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복강경 담낭절제술의 전신마취시 활력징후와 폐가스 교환의 변화
조성두,김영생,송남원,윤지영,권욱환 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7
Laparoscopic cholecystectomy is a relatively new surgical procedure, enjoying ever-increasing popularity and presenting new anesthetic challenges. Anesthetic problems are mostly due to physiologic changes associated with systemic absorption of the intra-peritoneally insufflated carbon dioxide (CO₂). We studied systolic and diastolic arterial pressure, heart rate, arterial blood gas, end-tidal CO₂ and peak inspiratory pressure changes in 30 patients who underwent laparoscopic cholecystectomy, before CO₂ insufflation (control value), 15 minute after CO₂ insufflation, after gall bladder delivery out, 15 minute after CO₂ excretion. After CO₂ insufflation, systolic and diastolic arterial pressure, peak inspiratory pressure, end-tidal CO₂ were increased sigmficantly in comparison to control values (P-value$lt;0.01). Also, in arterial gas analysis, arterial blood carbon dioxide tension (PaCO₂) was increased and pH was decreased significantly but arterial blood oxygen tension (PaCO₂) was not changed significantly. After CO₂ excretion, systolic and diastolic pressure, end-tidal CO₂ were increased in comparison to control values (P$lt;0.01) and pH was decreased significantly. But peak inspiratory pressure and PaCO₂ were not statistically significant. In conclusion, minute ventilation should be corrected during general anesthesia for laparoscopy with CO₂ insufflation according to continuous monitoring of end-tidal CO₂ and arterial carbon dioxide tension.
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갈색세포증 적출술의 마취관리 : 2예 보고 Two Cases Report
조성두,윤지영,김영생,송남원,권욱환 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.8
Two patients underwent anesthesia for pheochromocytoma involving adrenal gland and extra- adrenal space. Patient 1 was not diagnosed as pheochromocytoma before surgery and thus proper preoperative evaluation and care was not possible. During surgery and anesthesia, the patient showed a marked blood pressure variation, arrythmia and tachycardia. Pulmonary edema occurred intraoperatively, but subsided with positive end expiratory pressure and the use of diuretics and morphine. Patient 2 was preoperatively diagnosed as pheochromocytoma and was thus given prazosin and nifedipine (for 11 days) preoperatively. Blood pressure and pulse rate throughout the surgery and anesthesia were stable and no intra- and postoperative complication occured. We believe that careful preoperative preparation is essential to minimize intraoperative hemo- dynamic disturbance and their sequelae.
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