마취가 담도계 수술환자 간기능에 미치는 영향에 관한 임상관찰

엄대자,최령 대한마취과학회 1985 Korean Journal of Anesthesiology Vol.18 No.1

산과마취

엄대자,최령,권장연,김대현 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.2

Total 1950 cases of general, spinal and epidural anesthesia for cesarean section were performed in Dept. of Anesthesiology, Younsei University, Wonju College of Mdeicine from June 1982 to May 1987. The followings are results of the observations on 1950 cases: 1) The incidence of cesarean section was 21.76 percent of total deliveries and the tendency is increasing. 2) Types of anesthesia are General anesthesia (1004 cases), Spinal anesthesia (557 cases), Epidural anesthesia (389 cases), 3) One minute Apgar score in spinal, epidural anesthesia are better than in general anesthesia. 4) Perinatal mortality of total deliveries is 1.007%. 5) Painless delivery: 50 cases 6) Post operative pain control: Spinal anesthesia: 48 cases Epidural catheter: 335 cases 9Ketamine; 50 cases)

제왕절개술 마취시 동맥혈과 호기말 이산호탄소 분압차이의 비교

엄대자,박윤곤,임현교,윤경봉,최령 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.5

Studies were made to ascertain the relationship between arterial and end-tidal carbon dioxide tension in 19 patients during caesarean section under general anesthesia(Group 2). 27 nonpregnant patients scheduled for abdominal hysterectomy were also performed as a control group(Group I). 15 and 30 minutes after the induction of anesthesia in group I, and just before uterine incision, 15 minutes following induction in group 2, arterial blood was sampled for PaCO analysis and PETCO₂(end-tidal CO₂ tension) determined at the same time. In group 1, there was a statistically significant differences between PaCO₂ and PETCO₂ but in group 2, no differences between them were shown. The highly significant correlations between PaCO₂ and PETCO₂ in both groups were found. On the basis of the above results, we recommend that non-invasive measurement of PETCO₂ can be used reliably in stead of measuring PaO₂ to evaluate the ventilatory status during anesthesia in patients for caesarean section.

제왕절개술 후의 통증관리

엄대자 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.-

활성화된 마우스 대식세포가 Toxoplasma gondii의 증식에 미치는 영향

엄대자,민득영,안명희 한양대학교 의과대학 1992 한양의대 학술지 Vol.12 No.1

The present study was aimed to elucidate the effect of antitoxoplasma activity and oxidative capacity of peritoneal macrophage of immunized and/or normal mouse. BALB/c mice were immunized with dozens of cyst (Beverly of Fukaya strain) intraperitoneally. Glass adherent cells were used as macrophage from immunized and normal mouse peritoneal cells. Macrophage(?? cells/ml) and Toxoplasma tachyzoite(RH strain) were incubated in 10% fetal calf serum-minimum essential medium, 37℃, 5% CO₂ incubator. The ratio of cell to Toxoplasma was 1:1 or 2:1. After 4 and 24hr incubation, cell rupture and infection rate of macrophage, number of tachyzoite in a cell were observed under microscope. Production of hydrogen peroxide from immunized or normal macrophage after 1hr incubation of Toxoplasma or Toxoplasma with phorbol myristate acetate(PMA) were measured. After 4hr incubation of macrophage and Toxoplasma tachyzoite, 10% of cell rupture were observed in normal and immunized macrophages. One to five organisms per cell were observed 32.8~38.7% of normal macrophage and 50.7~52.6% of immunized macrophages. After 24hr incubation, Toxoplasma multiply freely in normal mouse macrophage and 90% of cells were ruptured. Meanwhile immunized mouse macrophage display toxoplasmacidal effect and 50% of cells were survived. Toxoplasma invation into cell were 34.~48.7% of normal macrophage and 59.4% of immunized macrophage. Immunized macrophages released 2~7 times of H₂O₂than those of normal macrophages. With above results, it is assumed that peritoneal macrophage from immunized mouse has high producibility of H₂O₂and then might enhance the subsequential toxoplasmastatic and/or toxoplasmacidal effect.

Change of respiratory mechanics at different intra-abdominal pressures and position change during laparoscopic surgery

장규용,엄대자,홍석주,임현교 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.64 No.6

Humphrey Circuit System 의 임상적 관찰

김원옥,엄대자,최령 대한마취과학회 1986 Korean Journal of Anesthesiology Vol.19 No.4

The Humphrey circuit system functions with the efficiency of the Lack system for spontaneous respiration and of the Bain system for controlled ventilation. It is designed to incorporate into a single system the advantages of the Mapleson A, D and E type systems and to be available in coaxial and non-coaxial forms. This study was done to sudy the functions of a new anesthetic breathing system and to evaluate the adequacy of the recommended fresh gas flow. For spontaneous and controlled ventilation the system required a low fresh gas flow to achieve normocarbia(In the Lack circuit system, 60 ml/min., is useded and in the Bain circuit system, 70 ml/mn.). The advantage of this system was that it was simple to poerate and maintain, more easily sterilized and applicable in academic use. Further more the non-coaxial from of the circuit overcame the hazard of the inner tube complication. But this form was thought to have the provlem of humidifying the inspired gas which still has to be studied. This multicircuit system was used satisfactorily with low fresh gas flow under spontaneous and controlled ventilation maintaining normal range of arterial carbon dioxide. It may become one of the preferred semiclosed breathing systems because of simplicity, multipurpose usefulness and other advantages.

이중 방식에 의한 독립적 폐환기에 적용한 고빈도 Jet 환기법 및 지속적 기도

김찬,엄대자,박윤곤,임현교,최령 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.3

The effects of oxygenation of differential independent lung ventilation using HFJV (High Frequency Jet Ventilation) and CPAP (Continuous Positive Airway Pressure) on PaO₂ and Qs/Qt were studied during one lung anesthesia in 11 mongrel dogs in left semilateral position with pentobarbital anesthesia. The dogs were divided into two groups. In group A(N = 7), following the conventional two lung ventilation, one lung ventilation, HFJV, one lung ventilation, cpap 5 cmH₂O, and CPAP 10 cmH₂0 were applied sequentially. In group B(N =4), following the conventional two lung ventilation the above applications were reversed. In group A PaO₂ revealed a similar increase among a two lung ventilation, CPAP 5 cmH₂O, CPAP 10 cmH₂O and HFJV. Intrapulmonary shunt showed the similar decrease among two lung ventilation, HFJV and CPAP 10cmH₂O, but CPAP 5 cmH₂O was higher than CPAP 10cmH₂O. Although there were no statistically significant differences in PaO₂ and shunt among each step in group B, HFJV showed a greate increas and shunt than one lung ventilation, CPAP 5 cmH 20) 20, and CPAP 10 cmH₂O. In conclusion, HFJV proved to be more effective than CPAP 5 cmH₂O in increasing PaO₂ and decreasing shunt in differential independent lung ventilation. Both CPAP and JFJV should be applied in the deflation phase of the nondependent lung to cause an effective increase in PaO₂. HFFV proved to be more effective than CPAP in recruiting the small airway closure.

경막외 Steroid 주입후 발생한 하반신마비 : 1예 보고

김찬,엄대자,최령,우남식,원민식 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.2

수술후 경막외강내에 주입한 케타민의 진통효과

길혜금,엄대자,우남식,최 령 대한통증학회 1988 The Korean Journal of Pain Vol.1 No.1

In recent years the use of epidural opiates has increased and although this method of pain relief has shown good results in clinical practice it is still subject to certain drowba- cks, the most serious of which appears to be delayed respiratory depression. Since ketamine administered systemically is unlikely to produce respiratory depression it seemed worthwhile to investigate the possibility of exploiting the potent analgesic property to ketamine by its epidural administration. The analgesic effect of ketamine 4 mg, administered epidural space, was evaluated. The duration of pain relief varied from less than 3 hours in 20% to over 24 hours in 30% of the cases. In 62.5% of the cases pain relief exceeded 6 hours. There was no evidence of respiratory depression, and there no postoperative neurologic sequelae. The present results indicated the need for further studies to compare the efficacy and safety of epidural ketamine with the response to epidural opioids for the relief of posto- perative pain.