http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
악성 두개강내압 상승환자에 대한 Barbiturate치료 : Management of Patients and Effect on Outcome
박춘근,황장회,김달수,이상원,김문찬,강준기,송진언 대한신경외과학회 1986 Journal of Korean neurosurgical society Vol.15 No.3
In spite of high-dose steroid, hyperventilation, hyperosmolar agents, appropriate surgical evacuation, and cerebrospinal fluid drainage when possible, uncontrolled intracranial hypertension, which was defined as occurring when intracranial pressure (ICP) exceeded 25㎜Hg for 2 hours or more. occurred in 8 patients. Persistent elevated ICP occurred in 4 patient with acute subdural hematoma and brain contusion, in 2 patients with aneurysm and brain infarction, in 1 patient with hypertensive intracerebral hematoma, and in 1 patient with meningioma. All of these patients received intravenous barbiturate to control the ICP. The initial thiopental loading dose(10㎎/㎏) effectively reduced the ICP in 5 patients (62.5%). In those patients responding to the initial loading dose, four have survived, and one died due to pulmonary comlication. None of three nonresponders to barbiturate survived. Two of the survivors have returned to a productive life, and two remain moderately disabled. The favorable outcome in this series suggests that early aggressive treatment of intracranial hypertension with barbiturate and careful attention to medical complications can improve the outcome in patients with uncontrolled intracranial hypertension, with barbiturate and careful attention to medical complications can improve the outcome in patients with uncontrolled intracranial hypertension, especially in postoperative state. A broader investigation of the clinical application of barbiturates is indicated.
Mannitol 투여에 의한 Blood-brain Barrier Distruption시에 Barbiturate와 Propofol의 비교
윤수한,안영환,안영민,조기홍,조경기 아주대학교 의과학연구소 1996 아주의학 Vol.1 No.1
We compared the anesthetic effects of barbiturate and propofol on mannitol-induced blood- brain-barrier disruption in four groups of each 6 rats. Group 1 was a barbiturate saline control, group 2 was propofol saline control, group 3 given propofol mannitol, and group 4 given barbiturate mannitol. There was no significant difference between group 1 and 2, or between group 3 and 4. These results suggest that barbiturate can be replaced with propofol for anesthesia in mannitol-induced blood-brain-barrier disruption.
Barbiturate 정주, 초저체온 및 순환 정지를 이용한 거대 뇌동맥류 수술의 마취 1예
윤대영,정순호,최영군,김영재,박진우,신치만,박주열 인제대학교 1997 仁濟醫學 Vol.18 No.1
영구적인 뇌손상의 위험 때문에 일반적으로 거대 뇌 동맥류는 외과적 처치를 피해왔었다. 그러나 마취 및 체외순환이 개선되고 발전하여 순환 정지를 이용한 방법이 거대 뇌 동맥류의 결찰의 부작용을 감소시켰다. 본 병원에서 뇌 보호 및 안전한 수술을 위해 barbiturate를 병용한 마취와 체외 순환을 이용하여 중심 체온을 18℃까지 하강시킨 저체온하에서 순환 정지 동안에 시행한 거대 뇌동맥류 결찰의 마취 1예를 경험하였기에 보고하는 바이다. Because of the various risks of permanent neurological injury, neurosurgeons generally hale avoided any attempts at surgical ablation of giant cerebral aneurysms. But techniques of special anesthesia and cardiopulmonary bypass have been developed to make this operative procedure safe during temporary circulatory arrest. We report 1 case of anesthesia using special anesthetic with barbiturate and deep hypothermia to 18℃ that protect the brain during temporary cardiac arrest for surgical ablation of giant cerebral aneurysm.
急性 局所腦虛血로 因한 腦에너지代謝의 變化에 對한 實驗的 硏究 : Energy Metabolism
李勳甲,李基燦,朱正和,金成鶴,辛奎萬 고려대학교 의과대학 1989 고려대 의대 잡지 Vol.26 No.1
It is the purpose of this experimental study to investigate the alterations of the amount of adenosine nucleotides and adenylate energy charge in the acute focal cerebral ischemia of cats utilizing high performance liquid chromatography and to make a comparative study of protective effects of recirculation and combined therapy with mannitol, steroid and barbiturate. Acute focal cerebral ischemia in cats was induced by occlusion of the left middle cerebral artery through the postorbital techniaue. The experimental animals were divided into four groups according to the duration of occlusion time. The experimental results are obtained as follows: 1) In 1, 3 and 5 hour-occulsion groups, amount of adenosine triphosphate and summation of adenosine nucleotides decreased dignificantly to 21.4%, 5% & 0%, and 44.0%, 29.9% & 10.8% of the sham control, respectively Also in these groups adenylate energy charge decreased significantly to 62.7%, 38.7% and 30.7% of the sham control, respectively. It was suggested that the longer duration of occlusion time was, the more amount of adenosine triphosphate, summation of adenosine nucleotides and adenylate energy charge decreased significantly. 2) In 1 and 3 hour-occlusion groups, 2 hour-recirculation increased significantly amount of adenosine triphosphate and summation of adenosine nucleotides to 37.4% & 29.4%, and 62.1% & 58.3% of the sham control, respectively Also in these groups recirculation increased significantly adenylate energy charge to 70.7% and 65.3% of the sham control, respectively. Whereas there was a slight increase of adenylate energy charge after recirculation in 5 hour-occlusion group, but not significant. 3) In the groups of recirculation following 5 hour-occlusion, pretreatment of combination of mannitol and steroid, or mannitol, steroid and barbiturate increased significantly amount of adenosine triphosphate, summation of adenosine nucleotides, and adenylate energy charge to 57.2% or 66.1%, 80.9% or 83.5% and 82.7% or 84.0% of sham control, respectively. These results suggest that in order to prevent the irreversible ischemic brain damage, restoration of cerebral blood flow must be accomplished within 3 hours following the onset of the acute focal ischemia in cat and that pretratment of combinations of agents(mannitol, steroid and barbiturate) with different sites of action of synergistic coupling may be best suited to combat the myriad processes that make up the ischemic cascade.
Influence of the Central Benzodiazepinergic System on Peripheral Cardiovascular Regulation
Jeong-Tae Koh,Jeong-Min Ju,Dong-Ho Shin,Han-Ho Cho,Bong-Kyu Choi,Jae-Ha Kim 대한생리학회-대한약리학회 1998 The Korean Journal of Physiology & Pharmacology Vol.2 No.3
<P> Diazepam is known to have cardiovascular depressive effects through a combined action on benzodiazepinergic receptor and the GABA receptor-chloride ion channel complex. Moreover, it is known that barbiturates also have some cardiovascular regulatory effects mediated by the central GABAergic system. Therefore, this study was undertaken to delineate the regulatory actions and interactions of these systems by measuring the responses of the cardiovascular system and renal nerve activity to muscimol, diazepam and pentobarbital, administered intracerebroventricularly in rabbits. When muscimol (0.03∼0.3 ㄍg/kg), diazepam (10∼100 ㄍg/kg) and pentobarbital (1∼10 ㄍg/kg) were injected into the lateral ventricle of the rabbit brain, there were similar dose-dependent decreases in blood pressure (BP) and renal nerve activity (RNA). The relative potency of the three drugs in decreasing BP and RNA was muscimol > pentobarbital > diazepam. Muscimol and pentobarbital also decreased the heart rate in a dose-dependent manner; however, diazepam produced a trivial, dose-independent decrease in heart rate. Diazepam (30 ㄍg/kg) augmented the effect of muscimol (0.1 ㄍg/kg) in decreasing blood pressure and renal nerve activity, but pentobarbital (3 ㄍg/kg) did not. Bicuculline (0.5 ㄍg/kg), a GABAergic receptor blocker, significantly attenuated the effect of muscimol in decreasing BP and RNA, either alone or with diazepam, and that of pentobarbital in decreasing BP and RNA, either alone or with muscimol. We inferred that the central benzodiazepinergic and barbiturate systems help regulate peripheral cardiovascular function by modulating the GABAergic system, which adjusts the output of the vasomotor center and hence controls peripheral sympathetic tone. Benzodiazepines more readily modulate the GABAergic system than barbiturates.
( Il Woo Shin ),( Ju Tae Sohn ),( Ju Young Choi ),( Heon Keun Lee ),( Chul Hee Lee ),( Young Kyun Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
An emergency left frontotemporal craniectomy with direct neck clipping and hematoma removal was performed in a 36-year-old man with a ruptured left middle cerebral artery aneurysm and sylvian hematoma. Because of severe brain swelling postoperatively, we induced barbiturate coma therapy to treat his intractable brain swelling. He had an initial loading dose of sodium thiopental (5 mg/kg) followed by continuous infusion of sodium thiopental (5 mg/kg/hour). The lowest potassium concentration recorded during the barbiturate coma therapy was 1.1 mmol/L; necessitating treatment with cardiac massage, epinephrine, and atropine because of asystole and severe bradycardia. However, he did not recover from cardiac arrest. We present here a case of cardiac arrest due to severe life threatening hypokalemia that occurred during barbiturate coma therapy. (Korean J Anesthesiol 2006; 50: S 71~3)
A Fatal Adverse Effect of Barbiturate Coma Therapy: Dyskalemia
권현묵,백진욱,이상평,조재익 대한신경손상학회 2016 Korean Journal of Neurotrauma Vol.12 No.2
The management guideline for traumatic brain injury (TBI) recommends high-dose barbiturate therapy to control increased intracranial pressure refractory to other therapeutic options. High-dose barbiturate therapy, however, may cause many severe side effects; the commonly recognized ones include hypotension, immunosuppression, hepatic dysfunction, renal dysfunction, and prolonged decrease of cortical activity. Meanwhile, dyskalemia remains relatively uncommon. In this study, we report the case of a hypokalemic patient with severe rebound hyperkalemia, which occurred as a result of barbiturate coma therapy administered for TBI treatment.
순환정지, 저온 및 Barbiturate 요법을 이용한 거대 뇌동맥류 수술 : 증례 보고
김종수,이정일,정진명,이선호,한대희,오용석 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.3
We are reporting a case of giant intracranial aneurysm operated under circulatory arrest. The patient was a 36-year-old woman with right hemiparesis and dysarthria. Brain MRI and angiographgy disclosed a patially thrombosed, dumbbell-shaped giant aneurysm involving the left distal ICA and M₁ portion of the MCA. The patient was treated with direct clipping under total circulatory arrest, hypothermia, and barbiturate cerebral protection. The clipping could be done more easily than with conventional methodology because the aneurysm was softened. But the patient didn't recover due to postoperative intracerebral hemorrhage and possible embolic infarct.