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제왕절개술에 이은 뇌교의 파열 해면상 혈관기형 제거술을 위한 마취 경험-증례 보고-
박수경,강진구,위희욱,신의용 대한마취통증의학회 2017 Anesthesia and pain medicine Vol.12 No.1
Cavernous malformation is an important cause of cerebral hemorrhage in pregnant women. We experienced a case of cesarean section followed by neurosurgery for resection of ruptured cavernous malformation of pons in a 24-year-old pregnant woman. Establishing integrated treatment strategy for pregnant women with cavernous malformation is difficult because of the small number of cases. Therefore, the cooperation between the brain surgeon, anesthesiologist and obstetrician is essential when surgical intervention is needed. Despite aspiration pneumonia, the patient successfully underwent surgery. We reported this case along with a brief literature review.
구혈대의 감압후 분시 호흡량의 증가가 호기말 이산화탄소 분압, 혈액가스분석 및 vital sign 에 미치는 영향
김태성,윤영준,길호영,진상호,위희욱 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.6
Tourniquets are often used for surgery on the extremities to provide a bloodless surgical field. However, tourniquets may cause nerve and other tissue injuries. While the tourniquet is inflated, metabolic changes occur in the ischemic limb, chages that include increased PaCO₂, lactic acid and pottasium, and decreased levels of PaO₂ and pH. Deflation of the tourniquet results in the release of these products of ischemia into the general circulation. The resultant decreases in arterial pH and PaO₂ and increased in arterial lactic acid, potassium, PaCO₂ and P_(ET)CO₂ are associated with significant decrease in mean arterial and central venous pressure and increase in heart rate. Since Pa is one of the important factor to control the cerebral blood flow and intracranial pressure, a sudden increase in PaCO2 immediately after toumiquet deflation may cause detrimental effects in head injured patients with elevated intracranial pressure. The purpose of this study was investigate the effect of the degree of hyperventilation by means of increased minute ventilation by 25%, 50% and 75% respectively, after deflation of toumiquets to keep P_(ET)CO₂ at former levels, for twenty minutes period, with arterial blood gas analysis, endtidal PaCO₂ and vital signs was monitored serially. We compared normal minute ventilation group I with increased minute ventilation groups(II, III and IV) before and after deflation of tourniquet. In summary, we calculated from our data that increasing minute ventilation by more than 50% for 5 minutes following tourniquet deflation could prevent P_(ET)CO₂ from increasing more than 1.5-6.5 mmHg in all patients.