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민진혜 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.4
Postoperative pain is under-treated, and especially postcraniotomy pain is under-treated due to the fear of missing postoperative neurologic complications, and the fear of increased intracranial pressure secondary to elevated arterial carbon dioxide tension caused by respiratory depression. However, it continues to be commonly observed, is frequently severe, and if unrelieved, it may cause distress for the neurosurgical patients and serious complications in the operated brains. Many contributing factors affect postcraniotomy pain, including anatomical, surgical, anesthetic, and patient related factors. Diverse modalities are used for relieving the pain such as certain surgical techniques, nerve and scalp blocks with local anesthetics, many drugs – nonsteroidal anti-inflammatory drugs, gabapentinoids, N-methyl-D-aspartate antagonists, and opioids, but individually none of these modalities have been proved to be the best and universally applicable. For proper treatment and management of postcraniotomy pain, it is necessary to have a patient oriented, evidence-based, well-organized guideline for neuroanesthesiologists, neurosurgeons, and postcraniotomy patients.
민진혜,강유진 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.4
Pheochromocytoma is an unusual tumor in pediatric age group and there are several different aspects from adult counterparts. Children have fewer malignant, more extra-adrenal, and greater bilaterality and multiplicity of tumor. We present a case of 14-year old boy with pheochromocytoma who has symptoms such as episodic headaches, vomiting, seizure and paroxysmal hypertension which is less common in children. Although the duration of preoperative preparation was not long enough, we decided to remove the tumor because symptoms were disappeared rather rapidly after alpha and beta adrenergic blocker treatment. The patient was managed with continuous epidural block and light general anesthesia but extra use of adrenergic receptor blocker and vasodilator were demanded during tumor manipulation. The patient has remained well postoperatively but long-term follow up is essential because of the possibilities of recurrence. (Korean J Anesthesiol 1999; 37: 721∼725)
The correlation between the Trendelenburg position and the stroke volume variation
민진혜,이상은,이홍식,채영근,이용경,강유,제의진 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.6
Background: The stroke volume variation (SVV), based on lung-heart interaction during mechanical ventilation, is auseful dynamic parameter for fluid responsiveness. However, it is affected by many factors. The aim of this study was toevaluate the effects of SVV on Trendelenburg (T) and reverse Trendelenburg (RT) position and to further elaborate onthe patterns of the SVV with position. Methods: Forty-two patients undergoing elective surgery were enrolled in this study. Fifteen minutes after standardizedinduction of anesthesia with propofol, fentanyl, and rocuronium with volume controlled ventilation (tidal volume of8 ml/kg of ideal body weight, inspiration : expiration ratio of 1 : 2, and respiratory rate of 10-13 breaths/min), the patientsunderwent posture changes as follows: supine, T position at slopes of operating table of -5o, -10o, and -15o, andRT position at slopes of operating table of 5o, 10o, and 15o. At each point, SVV, cardiac output (CO), peak airway pressure(PAP), mean blood pressure, and heart rate (HR) were recorded. Results: The SVV was significant decreased with decreased slopes of operating table in T position, and increased withincreased slopes of operating table in RT position (P = 0.000). Schematically, it was increased by 1% when the slope ofoperating table was increased by 5o. But, the CO and PAP were significant increased with decreased slopes of operatingtable in T position, and decreased with increased slopes of operating table in RT position (P = 0.045, 0.027). Conclusions: SVV is subjected to the posture, and we should take these findings into account on reading SVV for fluidtherapy.
천주 차단 (Tienchu block)을 이용한 후두통치료
정창우,민진혜 關東大學校醫科大學醫科學硏究所 1998 關東醫大學術誌 Vol.2 No.1
The occipital neuralgia starts with dull pain or stiffness of the posterior neck and occipital headache. When advanced, occipital neuralgia, eye general muscle and pain, contraction headache follow. It is frequently seen in pain clinic practice, either as an independent pbenomenon cause by fatigue or as the reffered symptom of other diseases. Tienchu is accupoint B-10 on the bladder meridian. It is situated at the depression adjacent to the upper lateral border of the trapezius muscle. The Tienchu syndrome is a myofasial condition of the posterior neck region with a trigger point. Therefore, a Tienchu block with local anesthetic is a most effective therapeutic method for many patients who complain of posterior headache or posterior neck pain.
증례보고 : 자발성 두개내 저압 환자에서 전산화 단층촬영 유도하에 시행된 경추 경막외 혈액봉합술에 의한 치료
민진혜 ( Jin Hye Min ),최영순 ( Young Soon Choi ),김용호 ( Yong Ho Kim ),이우경 ( Woo Kyung Lee ),이용경 ( Yong Kyung Lee ),채홍석 ( Hong Seok Chai ),채영근 ( Young Keun Chae ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Spontaneous intracranial hypotension due to spinal cerebrospinal fluid leakage is uncommon, relatively benign and usually self-limiting. However it is being increasingly recognized as a cause of postural headaches. The treatment options range from conservative supportive measures to an pidural blood patch. We report a 40-year-old woman who developed intracranial hypotention without any preceding events such as lumbar puncture, back trauma, surgical procedures or medical illnesses. The site of the cerebrospinal fluid leakage was identified at between the C1 to C2 level using computerized tomographic myelography. Consequently, the patient underwent a CT-guided autologous epidural blood patch at the C3-C4 level. Her symptoms were relieved immediately without recurrence. (Korean J Anesthesiol 2007; 52: 115~8)
척추수술환자에서 급성 동량성 혈액희석 및 유도저혈압을 병용한 마취관리
이규탁,민진혜,정창우 관동대학교 의과학연구소 2000 關東醫大學術誌 Vol.4 No.1
Due to the discovery that blood transfusion can evoked several side effects, there has been increased interest in technologies that reduce the amount of homologous blood used during and after surgery. Acute normovolemic hemodilution is known as a convinient and effective blood conservation method, and drug-induced hypotension can reduce the amount of intraoperative bleeding with better operative field. Combination of these two techniques was suggested to reduce homologous blood requirements in various surgeries. Therefore, to minimize homologous blood transfusion, we conducted general anesthesia using acute normovolemic hemodilution combined with induced hypotension in patient undergoing spinal fusion surgery. We think that the routine careful combination of these techniques can be carried out safely in many surgeries.