뇌동맥류 수술시 halothane 저혈압 마취에 대한 임상적 고찰

Abstract

[한글]

Halothane 마취에 의한 인위적인 저혈압법이 비교적 안전하다는 것은 Murtagh(1960) 및 Schettini등 (1967)에 의해 보고되었다. Holothane은 심근 억제작용, 중추성 자율신경 억제, 신경절 차단 작용, norepinephrine에 대한 말초반응의 감소, 및 혈관벽에 대한 직접적인 확장작용등으로 혈압을 하강시킨다. Halothane에 의한 저혈압마취는 심근억제작용, 부정맥발생등의 위험성이 있지만 평균 동맥압을 서서히 내리고 (1-3 mmHg/min) 심전도상에 일시적인 영향외에 뇌의 중추성 기능을 최소로 억제시킨다고 보고하고 있다. 저자즌 1972년 6월부터 1977년 12월 사이에 시행한 뇌동맥류 수술을 위한 halothane 저혈압마취 100예를 관찰한 결과 다음과 같은 결론을 얻을 수 있었다.

1. 뇌동맥류 발생부위는 전대뇌동맥 37예, 내경동맥 35예, 중대뇌동맥 23예, 후대뇌동맥 2예 순이었다. 그리고 다발성 뇌동맥류도 3예 있었다.

2. 저혈압기의 수축기 혈압은 평균 73.45mmHg±0.89이고 확장기 혈압은 평균 54.95mmHg±0.86이며 저혈압 기간은 평균 34.74분±1.60였다.

3. Halothane에 의한 혈압의 조절은 비교적 용이하였으며 임상적으로 뇌, 심장, 신장 및 간장에 대한 직접적인 손상은 찾아 볼 수 없었다.

4. 뇌동맥류 100예의 사망률은 16%였다.

이상과 같은 임상관찰을 통해서 볼 때 halothane 저혈압 마취법은 뇌동맥류 수술시에 이용될 수 있는 한 유용한 마취방법 이라고 사료된다.

[영문]

For lesion like intracranial aneurysms which are located near highly vascularized regions, adequate dissection becomes almost impossible unless local blood flow can be reduced.

Deliberate hypotension, purposefully lowering the arterial pressure to a level at which bleeding is no longer a problem, facilitates surgery, allows performance of a better dissection, and shortens the length of the procedure. Currently, the most

useful method for induced hypotensive anesthesia is the use of chemical drugs, such as trimethaphan, nitroprusside and halothane. Induced hypotension with halothane has been reported to be relatively safe and useful method by Murtaugh (1960) and

Schettini, et al (1967). Halothane has the effect of depression of myocaridal contractility, central autonomic inhibition, ganglionic blocking action and suppression of the peripheral actions of norepinephrine and direct vasodilation on the vesssel wall. The advantage of halothane is the reduction of mean arterial presure slowly (1-3mmHg/min) and it has transient effect on EKG, little effect on brain cortical function and appropriate oxygen supply to brain tissue.

The halothane induced hypotension in 100 cases of intracranial aneurysm surgery, which were performed at Severance Hospital of the Yonsei University Medical college from 1972 to 1977, was investigated clinically.

The results of our study were as follows:

1. The locations of intracranial aneurysm in order were the anterior cerebral artery (37 cases), internal carotid artery (35 cases), middle cerebral artery (23 cases) and posterior cerebral artery (2 cases). Three cases of multiple cerebral aneurysm were found in our study.

2. In the hypotensive phase, the mean systolic and diastolic pressures were 73.45 mmHg±0.80, 54.95mmHg±0.86 and the mean duration was 34.74 min±1.60.

3. The blood pressure controlled by halothane, was comparatively easy and there was no clinical evidence of direct injury to the brain, heart, kidney and liver due to halothane induced hypotension.

4. The mortality rate in the 100 cases of the intracranial aneurysm was 16 percent.

From the above observation it may be concluded that the technique of deliberate hypotension induced by halothane anesthesia is a useful method in the surgery of intracranial aneurysm.