for 4 hours. Group II (steroid treated group, n=6): They were treated with steroid (30 mg/kg) intravenously just after endotoxin injection and then saline was given at 20 ml/kg/hr for 4 hours. Group III (lidocaine treated group, n=6): They were received same as the endotoxemic group and lidocaine (3 mg/kg IV bolus, then continuous infusion at the rate of 2 mg/kg/hr) was administered with saline at 20 ml/kg/hr for 4 hours. Group IV (steroid & lidocaine treated group, n=6): They were received same as the endotoxemic group and after endotoxin infusion, steroid (30 mg/kg) and lidocaine (3 mg/kg IV bolus, then continuous infusion at the rate of 2 mg/kg/hr) was administered intravenously with saline. Numbers of neutrophils and monocytes in the samples of peripheral blood and lung tissue were counted and compared to evaluate the anti-inflammatory effect of drugs. Results: The group II, III, and IV showed significant attenuation of inflammatory responses compared to group I in the rabbit lung(P<0.05). But there were no significant differences among group II, III, and IV. There was no additive effect between steroid and lidocaine. Conclusion : These results suggest that lidocaine could be used as an alternative drug to steroid for its anti-inflammatory effects and cost-effectiveness. (Korean J Anesthesiol 1998; 35: 846∼851)

토끼에서 Enflurane 을 이용한 전신마취와 고위흉추 경막외마취에 따른 혈역학 및 간혈류량 변화의 비교

이병호,임용걸,김창재,정미영,채준석,손웅 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.4

Background: The causes of hepatic dysfunction after exposures to the halogenated inhaled anesthetics may be free radical, metabolites of inhaled anesthetics, immune reaction and hypoxic damage by decreasing total hepatic blood flow. The present study was performed to comparison of estimated hepatic blood flow and systemic hemodynamic changes between the general anesthesia with enflurane and thoracic epidural anesthesia in rabbits. Methods: In general anesthesia group with enflurane, anesthesia was performed with enflurane 2vo1% and 100% oxygen for 60 minutes. In thoracic epidural anesthesia group, epidural block was done at T5 level with 0.4 ml/kg of 1% lidocaine. Hepatic blood flow was estimated by clearance of indocyanine green according to the constant infusion method before and 30, 60 minutes after anesthesia. Heart rate, mean arterial pressure, central venous pressure and splanchnic vascular resistance were measured at the same time in both groups. Results: Heart rate was decreased significantly in thoracic epidural anesthesia group and mean arterial pressure and central venous pressure were decreased significantly in both groups at 30, 60 minutes. Hepatic blood flow was decreased at 30, 60 minutes in both groups. Splanchnic vascular resistance was increased significantly 30, 60 minutes in thoracic epidural anesthesia group. There were significant differences in mean arterial pressure and splanchnic vascular resistance between two groups. There was no difference in hepatic blood flow between two groups. Conclusions: The decreased hepatic blood tlow was caused by decreased mean arterial pressure in general anesthesia group with enflurane and by increased splanchnic vascular resistance in thoracic epidural anesthesia group.

소아의 일측폐 환기 마취 경험

강유진,임용걸,김기현 대한마취과학회 2005 Korean Journal of Anesthesiology Vol.48 No.1

Diclofenac 근주가 제왕절개술후 정맥 PCA 를 이용한 Morphine 과 Meperidine 의 제통효과에 미치는 영향

이병호,임용걸,김창재,정미영,채준석,정재엽 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.3

Background : Diclofenac is a nonsteroidal anti-inflammatory drug widely used as adjuvants for postoperative pain management with opioid sparing effect. The effect of diclofenac on postoperative opioid analgesia of morphine and meperidine was evaluated in 180 women after cesarean section. Methods : One hundred eighty parturients were randomly allocated to four groups and each group had 45 women. The parturients were given loading dose of morphine in M group and meperidine in D group using intravenous patient controlled analgesia(PCA) device for up to 48 hours when the parturients awoke and complained abdominal pain. The parturients received diclofenac 75 mg every 12 hours intramuscularly followed by loading dose of morphine in MV group and meperidine in DV group. We evaluated the postoperative opioid requirement, numerical rating pain score, delivery/demand ratio, patient's satisfaction and side effects including respiratory depression, itching, nausea, urinary retention and dizziness. Results : Diclofenac decreased over 40% of morphine or meperidine requirement and also pain score at 1, 2, 3, 6, 12, 24 and 48 hours in the use of PCA morphine and at 6, 12 and 24 hours in the use of PCA meperidine. And the incidence of sedation and itching decreased in MV and DV group. Conclusion : We concluded that diclofenac as adjuvant of opioid for postoperative pain after cesarean section could decrease requirement of morphine and meperidine, increase pain relief and decrease sedation and itching. (Korean J Anesthesiol 1997; 33: 510∼516)