임상연구 : 액와 대퇴 동맥 우회술을 위한 척추마취 시행 시 환자의 자세가 혈압과 심박수에 미치는 영향

박수경 ( Soo Kyoung Park ),김영국 ( Young Kug Kim ),정성량 ( Sung Lyang Chung ),진지현 ( Ji Hyun Chin ),이청 ( Chung Lee ),이유미 ( Yu Mi Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6

Background: Hypotension is one of the most common complications from the spinal anesthesia frequently used for surgery on the lower abdomen or extremities. It might be important in prognostic improvements to maintain cardiovascular homeostasis in elderly or patients with cardiovascular diseases. This study evaluated the effect of the patients` position on the preservation of cardiovascular stability when elderly patients suffering from hypertension undergo surgery for an axillo-femoral arterial bypass. Methods: 24 patients with hypertension undergoing an elective axillo-femoral bypass surgery were examined. The patients were randomly allocated into two groups (Lateral 20 min group: patients with lateral position for 20 min after spinal anesthesia; Supine group: patients with the supine position immediately after spinal anesthesia). The observers recorded the hemodynamic variables, as well as the loss of sensation on both sides. Results: Considering the changes in the arterial blood pressure and heart rate from the baseline values, patients in the supine group showed a greater decrease in arterial blood pressure and heart rate (P < 0.05). In the lateral 20 min group, there was a lower block level of cold sensation that reflected the sympathetic blockade at the non-operated site (P < 0.05). Conclusions: The lateral decubitus position for 20 min after spinal anesthesia can contribute to the maintenance of cardiovascular stability during unilateral axillo-femoral bypass surgery in elderly patients with hypertension. (Korean J Anesthesiol 2006; 51: 675~9)

지속적 경막외 차단중 발생한 세균성 뇌막염 1례

이종성,정성량 東國大學校 醫學硏究所 1995 東國醫學 Vol.3 No.-

경막외 마취중 세균성 뇌막염의 발생은 매우 드문 합병증이다. 면역이 저하되어 있는 암환자의 통증 치료를 위해 지속적 경막하 차단중 카테터에 의한 것으로 생각되는 세균성 뇌막염이 발생하였다. 50세된 직장암 환자가 항문, 회음부, 둔부의 격통을 주소로 통증 치료실을 방문하였다. 모르핀과 부피바카인으로 지속적 경막외 차단을 시행하였고, 3개월 후 환자는 약간의 경부 강직과 발열을 동반한 두통을 호소하였다. 진단적 뇌척수액 검사상 단백질 57㎎/㎗, 포도당 54㎎/㎗, 백혈구 8160/㎣소견을 보였다. 경막외 카테터에서는 균이 검출 되지 않았다. 뇌와 척추의 컴퓨터 단층 촬영과 척추의 자기공명 영상 촬영에서도 특별한 사항이 없었다. 항생제 치료와 대중 요법으로 증상이 호전되었으며 황산 모르핀 서방정과 데메롤 근육주사로 통증을 조절하던 중 환자의 원에 의해서 퇴원하였다. Bacterial meningitis is a rare complication of epidural block. Epidural abscess, subarachnoid infection associated with epidural catheters are related to the treatment of pain on cancer patients whose immune responses have been impaired. A 50-year old male with rectal cancer came to the pain clinic with pain on the anus, perenium and buttock. Treatment was continuous epidural block with subcutaneous tunnelling, and epidural morphine with bupivacaine was given on an outpatient basis. Three months later, the patient complained a diffuse global headache, fever and mild stiff neck. A diagnostic lumbar puncture revealed CSF total protein 57㎎/㎗, and 8160/㎣ Cultures of epidural catheter tip didn't revealed any organism. CT scan, spine MRI was negative. Antibiotic theraphy with claforan, vancomycin, gentamycin was given for several days. Symptoms and signs were relieved.

전신마취회복후 중환자실에서의 자살시도 1례

김태환,정성량,김학룡 동국대학교 경주대학 1993 東國論集 Vol.12 No.-

Many factors surrounding anesthesia and surgery may trigger emergence delirium and postoperative psychosis. These include drugs, fever, pain, hypoxia, metabolic derangements, and psychological factors. An elective preoperative psychiatric evaluation may be warranted in a patient suspected of suffering from a mental illness. This will not only be helpful in the differential diagnosis of postoperative psychosis, but also prevent the patient from harming himself or others, which is very important. In our reporting case, the 28-year-old male patient had already suffered from an undiagnosed psychiatric disorder which was proved a schizophrenia of paranoid type, and he attempted a suicide in the intensive care unit about 3 hours after general anesthesia. We prevent this case with review of concerned literature.

마취유도시 Thiopental Sodium과 Propanidid의 심부정맥 발생에 관한 임상적 연구

김용락,이호성,정성량,김태영,김현자,정춘근 최신의학사 1983 最新醫學 Vol.26 No.1

성인 수술환자에서 Lactate Ringer액을 수술중 유지 및 보충액으로 사용한 경우의 혈당치 변화에 대한 연구

정성량,김수영,김성순 東國大學校醫學硏究所 1993 東國醫學 Vol.1 No.-

수술중 정주되는 수액에 포도당을 첨가시키는 문제는 수 십년 동안 논쟁이 되어왔다. 에테르 마취중 생기는 고혈당증은 마취과의사로 하여금 수술환자의 술중 당불인내성을 믿게하였고 이의 사용을 제한시키는 결과가 되었다. 아편양제재나 강력한 흡입마취제 등 전신마취에 새롭게 사용되는 약물들은 고혈당을 일으키는 경향이 적으며, 술전 금식기간으로 인해 저혈당의 결과가 초래될 수 있다. 따라서 많은 마취의들은 술중 수액에 포도당이 첨가되어야 한다고 느끼고 있다. 본 연구의 목적은 성인환자가 정맥용 수액으로 사용되는 유산염 링거액만을 술중 유지 및 보충액으로 사용한 경우 혈당농도가 안전한 범위에서 유지되는지를 관찰하려 함이다. 연구대상은 대사성 질환 및 간질환이 없는 미국 마취과학회 분류에 의한 환자상태가 1 혹은 2에 해당하는 72명을 임의로 선택했다. 연구결과, 전체 환자군 및 성별, 연령, 체중, 마취방법, 금식기간, 정주된 수액량 등의 개별군에서 술 전후의 혈당치 변화는 통계적으로 유의하지 않았다. The role of sugar in intravenous solutions has been debated through the decades. The hyperglycemia which occurs with ether anesthesia caused anesthesiologists to believe that patients were intolerant of sugar during anesthesia, resulting in withholding of this substance. The newer regimens of general anesthesia using an opioid or potent inhalational drug are less likely to hypoglycemia, and the preoperative period in which food is withheld can result in hypoglycemia. Accordingly, many practitioners feel that sugar should be given with intraoperative fluids. The aim of this study was to determine whether Lactated Ringer solution commonly used intraoperatively in adults patients produces blood glucose levels within a safe range. This study was undertaken to measure preoperative and postoperative blood concentration of glucose in 72 adult surgical patients of ASA Physical Status 1 and 2. Neither blood nor glucose containing solution was given intraoperatively to any patient. Only Lactated Ringer solution was given to maintain and supplement intravascular volume. In results, there was not significant changes between pre and postoperative values in all patients, and in 6 group divided according to sex, age, weight, method of anesthesia, NPO time, fluid volume infused.

국소마취제와 저용량 Morphine을 혼합 투여한 척추마취중 급격히 발생한 耆眠(Somnolence) : 증례 보고

정성량,이종성 東國大學校醫學硏究所 1994 東國醫學 Vol.2 No.-

지주막하강내와 경막외 아편양제재의 의한 진통 효과는 술 후, 산과적 그리고 만성 통증관리의 분명한 개선을 제공하였다. 몰핀은 가장 광범위하게 연구되었고 사용되는 아편양제재이며, 저용량(0.2-0.8mg)의 지주막하 주입후, 진통효과 발현은 30-60분 소요되며, 작용시간은 18-24시간 정도이다. 부작용으로 발생하는 호흡억제나 기면은 지주막하강내에서 연수와 제 4 뇌실로의 이동으로 인한 것이며, 주입 7-9시간 후 최고 발생 빈도를 나타낸다. 저자들은 저용량 몰핀의 지주막하강내 주입 40분 후 중증도의 기면 상태를 경험하였기에 참고 문헌과 함께 보고하고자 한다. Intrathecally administered opioids are usually administered by the lumbar approach as a single bolus. They can be included as a part of a spinal local anesthetic. Morphine requires 30 to 60 minutes to achieve an analgesic effect. Intrathecally administered morphine carries the risk of respiratory depression, secondary to rostral migration of drug, with a peak occurrence at 7 to 9 hours after administration. Late or delayed respiratory depression does not occur rapidly but rather is a slow-onset and indolent process and is associated with progressive somnolence. However we experienced sudden onset of excessive somnolence, 40 minutes after intrathecal administration of preservative free morphine 0.25mg, which was reversed by intravenous bolus of naloxone(1mg). Postoperatively naloxone by intravenous infusion (0.2mg/hr) was given for 10 hours. The duration of complete or near-complete postoperative analgesia was more than 24 hours.

새로운 흉부 측면상을 이용한 한국 성인 상부 기도의 계측학적 연구

이상철,임승운,송치성,정성량 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.5

Authors measured various portions of upper airway by use of new radiologic lateral view of chest in order to study the mean values of upper airway in normal Korean adults (n=100). The length between anterior teeth and the top of the epiglottis was 8.9±0.6 cm in male and 8.5±0.6 cm in female. The length beteen anterior teeth and the mid portion of trachea was 20.4 ±0.7 cm in male and 18.8±0.8 cm in female. The length between anterior teeth and carina was 27.1±0.9 cm in male and 25.3±0.9 cm in female, while the length of trachea was 13.3±0.7 cm in male and 12.9±0.5 cm in female. The vocal cord and the carina were usually located at the level of the 5th cervicl and the 5th thoracic vertebra, respectively, in both sexes. This study also showed that the central portion of the trachea was located at the level of the lower border of the medial end of clavicle.

위암수술에서 지속적 복강내 고온관류요법시 혈역학적 변화

이유미,백종화,정성량 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.4

Background : Hyperthermia is currently effective treatment against numerous cancer gastric cells' seeding on the peritoneal surface and floating in the cancerous ascites. We evaluated changes in hemodynamics during continuous hyperthermic intraperitoneal perfusion (CHPP) to determine strategies for safer general management during this procedure. Methods : Ten patients with far-advanced gastric cancer were given surgical treatment followed by CHPP with anticancer drug. The body temperature, blood pressure, heart rate, central venous pressure, pulmonary artery pressure, cardiac output, electrolyte and blood gas were measured during pre-CHPP, CHPP and post-CHPP period. Results : The blood temperature reached 39.3±0.4oC (mean±SD) during CHPP. Heart rate increased to 104.4±14.2 bpm and the cardiac index to 5.3±1.5 l·min-1·m-2 during CHPP. The mean arterial pressure remained stable during the study period. The systemic vascular resistance index decreased to 996.7±324.0 dynes·s·cm-5·m2. The mixed venous oxation fell during the first part of the CHPP period. Conclusions : This study suggest that the CHPP with anticancer drug may be safe in humans, provided that appropriate monitoring, cooling and technical support are applied. (Korean J Anesthesiol 1998; 35: 738∼744)

척추마취후 발생한 전신적 근강직, 고열, 의식소실 및 자율신경기능부전 임상 2 예

김태환,김용철,정성량 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.2

Malignant hyperthermia is a fulminant hypermetabolic state of skeletal muscle induced by volatile inhalation anesthetics, succinylcholine, stress, exercise and etc. The primary signs of this disease included tachycardia, tachypnea, fever, generalized rigidity, metabolic and respiratory acidosis, central venous desaturation and hypercarbia as well as increasing endtidal CO₂ .Malignant hyperthermia is an utosomal dominant trait in human and quite different from the recessive trait in pig. There were some clinical reports that malignant hyperthermia can occur occasionally during and after spinal anesthesia. Now we also experienced two cases of generalized muscular rigidity, hyperpyrexia, tachycardia, hypotension, cardiae arrhythmia and slightly metabolic acidosis during and after spinal anesthesia. Those signs were very similar to malignant hyperthermia. And the two patients and someone among the family showed increased serum creatine kinase. There was no serum electrolyte imbalance such as natrium, ionized calium and magnesium. And function tests of thyroid and parathyroid, electroencephalogram and brain computed tomogram were all within normal limit. So we suspected and concluded that it should be malignant hyperthermia. But we could not confirm that malignant hyperthermia, because of not doing halothane caffeine contracture test due to a lack of equipment in our hospital.

동맥관 개존증 폐쇄수술을 받은 극소 저출생 체중 미숙아의 임상상태 및 마취관리

이유미,조명원,이청,허인영,정성량 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.1

Background : A delay in spontaneous closure of the patent ductus arteriosus (PDA) is frequent in premature infant and may lead to cardiopulmonary congestion and death. Surgical closure of the PDA in the premature infant can be a safe and effective procedure. Now, several centers prefer to eliminate the problem of transportation to operating room and adopt the policy of operating in the newborn intensive care unit (NBICU). So we investgated the anesthetic management and clinical status of premature infants who underwent surgical closure of PDA. Methods : We analyzed retrospectively the anesthetic management and clinical status of eleven premature infants below 1,500 g birth weight. Results : Range of gestational age of infants was 24∼30 weeks. Most common cause of operation was failure of medical treatment. All infants had features of respiratory distresses and prematurity complications. Fentanyl, vecuronium, oxygen, and air constituted a anesthetic regimen. The body temperature remained stable. Systemic blod pressure with ligation of PDA increased to 66.3 17.4 mmHg (mean±SD). After operation, three infants died from complication of prematurity. There were no deaths directly related to operation. Four infants underwent operation in NBICU and also had no wound infections. Conclusions : Premature infants with PDA had associated complications of prematurity and were severely ill. If the infants did not respond to medical therapy, the PDA was closed by operation with adequate anesthesia. Furthermore, the operation can be performed safely and efficiently in the operating room or NBICU. (Korean J Anesthesiol 1999; 36: 75∼81)