결론

Ⅴ Ⅴ.결 론

고혈압환자 혹은 관상동맥우회술이 예정된 환자는 마취유도시 혈역학적 안정성이 절대적으로 필요한 환자이다.앞선 연구에서 광봉을 사용하여 기관삽관 시 혈역학적 변화를 줄이고자 하였으나 직접후두경을 사용한 경우보다 혈역학 적 안정성을 보여주지 못하였다.이번 연구에서도 뇌동맥결찰술이 예정된 환자 에서 기관 삽관시 광봉의 사용은 직접후두경의 사용시와 혈압과 심박수의 변 화에 차이가 없음을 보여주었으며 그 이유는 기관내삽관시 혈압과 맥박의 변화 는 기관삽관 튜브의 직접적인 기도 자극으로 인해 생기는 것이라 할 수 있다.그 러므로 기관내 삽관시 직접적인 기도 자극을 줄여서 혈역학적 안정성을 유지 하기 위해서는 적절한 용량의 약물 사용과 적정농도의 호기말 흡입마취제 농도 를 유지함으로써 혈압과 맥박의 상승을 완화시킬 수 있다고 생각된다.

참

5.Fox EJ,SklarGS,HillCH,VillanuevaR,King BDl:Complicationsrelated to the pressorresponse to endotrachealintubation.Anesthesiology 524-5, 1977

6. Hamill JF, Bedford RF, Weaver DC, Colohan AR: Lidocaine before endotrachealintubation:intravenousorlaryngotracheal?Anesthesiology55:

578-81,1981

Charris H:Endotrachealintubation with a lightwand or a laryngoscope reults in similarhemodynamic variations in patients with coronary artery disease.CanJAnesth50:824-8,2003

10.Morgan GE,MikhailMS,Murray MJ:Clinicalanesthesiology,3rd ed.

McGraw-HillMedicalPublishingDivision,pp.80,2002

11.NishikawaK,KawamataM,NamikiA.Lightwandintubationisassociated with lesshemodynamicchangesthan fiberopticintubation in normotensive, butnotin hypertensive patients overthe age of60.Can J Anesth 48:

1148-54,2001

12. Nishikawa K, Omote K, Kawana S, Namiki A. A comparison of hemodynamic changes after endotrachealintubation using the lightwand device and the laryngoscope in normotensive and hypertensive patients.

AnesthAnalg90:1203-7,2000

13. Russel WJ, Morris RG, Frewin DB, et al: Changes in plasma catecholamine concentrations during endotrachealintubation.BrJAnaesth 53:837,1981

14.SakabeT,MaekawaT,IshikawaT,TakeshitaH:Theeffectsoflidocaine on canine cerebral metabolism and circulation related to the electroencephalogram.Anesthesiology40:433-41,1974

15. Takahashi S, Mizutanui T, Miyabe M, Toyooka H. Hemodynamic responses to tracheal intubation with laryngoscope versus lightwand intubating device(Trachlight)in adultswith normalairway.AnesthAnalg 95:480-4,2002

17.TsementzisSA,HitchcockER:Outcomefrom "rescueclipping"ofruptured intracranialaneurysms during induction of anesthesia and endotracheal intubation.JNeurolNeurosurgPsychia48:160,1985

18.YukiokaH,YoshimotoN,NishimuraK,FujimoriM:Intravenouslidocaine asasuppressantofcoughing during trachealintubation.AnesthAnalg 64:

1189-92,1985

andleadtohypertensionandtachycardia.Thechangesduring intubationmay causea ruptureofcerebralaneurysm and increasetherisk ofsubarachnoid hemorrhage.Itis reported thattrachealintubation with lightwand results in less hemodynamic stimulation compared with direct laryngoscopy. We therefore conducted this study to assess thatthe lightwand technique could resultlesshemodynamicchangesduringintubation.

Twenty six patients undergoing cerebralaneurysm clipping surgery

sodium(3-4mg/kg)followedby vecuronium(0.1-0.15mg/kg).Thelungswere ventilated with 3% isoflurane in oxygen. 1% lidocaine(1 mg/kg) were administered 90 seconds before the intubation.Patients were then intubated witheitherthelightwandorthelaryngoscopewhen endexpiratory isoflurane concentration2vol% andBIS lessthan40.Room lightweredimmedandthe endotrachealtube was introduced into the oralcavity and advanced until midlineillumination wasobserved in theanteriorneck.Systolicand diastolic blood pressures and heartrate were recorded continuously before and after intubationfor5minutes.

Therewerenodifferencesin sex,age,weight,initialbloodpressureand initialheartratebetween thetwo groups.And therewereno differencesin hemodynamicchangesafterintubationbetweenthetwogoups.

We found that, in patients with cerebral aneurysm, a lightwand intubation technique does not reduce the hemodynamic responses when compared to a laryngoscopy. Pharmacologic manipulation and volatile anesthetics might control the changes in blood pressure and heart rate associatedwithtrachealintubation.

Keywords:cerebralaneurysm,trachealintubation,lightwand,