全身痲醉의 深度基準

金光宇,郭一龍 최신의학사 1975 最新醫學 Vol.18 No.3

이중관을 이용한 체외순환식 탄산가스 제거법에 관한 연구

함병문,곽일룡,성시옥 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.3

Intermittent positive pressure ventilation is used as a respiratory support for acute respiratroy failure. Adult respiratory distress syndrome(ARDS) revealed mortality rate of 70% as yet. Hypoxemia is foremost problem in ARDS. Though various ventilatory support is tried on ARDS, extracorporeal membrane oxygenation(ECMO) is to be recommended when hypoxemia and hypercarbia are refractory to conventional treatments. Neonatal venoarterial (VA) ECMO in USA is recognized as a therapeutic modality for neonatal respiratory failure and extracorporeal carhon dioxide removal(ECCO₂R) in Europe is used for adult respiratory distress syndome. The partial bypass using the membrane oxygenator aims at lung rest while relieving the hard ventilatory setting on the diseased lung. VA ECMO can provide circulatory support as well but the right internal jugular vein and the right common carotid artery are ligated for the cannulation of draiaage and perfusion catheters. Recent follow up study shows that VA ECMO may not be completelyfree from neurologic complications such as embolism in the systemic circulation and ill effects due to the reduction of blood supply to the immature lungs. ECCO₂R adopts low-flow venovenous(VV) bypass. It has been reported to be valuable for treatment of neonatal respiratory failure. VV bypass provides gas exchange but no cardiac support. Venous drainage and perfusion catheters are placed in the right atrium or vena cavae via the femoral or internal jugular veins. Compared to VA bypass, the consequences of embolizations are potentially fewer, no major artery is sacrificed. Highly oxygenated blood flows into pulmonary eirculatiom which may relieve pulmonary artery hypertension. Total respiratory support may be obtained by VV bypass, VV bypass requires approximately 20-50% more flow for total respiratory sopport due to recirculation of oxygenated blood. Recently VV bypass is chosen for neonatal resyiratoty failure in USA. They alliveate the entry criteria for ECMO using the parameter of oxygenation index(OI). V ECCO₂R using to-and-fro system is tried also for neonatal respiratory failure in Europe. A double lumen tube was developed to reduce the number of veins to be cannulated during VV bypass. It is constructed with the outer drainage cannula(14 Fr.) and the inner perfusion cannula(8 Fr.) whose opening is placed on the left side of outer cannula. If perfusion opening is placed on the right atrium facing the right ventricle, the venous blood can be drained from both superior and inferior vena cavae through several drainage opening. To evaluate the effectiveness of ECCO₂R with a double lumen tube, we developed an experimental model of acute respiratory failure on 8 mongrel dogs. Under general anesthesia with i.v, pentobarbital, a double lumen tube was introduced via the right internal jugular vein and it was connected with the extracorporeal circuit. Without ventilating the oxygenator during VV bypass, respiratory failure was induced by hypoventilation. After obtaining control hemodynamic and blood gas values der hypoventilation, we proceed to apneic oxygenation(AO), extracorporeal CO₂ removal(ECCO₂R) and controlled mechanical ventilation(CMV) in that order. Arterial pH in control was 7.180.09(meanSD), and it was increased to 7.33±0.08 and 7.28±0.08 in ECCO₂R and CMV, respectively. PaCO₂ in control was 69±9mmHg and it was decreased to 41±4mmHg and 47±7mmHg in ECCO R and CMV respectively. PaCO₂ in control was 62±15 mmHg and it was increased in AO, ECCO₂R and CMV. Mixed venous blood gas analysis showed the same result as arterial blood gas analysis. There was no difference between ECCO₂R and CMV. The bypass flow enough to remove CO₂ was 30∼50% of cardiac output. It is concluded that ECCO₂R using a double lumen tube was effective to control the carbon dioxide tension in arterial blood, and a double lumen tube may permit the simplicity of an operation and patient care as well as minimizing the bleeding during extracorporeal respiratory support

23,385 마취례의 통계적 고찰

김용락,김성덕,곽일룡 대한마취과학회 1973 Korean Journal of Anesthesiology Vol.6 No.1

To evaluate historical trend, if any, anesthetic experiences of 23,385 in total performed at the Seoul National University Hospital from Jan. 1965 through Sept, 1972 were analyzed statistically according to age, sex, anesthetic agents and methods. The results are as follows: 1) General anesthesia has been used with increasing frequencies inversely to local anesthesia. 2) More than half the total cases were for the patients in the second or third decade of there ages. 3) The use of halothane has been steadily increasing ever since its introduction into clinical anesthesia in its country. 4) Thiopental has mainly been used for intravenous induction, and succinylcholine for facilitating endotracheal intubation. 5) In almost all cases semiclosed circle absorption system has been employed, and non-rebreathing system has recently been used with increasing favor for padiatric anesthesia.

엔후루란 마취심도 지표에 관한 연구

조명원,김종성,곽일룡 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7

It is essential for the safe conduction of anesthsia to monitor the depth of anesthesia during aperation. However no one method has been confirmed to be objective and accurate as yet. Hecently lower esophageal contractility (LEC) has emerged as a means of mesuring anesthetic depth. To evaluate the usefulness as an index of anesthetic depth, the author compared the cardio- vascular signs (blood pressure, heart rate), EMG, EEG, plasma epinephrine and norepinephrine concentrations and LEC, until now known to be relevent to the anesthetic depth, at varing conditions of of no anesthesia, under anesthesia and after stimulation. The subjects were 30 ASA class 1 surgical patients, aged from 20 to 49, who had no specific past midical history and no recent medications. Patients were given thiopental sodium 4 mg/kg and vecuronium 0.1 mg/kg for induction and intubation and respiration controlled with 100% oxygen, then baseline measurements were taken (control) and compard the values of under enflurane anesthesia with 1 minimum alveolar concentration (MAC), 1.7%, (anesthesia) and after surgical stimulation (stimulation) with each other. The results were as follows ; 1) EEG, response rate and frequency of spontaneous LEC, amplitude of provoked LEC, LEC index of under enflurane anesthesia and after stimulation revealed significant differences compared with control but no significant differences between under anesthesia and after stimulation values. 2) Systolic, diastolic, mean blood pressure revelaled significant differences among control, under anesthesia and after stimulation values. 3) Heart rate, EMG, plasma epinephrine and norepinephrine concentrations, amplitude of spontaneous LEC revealed no significant differences among control, under anesthesia and after stimulation values. According to the above results, compared to the control value, EEG, and LEC reflected anesthetic depth under 1 MAC enflurane anesthesia but were meaningless in the evaluation of surgical stimulation. Blood pressure change which revealed significant differences among three values could be judged to be useful as an index of anesthetic depth most commonly applicable in practice.

내경정맥도자시 좌우에 따른 적정 깊이의 비교

김종수,황정원,이병건,도상환,곽일룡,곽미숙 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.5

Background: The purpose of this study was to measure and compare the optimum depth of the internal jugular venous catheterization between the right and left side. Methods: Forty-four patients were enrolled for this study and divided into two groups(22 patients each). The optimum depth of the catheterization was calculated using the sum of two component(A and B); the advanced length of the catheter from the level of the cricoid cartilage(A) and the distance from the catheter tip to the junction of the superier vena cava and right atrium(B). Result: The optimum depths of the internal jugular venous catheterization were 16.0 1.0 cm(right) and 18.4 1.5 cm(left) respectively. Left side was significantly longer than right side(p<0.05). In this study, we experienced some complications; arterial punctures(5 cases) and migration of the catheter to the opposite subclavian vein(1 case). Five complications were associated with left internal jugular venous cannulation and one was associated with the right side cannulatio. Conclusion: We concluded that the optimum depth of the internal jugular venous catheterization was longer in the left side than in the right side. (Korean J Anesthesiol 1997; 33: 829∼832)

척추수술시 급성 동량성 혈액희석법은 수혈요구량을 감소시킨다

황의영,고홍,도상환,김지애,최익현,곽일룡,한미애 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.3

Background : Acute normovolemic hemodilution(ANH) is known as the easieat and most economical and the quality of autologous blood saved by it is the best of all methods of autotransfusion. To investigate the efficacy of ANH, we studied whether it could reduce the transfusion requirement in spinal surgery. Methods : Forty patients were randomly divided into 2 groups. In the hemodilution group(n=20), 2 or 3 units of autologous blood were procured immediately before or after anesthetic induction while Ringer's lactate and pentastarch were infused to maintain normovolemia. All patients received deliberate hypotension induced by labetalol. Perioperative changes of hemoglobin, hematocrit and platelets, the transfusion requirement and the amount of postoperative drainage were compared between each group. Results : Perioperative changes of hemoglobin, hematocrit and platelet showed no significant differences between each group. Less packed RBC were used in the hemodilution group(1.9 2.0 units) than in control group(5.9 6.8 units) (P<0.05). In the control group, 4 patients were transfused with fresh frozen plasma(mean 4.8 units), 3 patients with platelets(mean 13 units) and 1 patient with cryoprecipitate(10 units) while only one patient was transfused with 3 units of fresh frozen plasma in the hemodilution group. Postoperative drainage was significantly less in the hemodilution group(1,494 488 ml) than in the control group(2,476 1,730 ml). Conclusion : ANH seems to decrease the transfusion requirement in spinal surgery. Reduction of postoperative wound drainage appears to play an important role in that. (Korean J Anesthesiol 1997; 33: 458∼462)