室溫變動과 全身麻醉下에 開腹手術患者의 體溫變動에 關한 硏究

吉燦一 고려대학교 의과대학 1978 고려대학교 의과대학 잡지 Vol.15 No.1

開心術患者에서 2,3-Diphosphoglycerate 및 Phosphate치 變化에 對한 硏究

吉燦一,辛正順 고려대학교 의과대학 1985 고려대 의대 잡지 Vol.22 No.3

Benesch and Benesch demonstrated that hemoglobin affinity for oxygen is inversely related to the level of red blocd cell 2,3-diphosphoglycerate, an increase of this substance leading to a decreased affinity of hemoglobin for oxygen. With decreased affinity, oxyhemoglobin releases an increased percentage of oxygen to the tissue at any given oxygen tension. The concentration of plasma phosphate has been a factor to change the concentration of 2,3-DPG. In heart disease, the increased 2,3-DPG concentration is noted as a compensation for decreased tissue oxygen availability. The concentration of 2,3-DPG is influenced by open heart surgery and plasma inorganic phosphate concentration. Plasma inorganic phosphate concentration is also affected by open heart surgery. To clarify the extent and duration of falling in 2,3-DPG and phosphate concentration under open heart surgery, this study was performed. Twenty one patients for open heart surgery were divided into two group. One group was a cyanotic patient group. The other group was an acyanotic patient group. Blood samples were collected preoperatively and half day, 1, 2, 3, and 4 days postoperatively. The levels of 2,3-DPG were measured by ultraviolet enzymatic method of Sigma Chemical Company. Plasma inorganic phosphate level was measured by Spectrophotometer (JASCO UVIDEC-77). The results were as follows; 1. Preoperative mean value of 2,3-DPG was 32.4±5.9μmol/gm in cyanotic heart disease patients, and 22.8±5.9μmol/gm in acyanotic heart disease patients. There was a significant difference between the two groups. 2. In cyanotic patients, preoperative 2,3-DPG concentration had fallen significantly to 18.5±3.0μmol/gm by 12 hours after surgery, in acyanotic patients to 14.4±3.5μmol/gm significantly. By the 3rd day, red blood cell 2,3-DPG had increased in both groups, but was still below preoperative level. 3. Preoperative mean value of plasma inorganic phosphate was 3.53±0.69mg% in cyanotic group, and 3.91±0.60mg% in acyanotic group, but there was no significant difference between the two groups. 4. In cyanotic patients significant decrease of preoperative phosphate value was found only 12 hours after surgery-value (2.38±0.76mg%). In acyanotic patients, significant decrease was found in 12 hours postoperative value (2.52±0.67mg%), 2nd day postoperative value (3.26±0.61mg%), and 3rd day postoperative value (2.79±0.56mg%)

백내장 수술에서의 Curare Akinesia

길찬일,이경자,신정순 대한마취과학회 1977 Korean Journal of Anesthesiology Vol.10 No.3

It has been generally understood that curare in small doses produces ocular akinesia. The special value or curare in the surgery of cartaract lies in the selective sequence of the paralysis which it produces. This affects first the muscles innervated by the cranial nerves, then the extremitties, and lastly the respiratory muscles. Between May 1976 and August 1977, we have used curare in the cataract surgery for akinesia of ocular muscles. Conclusions are summerized as follows; 1. Smaller dosages of curare are sufficient for quieting the patient and achieving ocular akinesia. 2. Curare is valuable substance fo rreduction the incidence of vitreous loss when eye is opened. E. Ocular relaxation is a summation of premedication, analgesics, curare and retrobulbar infiltrations. 4. Curare should be administered only by anesthesiologists who are qualified experience with this drug because of it's toxicity.

Haloperidol 전처치가 진정효과와 수술후 오심 및 구토에 미치는 영향에 관한 연구

길찬일,안동애,서충호,이경자,최세진,신정순 대한마취과학회 1977 Korean Journal of Anesthesiology Vol.10 No.3

We used haloperidol as premedicants to be calm and reduce postoperative nausea and vomiting. From April to November, 1976, total 181 cases were evaluated. The results were as followings. 127 cases (70.2%) were indifferent to their surroundings; 22 cases (12.2%) drowsy and completely indifferent to, but, they answered questions adequately. We experienced postoperative nausea and vomiting in subjects (8.3% of all); in each analgesic and anesthetic drug; of 87 patients 5 (5.7%) in pentazocine, of 75 patients 5 (6.7%) in meperidine, no cases were found in halojhane, of 9 paitents 5 (55.6%) in diethyl-ether.

室溫變動과 全身麻醉下에 開腹手術患者의 體溫變動에 關한 硏究

吉燦一 고려대학교 의과대학 1978 고려대 의대 잡지 Vol.15 No.1

General anesthesia produces cutaneous vasodilation and depresses shivering reflex. Muscle relaxants, too prevent the increase in metabolism secondary to shivering. So anesthetized, paralyzed patient is partially or totally peikilc-thermic, gains heat in hot environment, and loses heat in cold environment. The purpose of this study was to examine the relationship between hot room temperature and body temperature of anesthetized, paralzyed adults undergoing intraabdominal surgery. The total number of patients in this study was 320, and the patients were devided in two groups. Group Ⅰ was consisted of 10 patients who were anesthetized in 26-29℃. rooms. Group Ⅱ was consisted of 10 patients who were anesthetized in 29-32℃ rooms. Conclusions are summerized as follows: 1. Maximal permizable room temperature in which no patient gained heat above normal body temperature range was 27.3℃. for 2 hours operation. 2. Patients in 26-29℃ rooms had normal mean esophagal temperature 2 hours after induction of anesthesia. 3. Patients in 29-32℃ rooms showed heat retention for 30 minutes after induction of anesthesia. 4. The effective methods of treating pyrexia which was developed when room temperature was more than 29.4℃ was to increase heat loss by conduction utilizing ice bag or water cooled mattres. 5. When anesthesia was maintained above 26℃. room temperature, body temperature should by taken at least 30 mimutes intervals for prevention of hyperthermia.

부교감신경차단제인 atropine sulfate와 glycopyrrolate가 위액 분비량 및 위액산도에 미치는 영향에 관한 임상적 연구

김용조,길찬일,신정순 고려대학교 의과대학 1982 고려대 의대 잡지 Vol.19 No.1

Gastric acid aspiration into the lung is a very grave pulmonary complication in general anesthesia for the surgical patients. There were many preventive methods of pulmonary aspiration of stomach contents such as N.P.O. prior operation, preoperative gastric lavage, administration of apomorphine to induce vomiting, metoclomide to empty stomach, and anticholinergics to reduce gastric secretion acidity etc. But, there were not absolute preventive measures of acid aspiration pneumonitis. Recently, a quaternary ammonium compound (glycopyrrolate) was introduced as an anticholinergics for its longer action and more potency than atropine. It is known to reduce gastric acidity and secretion. So, we performed a clinical survey to compare the effects of atropine and glyco pyrrolate on the pH and volume of gastric secretion. The results obtained were summarized as follows; 1. The incidence of dry cases of salivary secretion were 2/20 (10%) in group Ⅰ, 17/20(85%) in group Ⅱ, and 18/20(90%) in group Ⅲ. 2. The incidence of gastric volume≥0.4㎖/㎏ and pH≤2.5 were noted at 60min. after premedication as follows; 18/20(90%) in group Ⅰ, 16/20(80%) in group Ⅱ and 8/20(40%) in group Ⅲ. 3. The incidence of gastric volume≥0.4ml/㎏ and pH≤2.5 were noted at 120min. after premedication as follows; 18/20(90%) in group Ⅰ, 14/20 (70%) in group Ⅱ and 9/20(45%) in group Ⅲ.

氣管內 揷管을 위한 d-Tubocurarine chloride(d-Tc)의 定量에 대한 臨床的 考察

蔡秉國,吉燦一,辛正順 고려대학교 의과대학 1982 고려대 의대 잡지 Vol.19 No.1

Administration of succinylcholine for endotracheal intubation may cause untoward reactions such as elevation of intraocular pressure, increased plasma potassium level, increased intragastric pressure, bradycardia, and development of postoperative muscle pain, etc. Several attempts have been made to minimize the development of muscle fasciculation following administration of succinylcholine such as pretreatment with small doses of nondepolarizing neuromuscular blocking agent, self-taming of succinylcholine, or the use of hexafluorenium. When small doses of nondepolarizing neuromuscular blocking agent are given before succinylcholine administration, larger doses of succinylcholine should be given to chieve satisfactory relaxation. So, this study was intended to determine the adequate doses of d-tubocurarine chloride(d-Tc) for endotracheal intubation in patients with relative contraindication of using succinylcholine. We Observed the degree of vocal cord relaxation 3 minute after d-Te administration by fiberscopic examination and measured changes in mean blood pressure (MBP) and heart rate, just before, and after intubation, and 5 minutes after intubation. The total number of patients in this study was 100, and the patients were divided into five groups: Group 1, consisting of 10 patients, recieved 0.3㎎/㎏ of d-tubocurarine. Group 2, of 32 patients, recieved 0.4 ㎎/㎏ of d_Tc. Group 3, of 16 patients, recieved 0.45㎎/㎏ of d-Tc. Group 4, of 26 patients, recieved 0.5 ㎎/㎏ of d-Tc. Group 5, of 16 patients, recieved 0.6 ㎎/㎏ of d-Tc. The conclusions are summarized as follows; 1) The adequate doses of d-Tc for endotracheal intubation is 0.5 ㎎/㎏. 2) Maximum reductions in MBP were present 3 minutes following d-Tc administration in each group. 3) Heart rate did not change significantly after d-Tc administration in each group.

중증근무력증 환자 마취 8 예 경험

김용철,길찬일,신정순,장진경,임혜자,우설희 대한마취과학회 1983 Korean Journal of Anesthesiology Vol.16 No.3

Myasthenia Gravis is a chronic disease of disputed etiology, possibly an auto-immune reaction to the moter end-plate, characterized by exacerbations and remissions, a rare disease entity in Korea. Myasthenia Gravis has offered many anesthetic problems because it affects respiratory muscles occasionally and bronchial secretion from preoperative anticholinesterase therapy. The chief concern is to ensure adequate respiration both during and after operation. During the year 1976-1982, we have experienced the anesthetic management of 8 patients with myasthenia gravis and thymectomy. From our experiences, we conclude that respiratory care and disuse of relaxants is the key to successful management.

Gallamine Triethiodide 가 안압에 미치는 영향

김용철,신정순,길찬일 대한마취과학회 1983 Korean Journal of Anesthesiology Vol.16 No.2

The purpose og this experiment was to evaluate the effect of gallamine triethiodide on the intraocular pressure during general anesthesia for intraocular surgery. Twenty parionts in the American Society of Anesthesiologists, physical status I and II, aged from 15 to 65 years with no eye or kidney diseases were stydied during anesthesia for elective surgery. All were premedicated with 50mg of meperidine and 0.4mg of atropine. Before inducation intraocular pressure was measured under topical anesthesia with 0.5% tetracaine in the eye control value determined. Anesthesia was indyced with 5mg/kg of 2.5% thiopental and I mg/kg of succinycholine. The intraocular pressure was measured after endo-tracheal intubation.Anesthesia was maintained with 2mg/kg of meperidine, nitrous oxide and oxygen. On the return of spontaneous respiration followig succinycholine, 2mg/kg of gallamine triethiodide was adminidtered. Subsequent measurements were made 10 and 20 minutes after gallamine triethiodide administration, respectively. The results were as follows; 1) Succinycholine caused a significant rise in intraocular pressure. 2) Gallamine trierhiodide cause a slight decrease in intraocular pressure 10 and 20 minutes after administration.

Cushing`s Syndrome 환자의 마취 1 예 보고

박영철,박경숙,문숙희,김순점,길찬일,신정순 대한마취과학회 1982 Korean Journal of Anesthesiology Vol.15 No.3

We have experienced the anesthetic management of bilateral adrenalectomu in a 17-years old male, who was diagnosed as Cushing's syndrome. Anesthetic problems in Cushing's syndrome are hypertension, tachrcardia, hyperglycemia, hypokalemia and acute adrenal insufficiency. Therefore anesthetic management of this disease should focus on the thorough understanding of pathophysiology and adequate control of preoperative condition. Careful monitoring of the patient and frequent measurement of electrolytes and acid base balance status during the operation are also needed. We report the case of anesthetic experience of Cushing's syndrome and review anesthetic choice and management for better outcome of the patient.