전신마취후에 발생한 후두육아종 2례보고

이준례 全北大學校 齒醫學硏究所 1983 전북치대논문집 Vol.1 No.1

Intubation granuloma is one of the remote complications of endotracheal intubation. 2 cases of intubation granuloma are presented in this report. A 43-year-old male patient developed granulation on the medial aspect of the arytenoid 2 months after lobectomy under general anesthesia using Carlen's tube. This granulation was completely removed with laryngeal microsurgery(LMS). A 33-year-old female patient had hoarseness and mild degree of bronchial secretion 3 weeks after appendectomy under general anesthesia. A polyp-like mass was found on the left membrane of the vocal cord and completely removed with laryngeal microsurgery.

후두마스크를 유도자로 이용한 기관내 삽관시 맹안적 삽입법과 굴곡성 후두경 이용법의 비교

이준례,임용순,이상귀 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.2

Background: The laryngeal mask airway (LMA) has an established role in difficult airway management as a ventilatory device and airway intubator. In is eas to view the laryngeal aperature with a fiberscope througha laryngeal mask airway, so it offers a route to obtainingrapid access to the larynix. The objective of this study was to evaluate a narrowing degree of LMA by the epiglottis and to compare the intubation time and success rate of the blind intubation technique with the fiberscope-guided intubation technique through the laryngeal mask airway. Methods: The LMA (#4) was placed into the hypopharynx after induction of anesthesia and muscle paralysis. The fiberscopic findings through the lumen of the LMA were recorded after the LMA placements. The degree of narrowing of the LMA by the epiglottis was estimated as 0%, 1-25%, 26-50%, 51-75%, or 76-100%. The breathing circuit of the anesthesia circle system was then disconnected from the LMA and a well-lubricated, cuffed, 5.5 mm ID endotracheal tube was inserted into the trachea through the lumen of the LMA either by the blind techniques or fiberscope-guided techniques, and then intubation time and success rate were measured. Results: The most frequent incidence (44/60, 73.3%) of narrowing by epiglottis in both groups was 76-100%. The success rate for fiberscope-guided intubation was 100%, while the success rate for blind intubation was 20%. The average intubation time of fiberscope-guided intubation was 26.0 s, while the average intubation time of blind intubation was 17.7 s. Conclusions: The fiberscope-guided tracheal intubation technique through the LMA is a more reliable method than the blind intubation technique through the LMA. (Korean J Anesthesiol 1999; 37: 210~215)

개구리 皮膚의 Na 輸送에 關與하는 Dopamine係

李俊禮,崔峰奎 全北大學校 齒醫學硏究所 1988 전북치대논문집 Vol.6 No.1

To ascertain the existence of dopaminergic receptors involved in active transport of sodium in the frog skin and to delineate the physiological role, the effects of dopamine (DA), apomorphine (Apo) and bromocryptine (BRC) on the potential difference (PD), short-circuit current (SCC) and total skin conductance (TSC) of the isolated frog skin, as well as the influences of dopaminergic and alpha-adrenergic blockers upon the effects of dopaminergic agonists were studied in Rana nigromaculata. PD and SCC were determined by utilizing the Ussing technique. Both sides of the isolated frog skin were perfused with Ringer solution for cold-blooded animal. All the drugs were applied to the serosal side of the skin. Results were summarized as follows : 1. The responses to DA(6.5×10^-6 - 2.0×10^-4M), Apo(3.74×10^-6 - 3.74×10^-4M), and BRC(1.53×10^-6 - 4.60×10^-5M) were characterized by elevation of PD and SCC roughly in a dose-related fashion, but the maximal effects attained by DA were greater than those of Apo and BRC. Both Apo and BRC induced graeater increases in PD than SCC, resulting in slight decrease of TSC, whereas no change in TSC was noted with DA. 2. These increments of PD and SCC were inhibited by dopaminergic blockers, such as haloperidol (8.0×10^-5M), metoclopramide (1.0×10^-4M) and sulpiride (8.8×10^-5M). 3. The stimulatory effects of dopamine on PD and SCC were significantly inhibited also by prazosin (2.6×10^-6M), a specific alpha-1 adrenoceptor blocker and were completely abolished by phenoxybenzamine (3.3×10^-6M), an irreversible alpha-adrenoceptor blocking agent. 4. Norepinephrine (6×10^-8 -6×10^-5M), produced increases in PD and SCC. However, these effects were inhibited by prazosin but not influenced by sulpiride pretreatment. These results suggest that the dopaminergic system may play a role in the control of sodium transport in the frog skin, and that alpha-adrenoceptors may also be involved in the dopamine-induced increase of sodium transport. However, based on evidence at hand, no conclusion could be drawn on the subtypes of dopamine receptors mediating in the stimulation of sodium transport in the frog skin.

顎 顔面骨 骨折 患者에 있어서 手術 前 後 肝機能 檢査에 對한 臨床的 考察

李俊禮 全北大學校 齒醫學硏究所 1991 전북치대논문집 Vol.9 No.1

It is well known that most anesthetics and drugs are metabolized and excreted in the liver. There are many controversies regarding postoperative halothane hepatotoxicity and often reported postoperative hepatic dysfunction following enflurane anestesia. It appears that the development of hepatic necrosis after anesthesia depends on a chance combination of events but not anesthetics itself. This study was undertaken to investigate the effect of anesthesia and surgery on the liver function. 52 patients were investigated that had open reduction for maxillofacial fracture. The results are as follows ; 1) The level of SGOT were usually increased in patients with maxillo-facial injuries compared to patients without traumas. 2) It was found that the influence of anesthetic agents such as halothane and enflurane on the liver is not significant. 3) Patients who had shown preoperative raising of SGOT and SGPT were recovered with a statistic significance.

악교정 수술환자에서 Labetalol 을 이용한 유도 저혈압 마취가 출혈량 및 혈압에 미치는 영향

이준례 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.5

Background : The worst problem in anesthetic management of maxillofacial surgery is bleeding from bone cutting site. Induced hypotension reduces bleeding and minimizes the need for blood transfusion. This study was performed to evaluate the effects of induced hypotension with labetalol on blood loss and blood pressure in maxillofacial surgical patients. Methods : Twenty-four adult patients, either sex, ASA physical status I or II, undergoing orthognathic surgery were randomly selected and divided into two groups; one group was administered 20 mg of labetalol and the other group was not. Anesthetic maintenance was consisted of O2-N2O-enflurane(2∼2.5 vol%). Then 20 mg of labetalol was given intravenously at skin incision time in the labetalol group. Hemodynamic variables were recorded before induction of anesthesia, at the beginning of the labetalol infusion and at 10 min, 20 min, 30 min, 60 min and 90 min after the infusion. Blood loss determined by measuring the weight of the sponges and by measuring the volme of blood in suction-trap bottle. Results : There was no significant difference in preoperative hemoglobin and postoperative hemoglobin between two groups. The amount of blood loss in the labetalol group(408 202 ml) was less than those in the control group(450 255 ml), but statistically not significant. The blood pressure was significantly decreased in the labetalol group than those of the control group at 20 minutes after the labetalol infusion. Conclusions : Labetalol is a useful agent for inducing hypotension. But 20 mg of labetalol was insufficient to decrease the blood loss. So I think the more amount of labetalol required to reduce the blood loss. (Korean J Anesthesiol 1998; 34: 1009∼1013)

구강외과 환자의 전신마취관리

이준례 全北大學校 齒醫學硏究所 1984 전북치대논문집 Vol.2 No.1

201 patients who underwent surgical operation at the Department of oral surgery, school of Dentistry, Chon-buk National University from January 1983 to December 1984 were analyzed statistically according to age, sex, disease, endotracheal intubation and anesthetic technique. The results were as follows ; 1. The most frequent age group was in the 3rd decade(29%), and sex distribution was male (78%) and female(22%). 2. Of the total 201 operations, open reduction of maxillofacial bone fracture was 131 cases, cheiloplasty and palatorrhaphy 27 cases, benign and malignant tumor surgery 10 cases, orthognathic surgery 6 cases, osteomyelitis 4 cases. Caldwell-Luc operation 19 cases and radical neck dissection 3 cases, bone graft 1 cases. 3. The nasotracheal intubation and orotracheal intubation were performed in 179 cases and 25 cases respectively. In 6 cases, tracheostomy was done because of the difficulty in endotracheal intubation. 4. For anesthesia of the patients the semiclosed circle system was practiced using mainly halothane-O_2-N_2O and pancuronium as muscle relaxant in adults. Jackson-Rees technique using halothane-O_2-N_2Owithout muscle relaxant was used in children.

Pierre Robin 증후군 환자에서 후두마스크를 이용한 전신마취관리

이상귀,이준례 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.1

전신마취중에 발생한 부정맥

김정회,이준례,송윤식,최훈 전북대학교 의과학연구소 1981 全北醫大論文集 Vol.5 No.1

The incidence of cardiac arrythmias during general anesthesia is up to 30 to 50 percent and most of them are supraventricular arrhythmias such as atrial rhythm, A-V junctional rhythm, wandering pacemaker, or sinus arrest. But one can frequently confront the occurrence of ventricular arrhythmias, and even cardiovascular collapse under variable circumstances during general anesthesia, especially in the patient with cardiovascular disease including hypertensio, thyrotoxicosis, and ischemic heart disease. The authors observed that one patient having preoperative hypertension who underwent vaginal hysterectomy had developed various kinds of arrhythmias during induction, after local infiltration of epinephrine to minimize bleeding from the operative site, and during the traction of the uterus to be resected, under halothane anesthesia. There should be a clolse communication between surgeers and anesthesiologists in the management of the operative patients not only to minimize the occurrence of arrhythmias but also to prevent even more serous mishaps such as carciovascular collapse during operation and an esthesia. Every predisposing factors should be evaluated and appropriately managed as well.

Aminophylline 투여중인 환자에서 Halothane 마취중 발생한 심정지

한영진,이준례,정세진,권유성 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.3

Although halothane is generally anesthetic of choice for asthmatics due to its bronchodilatory action, its combined use with aminophylline should be discouraged. This report is a 43-year-old male who had primary closure and open reduction internal fixation(ORIF) for facial avulsion injury and zygomatic tripod fracture under N2O-O2-halothane anesthesia. About 90 minutes after the procedure, the patient who had aminophylline infusion for an acute bronchospasm developed a sudden cardiac arrest. The immediate cardiopulmonary resuscitation was applied and the patient was recovered without any neurological deficit. At the time, the serum theophylline concentration of the patient was 16 g/ml which was in the range of normal therapeutic dose. The cause for this cardiac arrest by halothane is unknown, but possibly a drug interaction between halothane and aminophylline might have contributed, since halothane sensitizes the heart to exogenous catecholamines. (Korean J Anesthesiol 1998; 35: 579∼582)

근치 위절제술 환자에서 Pentaspan의 혈장 증량효과

송정자,이준례,최훈 최신의학사 1993 最新醫學 Vol.36 No.5