11 a. 2012 1 15 26
http://www1.koalanet.ne.jp/anesth_memorandum/sub19.html SpO2 FIO2 Hypoxic Pulmonary Vasoconstriction HPV 30 FIO2 FIO2 PaCO2 20 30 8 10mL/kg I/E CPAP PEEP 27
b. CO2 ( ) SpO2 COPD PETCO2 35mmHg PEEP 28
PETCO2 25 CO2 c. Na Child-Pugh ICG 29
1100 1800ml/ 25 30 30% 70% 70%30% 1.75 1.5 40~50%15~20 1 or 90% (C 75% B 15 ) (PT-INR>1.3 1.4)(Plt 5 ) 2 30
CV 2 CV AOS fentanyl (remifentanil) sbp 80mmHg) ( ) CVP5~6mmHg 12~15mmH2O 6ml/kg 15 PEEP 0 CVP CVP PETCO2 (Lactate Acetate 4 5ml/kg/ Ht 25~30% 0.5ml/kg/ 1.0ml/kg/ Pringle Pringle mpdl1000mg 15 ( CVP 5 CVP d. Mallampati RAE 31
() SpO2 () () 20cmH2O 32
LMS 10 3 e. 12~15% ( 20%) PaCO2 33
PaCO2 (1.2mg/kg) () MEP MEP TIVA MEP TOF 30 volume MEP (NIM EMG ) () 34
CT CT ICU ICU CT CT f. ml/kg/min 7ml/kg 8 10 35
76cm 1L 150cm 1L 8 8 5 3 /6 36
0.5 3 /4 6 / 13 1 0.3 0.5 / 30 1 PEEP PACU SpO2 Caudal block 23G 0.25 1 / 30 45 g. 37
38
Preload Co-loading g T4 T6 //kg. -. - IVPCA 39
h. fentanyl 500mcg 10ml propofol 200mg midazolam 8ml total 10ml - sevoflurane - propofol(cpb )500mg - fentanyl vecuronium bromide 10mg/10ml Ranger 2 CV 2 500ml 2500 A 100cm CV PA 40
5% 250ml/B heparin = 300 /kg= 20ml heparin OPCAB = 300 /kg = 0.3ml/kg AAA ASO = 100 /kg = 0.1ml/kg Stent Graft = 150 /kg = 0.15ml/kg PCPS = 50 /kg = 0.05ml/kg norepinephrine = = 50mcg/ml = 20ml -( ) = 5mcg/ml = 10ml -( ) norepinephrine(1ml/a) 20ml 20 19ml -( ) 10ml 1ml 10 9ml -( ) ephedrine = = 4mg/kg = 10ml phenylephrine = = 0.05mg/kg = 20ml atropine = = = = 1000mg/16ml 6 8 SP-ET100LOSB)(100cm) NTG PVC 2 DOB (100mg/5ml/A) = = 150mg 200mg/50ml = 50ml NAD (1mg/1ml/A) = = 3mg/50ml = 50ml NTG( 5mg/10ml/A) = = 10 15mg (2 3A) = 50ml NTG PVC milrinone ( 10mg/10ml/A) = = 20mg/50ml = 50ml nicorandil( 12mg/V) = = 1mg/ml = 50ml diltiazem( 50mg/V) = = 1mg/ml = 50ml diltiazem 41
ECG = = 5 NIBP = IAP = PAP = (ASD ) CCO, SvO2 CVP = rso2(invos) = BIS = TEE = (NPT, BT) = CVC, PAC(Swan-Ganz CVC ( triple lumens 20cm) PAC ScvO2 PAC 8.0mmID, 7.0mmID) TEE ON TEE TEE CEDV 42
ECG NIBP SpO2 rso2 BISrSO2 20G 20G 22G 5L/min fentanyl 1 2 mcg/kg propofol 1mg/kg midazolam 1 3mg vecuronium br. 0.15mg/kg O2 5L /min sevoflunrane O2 5L /min sevoflunrane O2 5L /min sevoflunrane TEE (7mm) TEE TEE TEE CVC, PAC 43
CVC PAC TEE CVC, PAC PA CVC 13cm CVC PAC TEE PAC CVC CVC CVC middle CVC proximal CVC distal CVP O2/ Air (FIO2 = 1.0 0.5)(ABG, SvO2 FIO2 1.0) sevoflurane FIO2 sevoflurane TIVA propofol 4 6 mg/kg/hr TCI 2.0 4.0 mcg/ml fentanyl vecuronium br. 44
SvO2 PAC PAC ABG, ACT fentanyl 2mcg/kg fentanyl 500 1000mcg CPB Heparin /kg, cc ACT 250 Perfusionist ACT 250 1000mg 100mmHg propofol 2mg/kg loading 35 34 = 5 mg/kg/hr 34 33 = 4 mg/kg/hr 33 = 3 mg/kg/hr vecuronium 6 7mg fentanyl 5 mcg/kg Total flow O2 0.5L/min, APL 45
CPB protamin = heparin (ml) ACT Perfusionist mg 100ml/h 10 1/3 70% ACT ACT Perfusionist 2 3 ACT A. = CABG = A CV CVC = Swan-Ganz TEE = CABG = CABG 2 3 16G A rso2 B. = = + A CV + A TEE = CABG = rso2 = 46
C. Blueline PCPS = + A PCPS TEE = CABG = 50 /kg fentanyl MEP rso2 = = (PCPS) MEP MEP propofol (4mg/kg/hr) remifentanil (0.2 0.3 ) ketamine 1 1.5 mg/kg/hr MEP, sevoflurane fentanyl fentanyl 5%Glu (250ml/B) 47
NAD 5mcg/ml 3mg/ 50ml DOB NTG( 5mg/10ml/A) PVC nicorandil( 12mg/V) hanp (1000mcg/V) 1mcg/50ml 0.02 Ca GI 50% Glu 40ml + R 10 Glu 2g R 1 ECG 5 NIBP IAP 100cm PAP CVP rso2(invos) = BIS = TEE = (NPT, BT) = Ranger 2 CV 3 48
35 37Fr, 32 35 Fr) CPAP spinal drainage spinal drainage 15mmHg MEP spinal ischemia Clamp clamp vessel pool preload nicardipine TEE AR Clamp propofol PCPS FiO2 1.0, PEEP 5 SpO2 declamp NTG off NAD 0.055mcg/ml volume PSVT 0.1mg/kg i. 49
6 rapid sequence 0.5-1.0mEq/L 16 CV 50
Hb 8g/dl 7g/dl T&S 1 20 40 O(+) 5 51