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낮은 혈장 Cholinesterase 활성치를 가진 산모에서 제왕절개술 후 발생한 지연성 무호흡
류지한,태일산,심규호,전병돈,이신우 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.4
Succinylcholine-induced prolonged neuromuscular blockade may occur in patients with either a low level of plasma cholinesterase activity or genotypically abnormal form of that enzyme. We experienced a case of succinylcholine-induced prolonged apnea due to a low level of plasma cholinesterase activity. A 31-year-old woman, full term primigravida, underwent cesarean section for breech presentation under general anesthesia. Familial and past medical history were nonspecific and preoperative physical and laboratory findings were within normal range. After operation, delayed apnea was detected and lasted for about one hour. We performed controlled and assisted ventilation for two and half hours. Plasma cholinesterase activity measured 30.00 IU/L(colorimetric method, normal value: 1130∼1960 IU/L) at the first postoperative day. She was discharged on 7th postoperative day without any sequelae. From follow-up study after six months, it measured 1.02 U/ml(EIA, normal value: 7∼9 U/ml). (Korean J Anesthesiol 1997; 33:84∼787)
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지속적 액와부 상완신경총 차단술 - I. 카테테르 삽입방법의 변형 -
이후전(Hoo Jeon Lee),태일산(Il San tae) 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2
N/A Background: Authors modified the traditional continuous axillary brachial plexus block technique of Selander for purpose of increasing success rate and decreasing complications by use of commercial epidural anesthesia set. Method: Thirty-nine patients scheduled for upper extremity operations were injected with 40 ml of anesthetic solution by axillary perivascular technique, using 23-25G immobile needle at 2 cm from the pectoralis major. Tuohy needle was immediately introduced at 4 cm from the pectoralis major and pierced the expanded neurovascular sheath at an angle of 30 degree to the skin. The pop was well noted. Needle was advanced 0.5 to 3.0 cm and epidural catheter introduced through the needle. After removal of needle, occlusive dressing was done. Tip of catheter and spread of solution were demonstrated by fluoroscopy with contrast dye after completion of procedure. Result: Catheter insertion was successful at first attempt for all case. Total length of insertion was from 6 to 13(10.0+1.7) cm. Tip of catheter was placed in infraclavicular space(66.7%), about the humeral head(17.9%) and in upper arm in 3 cases as U-shape(7.9%). Catheters were maintained for 6.7+ 2.6(3-12) days. There were no complications such as: perforation of major vessels, needle trauma to nerve, infection, bleeding or hematoma. Conclusion: This study demonstrated continuous axillary brachial plexus block with epidural anesthesia set is safe, easy and convenient modification of technique of Selander.
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성상신경절 차단술과 상완신경총 차단술의 상지 피부온에 미치는 영향
심규호(Kyu Ho Sim),태일산(Il San tae),류지환(Ji Ha 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2
N/A Background: In our hospital, stellate ganglion block(SGB) has been performed for the prevention and treatment of vasospasm after microscopic reimplantation of finger(s). If brachial plexus blcok(BPB) has the same effect of sympathetic block on the upper extrem- ity as SGB, it may be preferable to the SGB because it povides postoperative analgesia and is administered continuously. So we measured and compared the change of skin temperature on the forearm as the parameter of sympathetic blockade after SGB and BPB. Methods: The forty-two patients, belonged to ASA class 1-2, were received BPB for hand surgery. The skin temperature was measured before and after BPB on the forearm with patient monitor(LN 6199, YSI 400 Series Temperature Probe, Hellige, Germany). After 24 hours, ipsilateral SGB was performed and skin temperature was recorded before and after SGB. Results: The increase of skin temperature after procedures was 1.1±0.5℃(from 34.5±0.7℃ to 35.6±0.5℃) in BPB and 0.6±0.3℃ (from 34.9±0.5℃ to 35.5±0.5℃) in SGB. The changes of skin temperature in both blocks were statistically significant(p<0.01), and the skin temper- atures after each procedure were revealed no significant difference(p=0.62). Conclusion: We thought that BPB produced sympathetic blockade on the upper extremi- ty as much as SGB. Moreover, it provides postoperative pain relief and may be employed as continuous method. So we suggest that continuous BPB could be used for hand surgery with many advantages.
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0.5% 고비중 Bupivacaine 과 Tetracaine을 사용한 척추 마취의 비교
이후전,류지한,심규호,전병돈,이신우,태일산 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.1
Several methods for the management of intractable pain for various conditions including malignant disorders, herpes zoster, and low back pain and/or sciatica in 80 patients were described and analyzed. Neurolytic blocks of celiac plexus were given to the patients suffering from intra-abdominal pain from malignant origin or chronic pancreatitis. Herpes zoster was treated mainly by chemical sympathectomy via paravertebral route and occassionaly corticosteroid was administered epidurally with the local anesthetic, bupivacaine. All the patients with low back pain and/or sciatica were given epidural corticosteroid one to three times. Other peripheral verve blocks and regional corticosteroid therapy were given to the rest of the patients. Fair to excellent result was obtainde in 71% of the patients but the response was poor in the remaining 28% of the patients. It seems that earlier the patients were referred to the pain clinic, the better the results were.
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