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백서 관장 혈류(白鼠 冠狀 血流)에 미치는 Bupivacaine 의 영향
최영룡,최봉규 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.6
To darify the cardiotoxic mechanism, the effect of bupivacaine on the cardiac function, especially in coronary flow rate was inveetigated in the isolated working rat heart. When administered into left atrium of the heart, lidocaine(10^(-6)-10^(-4) M) decreased heart rate in a dose-related fashion, whereae rate of coronary flow and mean coronary resistance tend to decrease and increase transiently, respectively. On the other hand, bupivacaine decreased the coronary flow rate and increased the mean coronary resistanee in a dose(10^(-6)-10^(-4) M) dependent manner. However, the decrement of heart rate by bupivacaine was not clear, but larger dose(10^(-4) M) produced marked bradycardic effect. Bupivaeaine decreased the coronary flow and increased the mean coronary resistance in the isolated working heart, in which the heart rate and aortic pressure were kept constantly by electrical stimulation(3-6 pps, 0.5 mS, 20 V). These effects of bupivacaine were not influenced by 1 μM prazosin and 2 μM atropine pretreatment. B the bupivacaine effeets were completely abolished by 100 mM KC1 pretreatment and were inhibited markedly by 10^(-7) M diltiazem, a Ca^(2+) -antagonist, pretreatment. From these results, it is suggested that the bupivacaine-induced coronary flow decrease is elicited via direct coronary vasoconstriction. And this vasoconstriction is due to the increments of intracellular Ca^(2+) concentration
비탈분극성 근육이완의 길항시 Atropine, Neostigmine 과 Glycopyrrolate, Neostigmine 의 혼합 정주가 심박수에 미치는 영향
최영룡,정종달,강석경 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.2
Clinically, neostigmine is most commonly used as the reversal agent for to the competitive muscle relaxants. Atropine (group 1) and glycopyrrolate (group 2) were studied in doses of 15ug/kg, 20 ug/kg and 77ug/kg, 10ug/kg given intravenously in a mixture with neostigm-ine 40ug/kg, during operation and at the end of operation 20 ASA class I patients, aged between 15 to 60, were selected in each group. Anesthesia was maintained with enflurane (1-1.5%), N_2O (2L/min), O_2(2L/min) and pancuronium (50ug/kg) was used as a muscle relaxant. The results were as fellows : 1) Group 1 showed significant increase and decrease in pulse rate compared with group 2. 2) Atropine-neostigmine mixture significantly showed initial increase and late decrease in pulse rate than glycopyrrolate-neostigmine mixture. 3) In group 2, 20㎍/kg dose of atropine, when administered in a mixture with neostigmine, showed significant initial increase in pulse rate, 15㎍/kg dose of atropine showed significant late bradycardia. 4) In group 2, 7 ㎍/k, 10 ug/kg dose of glycopyrrolate was not associated with initial tachy cardia but late bradycardia was obserred and 10 ㎍/kg dose of glycopyrrolate was associated with more stable heart rate.
최영룡,정종달,임윤모 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.6
A 4 year old girl was admitted for correction of PDA under the general anesthesia. A 4.5mm ID cuffed orotracheal Rusch tube was inserted and the Jackson-Rees system was used for maintenance of anesthesia with enflurane-nitrous oxide-oxygen. During surgery a mild increase in airway resistance was noticed and tachycardia was seen but all other vital signs were within normal limits. In the recovery room, she exhibited signs of complete airway oibstruction, and so the endotracheal tube was extubated. The obstruction was due to a dried mucous crust attached to the bevel of the endotracheal tube.
Von Gierke 씨 질환을 가진 환자의 마취관리 일례보고
최영규,최영룡,신광일,권무일 대한마취과학회 1981 Korean Journal of Anesthesiology Vol.14 No.2
Glycogen storage disease is a rare metabolic disorder of significant to the anesthesiologist. The term "glycogen storage disease" is applied to a group of congenital and familial disorders characterised by deposition of abnormally large or small quantities of glycogen in the tissues. 13 types of glycogen storage diseases have been described, classified on the basis of enzyme deficiencies. Type 1 glycogen storage disease (von Gierke's Disease) is the most common of this constellation of syndromes. The basic defect is a deficiency of enzyme, glucose-6-phosphatase. The patient has hepatomegaly, renomegaly, stunted growth, a tend towards severe hypoglycemia and acidosis. The adverse effect of the combined anesthetic and surgical procedure diring operation was reflected in a deterioration of the patient's biochemical parameters. A cardiac arrest after tonsillectomy of the patient with Von Gierke's disease was reported and this fact emphasizes serious anesthetic problems during operation. Anesthetic management of these patients should focus on prevention of hypoglycemia and lactic acidosis. The careful frequent measuring of the acid-base status is highly recommended, and is essential prior to and during any surgical procedure. We report a case of anesthetic management for a patient with Von Gierke's disease and review anesthetic problems for these patients.