내장 신경 차단후 합병된 양측 서혜부의 지각 탈실

이자원(Ja Won Lee),윤덕미(Duck Mi Yoon),오흥근(Hun 대한통증학회 1994 The Korean Journal of Pain Vol.7 No.1

Neurolytic splanchnic nerve block is effective for treatment of intractable upper abdominal cancer in. The possibility of neurologic complication cannot be completely precluded. A 53 year-oldofemale patient with hepatoma and lung metastasis was submitted for splanchnic nerve b1ock with alcohol. Splanchnic nerve block was performed under radiologic control by image intensifier without any difficulty during procedure. One day after the block, she com- plained 0f numbness with sensory deficit in bilateral inguinal area. Neurologic examination re- vealed that asymmetrical anesthesia, hypoesthesia at T,-L. She was discharged 70 days after the block with partial improvement. The possibility of alcohol spreading to the low theracic and upper lumbar somatic nerves cannot be excluded.

Hexafluorenium bromide(Mylaxen)사용의 임상경험

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

Hexafluorenium was used to potentiat succinylcholine in 36 patients undergoing major surgery, mainly abdominal, of from ½ to 7 hours duration. Anesthesia consisted of thiopental-nitrous oxide-oxygen-ether or haIothane and ventilation was controlled. In a first group, succinylcholine was administered for intubaticn and repeated intermittently as required with a single dose of hexafluorenium after the intubating dose of succinylcholine had worn off. In a second group, succinylcholine was administered similary but hexafluorenium was also given intermittenly. In a third group, a single initial dose of hexafluorenium was given followed by succinylcholine intermittently. In a fourth group, both drugs were given intermittently throughtout, 1) The apnea time of succinylcholine was prolonged about 8times after a single dose of hexafluorenium in the first and third groups but the prolongation was gradually lessened with successive doses of succinylchohne. Rut in second and fourth groups, the apnea times were significatly prolonged following successive dose of both drugs. 2) In third and fourth groups, fasieulation following succinylcholine was not observed and nausea, vomiting and muscle pains were not noted. 3) In recovery room, about 80% of patients could raise their heads by themselves but ether required longer recovery than halthane. 4) No bronchospasm or cardiovascular side effects were noted. It is considered that this drug combinations provides excellent relatation for surgery. The tech- nique with a single dose of hexafluorenium seems particularlly suitable in cases which last from 30 minutes up to 2 or 3 hours and repeated doses of hexafluorenium and succinylchloin are advisable for longer major cases.

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.

활성 Alkahne-glutaraldehyde 의 항균작용에 대한 시험관내 실험

고춘명,오흥근,최대경,송수헌,진재신 대한마취과학회 1970 Korean Journal of Anesthesiology Vol.3 No.1

The discovery of an ideal tecbnique for sterilising contaminated respirators and other anesthesia equipment remains a major problems, The antimicrobial activities of a recently discovered disinfectant alktaline-glutaraldehyde(Cidex), studied in vitro against various speeies of bacteria and fungi. The antimicrobial activity tests were performed according to the modified Kolmer method. The testing organisms were cultured in broth media at 37°C and 25°C for 18 hours to 14 days, and the disinfectant was diluted with sterile distilled;water to 0.4% and 2.0%. One milliliter of cultured broth was transferred into disinfectant-containing media and after 1, 2, 5, 10, 20, 30 and 60 minutes, one loopful of the mateials was removed from the media and inoculated into the broth media. All of the subcultures were incubated at 37°C for 24 hours and fungal subcultures were incubated at 25°C for 14 days. Results were obtained as follows: 1) Most of the bacteria were completely growth-inhibited by treatment with 0.4% activealine-glutaraldehyde solution for 2 minutes except a few strains such as St. aureus, B. subtilis and M. tuberculosis, which required from 16 to 20 min. 2) Mycobacterium tuberculosis was relatively resistant but it could be growth-inhibited by treatment with 2.0% solution for 2 minutes. 3) Growth inhibiting of fungi could be obtained by treatment with 2.0% solation for 5 to 10 minutes.

저혈압마취시 뇌순환계의 변화

鄭相燮,朴光遠,白光世,吳興根,李憲梓 대한신경외과학회 1974 Journal of Korean neurosurgical society Vol.3 No.2

An induced hypotension is employed .as a useful technique for operations on intracranial aneurysms, brain tumors and other intracranial lesions to diminish operative bleeding and to decrease brain tension. In aneurysm surgery under induced hypotension, the sac becomes softer and thus diminishes the risk of rupture when clips ire applied. In 1946 Gardner used arteriotomy to lower blood pressure by decreasing the blood volume during brain tumor surgery, then gradually improved. Pharmacologically-induced hypotension soon became the cominant method of producing hypotension. Halothane and trimethaphan are the most popular drugs for this purpose. On the other hand, the risks of hypotension are obvious. These include decreased cardiac output, decreased cerebral blood flow, and low perfusion pressure exposing brain tissue to the risk of hypoxia thereby aggravating the effects of the circulatory disturbance present in the brain lesion. In this situation the blood oxygen tension in jugular-bulb and lactate content in brain tissue have been found to be reliable indices of degres of cerebral oxygenation. Consequently, several investigators have studied the critical level of arterial blood pressure during hypotensive anesthesia and have accepted 60㎜Hg of systolic pressure. (40-50 ㎜Hg of mean arterial pressure) as a clinically applicable level free from the danger of cerebral hypoxia. Furthermore, Griffiths and Gillies (1948) postulated that systolic pressure over 30㎜Hg would provide adequate tissue oxygenation. However, there are only a few reports concerning the adequacy of cerebral oxygenation under such low levels of arterial blood pressure. The purpose of this study is to investigate cerebral hemodynamics and metabolism during halothane-induced hypotensive anesthesia and to find any evidence of cerebral hypoxia at the levels of 60 ㎜Hg and 30 ㎜Hg, of systolic blood pressure. 15 adult mongrel dogs, weighing 10-13 ㎏, were anesthetized with intravenous pentobarbital sodium. Endotracheal intubation was performed. One femoral artery was cannulated with a polyethylene tube for arterial blood sampling. The tube was connected to a Statham pressure transducer for continuous arterial blood pressure recording. The common carotid artery was exposed and a probe of square-wave electromagnetic flowmeter was placed on .the vessel to record the carotid blood flow. An electrocardiogram and above two parameters were recorded simultaneously on a 4-channel polygraph. The internal jugular vein was cannulated and a catheter threaded up to the jugular-bulb for sampling of venous blood draining from the brain. The cisterna magna was punctured with an 18 gauge spinal needle to sample the cerebrospinal fluid. The experiments were divided into control phase, induction phase, hypotensive phase Ⅰ, hypotensive phase Ⅱ, and recovery phase. Each phase was maintained for 30 minutes. Cerebrospinal fluid, arterial dvenous blood were sampled at the end of each phase for analysis of gas tension and lactate content. 100% oxygen was inhaled during the induction phase. During the hypotensive phases, halothane/O₂ was administered to lower the arterial blood pressure. In the hypotensive phase Ⅰ and hypotensive phase Ⅱ systolic pressure was maintained at 60㎜Hg and 30㎜Hg, respectively. In the recovery phase, halothane was discontinued and 100% oxygen only was inhaled. The results obtained are summarized as follows; 1. The carotid artery blood flow, which represents the cerebral blood flow, decreased linearly during the decline of the arterial blood pressure. At the end of each phase there was no differnece in the carotid blood flow between hypotensive phase Ⅰ and phase Ⅱ. Cerebral vascular resistance was markedly reduced in the hypotensive phase Ⅱ, which suggests cerebral vasodilation. 2. Cerebral venous pO₂ decreased significantly in the hypotensive phases, but the values still remained within normal limits. A marked reduction of arterial pCO₂ was noted in the hypotensive phases. The values approach the lower limits of safety. 3. The most outstanding difference between hypotensive phase Ⅰ and Ⅱ is in the lactate content of cerebral venous blood and cerebrospinal fluid. There was a moderate increase of lactate content, and a slight reduction of cerebral venous pH in hypotensive phase Ⅱ, however, a significant degree of cerebral hypoxia and metabolic acidosis could be excluded. 4. Most of the changes in the cerebral metabolism and hemodynamics including arterial blood pressure, tent to return to return to normal at the end of the recovery phase. From the result of this study, it is concluded; Halothane-induced hypotensive anesthesia at 60 ㎜Hg of systolic blood pressure (45 ㎜Hg of mean arterial pressure) is a safe level without threat of cerebral hypoxia. Although there is some possibility of mild metabolic acidosis 30 ㎜Hg of systolic blood pressure (23 ㎜Hg of mean arterial pressure), adequate cerebral oxygenation is maintained without difficulty.