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간엽절제술시 Citrate 투여후 혈중 Ionized Calcium 의 변화
박주열,신치만,김규완 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.6
Citrate in transfused blood forms a complex with calcium and decreases the free ionized calcium. Serum normalized ionized calcium(nCa^(2+)) concentration was measured in patients receiving resection of brain tumor(Group l) and hepatic lobectomy(Group 2) before and after transfusion. The results were as follows; 1) nCa^(2+) concentration decreased from 1.08±0.08 mmol/L at baseline to 0.98±0.10 mmol/L(p$lt; 0.05) at 10 min after transfusion in Group l. 2) nCa^(2+) concentration decreased from 1.13±0.05 mmol/L at baseline to 0.84±0.08 mmol/L(p$lt; 0.01) at 10min and to 0.87±0.11 mmol/L(p$lt;0.05) at 2hr after transfusion in Group 2. 3) nCa^(2+) concentration at 10 min and 2hr after transfusion in Group 2 were significantly lower than those in Group l(p$lt;0.05). nCa^(2+) concentration decreased significantly after transfusion and didnt returned to baseline at 2hr after transfusion during hepatic lobectomy. We conclude that it is essential to measure ionized calcium(Ca^(2+)) concentration directly and at frequent interval during transfusi hepatic surgery and we can prevent or treat severe hypocalcemia and cardiovascular depression with measured serum Ca^(2+).
소아에서 동맥혈 이산화탄소분압과 호기말 이산화탄소분압의 비교
박주열,신치만,이태인 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.3
End-tidal PCO₂ measurements are less accurate in neonates, infants, and small children than in adults. These in accuracies may by attributed in part to the dilution of end-tidal gas with fresh gas as a result of placing the sampling catheter between the endotracheal tube and a partial rebreathing circuit. To determine the most accurate catheter position for measurements of end-tidal gas tensions, end-tidal PCO₂ was measured continuously from the distal and proximal end of the endotracheal tube and these data were compared with simultaneous arterial PCO₂. The results were as follows: 1) In children weigthing above 15 kg ventilated with partial rebreathing circuit, both distal and proximal end-tidal PCO₂ values approximated arterial PCO₂ (p$lt;0.05). 2) In infants and children weigthing below 15 kg ventilated with Ayre's T-piece breathing circuit(Jackson-Rees modification), only distal end-tidal PCO₂ approximated arterial PCO₂.
박주열,신치만,정순호,최영균,김영재,박진우,허남학 인제대학교 1998 仁濟醫學 Vol.19 No.2
복강 내 거대 종양은 횡경막의 위치에 영향을 미치고 복강 내 종양 주위 장기와 혈관들 특히 복부 대동맥 및 하대 정맥을 압박하여 호흡 기능 및 혈액 순환기능에 장애를 일으킬 수 있다. 또한 거대 종양 제거 직후 심혈관계의 갑작스런 변화는 즉각적인 조치가 이루어지지 않을 경우 심혈관계 및 혈액 순환 장애를 일으켜 심각한 합병증을 초래할 수도 있다. 저자들은 이러한 복강내 거대 종양 제거술을 위한 마취를 경험하였기에 문헌 고찰과 함께 보고한다. Large intra-abdominal tumors interfere with respiratory and circulatory function by producing elevation and splinting of the diaphragm, and partial occlusion of the inferior vena casa and aorta. For anesthesic management we understand respiratory and hemodynamic changes which occured by tumor and removal of tumor. The main hazards involved in removing such tumors are consequences of abdominal decompression which may produce the sudden increase of preload and decrease of afterload in left ventricle, and the dysfunction of diaphragm and abdominal wall. A knowledge of the deranged physiology and its management may avert these complications. Careful preparation, modification of anesthetic technique, postoperative ventilation, and external abdominal compression are important.