전신 마취중 각성과 꿈을 꾼 빈도

이향림,장호조,김경아,정일영 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.3

Background: Experience of awareness with recall during general anesthesia can be most distressing for patients. The psychological sequelae of subsequent recall of intraoperative events have been highlighted recently, but the incidence of awareness with recall is uncertain. Methods: Randomly selected 451 patients, who received elective operation under general anesthesia and were able to communicate with anesthesiologists and follow up for 5 days between December 1995 and February l996 at Korea Cancer Center Hospital, were interviewed on the 2nd day after their operation. Results: The incidence of explicit memory for events during general anesthesia has been estimated at 0.4% by interviewing patients postoperatively. Auditory perception and the sensation of paralysis were most frequently mentioned. 1.1% of patients had been dreaming during general anesthesia. Conclusions: Under the influence of anesthetic drugs, the brain is capable of limited processing of information and memory function. Everyone in the operating room must be mindful of conversations during the course of anesthesia and all patients should be given an opportunity to discuss any awareness in detail.

양측성 갈색세포종의 적출에 관한 마취경험 : 2예 보고 Two cases

한상욱,장호조,인장혁,정일영 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.1

We had experienced anesthetic management of two patients with bilateral pheochromocytoma. They had been treated with phenoxybenzamine for 4 weeks preoperatively. Anesthesia was managed with thiopental sodium for induction,enflurane-N2O-O2 for maintenance, vecuronium for muscle relaxation, and sodium nitroprusside for controlling severe hypertension. After tumor resection, severe hypotension was controlled by rapid transfusion, fluid and dopamine infusion. A tolerable blood pressure and pulse rate were maintained throughout the procedure. Preoperative preparation, sufficient sedation, smooth anesthetic induction, complete analgesia, good muscle relaxation, adequate ventilation and proper cardiovascular control are required in resection of pheochromocytoma. (Korean J Anesthesiol 1997; 32: 149∼153)

신혈관성(腎血管性)고혈압증 환자의 신혈관 태건술의 마취관리 1 례 보고

김성덕,송현철,장호조,유명식 대한마취과학회 1982 Korean Journal of Anesthesiology Vol.15 No.3

It is very important for the anesthesiologists to manage this kind of patient during anesthesia, because of severe hemodynamic change that is induced by aortic clamping and declamping, and its secondary effect on visce a, heart and spinal cord, etc. To minimize the sudden severe hemodynamic change, we used the following agents and techniques in this clinical report. 1) Ethrane anesthesia with intermittent Innovar administration to minimize cardiac irritability. 2) To prevent secondary damage by distal hypotension during aortic clamping and declamping. (1) slight overhydraion (2) mannitol (3) diuretics 3) To prevent secondary damage by proximal hypertension during aortic clamping. (1) d-tubocurarine for muscle relaxation (2) Morphine (3) Chloropromazine (4) phentolamine More over, we recommended this kind of anesthetic method in some other surgeries such as coaractation of aorta, aortic aneurysm and pheochromocytoma, etc. which may exhibit severe hemodynamic change during anesthesia.

전신 마취 도중 발견한 Tracheo-esophageal Fistula 1 예 보고

백남선,황규현,정영환,장호조 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.3

A 69 years old, otherwise healthy male pt. was admitted and soheduled for subtotal gastrectomy under the Dx. of stornach Ca. The induction of anesthesia and beginning of operation were smooth and unevntful. After peritoneal opening, the surgeon complained of distended stomach which was synchronous with ventilation. With repeating tracheogram and endoscopic examination, the authors found unsuspected tracheo-esophageal fistula on the low-middle esophagus. During convalescenee the pt, had not suffered any pulmonary complication.

체온순환 전후 체온변화에 관한 임상적 연구

방성호,김성덕,김광우,장호조,권무일,김봉덕 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.4

Changes of body temperature were observed in the esophagus and rectum by telethermometer during extracorporeal circulation in 40 cases of open heart for detection of significant differences in survivals and non-survivals. The following results were obtained; 1) Esophageal and rectal temperature(just prior to extracorporeal circulation) were 36.4±0.69。C, 36.8±0.8。C respectiyely in non-survivals and 36.0±0.73。C, 36.4±0.8。C in survivals after open heart surgery 2) Normal differences between rectal and esophageal temperature came to disappear after 30 minutes of extracorporeal circulation in two groups. 3) Esophageal temperatures were higher than rectal temperatues after extracorporeal circulation for open heart surgery in both groups. 4) Changes of temperature diferences between rectum and esophagus have no correlation with mortality because of the variation in two areas in both groups.

기관지위루 환자의 마취시 일측폐 환기와 지속적 양압

김창원,한상욱,김경아,장호조,정일영 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.5

Broncho-gastric fistula caused by benign gastric ulcer perforation after esophagectomy is very rare. In general anesthesia of a patient with broncho-gastric fistula, in spite of hyperventilation, leakage of the anesthetic gases through fistula may make the patient hypercapneic, and positive pressure ventilation may increase the risk of the pulmanary aspiration by the regurgitation of gastric fluid by stomach distension. For that reason, in this patient, denitrogenation was performed during patient's voluntary respiration with 100% oxygen for 5 minutes, and induction was performed without positive pressure ventilation, and one lung ventilation was carried out. Hypoxemia was followed by one lung ventilation because his pulmonary function was moderate obstructive type and his lung was damaged by aspiration of gastric fluid via broncho-gastric fistula. A low level of continuous positive airway pressure(CPAP) has no significant hemodynamic effect and can maintain the patency of nonventilated lung, so hypoxemia induced by one lung ventilation may be reduced. Thus we carried out one lung ventilation with CPAP(10 cmH2O) in nonventilated lung and blocked broncho-gastric fistula with a bronchial blocker for prevention of both regurgitation of gastric fluid and leakage of anesthetic gases. One lung anesthesia was performed without any problem in this case. (Korean J Anesthesiol 1997; 33: 988∼992)

수술후 노인 환자에서의 자가 통증 조절시 진통 효과와 수술후 인식 장애

김명원,정일영,이지희,장호조 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.6

Background : Since postoperative cognitive impairement is common in elderly patients and normal cognitive function is important for proper use of patient controlled analgesia (PCA), we compared the efficacy, adverse effect and postoperative cognitive impairment among postoperative elderly patients given the PCA morphine, fentanyl and meperidine. Methods : Forty-five elderly patients were randomly allocated to receive patient-controlled analgesia with either morphine, fentanyl or meperidine following upper abdominal surgery. Patients were evaluated for used doses, adverse effects, visual analogue scale, the satisfaction for analgesia during postoperative 2 days and the Mini Mental Status Examination (MMSE) and the Short Portable Mental Status Questionnaire (SPMSQ) at posoperative 1 day. Results : Patients receiving the PCA fentanyl used more opioid based on a dose expressed as morphine equivalents using the putative potency ratios of 1:10:0.01 (morphine/meperidine/fentanyl). But adverse effects, visual analoe scale, and the satisfaction for analgesia were not statistically different between groups. The decrease in MMSE in the PCA-meperidine group was significantly greater than that seen in the PCA-fentanyl group and the PCA-morphine group. SPMSQ were not statistically different between groups. Conclusions : The present result suggest that PCA is effective method in posterative elderly without serious complications. But PCA meperidine may be avoided in the elderly because it can contribute to decrease postoperative cognitive function. (Korean J Anesthesiol 1999; 36: 1017∼1025)

동맥압 측정시 기포가 압력파의 감폭에 미치는 영향

민병구,김희찬,김성덕,송현철,최덕환,김광우,장호조,원영천 대한마취과학회 1982 Korean Journal of Anesthesiology Vol.15 No.4

By virtue of the development of monitoring system and increasing tendency of critically iN patients, We have performed canautation of radial artery after Allen's test for the continuous monitoring of arterial pressure. It is very important to measure blood pressure accurated, as it gives as many information in the poor risk patients. During monitoring of blood pressure for several years, we have had much troubles because of damping of arterial pressure waves due to air bubbles. In this study, we used P_25 Db pressure tranducer and Spacelab Alpha System for monitoring of blood-pressure, following cannulation of radial artery. Air bubbles of 0.5 ml, 1.0 ml, 1.5 ml and 2.0 ml were inserted into monitoring system, i.e. fluid-filled catheter respectively. The statistical analysis by paired student T-test showed following results. 1) Systelic blood pressure were decreased significantly from 110±14.4 torr of control group to 105±15.9 torr, 102±16.1 torr, 99±16.2 torr and 99±15.2 torr in 0.5 ml, 1.0 ml, 1.5 ml and 2.0 ml air groups respectively. 2) Diastolic blood pressure were increased from 70±12.4 torr of control group to 72±13.8 torr, 76±13.9 torr, 78±14.3 torr and 81±13.1 torr in each cases respectively. 3) Pulse pressure were decreased from 40±13.3 torr of control group to 33±15.4 torr, 26±13.6 torr, 22±13.0 torr and 18±12.0 torr in each cases respectively. 4) But mean arterial pressure showed no significant changes except in 2.0 ml air group, where showed slight change.

체위변경이 Furosemide 이뇨중 Aldosterone 배설에 미치는 영향

성호경,고주환,이장규,박기복,이경희,장호조,서성희,안희중,신옥자 주식회사 녹십자 1977 녹십자의보 Vol.5 No.2

증례보고 : 우측 개흉술 중 발생한 발작 심실상성 빈맥 환자의 전-후 전극 위치의 이극 심장율동전환 치료경험

이지희 ( Ji Heui Lee ),김진강 ( Jin Kang Kim ),이현도 ( Hyun Do Lee ),손동일 ( Dong Il Sohn ),이소영 ( So Young Lee ),이수남 ( Su Nam Lee ),장호조 ( Ho Jo Jang ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2

A 54-year-old male patient with squamous cell carcinoma of lung was scheduled for right lower lobectomy. He had suffered from diabetes mellitus during 8 years, but his preoperative electrocardiogram was normal sinus rhythm. During right thoracotomy, 2 times of unstable paroxysmal supraventricular tachycardia (PSVT) appeared but returned to normal sinus rhythm by carotid sinus massage. But, third unstable PSVT was not controlled by adenosine and anterior - lateral paddle positioned biphasic cardioversion. We changed anterior-lateral paddle position to anterior-posterior paddle position. And PSVT terminated abruptly and changed to sinus rhythm. So we present a case of unstable PSVT during right thoracotomy and treated with anterior-posterior paddle positioned biphasic cardioversion. (Korean J Anesthesiol 2006; 51: 246~51)