심정지의 치료

전세웅 대한마취과학회 1976 Korean Journal of Anesthesiology Vol.9 No.2

Succinylcholine 에 대한 올바른 인식

전세웅 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2

Non-depolarizing muscle relaxant; d-tubocurarine was introduced clinically in 1942. Thereafter depolarizing muscle relaxant; succinylcholine was introduced in 1951. Those muscle relaxants were highly contributed in modern anesthesia practice today. But, since many years ago complications of succinylcholine were reported clearly so many anesthesia practice. Complications were such as ventricular arrythmia(cardiac arrest), fasciculation, hyperkalemia, muscle pain, elevation of intragastric, intraocular & intracranial pressure, prolonged apnea, generalized muscle clonus, masseter muscle rigidity and malignant hyperthermia etc. Succinylcholine was still used in clinical practice despite of many complications reported as long as more than 45 years. Finally, FDA(USA) decleared the routine use of succinylcholine was contraindicated in children and adolescents. Many textbooks of anesthesiology shows that use of succinylcholine was contraindicated in children and adolescents those were published recently since 1994. What is the current status of succinylcholine in despite of changing current concept of succinylcholine use in Korea? Succinylcholine is still inadvertently used in Korea over 79% of resident training hospital. Intravenous dantrolene reserve was only one hospital(1.4%). Undoubtedly, amazing things were going on in Korea. Seventeen cases of malignant hyperthermia had been reported from 1971 to 1996 on Korean medical journals. It's mortality was 70.6%. Not only the reported malignant hyperthermia, there are many cardiac arrest during anesthesia reported on Korean medical journals. Etiological analysis of cardiac arrest was reviewed some of them, there are certain numbers of cardiac arrest cases confirmed by succinylcholine was guilty. What is the counterplan? Change the current concept of succinylcholine is important. Conclusions ; 1. Non-depolarizing mucle relaxant should be used for intubation &/or muscle relaxation. 2. Hot line for malignant hyperthermia should be established.. 3. Intravenous dantrolene reserve is necessary. 4. Routine monitoring during anesthesia should be blood pressure, ECG, SPO2, ETCO2, body temperature and peripheral nerve stimulator. (Korean J Anesthesiol 1997; 32: 171∼177)

협동로봇 동향

전세웅,정병진 대한전기학회 2019 전기의 세계 Vol.68 No.1

수술실에서의 환자체온의 변화

전세웅,전일곤 대한마취과학회 1974 Korean Journal of Anesthesiology Vol.7 No.1

It is known that changes in body temperature occur during surgical operations with the patient under general anesthesia. Body temperature who has had elective surgery on St. Mary's Hospital at spring time (February to April) was measured by rectal thermometer. Body temperature was checked at before surgery and immediate postoperatively. Measured body temperature was analysed for sex, comparison of abdorninal surgery, skin graft or cranial surgery (who had exposed room temperature (20~23℃) as almost naked), duration of operstion, types of anesthetic system and operating room temperature. Results were as follows; 1. In abdominal surgery, body temperature change in man was decreased 0.64℃ postoperatively, in woman decreased 0.35℃ pastoperatively. But no statistical significance was obtained(p$gt;0.05). 2. In abdominal surgery, body temperature change was decreased 0.25℃ postoperatively but room temperature was increased 0.51℃ significantly(p$lt;0.01) postoperatively. Correlation coefficient between body temperatud room temperature was not observed(γ=0.37, 0.04). 3. In skia graft and cranial surgery, body temperature was decreased 1.3℃ postoperatively and room temperature was increased 0.4℃, respectively. But no statistical significance and no correlation coefficient vrere observed. 4. In duration of surgery (in abdominal surgery), body temperature was decreased 0.75℃ within 2 hours and over 3 hours duration, each. 5. In duration of surgery (in skin graft and cranial surgery), body temperature was significantly decreaaed 0.51℃ within 2 hours and significantly decreased 1.17℃ over 3 hours duration(p$lt;0.001). 6. In vaporizer inside the circuit (Air-Med anesthetic machine), body temperature was incre- ased 0.3℃ postoperatively and was significant(p$lt;0.001). Room temperature change was significantly increased 1.17℃ postoperatively and was significant(p$lt;0.001).

근육이완제의 현재와 문제점

전세웅 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.1

Anesthesiologists may have close relationship with muscle relaxants in clinical practice Fortunately, few of the new muscle relaxants were discovered and used in clinic recently. In this moment we have to look back the old muscle relaxants. Undesirable side effects of thIn old ones are less common, but encountered often enough to be troublesome. For example, succinylcholine(depolarizer) mar enhance dysrhythmia, rise in plasma pot-assium, increase in intraocular pressure, rise in intragastric pressure, triggering malignant hrperpyrexia muscle pain and dual block etc. Is there a simple screen test for the atypical cholinesterase? Unfortunately it's not available now. Nevertheless depolarizer was still used in many decades. That's the matter? Muscle relaxants are also affected by many factors those are renal excretion, metabolism of the drug, lilver or disease, effect of jaundice, muscle blood flow, production and release of acetylcholine, body temperature, antibiotics, other drug interactions, electrolyte imbalance, pathological status, individual differences and species differences etc. Sometimes it will make a trouble for the anesthesia practice. So anesthesiologists must be familiar with the use of muscle relaxants. And also we have to think twice about it's clinical use before given to the patients. What Is the right methods of rational use of muscle relaxants? What is the right way to reverse muscle relaxation? Obviously, return of normal muscle function following muscle relaxant administration is of prime importance to restoration of adequate spontaneous ventilation because it is clini-call velr important. In human study; supramaximal ulnar nerve stimulation was delivered by a peripheral nerve stimulator(Myotest, Biometer MK Ⅱ ) through electrode at the wrist. Stimuli were delivered continuously) by either $quot;TOF$quot; or single twitch stimuli. The resultant force of thumb adduction was measured and recorded by Biophysiograph(San Ei, Japan) through the force displacoment transducer. In animal study: all animals were intubated through a tracheostomyt under the intraperitoneal urethane anesthesia with nembutal given intravenously. Respiration was controlled by means of Shinano animal respirator. The body temperature was kept at 35℃ with a thermo-blanket. The common peroneal nerve and anterior tibial muscle was exposed and nerve stimulator was applied to the nerve-muscle preparation. The twitch height of the muscle contraction was recorded on a Biophrsiograph through the force displacement transducer. The common peroneal nerve was stimulated supramaximally using a peripheral nerve stimulator with a $quot;TOF$quot; stimulation or single twitch stimulation. Obviously, newly introduced muscle relaxants are certainly have advantage over the old ones but we should hatre further studies on them. Conclusions ; 1) Minimal dose of muscle relaxant which may produce 90∼100% of twitch depression may use depend on the types of surgery. 2) To evaluate the type and degree of muscle relaxation intermittently by use of the ripheral nerve stimulator is essential. 3) Best choice of the muscle relaxants are should be non-depolarizers those mar promp-tly reversed by anticholinesterases.

가토에서 d-Tubocurarine 과 Ketamine 의 상호작용

전세웅,한영문,황호식 대한마취과학회 1982 Korean Journal of Anesthesiology Vol.15 No.4

Ketamine hydrochloride (ketamine) is a non-barbiturate anesthetic agent chemically designated as dI-2-(0-chlorophenyl)-2-(methylamino)-cyclohexanone hydrochloride. Ketamine anesthesia has been found distinctively different from that induced by conventional anesthetic agents, as it provides profound analgesia without significant impairment of respiratory function or stimulation of cardiovascular activities thus avoiding hypotension and are preserved the protective pharyngeal and laryngeal reflexes. In addition, ketamine appears to have muscle relaxation properties. This latter clinical finding, however, has not been experimentally substantiated since few report have appeared on the effect of ketamine on muscle relaxation. The present study therefore, was undertaken to determine whether this agent affects the muscle activity during d-tubocurarine block. The experiment was performed on sixteen rabbits weighing 1.8 to 2.5 kg and these were divided into two groups; eight rabbits for control and eight for the study group. All animals were intubated through a tracheostomy under general anesthesia with nembutal 40 mg/kg given intravenously. Respiration was controlled by means of a Harvard animal respirator. The body temperature was kept at 35℃ to 36℃ with a thermo-blanket. The common peroneal nerve and anterior tibial muscle was exposed and the nerve stimulator was applied to the nerve muscle preparation. The twitch height of the muscle contraction was recorded on a biophysiograph through the force displacement transducer. The common peroneal nerve was stimulated supramaximally using a single twitch, square wave of 0.2 msec duration at a frequency of 0.1 Hz once every 10 seconds. The degree of neuromuscular block following intravenous injection of d-tubocurarine 1 mg/kg was measured in the control group. And in the study group ketamine 5 mg/kg was administered intravenously when 25% of twitch height of muscle contraction was obtained spontaneusly after the intravenous injection of d-tubocurarine 1 mg/kg. The changes of the twitch height of muscle contraction and the time of spontaneous recovery in the study group were compared with those of the control group. The results were as follows; 1) The times and degree of maximal single twitch depressions were obtained at 194.8 sec and 87.3% in the control grop and were at 197.5 sec and 87.8% in study group. No significant difference was observed. 2) Recovery index of the control group was 1,560.0 sec and recovery index of the study group was markedly prologed to 2,387.5 sec (53.0% prolongation). 3) Mean descrease of single twitch height was 8.8% soon after the intravenous ketamine 5 mg/kg when 25% of twich height was obtained after the intravenous d-tubocurarine 1 mg/kg in the study group.

반복 고압증기멸균이 국소마취제의 pH 에 미치는 영향

전세웅,김창겸 대한마취과학회 1978 Korean Journal of Anesthesiology Vol.11 No.4

Autoclaving the local anesthetic ampuls has been suggested as a safer method of sterilization. However the method and time necessary to sterilize the ampul has not been standardizzed, and the amount of deterioration of anesthetic agents by this method is unkown, and the effect of injection of the caramelized dextrose has not been determined. If ampuls are autoclaved with the spinal tray or set up, the ampuls are subjected to sterilization for a prolonged time which in turn causes caramelization of dextrose and possible deterioration. We have studied the effect of multiple autoclavings on pH of the drugs whichart used in spinal anesthesia, 1% tetracaine, 10% dextrose, 2% xylocaine and epinephrine at 134˚C, 36 psi for 5 minutes. Statistical significance of the pH changes were observed by multiple autoclavings.

Potassum과 麻醉 -上-

全世雄 中央醫學社 1974 中央醫學 Vol.27 No.3

心肺蘇生法

全世雄 中央醫學社 1973 中央醫學 Vol.25 No.4

人工呼吸과 自動換氣器(下)

全世雄 中央醫學社 1973 中央醫學 Vol.25 No.1