제왕절개술을 위한 척추 마취시 Ephedrine의 예방적 정맥적주에 관한 연구

구본업 영남대학교 의과대학 1991 Yeungnam University Journal of Medicine Vol.8 No.1

척추 마취로 제왕절개술을 받은 건강한 30명의 산모를 대상으로 ephedrine sulfate의 정맥적 주군(15명)과 정맥내 주사군(15명)의 산모혈압과 심박, 오심, 구토, Apgar scores, 산모와 태아의 혈압가스압 등을 비교 관찰하였든바 다음과 같은 결론을 얻었다. 1) 척추마취후 적주군의 수축기 산모혈압은 의의있는 변화가 없었으나 (p>0.1), 정주군에는 5, 7분 후 술전치에 비해 통계학적으로 의의있게 하강하였으며 (p<0.005), 적주군과의 비교에서도 의의있는 변화를 나타내었다.(p<0.001) 2) 적주군에서 정주근보다 오심, 구토의 발생 빈도가 낮았다.(p<0.001) 3) 산모의 심박, Apgar scores, 산모와 태아의 혈액 가스압에는 양군간 유의한 차이는 없었다. 이상과 같이 제왕절개술을 위한 척추 마취시 ephedrine의 예방적 정맥내 적주가 안전하고 효과적일것으로 사료된다. Ephedrine sulfate was administrated 30 healthy parturients undergoing elective repeat cesarean section under spinal anesthesia. Fifteen patients received ephedrine infusin (0.01% solution, beginning with approximately 5 mg/min) immediately after induction of spinal anesthesia to maintain maternal systolic blood pressure between 90% and 100% of the baseline systolic blood pressure (mean dose of ephedrine 31.6mg). Fifteen patients (contral group) received 20mg of ephedrine as an intravenous bolus, and additional 10mg increments, if neccessary, when systolic blood pressure decreased to 80% of the baseline systolic blood pressure (mean dose of ephedrine 26.8 mg). Nausea and/or vomiting occurred in seven women in the control group and one patient in the infusion group (p<0.001). Apgar scores, fetal blood gas tension, and time for onset of respiration was comparable in the two groups. The results suggest that prophylactic ephedrine infusion is safe and desirable in healthy parturients undergoing cesarean section under spinal anesthesia.

Thiopental, Propofol, Etomidate 가 흰쥐의 적출 대동맥과 폐동맥에 미치는 영향

구본업,한석주 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.11

The induction agents produce various effects to cardiovascular system. Among these, thio- pental, propofol, and etomidate produce reduction in cardiac output and peripheral vascular resistance. As a result severe systemic arterial hypotension is evoked. This phenomenon results from combined effects of CNS, cardiovascular and peripheral vascular systems. The purpose of this study was to obeserve direct effects of thiopental, propofol, etomidate in isolated rat aorta and pulmonary artery. Isometric tension was recorded in rat aortic and pulmonary artery ring preparation contracted by norepinephrine(1.8×10^(-6)). Thereafter thiopental, etomidate, propofol was added to organ bath. And the contractile or relaxing response was observed. Thiopental relaxed aortic ring by 3.6±1.3%(low dose), 3.9±1.4%(high dose), etomidate relaxed aortic ring by 2.0±0.7%(low dose), 5.4±2.8% (high dose), respectively. It was statistically insignificant. However, propofol relaxed aortic ring by 12.7±3.8%(low dose), 14.7±2.7%(high despectively(p $lt;0.05). Thiopental relaxed pulmonary artery ring by 4.8±1.1%(low dose), 5.1±2.3%(high dose), etomidate relaxed pulmonary artery ring by 4.8±1.1%(low dose), 5.1±2.3%(high dose), respectively. It was statistically insignificant. However, propofol relaxed pulmonary artery ring by 8.4±2.4%(low dose), 10.4±3.6(high dose), respectively( p$lt;0.05). The results suggest that hypotension after propofol administration was due to direct vascular smooth muscle relaxation.

개심술 환자의 기관내 Lidocaine 투여 경로에 따른 혈역학적 반응의 비교

구본업,박세훈 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.5

The aim of this study was to compare the hemodynamic responses with various administration routes of lidocatine, which was used to blunt the sympathetic stimulation associated with intubation. The study population was from 24 patients scheduled for elective open heart surgery at Yeungnam University Hospital. Patients were randomly assigned to receive lidocaine by intravenous administration, laryngotracheal spray, and oropharyngeal gargling, and endotracheal intubation was performed. Heart rate, mean arterial pressure, central venous pressure, and arterial oxygen saturation were measured at 30 seconds, 1 minute, 3 minutes and 5 minutes after intubation and compared with the control group. The results were as follows: 1) In the control group which was not administered lidocaine, heart rate and mean arterial 1pressure were significantly increased (p$lt;0.05, p$lt;0.01). 2) In the group of intravenous lidocaine administration, heart rate was significantly increased (p $lt; 0.05), but mean arterial pressure was not significantly changed after endotracheal intubation. Compared with control group, the changes of heart rate and mean artrerial pressure were statistically significant (p$lt;0.05). 3) In the group of laryngotracheal lidocaine spray, heart rate and mean arterial pressure were increased after endotracheal intubation. 4) In the group of oropharyngeal lidocaine gargling, heart rate and mean arterial pressure showed significantly increased (p$lt;0.05, p$lt;0.01), and heart rare mintained an increased state but mean arterial pressure was reduced to the baseline value 5 minutes following intubation. 5) Laryngotracheal spray and oropharyngeal gargling group showed more significant increase in heart rate and mean arterial pressure than intravenous administration group. 6) No significant changes were observed in central venous pressure and arterial ocygen saturation in all three groups. It is concluded that intravenous administration of lidocaine before endotracheal intubation is more effective than laryngotracheal spray or oropharyngeal gargling

소아에서 Mapleson D 회로 사용시 필요한 Fresh Gas Flow 의 적정 유량

구본업,김흥대,서일숙,곽민규 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.3

Background : During pediatric general anesthesia with Mapleson D-circuit, we used large amount of FGF(fresh gas flow) for avoidance of rebreathing of expired gas but low FGF are employed, the amount of anesthetic consumption and air contamination can be reduced. The aim of this study was to evaluate the fact that FGF of 220 ml/kg/min is clinically acceptable. Methods : We selected sixty children weighing ≤20 kg who were scheduled for inguinal hernia repair under general anesthesia. The study was performed by 2 steps; In the step 1, the patients were divided into two groups according to weight(less than or greater than 8 kg) and end-tidal Pco2 were compared with simultaneous arterial Pco2 measurements. In the step 2, the patients were divided into two groups according to FGF(2MV or 220 ml/kg) and arterial Pco2, end tidal Pco2 and PminCO2(minimum inspired Pco2) were measured. Results : In the step 1 study, arterial Pco2 was significantly higher than end-tidal Pco2 in the group 1 and there was slight differencein arterial Pco2 and end-tidal Pco2 in the group 2. In the step 2 study, PaCO2, PetCO2, PminCO2 were significantly increased in the group 3 than group 2 but there were no clinical hypoxemia in all patients. Conclusions : We consider that FGF of 220 ml/kg/min is appropriate during controlled ventilation with Mapleson D circuit in children weighing ≥8 kg because of economic and ecological advantages. Also, we consider FGF can be reduced in children weighing <8 kg under accurate respiratory gas monitoring. (Korean J Anesthesiol 1997; 32: 397∼402)

개심술 마취후 발생한 급성간염 1례

구본업 영남대학교 의과대학 1988 Yeungnam University Journal of Medicine Vol.5 No.2

37세의 여자가 halothane 마취로 개심술후 14일에 고열, 황달등이 발생하여 급성간염으로 진단을 받아 치료하던 중 19일째 사망한 예로 급성간염의 원인이 수혈에 의한 virus성 간염과 halothane에 의한 간염, 기타 약제나 수술의 특수조작에 의한 간염인가를 대조 검토하였으나 정확한 원인을 규명할 수는 없었다. Although halothane is one of the most widely used inhalation anesthetics, it may cause postanesthetic complications such as halothane hepatitis. Halothane hepatitis has been reported intermittentely with variable incidence. However it is not easy to prove halothane as a causative agent, because there are many factors causing postoperative hepatic dysfunction. The author had a case of acute hepatitis developing after open heart surgery used halothane. On 37-year-old female underwent an open heart surgery for ASD repair under halothane anesthesia. On the 14th postoperative day, she developed high fever of 38 C.Liver function tests showed marked elevation of SGOT,SGPT, and bilirubin, followed by gross jaundice. ??, Ag(-) and ??, Ab(+)were reported. She died of acute respiratory, hepatic, and renal failure on the 19th postoperative day. Possible causes of the hepatitis were considered halothance, blood transfusion, and drugs.

기관내 삽관을 위한 Vecuronium 의 투여 방법

구본업,서일숙 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.5

Vecuronium bromide is a nondepolarizing neuromuscular blocking agent with minimal effect on the autonomic nervous system and little or no histamine release. Some investigators have found that as the dose of vecuronium increased from its ED the onset time is decreased. This study was designed to investigate the influences of a divided dose and single large dose on onset time of vecuronium in 40 ASA physical status l and 2 adult patients. The patients were divided into two groups: Gp. l; Priming dose(0.01 mg/kg) of vecuronium 4 minutes prior to intubating dose(0.14 mg/kg) Gp. 2; Single bolus intubating dose(0.15 mg/kg) of vecuronium followed immediately the induction agent. The results were as follows. l) After the priming dose administration, in the Gp. 2, 13 patients complained of side effcts. 2) The onset time (from the end of injection to l00% depression of the twitch tension) were 172.0±23.8 seconds in the Gp. I and 164.0±27.5 seconds in the Gp. 2. 3) Clinical duration of blockade (from the end of injectn to first return of the second twitch of TOF) was 39.2±6.4 minutes in the Gp. l. In conclusion, we recommend the single large dose of vecuronium(0.15 mg/kg) for the endotracheal intubation in whom SCC is contraindicated.

하지수술을 위한 0.5% 순수 Bupivacaine 척추마취

송선옥,구본업 영남대학교 의과대학 1990 Yeungnam University Journal of Medicine Vol.7 No.2

영남대학교 마취과학교실에서 하지에 국한된 수술을 받는 환자 40예를 대상으로 각군 20예씩 0.5% 고비중 tetracaine 2ml와 0.5% 순수 bupiva-caine 2.5ml을 사용하여 척추마취를 실시한 결과 다음과 같은 성적을 얻었다. 1. 각군의 연령, 성별, 신장 및 체중은 비슷하였다. 2. 양군 모두 감각차단이 ??분절에 도달되는 시간은 4분정도였고, 감각차단 최고분절높이도 T6-7이었으며 최고높이에 도달되는 시간도 20분정도였다. 3. 운동차단정도도 양군이 비슷하여 10분에 대부분이, 20분이내에 전예에서 완전차단이 초래되었다. 4. Bupivacaine군은 감각차단이 ??분절이상에서 유지된 시간이 3시간, 술후 진통시간이 7시간으로 tetracaine군보다 작용시간과 진통시간이 의의있게 길었다(P〈0.05). 5. 수축기 혈압의 감소는 bupivacaine군이 훨씬 적었으며((P〈0.05), 혈압은 마취후 20∼30분에 심하게 감소되었다. 6. 마취후 발생된 부작용은 전체 대상환자에서 두통(3예), 다리저림(5예), 배뇨곤란(3예) 및 배부통(4예) 등이었고 양군사이에 발생빈도의 차이는 없었다. 이상의 결과로 bupivacaine 척추마취의 임상적 특징은 감각차단 및 운동차단이 나타나는 양상과 마취후 부작용은 고비중 tetracaine과 비슷하고, 고비중 tetracaine보다 혈압감소가 적고 작용시간이 길고 술후 진통효과가 좋은 점등의 장점이 있으므로 0.5% 순수 bupivacaine은 하지 수술을 위한 척추마취제로 유용하게 사용될 수 있을 것으로 사료된다. Plain 0.5% bupivacaine and hyperbaric 0.5% tetracaine were compared for spinal anesthesia in 40 patients undergoing operation of lower extremities. Lumbar puncture was performed with a 22 gauge spinal needle with the patient in the lateral recumbent position. The third lumbar interspace was chosen for the puncture, when a free flow of clear CSF was obtained, the local anesthetic solution(2.5ml of 0.5% bupivacaine or 2.0ml of hyperbaric 0.5% tetrcaine) was injected at a rate of 0.1ml/ sec without barbotage. After injection of anesthetics, clinical features were observed and compared between the two groups. The results were as follows : 1. The two groups were well matched for age, sex, height and weight. 2. In both groups, sensory block to T₁₂dermatome was obtained within 4 minutes, mean maximal level of analgesia was T6-7, and the mean time for maximal level was around 20 minutes. 3. The onset times of motor block were similar in both groups and complete motor block was obtained in all cases within 20 minutes. 4. The duration of analgesia above the T₁₂dermatome was 3 hours, postoperative analgesia was 7 hours. These values were significantly prolonged than those of the tetracaine group(p〈0.05). 5. The changes in systolic pressure in the bupivacaine group were significantly less than those of the tetracaine group (p〈0.05). 6. The complications after spinal anesthesia were headache, numbness, urinary retention and backpain, and were no significant difference in both groups. From the obtained results, we concluded that plain 0.5% bupivacaine was a relatively satisfactory agent for spinal anesthesia for operation of lower extremities. The time of onset, height of block and the comlica-tions of postoperative period were similar in both groups. The advantages of plain 0.5% bupivacaine were less hypotension and long duration of analgesia.

대상포진 후 동통에 대한 치료 효과

구본업,박대팔 영남대학교 의과대학 1991 Yeungnam University Journal of Medicine Vol.8 No.1

영남의대 부속병원 통증 치료실에 내원한 대상포진후 신경통 환자에 특별한 부위에 국소 마취를 하여 좋은 효과를 나타내었기에 그 결과를 분석하였다. 1) 남여비 및 좌우측의 발생빈도는 비슷하였다. 2) 연령은 50∼70세 였으며 발생부위는 경부, 어깨, 팔이었으며 경부에 제일 많았다. 3) 국소마취의 효과는 연령과 시간에 관계없이 효과가 좋았으며 치료회수는 7∼10회였다. Fifteen patients was analyzed on effect of the mangement of postherpetic neuralgia by local anesthesia on the special region at pain clinic in Youngnam University Hospital. The results were on follows : 1) The frequency of occurrence of sex and the lesion side were similiar in all patients. 2) The age of incidence was between 50 and 70 years old. 3) The most frequent site of lestons was the neck. 4) There was no relationship between age and treatment time. 5) Whole patients was done average 7-10 time local injection.

상복부 술후 진통을 위한 요부 경막외 Narcotics의 투여효과

구본업,서일숙 영남대학교 의과대학 1985 Yeungnam University Journal of Medicine Vol.2 No.1

상복부 수술후 진통을 위하여 경막외 narcotics주입시 임상에서 경막외강 천자가 가장 많이 시술되고 있는 부위인 요부 경막외강에 morphine과 demerol을 각각 주입하여 진통효과를 관찰하였다. 전신 마취하에서 상복부 수술을 받은 환자 20명을 대상으로 하여서 morphine 1㎎을 주입한 10명의 Ⅰ군, demerol 10㎎을 주입한 10명의 Ⅱ군에서의 진통 효과를 관찰하였던 바 다음과 같은 결론을 얻었다. 1. Morphine을 주입한 Ⅰ군에서는 평균 진통 시간이 29.4시간이었다. 2. Demerol을 주입한 Ⅱ군에서는 평균 진통 시간이 4.0시간이었다. 3. Morphine을 주입한 Ⅰ군이 Demerol을 주입한 Ⅱ군보다 진통 시간이 훨씬 길었으며 통계학적으로 유의하였다. (P<0.05) 이상의 결과로 보아 상복부 수술후 진통 목적으로 마약제를 경막외강에 투여시 시술이 안전한 요부 경막외강내로 투여하여도 우수한 진통효과를 얻을 수 있으며 마약제로는 morphine의 투여가 demerol의 투여보다 더욱 진통 효과가 우수한 것으로 사료된다. To assess the effect of post-operative pain control of upper abdominal surgery through lumbar epidural narcotic injection, the 3rd or 4th lumbar epidural puncture was done, and were injected 1㎎. of morphine (GroupⅠ) or 10㎎. of demerol (GroupⅡ) mixed with 10㎖ of normal saline into the epidural space, after operation of the cholecystectomy in 10patients and antrectomy and vagotomy, subtotal or total gastrectomy in 10patients. Time interval of the post-operative analgesic effect between morphine and demerol groups were compared. The results of this study were as follows: 1. In the groupⅠ, average analgesic duration was 29.4 hours. 2. In the groupⅡ, average analgesic duration was 4.0 hours. It is concluded that post-operative pain control of upper abdominal surgery through the lumbar epidural narcotic injection was effective, and morphine injection was more effective than demerol.

Propofol 에 의한 유도저혈압시의 혈역학적인 변화

이병용,구본업 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2

Background : The studies related to induced hypotention using propofol were rare. So we studied the effectiveness of propofol as induced hypotensive agent in brain aneurysmal surgery. Methods : The hemodynamic changes during induced hypotension with propofol (propofol-group) and isoflurane(isoflurane group) were observed in patients undergoing aneurysmal surgery. Twenty patients were allocated randomly to receive propofol induction and maintenance, or thiopental sodium induction and isoflurane maintenance for anesthesia. Both groups also received fentanyl, vecuronium, nitrous oxide and oxygen. These hypotensive effects were evaluated before, during and after induced hypotension. Hemodynamic changes were evaluated by measuring systemic arterial blood pressure, heart rate, central venous pressure, pulmonary capillary wedge pressure, cardiac output, systemic vascular resistance and pulmonary vascular resistance. We also compared the ventilatory effect of hypotensive anesthesia by blood gas analysis. Results : There were no significant changes of heart rate, cardiac output, mean pulmonary arterial pressure, pulmonary capillary wedge pressure, central venous pressure and pulmonary vascular resistance before, during and after induced hypotension in both group. Mean arterial pressure and systemic vascular resistance were significantly decresed during induced hypotension (p$lt;0.05). There were no significant changes of PO2, PCO2, HCO3 , base excess before, during and after induced hypotension in both group. Conclusion : Propofol is also an effective hypotensive agent comparable to isoflurane. (Korean J Anesthesiol 1997; 32: 267∼273)