부록 : 뇌 보호의 생리와 약리

전세웅 대한마취과학회 1983 연수강좌 Vol.- No.-

심정지의 치료

전세웅 대한마취과학회 1976 Korean Journal of Anesthesiology Vol.9 No.2

가토에서 Succinylcholine Chloride 정주에 의한 " Train of Four " 반응

전세웅,한영문,유지섭 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.2

The history of muscle relaxants is fascinating, and their use for clinical applications has been accepted. Depolarizing drugs can prodee a non-depolarizing type of neuromuscular block. Decamethonium produces a nondepolarizing block in the isolated rabbit lumbrical muscle. Electromyographic studies of the hand muscles in man have demonstrated that a dual block will be produced with doses of succinylcholine varying from 500 to 1,500 mg (initially a delpolarizing block and subsequently a non-depolarizing block exists). The common peroneal nerve in the rabbit knee was stimulated by a $quot;train of four$quot; method (Ali et al) repeated intermittently. The muscle response with the $quot;train of four$quot; method to intravenous succinylcholine chloride (1 mg/kg) in the rabbit was recorded and analysed after a single injection and repeated intravenous injections of succinylcholine chloride 1 mg/kg. Result were as follows: 1) Time after the $quot;train of four$quot; to depression of muscle twiteh of 25, 50, 75 & 100% was 128. 2, 135. 3, 142. 8 and 159 seconds respectively. 2) Recovery index of a single intravenous injection of succinylcholine chloride 1 mg/kg was observed as 3 minutes and 14 seconds. 3) A depolarizing form of $quot;train of four$quot; response to the first succinylcholine chloride injection 1 mg/kg was observed and, a non-depolarizing form of $quot;train of four$quot; response to the second dose of succinylcholine chloride 1 mg/kg was observed definitely.

마취승낙서를 받은 환자에 대한 평가

전세웅,박경웅 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.2

Anesthesia consent was requested by our anesthesiology department when the patient condition was found to be critical during the preanesthetic visit. To evaluate the trend, one hundred and five anesthesia consent cases among the 6,430 anesthetics from January 1977 to December 1978 at the department of anesthesiology, St. Mary's hospital, Catholie Medical College, were analyzed according to the anesthetic method, age, sex, surgical department, anesthetic agent, physical status, site of operation, diagnosis, preanesthetic problem and cause of death. The results were as follows; 1) Fifteen cases(14%) died among the 105 cases of anesthesia consent during and/or after .surgery, within the first 7 days. 2) Physical status was class Ⅱ E in 43% and the ratio of elective to emergency surgery was 1 to 1.4. 3) Upper abdominal surgery was performed in 52 cases(50%), urogenital surgery in 21 cases (20%), head and neck surgery in 18 cases(17%), surgery on extremities in 12 cases(11%) and thoracic surgery in 2 cases(2%), acordingly. 4) Cardiovascular problems were found in 27 cases(26%), hematologic disorders in 13 cases (12%), respiratory problems in 13 cases(12%), sepsis in 9 cases (9%), problems of central nervous system in 9 cases(9%), hepato-renal disorders in 8 cases(8%) and endocrine disorders in 5 cases(5%), respectively, 5) Postanesthetic cause of death was cardiopulmonary disturbance(33%), sepsis(27%) cerebral edema(20%) and hemorrhage(13%).

Succinylcholine 에 대한 올바른 인식

전세웅 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2

Non-depolarizing muscle relaxant; d-tubocurarine was introduced clinically in 1942. Thereafter depolarizing muscle relaxant; succinylcholine was introduced in 1951. Those muscle relaxants were highly contributed in modern anesthesia practice today. But, since many years ago complications of succinylcholine were reported clearly so many anesthesia practice. Complications were such as ventricular arrythmia(cardiac arrest), fasciculation, hyperkalemia, muscle pain, elevation of intragastric, intraocular & intracranial pressure, prolonged apnea, generalized muscle clonus, masseter muscle rigidity and malignant hyperthermia etc. Succinylcholine was still used in clinical practice despite of many complications reported as long as more than 45 years. Finally, FDA(USA) decleared the routine use of succinylcholine was contraindicated in children and adolescents. Many textbooks of anesthesiology shows that use of succinylcholine was contraindicated in children and adolescents those were published recently since 1994. What is the current status of succinylcholine in despite of changing current concept of succinylcholine use in Korea? Succinylcholine is still inadvertently used in Korea over 79% of resident training hospital. Intravenous dantrolene reserve was only one hospital(1.4%). Undoubtedly, amazing things were going on in Korea. Seventeen cases of malignant hyperthermia had been reported from 1971 to 1996 on Korean medical journals. It's mortality was 70.6%. Not only the reported malignant hyperthermia, there are many cardiac arrest during anesthesia reported on Korean medical journals. Etiological analysis of cardiac arrest was reviewed some of them, there are certain numbers of cardiac arrest cases confirmed by succinylcholine was guilty. What is the counterplan? Change the current concept of succinylcholine is important. Conclusions ; 1. Non-depolarizing mucle relaxant should be used for intubation &/or muscle relaxation. 2. Hot line for malignant hyperthermia should be established.. 3. Intravenous dantrolene reserve is necessary. 4. Routine monitoring during anesthesia should be blood pressure, ECG, SPO2, ETCO2, body temperature and peripheral nerve stimulator. (Korean J Anesthesiol 1997; 32: 171∼177)

Tetralogy of Fallot 의 마취관리 : 병태생리를 중심으로 Pathophysiological view

전세웅,박호상 대한마취과학회 1978 Korean Journal of Anesthesiology Vol.11 No.4

The tetralogy of Fallot is the commonest cyanotic congenital heart disease and is not a single entity but is classified according to variations in clinical and hemodynamic findings based primarily on the degree of pulmonary stenosis and the size of the ventricular septal defect. Total surgical correction was performed with Sarns 500 pump oxygenator, hypothermia 28 to 30 C and perfusion flow rates of 2. 4 L/min/m2. A successfully performed tetralogy of Fallot discussed mainly fromthe pathophysiological view.

근육이완제의 현재와 문제점

전세웅 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.1

Anesthesiologists may have close relationship with muscle relaxants in clinical practice Fortunately, few of the new muscle relaxants were discovered and used in clinic recently. In this moment we have to look back the old muscle relaxants. Undesirable side effects of thIn old ones are less common, but encountered often enough to be troublesome. For example, succinylcholine(depolarizer) mar enhance dysrhythmia, rise in plasma pot-assium, increase in intraocular pressure, rise in intragastric pressure, triggering malignant hrperpyrexia muscle pain and dual block etc. Is there a simple screen test for the atypical cholinesterase? Unfortunately it's not available now. Nevertheless depolarizer was still used in many decades. That's the matter? Muscle relaxants are also affected by many factors those are renal excretion, metabolism of the drug, lilver or disease, effect of jaundice, muscle blood flow, production and release of acetylcholine, body temperature, antibiotics, other drug interactions, electrolyte imbalance, pathological status, individual differences and species differences etc. Sometimes it will make a trouble for the anesthesia practice. So anesthesiologists must be familiar with the use of muscle relaxants. And also we have to think twice about it's clinical use before given to the patients. What Is the right methods of rational use of muscle relaxants? What is the right way to reverse muscle relaxation? Obviously, return of normal muscle function following muscle relaxant administration is of prime importance to restoration of adequate spontaneous ventilation because it is clini-call velr important. In human study; supramaximal ulnar nerve stimulation was delivered by a peripheral nerve stimulator(Myotest, Biometer MK Ⅱ ) through electrode at the wrist. Stimuli were delivered continuously) by either $quot;TOF$quot; or single twitch stimuli. The resultant force of thumb adduction was measured and recorded by Biophysiograph(San Ei, Japan) through the force displacoment transducer. In animal study: all animals were intubated through a tracheostomyt under the intraperitoneal urethane anesthesia with nembutal given intravenously. Respiration was controlled by means of Shinano animal respirator. The body temperature was kept at 35℃ with a thermo-blanket. The common peroneal nerve and anterior tibial muscle was exposed and nerve stimulator was applied to the nerve-muscle preparation. The twitch height of the muscle contraction was recorded on a Biophrsiograph through the force displacement transducer. The common peroneal nerve was stimulated supramaximally using a peripheral nerve stimulator with a $quot;TOF$quot; stimulation or single twitch stimulation. Obviously, newly introduced muscle relaxants are certainly have advantage over the old ones but we should hatre further studies on them. Conclusions ; 1) Minimal dose of muscle relaxant which may produce 90∼100% of twitch depression may use depend on the types of surgery. 2) To evaluate the type and degree of muscle relaxation intermittently by use of the ripheral nerve stimulator is essential. 3) Best choice of the muscle relaxants are should be non-depolarizers those mar promp-tly reversed by anticholinesterases.

흡입마취중 Intracuff Pressure 의 변화

전세웅,한영문 대한마취과학회 1978 Korean Journal of Anesthesiology Vol.11 No.4

The effect of nitrous oxide on endotracheal tube cuff pressure was measured during N2O-O2-halothane anesthesia. Intracuff pressure was increased in a time-related fashion up to 150 minutes. Thereafter no significant increase was observed, The other hand, there is no endotracheal tube cuff pressure change during O2-halothane anesthesia. These findings demonstrate that nitrous oxide has the capacity to diffuse into Portex endotracheal tube cuffs in significant volumes and may result in increased intracuff pressure, and in O2-halothane anesthesia, the nitrogea in the cuff wras diffused out from the cuffs.

Ketamine 근육주사에 의한 마취의 실패 증례

전세웅,권오경 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.2

Ketamine, a phencyclidine derivative, has been used as an anesthetic agent since 1965 and it has received much attention as an anesthetic for minor surgical procedures, in some diagnostic procedures in children or as an induction agent for poor risk patients. A troublesome problem has been psychic disturbance on emergence. There are many reports on ketamine anesthesia but some cases describing the failure of recommended doses of ketamine to produce adequate analgesia have been reported with cerebral cortical disease or massive craniocerebral trauma. In this case, we experienced a failure to produce adequate analgesia with intramuscular ketamine (11 mg/kg). It was not confirmed in this case whether the patient had suffered any cerebral cortcial disease or not.

뇌동맥류수술에서 저혈압마취시(Trimetaphan 사용)의 제검사소견의 분석

전세웅 대한마취과학회 1974 Korean Journal of Anesthesiology Vol.7 No.1

Hypothermia and/or hypotensive anesthesia are well known technics for surgery of cerebral aneurysm. This study was performed to compare the Iaboratory data from hypotensive anesthesia with trimetaphan (Arfonad) to hypothermic anesthesia without trimetaphan for surgery of cerebral aneurysm. For this purpose, the author performed hypotensive anesthesia with trimetaphan. Laboratory data studied were blood gases, hemoglobin, hematocrit, blood chemistry, urine output, specific gravity of urine, dose of trimetaphan, period of hypotensive state and dose of mannitol, etc. Laboratory data were obtained before surgery (Group A), hypotensive period (systolic blood pressure; 50~60 mmHg) (Group B) and immediately after the surgery (Group C) and were analysed. The results of analysis were as follows; 1. In gas studies, metabolic alkalosis and respiratory alkalosis were shown before surgery and the hypotensive period. Metabolic alkalosis and respiratory acidosis were shown after surgery. It is hard to imagine an explanation for the data. Metabolic acidosis and compensatory respiratory alkalosis should be expected due to decreased tissue perfusion by hypotension, presumably. 2. In Hb. and Hct. studies, among the 3 groups shown there was statistical significance (p( 0.001), but no clinical significance was noticed. 3. In blood chemistry; Serum K showed significant decrease (p$lt;0.001) in the hypotensive period and immediate postoperative period compared with before surgery. Serum Na showed significant decrease (p$lt;0.05) in the hypotensive period and significant increase (p$lt;0.001) in the immediate postoperative period. Serum creatinine showed significant increase (p$lt; 0.001) in the hypotensive and immediate postoperative period. Serum NPN showed significant decrease (p$lt;0.001) in the hypotensive period compared with before surgery and the immediate postoperative period, but statistical significance was noticed in the hypotensive period only. There was no clinical significance among the 3 groups. 4. In urine output, significant decrease was noticed in the hypotensive and postoperative periods: but no statistical signicance was found. 5. In specific gravity of urine, progressiv increase was found in the hypotensive and postoperative period than before surgery. 6. In ECG study, no significance change was noticed except one atrial premature contraction during hypotensive period. 7. All the above data were suggested no cerebral hypoxia and/or renal failure were encountered. 8. The mean trimetaphan dose was 189.50±172.73 mg, the mean mannitol dose was 53.75±13.75 g and the mean hypotensive period was 40.50±20.91 minutes respectively. In the statistical significance, unreasonable explanations were encountered. And also, clinically significant results were encountered among the non-statistical significance. To conclude through this study, when we present to give a results of statistical significance, there must be needed more careful analysis not only of obtained data but also analysis with more variable aspects, so further study is indicated.