한국인 복강신경총의 해부학적 변이

허철령(Chul Ryung Hur),윤덕미(Duck Mi Yoon),정민석 대한통증학회 1989 The Korean Journal of Pain Vol.2 No.2

N/A Celiac plexus block is recommended in patients with intractable upper abdominal cancer pain. The success rate of a celiac plexus block is variable among the authors. One of the causes of this is the anatomical variations of the celiac plexus. There has not been a study concerning anatomical observations of the celiac plexus in Korean cadavers. So, anatomical dissections were performed and observations were made of the celiac plexus and related structures in Korean cadavers. The results were as follows: 1) The subjects were 21 male bodies and 5 female bodies. The mean age at death was 69.9 ±15.5 years (range 37-93). The mean height was 155.5±8.3 cm (range 143-172). 2) The number of celiac ganglia ranged from 1-4. The mean numbers were 2.3±1.9 in the right plexus and 1.9+0.8 in the left, and the mean sizes were 18.9+7.l#X8.0+3.8mm and 18.5±8.3X9.5±3.9 mm respectively. 3) Celiac ganglia were most frequently located at the level of the upper third and middle third of Ll in both sides (65.5% in right, 64.0%. in left). The vertical range of celiac ganglia ranged from 1 space, which is one third the height of one vertebral body, to 4 spaces. Mean vertical ranges were l.5±0.6 spaces in the right plexus and 1.60.7 spaces in the left. The celiac ganglia located at the level of the upper third of Ll in the right and the lower third of Ll in the left side, had the largest vertical ranges respectively (1.8±0.5 spaces in right, 2.3±0.6 spaces in left). 4) Right side celiac ganglia were located near the midline of the vertebrae compared to the left ones (mean 5.0 mm). The horizontal dimension was greater in the right ganglia (24.2±9.2 mm) than in the left ganglia (18.8±7.0 mm). 5) There was no vertebral level difference between both celiac ganglia in most cases (60%). However, of the 40%. of cases at different levels, in half of these (20%) the right ganglia were located higher than the left ganglia; and in the other 20%, this was reversed. 6) The origin sites of the celiac artery were most frequently in the upper third and middle third of Ll (61.6%). The celiac ganglia were usually located at the same level as the site of origin of the celiac artery (61.6% in right. 52.0% in left). 7) The vertebral level of the splanchnic nerves piercing the abdominal surface of the diaphragm was most frequently in the upper third and middle third of Ll (66.6% in right. 66.7% in left). 8) The level of the origin of diaphragmatic crura from the anterior surface of the vertebral bodies varied from the Ll-L2 interspace to the L3-L4 interspace. Right crura most frequently originated at the level of the lower third of L2 to the upper third of L3 (57.69.), while left crura originated from the level of the L2-L3 interspace to the middle third of L3 (69.3%). From the above results, we realized that there were some anatomical variations of the celiac plexus and its relations to adjacent structures in Korean bodies. However, when the needle point is behind the anterior margin of the upper third of Ll, it is possible to perform a successful retrocrural splanchnic nerve block.

편도 및 아데노이드절제술 후 발생한 종격동기종과 피하기종

이영석,허철령,강용인,이영주 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.6

The causes of pneumomediastinum during perioperative period are trauma to the airway from intubation or other manipulation, raised airway pressure during anesthesia, rupture of a bleb or other intrapulmonary lesion, upper airway damage during neck surgery, infiltration of the tonsillar fossa or adenoid bed with air under pressure, increased airway pressure after nausea and vomiting, and coughing during awakening. This paper is represents and discusses a case of pneumomediastinum, pneumothorax, extensive subcutaneous and retroperitoneal emphysema which occurred suddenly a few minute after several times of bucking and straining in the intubated state with oxygen catheter after tonsillectomy and adenoidectomy at recovery room. The complieation was thought to be a infiltration of air through tonsillar fossa under pressure or alveolar rupture due to increased airway pressure after coughing. The patient was treated with high concentration of oxygen and recoverd uneventfully.

Heparin Dose Response Curve 를 이용한 Protamine 투여량에 대한 검토

오흥근,박윤곤,남순호,방서욱,허철령 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.4

Dosage titration of protamine using a heparin dose response curve for the reversal of heparinization after cardiopulmonary bypass and the factors which affect ACT were investigated. This study included 170 patients undergoing surgery for congenital or acquired heart diseases. Patients were randomly allocated to 5 groups according to a protamine dosage of either 0.8,1.0,1.3 or 1.5 times the residual heparin amounts, or protamine 3 mg/kg. The factors affecting ACT which we investigated were the differences between arterial and venous blood, between men and women, between a hematocrit value less or greater than 40%, and between less or more than 2 hours duration of bypass time. The results are as follows: 1) There were no significant differences in postprotamine ACT among the 5 groups. 2) ACT of arterial blood ws more prolonged than that of venous blood (139.85±4.77 vs 111.50±2.36 sec). 3) ACT in men ws more prolonged than in women (638.81±32.10 vs 559.08±14.33 sec). 4) ACT in which the hematocrit value was less than 40% was more prolonged than that in which it was above 40%. 5) Although there was no difference between less and more than 2 hours duration of bypass time in ACT, additional protamine ws needed in latter group.

기관내 삽관시 Esmolol 과 Labetalol 투여가 혈역학적 변화와 혈중 Catecholamine 치에

이상열,이영석,한정선,이영주,윤장운,허철령 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.1

Background : Sympathetic blocking agent, esmolol(selective beta 1 blocker) or labetalol( alpha and beta blocker) would prevent the hypertension and tachycardia from endotracheal intubation. We have carried out the study to see the effects of esmolol or labetalol on the blood pressure, heart rate, rate pressure product and plasma catecolamines during the endotracheal intubation. Methods : Thirty-three ASA physical status 1 or 2 adult patients were allocated into three groups; Group I:control(n=10), Group II:esmolol(n=11) and Group III: labetalol(n=12). In Group I, 2 ml of normal saline, in Group II, 1 mg/kg of esmolol, and in Group III, 0.2 mg/kg of labetalol were given 3, 2 and 4 minutes before endotracheal intubation. Blood pressure and heart rate were measured after arrival at the operating room, before endotracheal intubation and after endotracheal intubation at 15, 60, 120, 180 and 300 seconds interval under the inhalation anesthesia (enflurane-N2O-O2). Rate-pressure product was calculated from the heart rate and systolic blood pressure(RPP = heart rate x systolic blood pressure). The plasma cathecolamines, dopamine, norepinephrine and epinephrine, were measured before intubation as a baseline value and 2 minute after intubation. Results : Systolic blood pressure, rate-pressure product and heart rate were significantly lower in esmolol and labetalol groups than in control group after intubation( P<0.05). Esmolol reduced the heart rate and the rate-pressure product than labetalol, but statistically there were no significance(P > 0.05). Plasma level of dopamine, norepinephrine and epinephrine showed higher values after intubation in all three groups( P<0.05). But there were no difference among groups(P>0.05). The side effects of esmolol and labetalol did not appear at all. Conclusion : 1 mg/kg of esmolol given 2 min before intubation or 0.2 mg/kg of labetalol given 4 min before intubation reduce increasing of blood pressure and heart rate, caused by adnergic response following endotracheal intubation, significantly. The reason is that esmolol and labetalol do not decrease release of catecholamines but attenuate responses of elevated catecholamines following endotracheal intubation. (Korean J Anesthesiol 1998; 34: 77∼85)

성상신경절 차단후 중뇌동맥의 혈류 속도 변화

서영선(Young Sun Seo),김승희(Seung Hie Kim),허철령 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1

N/A Stellate ganglion block(SGB) improves cutaneous blood flow of the head and neck region and upper extremity. For this reason, SGB has been performed in neural and circulatory disorders. But there is controversy on the cerebral blood flow regulation by sympathetic innervation. We investigated the hypothesis that cerebral blood flow could be affected by blocking ipsilateral sympathetic innervation of cerebral vasculature. In 10 volunteers, the blood flow velocity and pulsatility index(PI) of middle cerebral artery(MCA) was measured using Transcranial Doppler Flowmeter, before and l5 minutes after SGB, at block side and opposite side. The blood flow velocity of MCA at block side was increased from 62.60±7.60 cm/s to 72.80±8.01 cm/s(P<0.0l) and the PI at block side decreased from 0.75±0.12 to 0.60±0.11(P<0.05). But the blood flow velocity and PI at opposite side did not change. This study demonstrated that the cerebral blood flow could be increased by SGB, the pregangli- onic nerve fibers of which synapse with other cervical sympathetic ganglions.