Sodium Nitroprusside를 이용한 뇌동맥류수술의 마취경험

Abstract

This report is concerned with our clinical experience of 74 cases of anesthesia using sodium nitroprusside for cerebral aneurysm clipping at the Dong San Medical Center during the last two years.

Halothane was used as a main anesthetic agent and blood pressure was easily controlled by the combination of halothane anesthesia and sodium nitroprusside dripping during the clipping period.

Arterial cannulations were carried out mainly in femoral arteries to observe continuous MAP throughout the operation time, and CVP catheterizations were performed in an approach of right supraclavicular puncture method to monitor circulating volume. Intermittent blood samples were taken from the arterial cannulations for blood gas analysis to maintain PC02 between 25 to 30mmHg by hyperventilation. Additionally, spinal catheters were inserted into the lumbar subarachnoid space to drain CSF constantly to lower the intracranial pressure.

Mannitol and Jasix were injected intravenously at 30 minutes before opening dura mater for osmotic diuresis and tissue dehydration.

SNP를 使用한 低血壓麻醉下에 手術을 받은 腦動脈瘤 74例를 경험하고 다음과 같은 知見을 얻었다. 1) 主麻醉劑는 할로탄과 N₂O로 하였으며 SNP로 低血壓을 誘導하여 容易하게 血壓을 調節할 수 있었다. 2) 持續的 動脈壓測定을 위하여 카데터를 大腿動脈에 据置하였고, 이것은 患者의 순환상태를 감시하는데 편리하였다. 3) 大腿動脈카데터를 通하여 간헐적으로 血液가스分析을 실시하여 PCO₂가 25~30torr되도록 分時呼吸量을 調節하였다. 4) 麻醉科醫師에 依해 척수강내 카데터를 삽입함으로써 뇌척수액의 排出이 容易하여 腦壓調節에 도움이 되었다. 5) mannitol과 lasix는 硬膜切開 30分 前에 靜注하였는데 이의 投與時刻은 좀 더 일찍 靜注하여 脈管內容量을 감소케 함이 바람직하다고 생각되었다.