비타민 K 정주 시 발생한 심혈관계 허탈

지대림,박상진,성채림 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.4

A cardiovascular collapse, due to preoperatively administered intravenous vitamin K (phytonadione), was experienced in a 59-year-old woman who was scheduled to undergo a left upper lung lobectomy. The patient developed sudden facial flushing, an upper torso rash, dyspnea, palpitation, and severe hypotension about 2 min after the intravenous administration of approximately 2 mg of vitamin K. Immediate hydration and an injection of 20 mg ephedrine restored her blood pressure to the preoperative level within 5 min. The patient recovered without any sequelae, but the operation was postponed. The patient's symptoms seemed to be due to an anaphylactoid reaction or anaphylaxis following the intravenous administration of vitamin K. This case report suggests that physicians should carefully review the indications of vitamin K prior to administration, even at low doses.

양성 항문질환 수술 후 발생하는 요정체

지대림,손기석 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.28 No.3

Acute urinary retention is a common complication following anorectal surgery. However, the cause of this complication is poorly understood. We investigated the influence on postoperative urinary retention of age, sex, premedicants, intraoperative fluid volume administered, surgeon, operating time, type of operation, anesthetic technique in 278 patients undergoing elective surgery for benign anorectal disease by a review of the charts. The results were as follows. The overall urinary retention rate was 31.7%. Age, sex, premedicants (narcotics, anticholinergics), surgeon did not correlate with urinary retention. Increasing age was associated with a relatively high incidence of urinary retention, but the difference did not reach statistical significance (P=0.054). The variables of intraoperative fluid volume administered ($gt;200 ml), anesthetic technique (spinal anesthesia vs. general or caudal anesthesia), type (hemorrhoidectomy, especially including multiple mucosal ligation or sphincterotomy) of the operation, and operating time ($gt;30 min) correlated significantly with retention (P$lt;0.05). Urinary retention was 2, 7 and 3 times more likely to occur in patients who had duration of operation more than 30 minutes, hemorrhoidectomy, and spinal anesthesia respectively. After all above variables were controlled for, duration and type of the procedure and anesthetic technique remained significantly correlated with retention (P$lt;0.05). We concluded that operating time of more than 30 minutes, hemorrhoidectomy (especially using multiple mucosal ligations or sphincterotomy), and spinal anesthesia were significant precipitating factors, but could not determine whether age and intraoperative fluid volume administered were associated with urinary retention with this retrospective study.

발관 전 기관튜브로 주입된 Lidocaine 은 기침반사 억제효과가 있다

지대림,박소영 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.1

Background : Lidocaine sprayed down the endotracheal tube (ETT) before extubation and during ETT removal was reported to prevent increases in blood pressure and heart rate during and after extubation. We hypothesized that lidocaine administered via this route would suppress the cough reflex associated with tracheal extubation. Methods : Eighty-five patients requiring intubation in the supine position were studied. All patients received a standardized anesthetic protoco. At the end of surgery, the patients were randomly divided into three groups and given no drug (group 1-control), given 1 ㎎/㎏ 2% lidocaine sprayed down the ETT 5 minutes prior to extybation (group 2), or given intravenous lidocine (IVL) 1 ㎎/㎏ 3 minutes prior to extubation (group 3). Extubation was performed when the patients met the criteria of extubation. Number of coughs was recorded from 5 minutes before until 5 minutes after extubation. Each value was compared among the three group. Conclusions : Lidocaine sprayed down the ETT suppresses cough reflex and is more effective than IVL in blunting the cough reflex. This study indicates that lidocaine sprayed down the ETT has a topical anesthetic effect suppressing the cough reflex. (Korean J Anesthesiol 2002; 42: 36~42)

개심술 중 경정맥 산소포화도의 역활

김세연,지대림 영남대학교 의과대학 1994 Yeungnam University Journal of Medicine Vol.11 No.1

승모판 치환술이 예정된 10명의 환자를 대상으로 심폐우회술 동안 발생할 수 있는 뇌산소 요구량과 소모량 사이의 불균형을 조사하기 위해 내경정맥내의 산소포화도를 체외순환 5분전과 시작후 1분이내, 저체온 상태가 안정되었을 때와 재가온하여 체온이 34℃가 되었을 때, 그리고 체외순환 종료후 15분 이내 등 5단계로 나누어 혈액을 채취하여 평균 동맥압, 체온, 동맥내 이산화탄소 분압, 혈색소치, PH 등을 비교 분석하여 다음과 같은 결과를 얻었다. 1. 심폐우회술 중 이산화탄소 분압과 혈색소치 및 PH 의 특이한 변화는 없었다. 2. 체외순환 직후 체온 및 평균 동맥압과 혈색소치의 급격한 변화가 있었으나 임상적인 의미는 없었으며, SjO₂의 변화도 없었다. 3. 저체온 상태가 안정되었을때 SjO₂평균치가 72.4%이었으나 체온을 34℃로 재가온하였을 때 56.1%로 감소하였다. 4. 재가온 시기에 SjO₂감소를 예방하기 위해 재가온 속도를 천천히 하고 이산화탄소를 증가시킴으로써 뇌혈류를 증가시키고 마취약제 등을 이용하여 산소에 대한 뇌대사율을 관류지수를 증가시켜야 하겠다. Postoperative brain damage is one of most serious complications of cardiopulmonary bypass (CPB). To prevent brain damage during CPB, adequate cerebral perfusion for cerebral oxygen demand should be maintained. This study monitored jugular venous oxyhemoglobin saturation (SjO₂), which reflects the overall balance of cerebral oxygen supply and demand, intermittently in 10 patients undergoing cardiac surgery. At the initiation of CPB, in spite of a significant decrease in mean arterial pressure, SjO₂did not change, and it was stable during the hypothermic period of CPB. But a significan reduction in SjO₂was observed during the rewarming period, and SjO₂had an inverse linear correlation with esophageal temperature. Furthermore, the percent decrease of SjO₂was related to rewarming speed. Therefore, therapeutic approaches for SjO₂desaturation include slower rewarming, increasing cerebral blood flow, decreasing the cerebral metabolic rate for oxygen, increasing oxygen content, and increasing perfusion flow rate.

단시간 기관내삽관술 후 후두 및 기관의 손상

김용대,지대림 대한이비인후과학회 1993 대한이비인후과학회지 두경부외과학 Vol.36 No.4

기관내 삽관을 위한 후두경 조작 시 연부 조직에 가해지는 힘이 순환계 반응에 미치는 영향

서영호,지대림 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.4

Circulatory Effects of Force Applied to the Soft Tissue during a Laryngoscopy Yung Ho Suh, M.D., and Dae Lim Jee, M.D. Department of Anesthesiology, College of Medicine, Yeungnam University, Daegu, Korea Background: During laryngoscopy, force applied to the soft tissue are assumed to cause cir-culatory response. The aim of the study was to evaluate this circulatory response and to analyze the relationship between the intensity of the force and the magnitude of the associated circulatory responses. Methods: Sixty-three healthy patients, aged 17 to 29 years, were randomly allocated to one of three groups according to the three different subjective forces applied intentionally. Subjects in group 1 received minimal force enough to stimulate circulatory response, but not enough to expose the glottis. Group 2 received the optimal force necesary to expose the glottic opening Group 3 received excessive force to expose the glottic opening. The axial forces of the laryngoscope handle with a Macintosh blade were measured during a ten-second laryngoscopy, and peak force, mean force, and area under the curve were calculated. Then. arterial pressure and heart rate were re-corded after the laryngoscopy at 30 seconds intervals for 3 minutes. The data was compared among groups and with the baseline post-induction values. Results: No significant difference was found in heart rate and blood pressure at each interval among the three groups, with increasing arterial pressure and heart rate after the laryngoscopy. Blood pressure and heart rate were maintained high, being progressively higher in the groups receiving a higher force. Conclusions: We conclude that little association was found between the force and the magni-tude of circulatory response although higher forces cause longer circulatory responses. (Korean J Anesthesiol 2001; 41: 415~422)

마취통증의학에서의 마그네슘 사용

성채림,지대림 영남대학교 의과대학 2009 Yeungnam University Journal of Medicine Vol.26 No.2

The use of magnesium sulphate has recently increased in anesthesiology and pain medicine. The roles of magnesium sulphate are as an analgesic adjuvant, a vasodilator, a calcium channel blocker and reducing the anesthetic requirement. These effect are primarily based on the regulation of calcium influx into the cell and antagonism of the N-methyl-D-aspartate receptor. We discuss here the clinical effects of magnesium sulphate on anesthesiology and pain medicine.

Succinylcholine 정주후 Pseudocholinesterase 활동력의 변화

전재규,지대림,배정인 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.2

경막외강 확인을 위하여 수주 마노메터를 이용한 음압법

전재규,지대림 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.6

To identify the epidural space various methods have been recommended and the methods are divided into two major categories, either loss of resistance or negative pressure technics. A syringe technic to feel loss-of-resistanse is now widely used clinically due to its reliability and simplicity. However, in some instances, it is very difficult to recognize the epidural space despite using the above methods so that the need for a more safe and easier one is required. After the patient is placed in a sitting flexed position, an 18 gauge Tuohy needles is inserted epidurally at the lumbar area with a saline filled CVP manometer connected via a 3-way stopcock, then a sudden drop of pressure is usually observed and a fluctuation of the pressure can be observed in the water column of the manometer according to the changes in positions, respiration and heart beat. Although this method can be criticized because the technique is somewhat cumbersome and is difficult for retrial when the dura has been punctured, the authors appreciate the experimental values of the technic and suggest its aduantanges as follows: 1) it is a visual thchnic. 2) the measurement of epidural pressure is possible. 3) it prevents back-drip of local anesthetic solution with a 3-way stopcock. 4) it is useful as an index for determination of local anesthetic volume to be injected.

Unusual excessive sweating and hypothermia during hysterectomy under general anesthesia -A case report-

김혁구,지대림,이혜미 대한마취통증의학회 2015 Anesthesia and pain medicine Vol.10 No.4

A 78-year-old female patient was undergone general anesthesia for total abdominal hysterectomy with bilateral salpingo-oopherectomy. Arterial blood pressure dropped 20 minutes after beginning of the surgery when uterine manipulation was started. From then, excessive sweating was found in the face and whole body and core temperature decreased to 34.3oC. Sweating and low body temperature were sustained despite of various aggressive warming efforts. Anticholinergic medication immediately put an end to an hour of excessive sweating and prevented further body temperature decline. Several possibilities of excessive sweating were discussed in this case: uterine manipulation during the light plane of general anesthesia, age related autonomic changes, use of intraoperative opioid and antihypertensive medications.