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小兒吸入麻醉時 Dead Space의 管理

중앙의학 1970년 18권 3호 p.205 ~ 207
김성열,
소속 상세정보
김성열 (  ) - 고려병원 마취과

Abstract


The hemodynamic changes along with the postoperative courses were observed in twelve dogs after replacement of homografts and crimped nylon prosthesis to the thoracic aorta employing polyethylene shunt.
The homografts lost its size in diameter on preservation in formalin and the animals with these grafts died from cardiac failure shortly after operation without full recovery from anesthesia. And, with the homografts preserved in the same solution on a large rubber tube to keep their lumen large, a pressure gradient across the graft was minimal and a case out of three dogs is living well at the present report over sixty days after the replacement. All the three animals with the alcohol preserved homografts died within twenty four hours from cardiac failure and the grafts were found occluded with thrombosis in all cases on autopsy. The nylon prostheses revealed nearly as good hemodynamics as the same sized and formalin preserved homografts, and two out of three dogs had empyema on postmortem examination and paralysis of hindquarters was observed in a case of these two.
Generally, the systolic pressure gradient across the graft preceded the diastolic pressure and this observation appeared important as the early indication of the decreased blood flow into the distal aorta. And it was mentioned that the direct change in hemodynamics is best observed from the aortic pressure recodings across the graft. The polyethylene shunt with inside diameter of over three millimeter appeared feasible to maintain sufficient blood flow without significant elevation of proximal aortic pressure during temporary occlusion of the descending aorta in dogs in spite of a significant pressure drop to the distal aorta.

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