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소하악증 환자의 기관내 삽관 곤란을 판별 할 수 있는 해부학적 인자에 관한 연구
김경태,조강희,이승홍,허철희,김문철 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.1
Background: Micrognathia is the prime, constant bony finding that signals trouble for access to the airway. Anatomical factors of difficult tracheal intubation in micrognathia have been evaluated. Method : Forty one patients with micrognathia were divided into 3 groups based on modified Mallampati classification. Lateral cephalometric view taken preoperatively was used to measure 13 anatomical factors. Kruskal-Wallis test and discriminant analysis were used to select the most predictable factors for distinguishing between the difficult and easy groups. Results : The most discriminating factors are mandibulo-hyoid distance(V12), atlanto-occipital distance(V10) and mentum-hyoid distance(V11). The discriminant analysis using above 3 factors gives the following discriminant functions(Y1= 0.7924(V12) - 0.2154(V10) - 0.3531(V11) (discriminant function 1), Y2= -0.2177(V12) + 0.8221(V10) -0.6304(V11) (discriminent fuction 2)) and the discriminating power of difficult intubation is 72.9%. Conclusions : Modified Mallampati classification and lateral cephalometric assessment of 3 anatomical factors can predict the difficult intubation. (Korean J Anesthesiol 1998; 35: 40∼49)
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경막외 마취 시술 중 발생한 Bupivacaine 의 혈관 내 주입이 전신독작용 1예
이승한,이기재,하경호,허철희,김문철,조강희 인제대학교 2001 仁濟醫學 Vol.22 No.1
The epidural anesthesia is a popular regional anesthetic technique for surgical anesthesia and analgesia. But it also has many complications such as intravascular injection of local anesthetics. Bupivacaine has become a popular local anesthetics because of its long duration of action and excellent sensory blockade effect. Nevertheless, it must be warned against the potential for systemic toxicity, usually owing to accidental intravascular injection or to the administration of an excessive dose of Bupivacaine. We report a case of sudden generalized convulsion in patient received epidural anesthesia with Bupivacaine. And the best treatment of complications during epidural anesthesia is a just prevention. Thus, We should take care of the patients recieved epidural anesthesia with Bupivacaine throughout all procedures.
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상박신경총차단 환자에서 진정목적으로 투여된 Propofol의 효과적인 주입방법에 관한 비교연구
조강희,김문철,이병준,우수영,정수봉,허철희 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.6
Background : Patients who are scheduled for upper extremity surgery under brachial plexus block (BPB) prefer to have no memory of the surgical procedure and some form of sedation is therefore necessary. Because of this we have tried to find an adequate infusion method for propofol that would supply better sedation and less complications. Methods : We divided 60 patients who were scheduled for upper extremity surgery under BPB into four groups according to loading dose and following continuous infusion rate of propofol (Group 1: 0.2 mg/kg, 8 μg/kg/min, group 2: 0.4 mg/kg, 16 μg/kg/min, group 3: 0.6 mg/kg, 33 μg/kg/min, group 4: 0.8 mg/kg, 50 μg/kg/min.). We evaluated the degree of sedation, amnesia, recovery, changes of blood pressure, heart rate, and respiratory effect of each group. Results : According to the sedation score, groups 3 and 4 were sedated better than groups 1, 2 (P< 0.05). But the mean arterial pressure (MAP), heart rate and respiration were more depressed and recovery time prolonged in igher dosage groups (P< 0.05). Three patients among group 4 developed severe respiratory depression, at which time infusion of propofol was stopped. Conclusions : The ideal infusion method of propofol for effective sedation was 0.4 0.8 mg/kg of loading dosage, followed by 16 50μg/kg/min of continuous infusion dosage. But the more dosages of propofol that were administered, the more complications appeared, so we must use care in administering propofol as a sedation adjuvant to BPB. (Korean J Anesthesiol 1999; 37: 1007∼1014)
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In Vitro에서 Bupivacaine이 혈액응고에 미치는 영향의 Thromboelastography를 이용한 비교
조강희,김문철,이병준,우수영,정수봉,허철희 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.5
Background : Deep vein thrombosis (DVT) is a common complication following major surgical procedure. In regional anesthesia with local anesthetics, deep vein thrombosis is less frequent than in general anesthesia. Several studies have advocated that local anesthetics alter the function of platelets, the stability of vascular endothelium, and the hemodynamics of the blood flow in the epidural anesthetic region. We investigate the effect of the local anesthetic bupivacaine on blood coagulation in vitro under thromboelastography (TEG). Methods : 16 Healthy volunteers who had no history of coagulation defect and anticoagulant use were evaluated. The patients were divided into 4 groups and each group was treated with bupivacaine in the following concentrations; the lower clinical level (1 μg/ml, B1 group), the higher clinical level (2 μg/ml, B2 group), the systemic toxicity level (4 μg/ml, B3 group), and a control group which was treated with normal saline. We compared the TEG parameters of each group, reactitime (R), coagulation time (K), alpha angle (α), maximal amplitude(MA) and fibrinolysis index (lysis 60), respectively. Results : As compared with the control group, there were no significant differences in the other 3 groups, especially in maximal amplitude. Conclusions: In the clinical concentration, bupivacaine had no effect on blood coagulation under TEG. Thus in the clinical concentration of bupivacaine, DVT is more influenced by several physiologic changes which are induced by epidural anesthesia, include stability of vascular endothelium, increased blood flow, and decreased catecholamine release rather than by the effect of bupivacaine on blood per se. (Korean J Anesthesiol 1999; 37: 781∼786)
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