제왕절개술시 후두마스크 삽입이 심혈관계 반응에 미치는 영향

박대팔,하승호 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.2

In 1983, Brain introduced laryngeal mask as a new airway. Laryngeal mask have many advantages of easy insertion without laryngoscope and muscle relaxants, minimal cardiovascular responses, decreasing damages of larynx and pharynx and also useful in difficult intubation or emergency airway care. We studied cardiovascular responses of parturients and Apgar score of neonates during tracheal intubation(Group I) and laryngeal mask insertion(Group II), After tracheal intubation or insertion of laryngeal mask, blood pressure(systolic, diastolic and mean) and heart rate were measured for 5 minutes at 1 minute interval. The results were as follows: 1) There were significant increase in systolic, diastolic, mean arterial pressure and heart rate in both groups, but degree of increase was less in laryngeal mask group. 2) The Apgar scores of the neonates did not differ significantly, 1 minute Apgar score was up 8 in both group. It is concluded that insertion of laryngeal mask is beneficial to parturients than use of laryngoscope and tracheal intubation to avoid harmful cardiovascular responses in the management of airway during cesarean section. (Korean J Anesthesiol 1995; 29: 213~217)

기관절개후에 발생한 기관협착증 마취례

박대팔 영남대학교 의과대학 1987 Yeungnam University Journal of Medicine Vol.4 No.2

기관 절개술 후에 발생한 기관협착증 환자에 기관 절제술을 하지 않고 전신마취 하에서 Trough method를 성공적으로 시행하였기에 이에 문헌적 고찰과 함께 보고하는 바이다. A 25years old male patient was experienced Trough method operation to correct of Tracheal stenosis following Tracheostomy. After admission, a No.3 Magill plastic portex tube had been placed in the previous tracheostomy opening. Stenotic narrowing portion was noted low trachea(about 3.5㎝ above carina) Despite of narrowing of the lesion, anesthetic course was uneventful with oxygen, halothane and non depolarized muscle relaxant by controlled respiration. Postoperative course were also favorable with adequate respiratory cares and blood gas analyzed.

화상 환자의 마취관리

박대팔 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.2

최근 화상 환자로 인하여 많은 의료팀과 막대한 경비가 소요되고 있으며 해마다 미국에서는 십만명의 환자가 입원하고 있으며 입원 날짜만도 2백만 일이나 되고 있다. 화상은 affected body surface의 %와 injury의 depth로 분류하며 A) affected body surface의 % nine of rule을 사용 B) injury depth 1)partial thickness 1도 혹은 2도 화상 2)full thickness 3도 화상 Major burn injury라고 하는 것은 partial thickness 는 BSA의 25%, full thickness 는 BSA는 10%이상으로 정의되어지며 모든 전기화상 연기를 흡입한 모든 화자 infants, elderly, co-existent disease가 있는 환자는 여기에 속한다. 사망율은 화상의 심도 연령의 증가에 따라 증가하며 50% 이상의 화상 환자는 예후가 나쁘며 화상환자는 감염이나 합병증으로 죽는다고 한다.

성인 환자의 전신 마취동안 사용되는 O2 와 N2O 의 적정유량

박대팔,구본업,서일숙,박세훈,박준만,손기석,김세연,이병용 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.2

Background: During adult general anesthesia, we used 3~5 L/min of fresh gas flow(FGF) but low FGF are employed, the amount of anesthetic consumption and air contamination can be reduced. The aim of this study was to determine the minimal appropriate inflow rate of oxygen and nitrous oxide during semiclosed circle technique. Methods: We selected 40 patients, ASA group l or 2, scheduled for elective, nonabdominal surgery under general anesthesia with semiclosed circle system. Anesthesia was maintained with 50% oxygen, nitrous oxide and enflurane, controlled ventilation was used; rate of 10/min, tidal volume of 10 ml/kg. After induction and vital signs stabilized, FGF was changed to 4 L, 3 L, 2 L and 1L/min at interva1 of 30 minutes. We observed mean airway pressure and arterial blood gas tensions. Results: The changes of mean airway pressure did not correlated with fresh gas inflow rate. In arterial blood gas analysis, PaO showed a decreasing tendency significantly according to decreasing fresh gas inflow rate(p$lt;0.01) but there were no clinical hypoxemia in all patients. There were no significant changes in pH, PaCO₂ and base excess. Conclusions: We consider that FGF of 1-2 L/min is appropriate during adult general anesthesia because of economic and ecological advantages. Also, we consider low flow technique with below 1L/min can be used safely and effectively under proper gas monitoring such as oxygen analyzer capnometer.

수술후 발생한 기관지 폐쇄증 치험 1예 보고 : A Case Report

박대팔,김준호,윤병래,김익수,최세진 한국의 현대의학사 1975 한국의 현대의학 Vol.8 No.2

제왕절개환자에 있어서 Succinylcholine-Atracurium의 임상적 고찰

박대팔 영남대학교 의과대학 1986 Yeungnam University Journal of Medicine Vol.3 No.1

제왕절개술 환자 10인에게 Succinylcholine Chloride 및 atracurium을 준 결과 다음과 같은 결론을 얻었다. 1.Succinyline chloride 1㎎/㎏와 atracurium 0.4㎎/㎏를 주어 충분한 근육이완을 유지하였다. 2.혈압과 맥박은 atracurium주사 후 의의있는 변화는 없었다. 3.태아의 Apgar score는 1분과 5부때 8∼10점으로 모두 양호한 상태였다. Atracurium was used in 10 parturients undergoing eletive cesarian section under general Anes-thesia. An initial bolus of 0.4㎎/㎏ of the atracurium was injected after recovery from succinylcholine block. Complete neurmuscular block resulted in all cases. Muscular relaxation was maintained by incremental dose of 0.2㎎/㎏ of atracurium. Administration of atracurium did not cause significant change in blood pressure, pulse rate and infants apgar score. The residual neuromuscular block could be antagonized at the end of the procedure by mixture of 0.005㎎/㎏ glycopyrrolate and 0.03㎎/㎏ of neostigmine. In all parturients, antagonism was adequate as evidenced by repiratory response and head lift test. Atracurium may be advantageous in parturients undergoing ceasrian section under general anesthesia cause it maintained cardiovascular stability, is non-cumulative, is readily antagonized by neostigmine and has no deleterious effect on the newborn.

제왕절개술 마취에 대한 임상적 고찰

박대팔 영남대학교 의과대학 1986 Yeungnam University Journal of Medicine Vol.3 No.1

영남대학교 의과대학 부속병원에서 1983년 5월부터 1986년 8월까지 여러 마취하에서 시행된 423예의 제왕절개술 환자를 임상적으로 고찰하여서 다음과 같은 결론을 얻었다. 1) 제왕절개술의 빈도는 총분만예의 13.9%였다. 2) 제왕절개술 환자의 63.2%가 응급수술을 시행하였다. 3) 산모의 상태와 태아의 Apgar지수와의 관계는 산모의 상태가 좋을수록 태아의 Apgar지수가 좋았다. 4) 마취 유도에서 신생아 분만까지 시간이 짧을수록 신생아의 상태가 좋았다. Maternal and fetal effects of anesthesia for 423 cesarian section, performed during the past three and quarter years period in this hospital, have been evaluated. It is emphasized that the selection of anesthetic and method should depend upon the physical satus of the patients and the ability of both obstetrician and anesthesiologists. Author results were as follows: 1.The incidence of c-section was 13.9% of total deliveries. 2.More than about three fourths of total cases were emergency cases. 3.Almost all cases were operated under general anesthesia. 4.The good physical states of patients resulted in better Apgar score of infants. 5.The shorter the interval from induction of anesthesia to delivery, the better was the Apgar score of infants.

전신마취중 발생한 부적합 수혈 2예 보고

박대팔,김익수,최세진,Park, Dae Pal 충남대학교 의과대학 지역사회의학연구소 1976 충남의대잡지 Vol.3 No.1

Authors have experienced two cases of incompatible blood transfusion during general anesthesia, which was due to technical error and lack of attention.

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.

경요도 전립선 절제술시 투여한 Furosemide가 수술중,후 혈중 나트륨 및 삼투질농도에 미치는 영향

김세연,노운석,박대팔 영남대학교 의과대학 1992 Yeungnam University Journal of Medicine Vol.9 No.1

경뇨도 전립선 절제술을 시행한 환자 30명을 대상으로 하여 furosemide투여에 따른 혈중 나트륨치와 삼투질 농도를 비교 관찰한 결과 다음과 같은 결론을 얻었다. 1. 혈중 나트륨치는 대조군에서 술전에 비해 10분, 20분, 30분, 수술직후에 의의있는 감소(p<0.05)가 있었으나 실험군에서는 변화가 없었다. 2. 혈장 삼투질농도와 유효 삼투질농도는 대조군에서 술전치와 비교시 술중 30분과 수술직후에 의의있는 감소(p<0.05)가 있었으나 실험군에서는 잘 유지가 되었다. 이상의 결과로 보아 술중 흡수된 관류액의 영향을 줄일 목적으로 furosemide를 투여한 실험군에서 대조군에 비해 혈중나트륨치와 삼투질농도를 잘 유지시키기에 그 예방적 투여가 의의있다고 사료되며 특히 울혈성 심부전이나 신부전이 있는 환자의 수술시 furosemide를 투여하면 그 의의가 더 클 것으로 사료된다. The purpose of this study was to prevent the dilutional effect of excessive absorption of irrigating solution by using furosemide intraoperatively during transurethral resection of the prostate. 30 patients, who belonged to physical status Ⅱ or Ⅲ of ASA classification, were selected randomly and divided with two groups as follows: G1(N=15): Not-administrated furosemide(control group) G2(N=15): Administrated furosemide(Experimental group) All patients were premedicated with Hydroxyzine(l㎎/㎏, IM) and were performed continous epidural anesthesia with 2% lidocaine(l- 1.5㎎/segment). For irrigating solution, 5% D-sorbitol was used and Hartman's solution were given for maintenance fluid and fixed the height of irrigating container to 60 cm from symphsis pubic. With the starting of operation, 20㎎ furosemide was administrated to experimental group. The blood samples for the values of Na+, K+, Glucose and BUN were performed at the periods of preoperation, 10 min, 20 min. 30 min after the starting of operation and immediate postoperation. Based these data, serum osmolality and effective osmolality were calculated. The results were as follows: 1.The sodium concentration of control group was decreased statistically significantly at 10 min, 20 min,30 min after the starting of operation and immediate postoperative period as comparing with the preoperation value (p<0.05). But that of experimental Group was not changed significantly. 2. The serum osmolality and effective osmolality were decreased statistically significantly at 30 min after the starting of operation and immediate postoperative period as comparing with the preoperation value(p<0.05). But those of experimental group were not changed significantly. These results show that the dilutional effect of excessive absorption of irrigating solution might be prevented by using furosemide intraopertively. And so we recommend the use of furosemide during TURP, especially in patients with congestive heart failure or renal failure.