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      • SCOPUSKCI등재

        Effortil 이 척추마취효과 연장에 미치는 영향

        전재규,권오극 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.3

        Effortil is commonly used in this country as a vasopressor, replacing ephedrine. Various sbustances(i. e. ephedrine, neosynephrine, methedrin and epinephrine) have been added to spinal anesthetic agents in an attempt to prolong their action. We have used premixed 5% lidocaine with 5% dextrose solution as a main agent for spinal anesthesia for the past 6 years, and epinephrine has been used to prolong the spinal anesthesia. In this study, we have attempted to assess the possibility of the clinical use of Effortil in comparison with epinephrine for prologing the anesthetic effect of a spinal anesthetic agent. As a control group, 404 patients received premixed 5% lidocaine solution. In the 2nd group, 398 patients received 0. 2 mg of epinephrine added to the lidocaine solution. In the 3rd group, 337 patients received 3.0mg of Effortil added to the lidoeaine solution. The average duration of anesthetic effect was 97 minutes in the control group with lidocaine, 151 minutes in the 2nd group with epinephrine added to the lidocaine solution, and 113 minutes in the last group with Effortil added to the lidocaine solution. As a result of this study, we came to the conclusion that the Effortil may have a slight prolonging effect. However its effect is questionable as to its reliability for clinical use. Epinephrine is far better than Effortil and is more reliable and predictable for clinical use, as previously reported by other workers.

      • SCOPUSKCI등재

        소아수술을 위한 미추마취(尾椎麻醉)

        전재규,정정길 대한마취과학회 1980 Korean Journal of Anesthesiology Vol.13 No.3

        Advantages of caudal anesthesia for pediatric surgery i.e. clearly defined anatomic landmarks, a simplicity of the technic and high success rate have been reported. However, it has not been popular in clinical practice due to several reasons. First of all, small children do not cooperate with technical procedures. Therefore, an additional measure to provide a cooperative state is needed, such as Pentothal or ketamine injection, or general anesthesia induced beforehand. Secondly, there is no clear determination or an unanimity in anesthetic dosage according to the patient's age or body weight. Lastly, clinical experience and reports have not been enough for clinical practice. In consideration of these points, this report summarizes experience with caudal anesthesia in 230 cases ranging in age from 1 day to 15 years. They were recorded by the Department of Anesthesiology, Dong San Presbyterian Medical Center, for the past two years. Premedication was administered as Demerol 2mg/kg or mixed solution of Demerol 1mg/kg and Vistaril 1mg/kg intramusculary one hour before surgery. Caudal puncture was performed in the patients left lateral position, following which Pentothal 4mg/kg was administered intravenously. In this study, we have used 3 different concentrations of lidocaine i.e. 2.0% 1.5% and 1.0%. In the first group, 50 patients received adremline premixed with 2% lidocaine solution, 1mg/kg body weight. In the second group, 90 patients received adrenaline premixed with l. 5% lidocaine solution, 1mg/kg body weight. In the 3rd group, 90 patients received adrenaline premixed with 1% lidocaine solution, 1ml/kg body weight. From the result of this study, duration of anesthetic effect is variable and ranges from 2 to 3 hours in the first group with 2% lidocaine-E, 1. 5 to 2. 5 hours in the second group with 1. 5% lidocaine-E and 1. 5 to 2 hours in the third group with 1% lidocaine-E. The authors consider that 1% lidocaine 1ml(10mg)/kg bodyweight is most suitable for the practice of pediatric caudal anesthesia. Blood pressure after caudal analgesia falls slightly which is unimportant and other complications have not been major problems. We came to the concluaion that eaudal anesthesia for pediatric surgery is reliable, simple in technic, favorable to surgeons, nurses and parents and is considered to be a good technic for pediatric anesthesia.

      • SCOPUSKCI등재

        척추천자후 두통증 치료를 위한 반복적 경막외 Blood Patch : 일례 보고

        전재규,권오극 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.4

        A headache is the most common untoward compIication of a spinaI puncture. Many conservative methods of treating post lumbar puncture headaches have been most unsatisfactory. However, use of an epidural blood patch which results in immediate and permanent relief of the headache has been well documented. This case report is that of a 38 year-old pregnant woman who developed a post spinal headache and was treated with repeated epidural blood patches 3 times. The patient had complained of a headache on the 1st postoperative day, then was started on conservative therapy such as fluid infusion, analgesics, etc., but there was no relief for her headache. An attempt at an epidural blood patch for treating headache was decided on the 2nd postoperative day. A lumbar puncture using a Tuohy needle was performed in a sitting position at the L 4-5 interspace, which was one interspace below the site punctured for the spinal anesthesis. Then l0 ml of autologaus blood was injected in the identified epidural space. The patient did well for 15 hours after the 1st attempt, until she started having the same intense headache, so that a 2nd attempt of using a blood patch with another 10 ml of autologous blood was carried out with the same good result. About 15 hours later, she started having a same kind of headache with neck rigidity. The 3rd attempt with a blood patch was considered again and lumbar tapping for the 3rd attempt was performed at the L 3-4 interspace which was the same level of puncture when the spinal anesthesia was performed. This last attempt resulted in permanent and satisfactory reIief of headache with no untoward complications. However, possible complications from repeated blood patches should be seriously considered, and an absolute indication must be evaIuated to avoid additional complications from the repeated blood patches. Possibilities of additional complications from repeated blood patches are as follows: l. Incidence of localized back pain is increased due to repeated puncture with a large bore needle. 2. Possibility of inadvertent subdural puncture is increased due to reduced epidural negative pressure by the preinjected hematoma formed in the epidural space. 3. Possibility of epidural abscess is increased by the repeated blood injection because blood is agood media for bacterial growth. 4. Chances of nerve root compression are incressed due to repeated blood injections into the same area.

      • SCOPUSKCI등재

        전신마취 유도중 발생한 숨겨진 뇌동맥규의 파열

        전재규,김세연,서인옥,김연규 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.5

        Unexplained incidental intracranial hemorrhages during induction of general anesthesia are very rare. When it dose occur, anesthetists are involved in serious problems which can lead to disaster. We had a case where a hidden cerebral aneurysm ruptured during the induction in a patient. A 56 year old female was scheduled for a skin graft procedure on her face, anterior chest and both arms. For general anesthesia, she was induced with 300 mg of thiopental and 75 mg of succinylcholine. This was followed by endotraeheal intubation. The Anesthesia was maintained with N₂O/O₂ and enflurane. Appoximately 10 minutes after the induction was started the patient's pupil became fully dilated and we observed that her light reflexes were gone. Consequently, all anesthetics were discontinued, and the schedule was cancelled. She had a brain CT taken which showed subarachnoid hemorrhage. She died of rebleeding from cerebral aneurysm on the 12th postoperative day during the recovery process.

      • SCOPUSKCI등재

        요추 추궁절제술을 위한 Bupivacaine 척추마취

        전재규,배정인 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.5

        Spinal anesthesia has been virtually abandoned in general practice for lumbar laminectomy because of the fear of airway obstruction and the difficulty of sedation in the prone position. Nontheless, spinal anesthesia offers obvious benefits to the surgeon such as a clear surgical field with less bleeding. The objective of this study was to evaluate the effects of bupivacaine as a spinal anesthetic for lumbar laminectomy. Spinal anesthesia was induced to 25 random patients who were scheduled for lumbar laminectomy. This spinal anesthetic was isobaric 0.5% bupivacaine mixed with 1:300,000 epinephrine. A spinal tapping was made in a sitting position at the interspace above or below the surgical area depending on the patients height and then 3 ml of local anesthetic was injected. Next, each patient was laid down in a supine position for 3 minutes and then turned him around in a prone position. Each patient was then given a deep sedation using thiopental or nembutal until the operation was over. Arterial blood gases were analysed for the evaluation of ventilatory function. P.CO₂ were 39.3±3.9mmHg preoperatively and 50.39±6.8 mmHg at 1 hour during operation. P.O₂ were 94.4±11.2mmHg preoperatively and 83.57±14.4 mmHg at 1 hour during operation. PH were 7.40±0.02 preoperatively and 7.30±0.04 at 1 hour during operation. The duration of motor paralysis was 3-3.5 hours which waa suitable for the lumbar laminectomy. We observed no serious complications. This study showed that spinal anesthesia using bupivacaine with sedation in the prone position for laminectomy caused slight hypoventilation but it was a tolerable amount. Furthermore, the duration of anesthetic effect of bupivacaine was suitable for laminectomy. Consequently, we concluded that bupivacaine can be a good choice of spinal anesthetic agents for laminectomy.

      • SCOPUSKCI등재

        한국인의 척추마취후 합병증 : 5318 증례

        전재규,배정인,정정길 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.2

        Various post-spinal complications have been well reported for a century since spinal anesthesia first started in 1885. However, we have no statistics on postspinal complications observed in Koreans. During the five year period from 1974 to 1979, 5318 cases of spinal analgesia, mainly using a premixed 5 percent lidocaine solution with 5% dextrose, were recorded at Dong San Medical Center. This study was primarily undertaken to observe various postspinal complications in Koreans. As a result of this, we can summarize as follows: 1) The mean age of these cases was 43 years. 2) The main anesthetic was the premixed 5 percent lidocaine solution with 5 percent dextrose. 3) The needles for the lumbar puncture were mainly 22 gauge Whitacre pencil point needle. 4) The overall incidence of headache was 3.4 percent. The details as to postspinal headache and treatment were published previously. 5) Backache was subdivided into three different groups: localized pain(3.88%), diffuse pain(2.47%) and radiating pain(0.17%). The overall incidence was 2.7 percent. 6) The incidence of voiding difficulty was 2.7%. 7) The Rare neurological sequelae were not observed in our series and the other complications are noted in table 5. 8) The results are compared with the Dripps and Phillips series in table 2.

      • SCOPUSKCI등재
      • SCOPUSKCI등재

        각성상태하 무호흡후의 혈역학 및 산소 이용률의 변화

        전재규,지대림,김성기,박준만 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.6

        Background: This study examined hemodynamic variables, oxygen delivery, extraction, and consumption in response to acute progressive hypoxia and hypercarbia in the setting of apnea. Methods : Apnea was induced in 9 healthy mongrel dogs by disconnecting animals from mechanical ventilation of 30 minutes with pure oxygen. Hemodynamic variables, oxygen transport, extraction, and consumption were rapidly and repeatedly measured using pulmonary arterial and arterial catheters until cardiac output was undetectable. Results : The baseline PaO2, PaCO2, pH, base excess were 318±137 mm Hg, 36±3.5 mm Hg, 7.30±0.06, 6.81±2.65 mmol/l respectively. Hypercarbia and hypoxemia(76±33 mm Hg) was first noted at 1 and 4 minute respectively. Base excess was not changed. Indices of preload(PCWP and CVP) were increased early in the time course(P<0.05). In contrast, indices of afterload(SVR) increased later, just before cardiac decompensation began(P<0.05). No significant reduction of cardiac output, oxygen delivery, extractd consumption was detected just until abrupt cardiac decompensation started, 5 minute. Conclusions : These data suggest that the early increase in preload was primarily due to hypercarbia whereas the late increase in afterload was due to hypoxemia, but the main cause of acute cardiac decompensation was a critical decrease in arterial oxygen tension with some contribution of increased preload and afterload. (Korean J Anesthesiol 1997; 33: 1020∼1028)

      • SCOPUSKCI등재

        척추 마취후 발생한 뇨 저류

        전재규,배정인 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.4

        Urinary retention has been well documented as a complication of spinal anesthesia. This occurs somewhat more frequently than after general anesthesia because the bladder wall, supplied by the parasympathetic system is paralysed by local anesthetics and its fibers from S₂ are very susceptihle to analgesic solution. For 5 years since 1974, 127 cases of urinary retention were recorded from 4733 cases of spinal analgesia performed at the Dong San Medical Center. The incidence of urinary retention is 2.7% in our data. In this article, two cases of prolonged urinary retention due to spinal anesthesia are described. Case Ⅰ A 44 year old female was scheduled for a vaginal hysterectomy because of a prolapse of the uterine cervix. Spinal tapping was performed at L(4~5), and 16 mg of 0.4% Pontocaine was administered. The surgery was uneventful and the patient slept from Nembutal during the whole procedure. Postoperatively the patient developed retention of urine without any abnormality observed by cystoscopy, so that e was treated with urecholine orally and recoverd on the 14 th postoperative day. Case Ⅱ The patient was a 39 year old female, scheduled for a cholecystectomy. Spinal analgesia was performed and the patient was put to sleep by Nembutal and the surgery was uneventful during the whole procedure. She complained of the diffculty of voiding postoperatively. She was started on urecholine 20 mg tid orally from the 7th postoperative day, then she started voiding on the 10th postoperative day. Since then there have been no problems. The mechanism and the precipitating factors are described.

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