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전신마취중 발생한 혼합응혈괴에 의한 기관내 튜브 완전폐쇄-증례보고-
정정일,조재군,김정성,이규창,강포순,이예철 건국대학교 의과학연구소 1997 건국의과학학술지 Vol.7 No.-
A fifty seven year old female patient was scheduled for emergent craniectomy and removal of hematoma, open reduction and internal fixation of frontal bone with miniplate and wire under general anesthesia. Preoperative checked datas for emergent operation were within normal limits and vital signs of the patient were stable. During the induction of general anesthesia, an orotracheal intubation was done in operating room. About 50 minutes after induction of anesthesia, signs of complete airway obstruction developed suddenly. so we inserted suction tip into the lumen of the endotracheal tube, but the suction tip into the lumen of the endotracheal tube. After we stopped the operating procedure, we removed the tube and intubated another endotrcheal tube. We found that the distal part of lumen of extubated tube was obstructed completely by blood clots and mucus.
척추마취 후 통증 자가조절법 시행이 척추강 내 몰핀의 용량에 미치는 영향
이예철,우남식,김윤수 건국대학교 의과학연구소 1998 건국의과학학술지 Vol.8 No.-
Intrathecal administration of morphine is a highly efficacious modality for the treatment of postoperative pain. However, side effects are often present and rarely life-threatening. Routine management of postoperative pain have been changed as a result of technological advances in drug delivery systems(patient controlled analgesia: Ⅳ-PCA). The purpose of this study was to observe the effect of Ⅳ-PCA on variable dosage of intrathecal morphine, and to evaluate the minimal dosage of intrathecal morphine for pain relief. Eighty patients requiring spinal anesthesia for operation were randomly assigned to receive intrathecal morphine 0.01mg(Group Ⅰ: n=20), 0.02mg(Group Ⅱ: n=20), 0.04mg(Group Ⅲ: n=20), and 0.1mg(Group Ⅳ: n=20). All patients were operated under spinal anesthesia with 0.5% bupivacaine 10-15mg, and taken Ⅳ-PCA. PCA unit was filled with 60ml: mixed with fentanyl 50㎍, ketorolac 18mg, and normal saline. It had a flow rate of 0.5ml/hr and lockout interval was 15minutes. The degree of analgesia was subjectively evaluated by visual analogue scale(VAS). Patients were evaluated 3, 6, 12, 24, and 48 hours after operation for pain relief, nausea, vomiting, pruritus, and respiratory depression. VAS pain score were significantly lower in group Ⅱ,Ⅲ, and Ⅳ than group Ⅰ at postoperative 6, 12, 24hours(p<0.05), but were no significant difference at 3 and 48hours. There were no apparent cases of respiratory depression. Nausea or vomiting occurred in 10-25% of all patients. Pruritus occurred in 5-10% ofⅠ,Ⅱ,Ⅲ group, and occurred in 40% of group Ⅳ. Urinary retention occurred in 5% ofⅠ and Ⅱ group, and in 35-40% of group Ⅲ and Ⅳ. We conclude that the Ⅳ-PCA with 0.02mg of morphine is an effective and safe method for pain control after spinal anesthesia.
Atracurium 투여에 의한 기관내삽관의 임상적 평가
우남식,이예철 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.3
The usefulness of nondepolarizing muscle relaxants for intubation is limited by a relatively slow onset of neuromuscular block compared to that achived with succinylcholine. But, authors have reported that larger doses of nondepolarizing muscle relaxants produce a more rapid onset of maximal neuromuscular block and conditions conductive to endotracheal intubation and recent reports support the use of the $quot;priming principle in the clinical practice of anesthesiology. This phenomenon may apply to all nondepolarizing relaxants: it is reported to facilitated neuromuscular blockade and tracheal intubation when used with atracurium, vecurouium, alcuronium or pancuronium. In this study, administering a small subclinical dose of atracurium (75μg/kg) Smin. prior to the remainder of an intubating doae of atracurium (250μg/kg) had no different on grade of block for intubation compared to single IV bolus of atracurium (500μg/kg).
다발성 늑골골절 환자에서 경막외강내 Narcotics 를 이용한 치료 : 1예 보고
우남식,이예철 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.6
Pain relief becomes a major concern when treating patients with rib fractures so adequate ventila-tion must be maintained. Many thniques have been described for the management of frectured ribs, including systemic analgesics, intercostal nerve blockade, intrathecal morphine, epidural bupivacaine and epidural morphine. This case report illustrates the successful use of epidural narcotics in a patient with multiple fractured ribs.
우남식,이예철 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.6
The popular term malignant hyperthermia syndrome (MHS) refers to a clinical syndrome classically observed during general anesthesia. It is characterized by a rapidly increasing.temperature and a high mortality rate. A case of MHS was experienced which developed 60 minutes after induction of general anesthesia with thiopental sodium, succinylcholine, halothane, N₂O and O₂. High fever, muscle rigidity and cyanosis developed and were followed by arrythmia and unstable blood pressure. Anesthesia was terminated and vigorous emergency treatment was attempted. The patient died about 6 hours after induction of anesthesia.
개방성 동맥관 절단술시 Sodium Nitroprusside 저혈압마취례 보고
고신옥,오흥근,이예철,김인세 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.3
Sodium nidroprusside has recently come. into widespread usage, not only for the treatment of severe hypertension but also for induced hypotension during surgery. Induced hypotension was produced during general anesthesia by the infusion of sodium nidruopsside in 0. 0l% solution, in two patients undergoing ligation and division of patent ductus arteriosua with pulmonary hypertension. In these cases, no acidotic tendency or CN toxicity were seen and conditions were satisfactory for correction of the PDA.