氣管內揷入麻醉의 臨床經驗

朴光遠,李昉遠 육군의무장교단 1955 육군의무장교단잡지 Vol.2 No.1

제왕절개술 마취의 임상적 고찰

박광원,이희전,전용애,정순미 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.1

To provide optimal obstetric anesthetic care, it is essential for the anesthetist to know well the maternal physiological alterations produced by pregnancy, labor and paturition, physiology and pharmacology of the fetal placental complex and how these are altered by analgesics and anesthetics (Bonica, 1972). Recently, the tendency to cesarean section has increased; the cesarean section rate was 8.1. (Lee et al., 1974) and 15% (Dripps et al., 1977). Choice of regional or general anesthesia for cesarean section depends on many factors. As, the paturient is considered to have a full stomach, regional anesthesia is advantageous. However, if the indication is fetal distress or maternal hemorrhage, the necessity for rapid delivery overrides all other considerations. For elective cesarean section the choice of anesthesia largely relates to patients condition and physicans preference, although the somewhat. longer time required for delivery in a repeated cesarean section may indicafes regional rather than general anesthesia (Dripps et al., 1977; James et al., 1977). The problem of anesthetic management of cesarean section was fetal depression due to sedatives, analgesics and anesthetics during delivery. In emergency cesarean section, the major problem in general anesthesia is aspiration of gastric contents and in regional anesthesia it is hypotension. Regarding fetal and neonatal depression associated with anesthesia, the effects of general or regional anesthesia or. the neonatal neurobehavioral status have been reported by many authors (Standley et al., 1974; Tronick et al., 1976; Hollmen et al., 1978). Thus we have made a clinical analysis of anesthesia for 300 cases by random sampling among 1725 cesarean sections. including emergency and elective operations, performed from July 1973 to June 1978 in Severance Hospital at Yonsei University College of Medicine. Clinical analysis was made of frequency of cesarean section, age distribution, parity, indication of cesarean section, physical status (A.S.A. classification), premedication, anesthetic method, relationship between Apgar seore and the type of anesthesia, relationship between induction to delivery time and one minute Apgar score, time to initial blood pressure drop after spinal anesthesia, blood loss, the methods of cardiopulmonary resuscitation of the newborn, perinatal mortality and neonatal neurobehavioral states. The result are as follows: 1) The incidence of cesarean aection was 18.4 percent of total deliveries and the tendency is increasing. 2) One minute Apgar score in spinal anesthesia is better than in general anesthesia (0. 01 $lt;p $lt;0 025). 3) Blood loss in spinal anesthesia (566±146ml) is less than in general anesthesia (796 ± 388ml). 4) Blood pressure showed a drop within ten minutes in 83 percent of cases after induction of spinal anesthesia. 5) Perinatal mortality of general anethesia (3. 9%) is more than spinal aneathesia (1.9%) Even tbough clinical results of spinal anesthesia seem to be more favorable than those of general anesthesia, from the above obrvation it may be concluded that choice of anesthesia for cesarean section depends on each maternal condition and only one anestbetic method should not be exclusively used.

인공기도 관리에 따른 합병증에 대한 연구

박광원,강정완,정경숙,고신옥 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.6

Artificial airways have been widely used to keep patency of airway and apply respiratiory care, however those airways may cause frequent and severe complications. Many etiologic factors have been implicated in the development of these problems with the exact reasons being as yet unknown. The purpose of this study was to assess the incidence, evolution and long-thrm effects of complications following artificial airways and to evaluate the effect of complications following artificial airways and to evaluate the effect of factors in the genesis of those complications. 332 consecutive patients admitted to Intensive Care Unit in Shinchon Severance Hospital over a 6-month period from March to August, 1990 were studied who had been intubated or tracheostomied. 1) Complications following artificial airways occurred in 58 patients among 332 patients and the rate of complication was 17.5% and the total number of complication was 63 cases. 2) There was no significant relationship between the rate of complications and patient's demographic factors, such as age and sex. 3) There was statistic significance between the rate of complications and factors such as frequencies of intubation and drugs used for intubation such as sedatives and muscle relaxants. 4) As frequency of intubation increased once, the rate of complication increased about twice. 5) The rate of complications in the patients without sedatives and muscle relaxants at intubation was 2.34 times greater than in those administered either medications.

뇌동맥류수술시의 저혈압마취의 경험

박광원,최령,정명희,한윤선 대한마취과학회 1972 Korean Journal of Anesthesiology Vol.5 No.2

Deliberate hypotension in the surgery of intracranial aneurysm !s used to diminish bleeding and render an aneurysmal sac slack to make clipping easy. It has been reported by Murtagh (1960) and Schettini et al. (1967) that deliberate hypotension induced with halothane anesthesia is a useful method. We are reporting clinical experience of halothane induced hypotension in 13 cases of intracranial aneurysm surgery. The results of clinical observation were as follows: 1. On the average, the systolic blood pressure lay betveen 60 and 80 mmHg. Hypctension by halothane was readily controllable by increasing and decreasing the inspired concentration of halothane. The use of vasopressors was not necessary to raise the blood pressure. Recovery from anesthesia was rapid. The mean of Mean Arterial Blood Pressure of 13 cases was 56.077 mmHg during the .hypotensive phase. The rate of fall of the mean arterial blood pressure was 1.862 mmHg per minute. 2. The common EKG finding was bradycardia associated with hypotension, but the pulse rate increased by raising the blood pressure. 3. The serum electrolytes, Na, K, Cl, and CO₂ combining power, checked in the pre and posto-perative period, showed no significant change. 4. Arterial blood gas study showed increased values for PaCO₂ and oxygen saturation during the hypotensive phase. The PaCO₂ was slightly lowered during hypotension. The pH was within normal limits. 5. The Hb and Hct, checked pre and postop ratively, showed lowered values in the postopertive period. During surgical clipping of the aneurysm, there were two cases of aneurysmal rupture, requiring blood transfusion; the amount of whole blood transfused was 500 ml to 1, 000 ml. 6. Urinary excretion, observed during hypoension, showed a decreased urine output at a systolic blood pressure of about 70 mmHg. 7. Postoperatively there was one death at the end of second week and the cause was thought to be cerebral infarction, not directly relnted to anesthesia.

Pheochromocytoma 척출술의 마취 : 1례 보고 A Case Report

박광원,오흥근,김박철,송수헌 대한마취과학회 1970 Korean Journal of Anesthesiology Vol.3 No.1

A 54 year-old woman underwent resection of pheochromocytoma under general anesthesia. Following induction of anesthesia with intravenous thiopental sodium, succinylcholine iodide was administered intravenously and endotracheal intubation was performed. Anesthesia was maintained with nitrous oxide, oxygen and diethyl ether using a semi-closed carbon dioxide absorption circle system. The course of anesthesia was rather stormy, reflected by hypertension, arrhythmia and hypotension, but the patient tolerated anesthesia well.

神經外科의 麻醉

朴光遠 최신의학사 1976 最新醫學 Vol.19 No.2

β- SiC Whisker 합성시 탄소원 반응가스의 종류에 따른 영향

박광원,김수식 대한금속재료학회 1988 대한금속재료학회 학술대회 개요집 Vol.1988 No.0

Hypothermia에 關한 實驗的 硏究

朴光遠 최신의학사 1966 最新醫學 Vol.9 No.7

Atracurium 에 의한 중중근무력증 환자의 근육이완

박광원,김원옥,남순호,윤경봉,사희순 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.1

Generally, myasthenic patients are believed to have enhanced sensitivity with variety to the nondepolarizing neuromuscular blockade, even though some authors do not agree with that. Recent1y, the use of the new intermediate-acting nondepolarizing relaxant atracurium has been reported in patient with myasthenia gravis. The unique mode of elimination of atra-curium, which undergoes spontaneous degradation at physiologic body temperature and pH. may offer an advantage over the previously available Bong-acting muscle relaxants. We describe a case report of the anesthetic management of mysthenic patient using atracurium because of its relatilvely rapid rate of recovery. Reduced dosage of atracurium appeared to be a reasonable choice for myasthenic patients requring surgical relaxation when clinically indicated. However, continuous monitoring of neuromuscular function is of course mandatory for the proper and safe use of atracurium.

부록 : 체외순환의 관리

박광원 대한마취과학회 1982 연수강좌 Vol.- No.-