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제왕절개술을 위한 경막외마취시 국소마취제의 Alkali 화가 마취작용에 미치는 영향
이상화,노운석,조성경,백승희,김건수 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.1
Several studies have indicated that the addition of sodium bicarbonate and opioid to solutions of lo?? anesthetics shortens the onset time, increases the intensity and prolongs the duration of neural blockade. This study was performed to compare onset times and duration of neural blockade in each groups. Eighty-two parturients scheduled for cesarean section at term unter epidural anesthesia were assigned to three groups. Group 1 (n=19) received 1.5% lidocaine hydrochloride (pH 6.32±0.01), group 2 (n=26) received 1.5% lidocaine hydrochloride plus fentanyl 50 mcg (pH 6.27±0.02) and group 3 (n=37) received 1.5% lidocaine hydrochloride plus fentanyl 50 mcg plus 8.4% sodium bicarbonate (sodium bicarbonate 1 mEq/lidocaine 10 ml)(pH 7.32±0.03). All groups were given 22-28 ml of local anesthetic solutions according to their height. Onset times and duration of sensory blockade were evaluated using pin prick test at two minutes interval after epidural injection at L2, T6, T4 dermatomes. Onset times (time between the completion of anesthetic injection and loss of pin prick sensation at each dermatome) of sensory blockade at L2 dermatome were 3.1±0.2 minutes in Group 3, which were shorter than 5.0±0.3 minutes in Group 1 and 4.7±0.4 minutes in Group 2 (p<0.05). At T6 dermatome, onset times of sensory blockade were 6.9±0.6 minutes in Group 3, which were shorter than 15.4±1.2 minutes in Group 1 and 12.9±1.0 in Group 2 (p<0.05). At T4 dermatome, onset times of sensory blockade were 10.1±0.2 minutes in Group 3, which were shorter than 22.3±1.2 minutes in Group 1 and 18.8±1.1 in Group 2 (p<0.05). The duration (time between loss of pin prick sensation and complete recovery of pain at each dermatome) of sensory blockade at T4 dermatome in Group 3 were 74.0±3.8 min, which were longer than 52.9±2.4 minutes in Group 1 and 52.7±1.4 minutes in Group 2 (p<0.05). The duration of sensory blockade at L2 dermatome in Group 3 were 119.6±4.4 minutes, which were longer than 78.6±4.8 minutes in Group 1 and 81.6±2.5 minutes in Group 2 (p<0.05). The above results seggested that alkalinization of lidocaine solution is an effective way to shorten the latency and to prolong the duration of epidural block for cesarean section. (Korean J Anesthesiol 1995; 29: 106~111)
제왕절개술시 Ultrasonic Doppler 에 의해 탐지된 정맥 공기 색전증의 발생빈도
이상화,노운석,조성경,정진용,이태현 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.6
Venous air embolism(VAE) can occur by the entry of air into open veins, being facilitated if the operative field is above the level of the heart. Among the many diagnostic methods, precordial ultrasonic Doppler is currently the more sensitive. Thus we have attempted to define the incidence of VAE using this device. 103 ASA physical status 1 or 2 parturients undergoing Cesarean section with general anesthesia in 73 parturients and epidural anesthesia in 30 parturients were studied with the ultrasonic Doppler transducer placed parasternally over the 4th right intercostal space. Total incidence of venous emboli was 31%(32/103) during surgery. In some parturients, embolism occurred more than once during operation and leaded to total 45 episodes of venous emboli. The incidence of venous emboli was 26%(19/73 ) during general anesthesia and 43.3%(13/30 ) during epidural anesthesia. No statistical difference existed in the incidence of venous emboli detected related to the type of anesthesia. Among the 45 episodes of venous emboli, 19 episodes(42.2%) were detected during repair of the hysterotomy. As even small air bubbles in the circulation are potentially harmful especially in patent foramen ovale and emboli events may occur at risk cases involving profound hypovolemia, abruptio placenta, or placenta previa, clinically insignificant venous air emboli, although low, is still worrisome. Thus above the cases, the use of additional precordial Doppler monitoring may be considered during cesarean section to detect VAE promptly, efficiently.
척추마취시 국소마취제에 첨가한 Epinephrine 과 Morphine 혼합액이 마취 지속시간에 미치는 영향
이상화,손덕희,조성경,진선미 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.3
The effect of anesthetic duration of epinephrine and morphine mixture with hyperbaric tetracaine on spinal anesthesia was studied at Tague Catholic University Hospital. Fifty-two pa- tients, ASA physical status I-II, were selected randomly and divided them into 4 groups as follows: Group A; Only 0.5% hyperbaric tetracaine 14 mg injection. Group B; Mixture of 0.5% hyperbaric tetracaine 14 mg and morphine 0.15 mg injection. Group C; Mixture of 0.5% hyperbaric tetracaine l4 mg and epinephrine 0.2 mg injection. Group D; Mixture of 0.5% hyperbaric tetracaine 14 mg, morphine 0.15 mg and epinephrine 0.2 mg injection. The results of motor block onset, motor block duration, sensory block onset and sensory block duration were as follows: 1) Motor block onset; There were no statistical differences between each groups. 2) Motor block duration; The duration of motor blocks were significantly longer in group C and D than group A. The duration of motor block was significantly longer in group D than group B. 3) sensory block onset; There were no statistical differences between each groups. 4) Sensory block duration, The duration of sensory blocks were significantly longer in group D than group A, B and C. These results suggested that the effect of anesthetic duration of epinephrine and morphine mixture with local anesthetics simultaneously on spinal anesthesia were more prolonged than tetracaine injeetion only and injection of tetracaine, epinephrine mixture.
이상화,김봉일,노운석,박훈민,조성경 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.3
Unidirectional valve (UDV) malfunction causes rebreathing of expired gas during anesthesia. However, the resultant hypercarbia without hypoxemia by UDV malfunction is not easily detected. We experienced a case of severe hypercarbia which caused by sticking expiratory valve at 45 minutes after the induction of anesthesia, in spite of checking UDV function preoperatively. In this case, expiratory UDV malfunction was diagnosed with the change of capnographic waveform. And so, we recommend monitoring of capnographic waveform during every anesthesia, in addition to preoperative UDV checking. (Korean J Anesthesiol 1999; 36: 519∼523)
임신 2기 계류유산환자에서 경관확장 자궁소파수술시 발생한 양수색전증
이상화,김봉일,노운석,조성경,백승희,이상평 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.4
Amniotic fluid embolism(AFE) is a rare but devasting obstetric emergency. We experienced a case of AFE during dilatation and curettage(D&C) in a 15 2/7 weeks pregnant woman, age 30, who was diagnosed as having a missed abortion. Sudden rapid hypoxemia, low SpO2, hypotension, low PETCO2, high CVP, and tachycardia, right axis deviation and right bundle branch block in 12 leads ECG were developed during D&C under general anesthesia, and signs of disseminated intravascular coagulation(DIC) followed after the operation, which are consistent with the findings of AFE. Even though there was no definite pathologic and radiologic confirmation of AFE, laboratory findings showed 100 times higher level of α-fetoprotein in her central venous blood than same weeks of missed abortion woman's blood. Though it is rare, the anesthesiologist should always suspect the possibility of AFE, when the patient shows an unexplained collapse, cyanosis, low PETCO2, high CVP, low SpO2, ECG change and DIC during any kind of obstetric proceure. (Korean J Anesthesiol 1997; 33: 778∼783)
쇄골상차단법으로 시행한 상완신경총차단시 발생한 일측성 횡격신경차단
이상화,김봉일,노운석,조성경,이건희 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.5
The incidence of phrenic nerve block following brachial plexus block, performed above clavicle, have varied widely. However, respiratory difficulty due to unilateral phrenic nerve block is rare complication of brachial plexus blocks, We experienced a case of symptomatic unilateral phrenic nerve block after supraclavicular approsch in thirty-four-year old woman. For brachial plexus block, 30 ml of 1.5% lidocaine and 0.2 mg of epinephrine were injected. Twenty five minutes after injection, she complained of respiratory difficulty. At recovery room, she complained sharp chest pain at apex of heart and epigastrium. We diagnosed her case as right phrenic nerve block because her right diaphragm was normal contour but was markedly displaced upward in portable chest X-ray. Respiratory difficulty was recovered 5 hours after injection and her chest pain was recovered 9 hours after injection.