1세 이하 소아의 개심술시 Fentanyl 용량에 따른 혈당치의 비교

김계용,황재현,문희원 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.5

Hyperglycemia has been noted to occur in pediatric patients undergoing cardiac surgery with hypothermia. Because even moderate hyperglycemia during cerebral ischemia may predispose patients to an increased risk of neurologic deficit, the authors wished to determine whether the large dosage of fentanyl might contribute significantly to the decrease in blood glucose, The authors examined 20 infants who underwent cardiac surgery with small dosage of fentanyl(Group I, n= l0) or large dosage of fentanyl (Group II, n=10), none of whom received dextrose in the clear cardiopulmonary bypass pump prime, maintenance iv fluids, or cardioplegic solution. Blood samples were obtained after induction, during cardiopulmonary by-pass, after cardiopulmonary bypass and after operation. There was no hypoglycemia during the entire surgical periods in all patients. During cardio-pulmonary bypass in group I and group II, after cardiopulmonary bypass, after operation in group II, blood glucose levels were significantly decreased compared with after induction values(p$lt;0.05). Compared with group L the rates of changes from the values after induction were significant during cardiopulmonary bypass and after operation in group II(p$lt;0.05). In conclusion, large dosage of fentanyl is valuable in control the hyperglycemia during open heart surgery in infants.

중환자실 환자의 임상통계 고찰

김계용,황재현,조성강 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.1

We have analyzed 785 ICU patients admitted between May 24, 1989 and April 30, 1990, to obtain better guidance and management in the ICU. The results of analysis are as follows: 1) Total number of patients was 785; 459 male and 326 female. The number of patients admitted was 337 (42.9%) from the Department of neurosurgery, 259 (33.0%) from internal medicine and 70 (8.9%) from genreal surgery. 2) 183 patients were involved in 51~60 age group, 166 in 61~70 age group, 138 in 41-50 age group and 85 in over 71 age group. 3) The number of patients by admission days was 223 (28.4%) in 3~4 days group, 197 (250%) in 1~2 days group and 128 (16.3%) in 5~6 days group. 4) The total number of expired patients was 103 (mortality rate, 13,1%); 66 male and 37 female. The expired 63 patients admitteed in ICU due to medical problems and 40 patients due to surgical problems. The number of expired patients was 54 (52.4%) from the Department of internal medicine, 31 (30.1%) from neurosurgery and 5 (4.9%) from general surgery. 5) The highest mortality group was 51~60 age group by age and 1~2 days group by duration of admission.

개의 할로탄 마취시 Lidocaine 의 혈역학적 작용

김성덕,김계용 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.2

The hemodynamic responses to lidocaine were studied in eight mongrel dogs during halothane anesthesia. The animals inhaled 1 MAC of halothane (group H). During halothane anesthesia, a small dosage of lidocaine (group H; iv bolus 1.5 mg/kg over 1 min, followed by continuous iv infusion with 0.1 mg/kg/min), and a large dosage of lidocaine (group HL; iv bolus 1.0 mg/kg over 1 min, followed by continuous iv infusion with 0.3mg/kg/min) were administered for 30 min, respectively. One MAC of halothane anesthesia decreased the heart rate (10.9%), systolic blood pressure (13.3%), rate pressure product (22.5%), coronary perfusion pressure (16.5%), cardiac index (17.6%), and left ventricular stroke wark index (22.5%) compared with the control. Compared with group H, a small dosage of lidocaine (group H(1)) only significantly decreased the heart rate by 10%, but it seemed to decrease the above mentioned paramenters further. A large dosage of lidocaine (group H L) decreased the heart rate (27.3%), systolic blood pressure (26.0%), cardiac index (35.1%) and rate pressure product (46.0%), compared with the control value, and significantly increased the PR interval in ECG (30%). Although all the parameters indicating oxygen demand and supply were decreased, the shunt ratio was decreased and the alveolar-arterial oxygen tension difference was maintained at the control level. This study demonstrates that the hemodynamic changes by lidocaine might be induced by direct cardiac effect, not by the effect on peripheral vessels and that oxygenation might be well maintained during lidocaine infusion in a clinical dose.

관상동맥제건술후 Fentanyl 과 Halothane 의 호흡능에 대한 비교연구

이청,김계용,김용락 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.4

Among the claimed advantages of moderate to high dose fentanyl as the principal anesthetic agent for coronary artery bypass graft (CABG) surgery is its general lack of postoperative respiratory depression. We reviewed our experience with this technique compared to a standard halothane technique in regard to requirement for postoperative mechanical ventilation. 19 of 24 patients in the halothane group and 8 of 24 patients in the fentanyl group were extubated after T-piece trial and the required time for T-piece trial were not statistically different (3.4±0.7 hours in halothane group and 4.0±0.5 hours in fentanyl group, mean ±SE). While the $quot;successful$quot; fentanyl patients whose mean dose of fentanyl was 39.9±10.5μg/kg (small dose, mean±S.E.) were extubated at about the same time postoperatively as the halothane patients (meank S.E.: 6.6±0.6 hours forfentanyl group and 5.7±0.5 hours for halothane group), the $quot;unsuecess- ful fentanyl patients whose mean dose of fentanyl was 77.4±7,1μg/kg (large dose, meare not extubated until 21.0±1.11 hours. We concluded that moderate to high dose fentanyl anesthesia supplemented with other IV agents does prolong the need for postoperative mechanical ventilation.

F-flow Circuit 를 이용한 마취경험

함병문,김계용,김용락 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.5

In order to evaluate the ventilatory efficiency of the F-type breathing circuit, the authors compared the conventional anesthetic circuit using a 2-corrugated tube with the F-type breathing circuit through arterial blood gas analysis in 20 adult patients. There were no statistical differences between the two groups in arteral blood pH, PCO2 and PO2 and so the authors concluded that the F-type breathing circute could be substituted for the conventional anesthetic circuit using a 2-corrugated tube and even is superior in the case of head and neck surgery.

중환자 호흡관리 실태보고 : 제 10 보 10th report

이상철,김계용,김광우,양혜경,이경령 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.5

A clinical study was performed of the respiratory care of 1309 critically ill patients who had been admitted to respiratory intensive care units (RICU) in 1986 and 1987. 1) The number of patients who needed respiratory care was 691 and the mortality in RICU was 1.45% (10 case) in 1986, and 618 and 2.59% (16 cases) in 1987, respectively. 2) The average duration of ventilatory support was 2.1 days in 1986, and 1.9 days in 1987. The patients of thoracic surgery needed respiratory support for 2.6 days in 1986, and 2.3 days in 1987. 3) The mortalities according to department were:1.42% (6 of 424 cases) in thoracic surgery, 1.89% (2 of 107 cases) in general surgery, 20% (1 of 5 cases) in pediatry surgery, and 7.14% (1 of 14 cases) in gynecology in 1986. In 1987, 2.56% (8 of 312 cases) in thoracic surgery, 4.0% (6 of 150 cases) in neurosurgery, 0.96% (1 of 104 cases) in general surgery, and 7.69% (1 of 13 cases) in urology. 4) The most frequently used ventilator was Bear II, followed by Benett MA-I. 5) The major causes of death in RICU were low cardiac output syndrome, sepsis, respiratory failure, and brain damage.

임신한 양에서 혈액희석이 모체와 태자의 혈역학 및 산소운반능에 미치는 영향

고홍,김계용 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.4

Massive bleeding during pregnancy has a significant effect on the mother and the fetus. To evaluate the safety of hemodilution as a therapy for hemorrhage during pregnancy, the author compared maternal and fetal hemodynamics and oxygen carrying capacity at varying conditions in gravid ewes. Six Corriedale-breed, near-term pregnant ewes (120-140 days gestation) were anesthetized with nitrous oxide, halothane and oxygen. After the vital signs became stable, the maternal and fetal parameters of hemodynamics and oxygen carrying capacity were measured as control values. After then, 15% of total estimated matemal blood volume (12.5 ml/kg) was removed over approximately 15 minutes and infusion of the same amount of a mixture of lactated Ringer's solution and 10% pentastarch was done simultaneously (15% bleeding). Twenty minutes later the same parameters were measured. After then, a second phlebotomy was performed to remove an additional 15% of the total estimated maternal blood volume and infusion of the same amount of a mixture of the same solutions was done simultaneously (30% bleeding). And the same parameters were measured. Data collections included matemal heart rate, systolic, diastolic and mean arterial pressure, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, cardiac output, hemoglobin, hematocrit, serum lactate, arterial and mixed venous pH, oxygen tension, carbon dioxide tension, oxygen saturation, and fetal heart rate, systolic, diastolic and mean arterial pressure, hemoglobin, hematocrit, serum lactate, and umbilical arterial and venous blood gas analysis. Matemal arterial blood pressure, heart rate, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure and carfiac output revealed no significant changes, and there was neither hypoxemia nor acidosis in gravid ewes. Serum lactate concentration at 30% bleeding increased significantly but within normal range. Oxygen flux, oxygen consumption and oxygen extraction ratio revealed no significant differences. In fetal lamb blood pressure was not changed, but heart rate, serum lactate concentration and oxygen extraction ratio were revealed significant increases in 15% bleeding and 30% bleeding cases. In conclusion, gravid ewe was well tolerated to acute hemodilution, and.fetal lamb was well compensated.

마취전투약시 물의 경구투여가 위액량, pH 및 불안해소에 미치는 영향

이청,김계용,최종무,서병태,이근창 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.6

There is no information on the effects of variable amounts of water given less than 2 hour before induction of general anesthesia, although most patients receive oral premedication at that time. We have studied the effect of the volume of water which should accompany diazepam 0.2 mg/kg oral premedication given 90 minutes before induction of anesthesia in 75 patients undergoing elective laparoscopic cholecystectomy. The patients, ASA physical status I, randomly assigned to one of five groups. Fifteen patients were received no premedication (group A), 15 patients 50 ml (group B), 15 patients 100 ml (group C), 15 patients 150 ml (group D), and 15 patients 200 ml of water (group E). Immediately following induction of anesthesia the gastric fluid was obtained by suction on a nasogastric tube and its volume and pH were measured. Gastric fluid volume showed no statistically significant differences among the groups. Values for pH among the groups were also similar. All premedication groups reported a reduction in thirst after water intake, while only group D reported significant anxiolysis. We conclude that 150 ml is the ideal amount of water given with oral prnedication 90 minutes before general anesthesia.

심장 이식 수술의 마취 1예 보고

조명원,권진형,김계용,백종화 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.2

Cardiac transplantation has become an acceptable therapy for patients with end stage heart disease over the last decade. We experienced a case of heart transplantation to the 50 year old female patient. We used sterile technique all the time to reduce the incidence of infection. Anesthesia was induced and maintained with fentanyl 100 ㎍/kg. After cardiopulmonary bypass, blood products, inotropics and vasodilators were given to maintain myocardial contractility and cardiac output. The patient recovered uneventfully and discharged on 29th postoperative day.

기관지 성형술에서 Fogarty Catheter 를 이용한 일측 폐 마취

이상철,이청,함병문,김계용,김광우,윤병엽,양혜경 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.4