약물동태학에 의한 Fentanyl 의 예측혈중농도

박광원,김원옥,남용택 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.2

Anesthetic doses of fentanyl are sometimes determined empirically by repetetive doses which are accompanied by fluctuating concentrations. If a constant plasma concentration can be maintained, then analgesia and anesthesia can be guaranteed for the duration of surgery. After an I.V. bolus injection (3 mcg/kg), fentanyl (2 mcg/kg/hr) was continuously infused for anverage length of time of 78.3 minutes in a manner analogous to the safety of the administration of inhalation anesthetics. To evaluate whether this method is applicable tothe clinical situation, the decay of plasma fentanyl with time was simulated based on a popualtion pharmacokinetic model used to predict estimated concentrations in the plasma. The clinical effect of the concentrations was determined by a scoring system which consisted of 4 components, systolic blood pressure, heart rate, swear production and lacrimation. Using a modified computer program, the mean and 68% confidenceinterval of the estimated fentanyl plasma concentration (peak concentration 8.5∼6.8mcg/l, maintenance concentration 1.3∼0.8 mcg/l, 10minutes after discontinution of infusion 0.9∼0.5mcg/l and elimination half-life 267±15.7 minutes) were predicted, while the clinical scores were maintained under 4 points. The pharamacokinetic model based on estimation proved to be effective and valid for all patients and predicted a steady target concentration of fentanyl in the plasma.

小兒 및 老人에 있어서의 痲醉管理

朴光遠 대한의학협회 1965 대한의학협회지 Vol.8 No.10

외래수술환자의 마취

박광원 의학교육출판사 1987 Korean Journal of Family Medicine Vol.8 No.9

개심술후의 혈청 Transaminase 치의 변화

박광원,윤소영,윤덕미 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.4

This study was done to see the changes in the serum transaminase and LDH levels after general anesthesis in open heart surgery. We selected at random 60 patients who had received open heart surgery under cardiopulmonary bypass with mild to moderate hypothermia. They were divided into 3 groups depending on the anesthetic agents, halothane, Penthrane and morphine group. Serum transaminase and LDH levels were checked before operation and also about 24 hours after operation; SGOT; spectrophotometric assay by end-point method with Sequential Multiple Autoanalyser(SMA), SGPT; Spectrophotometric assay by kinetic method with SMA, LDH; Spectrophotometric assay by kinetic method. The results were as follows; 1) Serum transaminase and LDH levels were not significantly influenced by anesthetic agents after open heart surgery. 2) Serum transaminase and LDH levels were not significantly influenced by anesthetic agents in congental heart disease. 3) Serum transaminase and LDH levels were not significantly influenced by anesthetic agents in acquired heart disease.

임산부에서 1 분간 무호흡에 동맥혈 가스분압에 미치는 영향

박광원,윤소영,윤덕미,임옥순 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.2

Recent studies(Rorke et al., 1968: Moir 1970; Baraka, 1970; Fox and Houle, 1971) have demonstrated that the maternal arterial oxygen tension during Cesarean section is an important determinant of fetal oxygenation and consequently of the clinical condition of infant at birth for oxygen is transferred by simple diffusion across the placenta to the fetus. Fetal blood oxygen tension is affected by the arterial oxygen tension and concentration of the mother, and also is affected by uterine blood flow(Fox and Houle, 1971). The enlarged uterus pushes the diaphragm upward. This results in a change in position of the heart which is lifted upwards, shifted to the left and anteriorly, and a change in the thoracic cage, and heart rate is increased about 10~12 beats above normal. There is a significant increase in cardiac output which reaches a peak 30~50% above normal until term, and in respiratory rate, so that it follows that oxygen consumption increases but its direct cause is the metabolic need of the uterus, placenta and fetus (Atkinson et al., 1977). As well as increased oxygen consumption in parturients hypoxia may occur in situations of difficult intubation, laryngoscopy for intubation, extubation and during endotracheal suctioning. Because of the markedly decreased oxygen tension, these procedures are more dangerous than for non-parturients. Therefore sufficient oxygenation is recommanded (Archer and Marx, 1974). We selected at random 78 adult female patients who had received Cesarean section and other surgical procedures under general anesthesia with intubation at Severance Hospital from September to November, 1980. They were divided into 3 groups. Group 1 was ventilated with 100% oxygen for e minutes. followed by 1 minute of apnea. Group 2 was ventilated with 50% oxygen for 5 minutes followed by 1 minute of apnea. Group 3 was ventilated with 50% oxygen for 5 minutes followed by 1 minute of apnea with endotracheal suction. We analysed the decrease in oxygen tension between parturients and nonparturients. The results were as follows: 1) During apnea, the decreases in arterial blood oxygen tension were significantly greater (p<0.05) in parturients than in non-parturients in the 100% oxygen group. 2) During apnea, the decreases in arterial blood oxygen tension were significantly greater (p<0.05) in parturients than in non-parturients in the 50% oxygen group. 3) During apnea, the decreases in oxygen tension were significantly greater (p<0.05) in parturients than in non-parturients in the 50% oxygen and endotracheal suction group. These results indicate the importance of preoxygenation prior to endotracheal intubation and endotracheal suction and also of prompt reoxygenation following endotracheal intubation, extubation and endotracheal suction.

유고슬라비아 역사개관

박광원 한국외국어대학교 서양학대학 편집위원회 1988 西學人 Vol.1 No.1

부록 : 체외순환의 관리

박광원 대한마취과학회 1982 연수강좌 Vol.- No.-

포스터발표 P-C15 : 생물학적 사료의 Radiochemical Neutron Activation Analysis 에 의한 우라늄의 정량

박광원,문종화,강상훈,정용삼 한국분석과학회 1999 학술대회논문집 Vol.- No.-

痲醉에 隨伴되는 몇가지點

朴光遠 中央醫學社 1962 中央醫學 Vol.3 No.5

제왕절개술 마취의 임상적 고찰

박광원,이희전,전용애,정순미 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.1

To provide optimal obstetric anesthetic care, it is essential for the anesthetist to know well the maternal physiological alterations produced by pregnancy, labor and paturition, physiology and pharmacology of the fetal placental complex and how these are altered by analgesics and anesthetics (Bonica, 1972). Recently, the tendency to cesarean section has increased; the cesarean section rate was 8.1. (Lee et al., 1974) and 15% (Dripps et al., 1977). Choice of regional or general anesthesia for cesarean section depends on many factors. As, the paturient is considered to have a full stomach, regional anesthesia is advantageous. However, if the indication is fetal distress or maternal hemorrhage, the necessity for rapid delivery overrides all other considerations. For elective cesarean section the choice of anesthesia largely relates to patients condition and physicans preference, although the somewhat. longer time required for delivery in a repeated cesarean section may indicafes regional rather than general anesthesia (Dripps et al., 1977; James et al., 1977). The problem of anesthetic management of cesarean section was fetal depression due to sedatives, analgesics and anesthetics during delivery. In emergency cesarean section, the major problem in general anesthesia is aspiration of gastric contents and in regional anesthesia it is hypotension. Regarding fetal and neonatal depression associated with anesthesia, the effects of general or regional anesthesia or. the neonatal neurobehavioral status have been reported by many authors (Standley et al., 1974; Tronick et al., 1976; Hollmen et al., 1978). Thus we have made a clinical analysis of anesthesia for 300 cases by random sampling among 1725 cesarean sections. including emergency and elective operations, performed from July 1973 to June 1978 in Severance Hospital at Yonsei University College of Medicine. Clinical analysis was made of frequency of cesarean section, age distribution, parity, indication of cesarean section, physical status (A.S.A. classification), premedication, anesthetic method, relationship between Apgar seore and the type of anesthesia, relationship between induction to delivery time and one minute Apgar score, time to initial blood pressure drop after spinal anesthesia, blood loss, the methods of cardiopulmonary resuscitation of the newborn, perinatal mortality and neonatal neurobehavioral states. The result are as follows: 1) The incidence of cesarean aection was 18.4 percent of total deliveries and the tendency is increasing. 2) One minute Apgar score in spinal anesthesia is better than in general anesthesia (0. 01 $lt;p $lt;0 025). 3) Blood loss in spinal anesthesia (566±146ml) is less than in general anesthesia (796 ± 388ml). 4) Blood pressure showed a drop within ten minutes in 83 percent of cases after induction of spinal anesthesia. 5) Perinatal mortality of general anethesia (3. 9%) is more than spinal aneathesia (1.9%) Even tbough clinical results of spinal anesthesia seem to be more favorable than those of general anesthesia, from the above obrvation it may be concluded that choice of anesthesia for cesarean section depends on each maternal condition and only one anestbetic method should not be exclusively used.