제왕절개술후 통증치료로 지속적 정주방법과 고식적 근주방법의 비교

조영례(Yung Lae Cho) 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

N/A Background: Recently, improvements in drug administration technology have intensified interest in the treatment of postoperative pain. This has resulted in increased use of con- tinuous intravenous infusion of opioid and epidural opioid as alternative to traditional in- tramuscular administration of opioid. The goal of this study, therefore, was to document the effects of pain control and side effects following continuous intravenous infusion of morphine or meperidine and intramuscular meperidine following cesarean section. Methods: The vital signs, pain score, oxygen saturation and side effects were eompared in 150 patients receiving continuous intravenous infusion of morphine, 30 μg/kg/hr (n=50, group l); continuous intravenous infusion of meperidine, 150 μg/kg/hr (n=50, group 2); or intramuscular meperidine, 50mg/every 6hrs (n=50, group 3). Results: VAS#(Visual Analogue Scale) was significantly decreased after 30 minutes of administration in all three groups and was significantly lower at 1 hour, but higher at 6 hours in group 3 than two other groups. Severe desaturation episodes, defined as Sp02<90 %, occurred in the group 3(0.2%). Moderate desaturation episodes, defined as Sp02 91-95%, occurred more in group 3 than in group 1 and 2(17.4% vs. 10.4%, 8.2%). The incidence of side effects were similar among three groups. Conclusion: The continuous infusion of opioid was more effective and safe method of postoperative pain control than traditional intramuscular injection.

경막외마취에 의한 무통분만

조영례,조문희,김일선 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.4

The most interesting change in anesthetic technic for pain relief during labor and delivery has been the sidespread acceptance of continuous lumbar epidural analgesia. Primary effect of epidural analgesia is to relieve pain and thereby to preserve the morale and to prevent exhaustion of the mother. For the past year in our hospital, continuous lumbar epidural analgesia was attempted on 38 pregnant women and its effect was assessed. In established labor, epidural analgesia was started for pain relief and was maintained with intermittent injections until delivery; in 45% the duration exceeded six hours. Labor was slightly retarded, probably due to inadvertent selection of patients with slow and painful progress. Vacuum extraction was used in 52.6%. Fetal condition was excellent(Apgar score of 7 or greater in 97.4%) Continuous epidural analgesia gives superior relief of pain but calls for experienced management and nursing care.

제왕절개술시 전신마취유도제로서 Thiopental Sodium 과 Ketamine 의 비교연구

조영례,박정출,이경천 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.5

This study was undertaken to estimate the effects of the induction agents on the bioparameters such as changes in blood pressure, pulse rate, Apgar score, patients movement, fetal arterial and venous blood gas analysis, memory and emergence reactions. 116 parturients undergoing cesarian section were divided into two groups: ketamine group and thiopental group, and were given 1.2 mg/kg ketamine in ketamine group and 4 mg/kg thiopental sodium in thiopental group as an induction agent respectively. The results were as follows; 1) Blood pressure increased in both groups, but ketamine group less increased than thiopental group statistically. Pulse rate did not increased in skin incision in ketamine group statistically. 2) The patient's movement were 5 case(9%) in ketamine group and 17 cases(29%) in thiopental group. 3) There was not significant difference in fetal arterial and venous blood gas analysis. 4) In Apgar score, ketamine group is better than thiopental group. 5) There was no psychologic side reactions in both groups. 6) Postoperative recalling of intraoperative awareness occured in seven patients(12%) only in the thiopental group

소아환자 전투약제로서 Ketamine Hydrochloride 의 효과

조영례,정병연,조문희 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.3

Preoyerative sedation of children is a difficult problem of great importance, for the psychic trauma comsequent to anticipation of surgery may be as great a hazard to the patient as his original diseaae. Until now, a number of sedatives have been used eommonly for adequate sedation of pediatric patients, but, no method has been universally accepted. At our hospital fifty pediatric patients receiving general anesthesia for minor elective surgery were studied to evaluate the effect of ketamine hydrochloride as a preanesthetic agent. The results were as follows: 1) The onset of drag action was about, about 5min. 2) The induction of anesthesia and maintenanee of operation was smooth, because a sedative effect was obtained without cardiovascular and respiratory depresaion. 3) With a small dosage of ketamine(2mg/kg), patients were free from apprehension. So, perioperative psychic trauma was preventible. 4) The two excitable patients were anesthetized by intravenous anesthetics with ease. 5) Mild cornplications, accured but they were not significant.

개심술 마취 150 예 보고

조영례,박정출,이경천,김홍순 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.5

This report is concerned with our clinical experience of 150 cases of anesthesia for open heart surgery at department of anesthesiology, In chon Gil hospital from Februry, 1990 to April, 1993. The results were as follows ; 1) Among 150 cases, 68 cases (45.3%) were congenital heart disease and 82 cases (54.7%) were acquired heart disease. 62 cases (41.3%) were males and 88 cases (58.7%) were females. 2) Glycopyrrolate, diazepam, morphine, were used as premedicants. 3) Fentanyl, ketamine, diazepam, thiopental sodium were used as induction agents and injected singly or in combination. 4) In congenital cyanotic heart diseases, ketamine was used as main anesthetic agent. In other heart diseases, fentanyl, isoflurane, diazepam were used. 5) Vecuronium was used for intubation and maintenance of muscle relaxation. 6) Overall mortality rate was 3.3% (5 cases) and the causes of death were low cardiac output, respiratory insufficiency, mediastinal infection.

쇄골하정맥 도관삽입술후 발생한 수혈흉 : 증례 보고 A Case Report

조영례,정병연 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.3

Central venous catheterization has become an important aid in the correct management of the criticalIy ill patient and is being uaed more often than in the past. However, no technic of cannulation has been entirely free of complications. A needle which is inserted properly and positioned in the vein is not likely to produce complications arising from injury to adjacent structures; hence accurate knowledge of their anatomic relations is essential for central venous catheterization. We have experienced a case of hydrohemothorax as a complication of subclavian vein catheterization. We report this case with a review of the literature of central venous cathetherization and its possible complications.

도색 색전증

조영례,박무정 대한마취과학회 1978 Korean Journal of Anesthesiology Vol.11 No.3

The introduction of polyethylene catheters for intravenous use by Meyers in 1945 has been a major contribution to patient care. Within recent years however there has been a mounting number of reports warning of the hazards associated with their use. Especially, embolism of an intravenous polyethylene catheter is the most serious complication. The authors had experience with a case of catheter embolism from subclavian catheterization for monitoring of central venoas pressure and rapid transfusion or fluid infusion. The case, a woman with ectopie pregnancy, in extreme shock, was operated on with serious risk of catheter embolism. Vital signs were stable during the operation. When the patient recovered from the anesthesia she suffered a sudden onset of chest pain and slight dyspnea for 10- minutes in the recovery room. Due to the fact that the embolus could not be seen by X-Ray, operation for removal of the catheter embolus was not performed. The patient's condition was good during the hospital stay and at discharge, and no trouble has been noted during 9 months follow-up.

영아마취 1436 예의 통계적 고찰

조영례,모근석,이경천,김홍순 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.6

Background: Infants are very different from children and adults in the point of anatomy, physiology, pharmacology and psychology. The mortality rate of infant anesthesia is higher than that of child and adult. So that this study is to analyze the infant's operation and to recognize the tendency and problems of infant's anesthesia and also to improve the outcome. Methods: A retrospective analysis was performed on 1436 infants who had operations from april 1987 to february 1995 according to age, sex, department, disease, operation time, postoperative complications, mortality rate and anesthetic method. Results: Total number of operation tend to increase annually. The male to female ratio was 67.5% to 32.5%. The distribution of patients by department was 60.6% of general surgery, 21.0% of plastic surgery and small percentage of other department. The distribution of disease was the following: inguinal hernia - the most common; cleft lip and palate, intussusception and others. The postoperative complications developed in 98 of 1436. The most common complication was the respiratory problems, the others were sepsis, electrolyte unbalance, gastrointestinal and CNS problems. The total mortality rate was 3.6%. The emergency operation case was 17.9%. Conclusions: The most common distribution of age was neonate and the most commm department was general surgery and the most common disease was inguinal hemia. The most common pestoperative complication was respiratory problems and the second was infection and sepsis. The mortality rate in preterm infant, neonate, emergency operation and long duration operation was higher than total motality rate.

Ketarnine 산과마취

조영례,박무정,정병연 대한마취과학회 1978 Korean Journal of Anesthesiology Vol.11 No.3

The pharmacologic actions of ketamine in human volunteers were reported by Domino et al in 1965 and it was used in 130 patients by Corssen Domino in 1966. Chodoff and Stella were the first to investigate ketamines suitabilityas an in ahesthktic in childirth. Since then several authors reported that ketamine has several authors reported coventionll andsthetics in obstetric anesthesia. getamine was used as the sole anesthetic agent for forceps deliveiy ia 50 wom6n uho were selected randomly. Ketamine was dminist5red intiiv6rioiisly mst before delivery in doses of 30 to 60 mg and after delivery dosage was not limited, The followidg results were observed: 1) During delivery, a rapid and intense analgesic effect was sufficiently maintained with a small dose of ketamine. 2) With the use of ketarnine it is possible to shorten the second stage of labor with a short induction-delivery-interval because of the advantages of forceps delivery. 3) Ketamine could be used without intubation during with a short fasting time because protective laryngeal quate airway could be maintained. 4) Ketamine did not appear to induce an increase of Very. delivery even in patients and pharyngeal reflexes and an ade uterine bleeding during or after deli 5) The use of ketamine during delivery appeared to have almost no affect on the Apgar score. 6) The use of ketamine was accompanied by mild complications but they were not significant.

선천성 심질환 수술 후 폐동맥 고혈압에 대한 흡입 산화질소의 효과

장영진,김지희,조영례,박정출,이경천,임유택 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.6

Background : Congenital heart disease may be complicated by pulmonary hypertension. We assessed whether inhaled nitric oxide would produce selective pulmonary vasodilation in pediatric patients with congenital heart disease and pulmonary hypertension. Methods : Inhaled low dose (10 20 ppm) nitric oxide was administrated in patients who were at risk of pulmonary hypertension after operations for congenital heart disease. To identify the nitric oxide effects, we evaluated hemodynamic and ABGA data before (T0) and after (T1) inhaled nitric oxide and just before (T2) decreasing concentration of inhaled nitric oxide. Results : Inhaled nitric oxide decreased pulmonary arterial pressure and increased PaO2/FiO2 without decreasing systemic arterial pressure. Conclusions : Inhaled nitric oxide selectively decreased pulmonary arterial pressure in patients with congenital heart disease complicated by pulmonary artery hypertension. (Korean J Anesthesiol 1999; 37: 1084∼1088)