요부 신경질환에서 우측 L5 신경근 차단시 보여진 우측 S1 신경근 차단

김종렬(Jong Lul Kim),윤건중(Keon Jung Yoon),강준구 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.2

Selective lumbosacral radiculography and nerve root block techniques are very useful in determining the nerve root involved. We have done the lumbar root block to 61-year-old female who had suffered from low back pain radiating to right lower leg which was not relieved by epidural steroid injection two times. L5 root block was performed under the fluoroscopic C-arm guide. When the needle was in correct position, we injected contrast medium (lsovist® - 300, Schering, Germany). After we injected 1.5 cc isovist, the S root was figured but L5 root was not figured. When we reinjected 1.5 cc isovist, S1 root was enhanced and L5 root was slightly visible due to severe disc bulging and lateral spinal stenosis.

복합부위통증 증후군 II형 (CRPS Type II) 환자의 치험

윤건중(Keon Jung Yoon),김종렬(Jong Lul Kim) 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

Complex regional pain syndrome Type II(CRPS) can be diagnosed by new IASP criteria in l994. Sympathetically maintained pain may or may not be present in a patient with com- plex regional pain syndrome. We experienced a CRPS Type II patient who has sympathetically maintained pain as a major painful nature developed after right multiple iliac bone fracture right femoral artery thrombosis and lumbosacral plexus injury. Combination treatment with L2, L3, L4 sympathetic ganglion block and continuous lower thoracic epidural block for 30 days were tried to get long term effect. The patient had signs of successful sympathetic denervation of the right foot. After that pain relief was sustained until three month later.

항문 이급후중의 치료에 있어 요부 교감 신경절 차단

윤건중(Keon Jung Yoon),김종렬(Jong Lul Kim),박규호 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.2

Rectal tenesmus is a persistent, painful and ineffectual sensation of straining at stool or opening of the bowels. Lumbar sympathectomy was performed in patient whose main complaint was rectal tenesmoid pain resulting from hemorrhoid operation, and in whom analgesic or psychotropic drugs had failed in controlling the symptom. After chemical lumbar sympathectomy, patient was free from the rectal tenesmoid pain. It is concluded that lumbar sympathectomy is a safe and effective treatment for rectal te- nesmus.

다한증 환자에서 흉강경 하 흉부교감신경 절제술 후 발생한 복합부위 통증 증후군 -1례보고-

권종범,심성보,원용순,박건,이재광,곽문섭,김종렬,윤건중,Kweon, Jong-Bum,Sim, Sung-Bo,Won, Yong-Soon,Park, Kuhn,Lee, Jae-Kwang,Kwack, Moon-Sub,Kim, Jong-Lul,Yoon, Keon-Jung 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.6

Thoracoscopic sympathectomy is a common technique used to treat plamar hyperhiodrosis. The complications of thoracoscopic sympathectomy are rare. Recently, we experienced a complex regional pain syndrome(CRPS) after thoracoscopic sympathecotomy in a patient with hyperhidrosis. The treatment of this complication was chemical epidural sympathetic block and conservative pain control. The result of this treatment was good. The patient was recovered after one month.

선천적으로 후두개가 없는 환자에서의 기관내 삽관

윤건중,김종렬 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.2

A 27-yr old female patient who had a lumbar herniated nucleus pulposus was scheduled to undergo a laminectomy. In the past history, she has suffered from frequent upper respiratory infection and muffled voice. When we tried to intubate the patient for general anesthesia by routine method, we could not find the epiglottis and vocal cord. Fortunately we could intubate sucessfully through the folds were composed of hypertrophied aryepiglottic muscle and arytenoid cartilage between the tongue base and pharynx. In the postoperative period, we made observation of anatomical structure around the vocal cord by fiberoptic laryngoscope. We confirmed a congenital absence of epiglottis, hypertrophy of aryepiglottic fold and arytenoid region, elongated larynx and a large false vocal cord. (Korean J Anesthesiol 1997; 32: 302∼305)

수술시 수혈의 임상적 고찰

최세진,김종렬,강평희 대한마취과학회 1988 Korean Journal of Anesthesiology Vol.21 No.6

Of atotal of 11690 operative cases, 2111 patients who received a transfusion during operation were analyzed statistically at the Department of Anesthesiology, Chung-Nam National University Hospital from January 1985 to December 1987 according to department , sex, preoperative hemoglobin, blood type, operation time and blood component therapy. The results were as follows: 1) The percentage of transfused patients among all operative cases was 18.05 percent. 2)Of all the transfused patients, 477 cases (22.95%) were general surgery cases. 3) Of all the transfused patients, 1187 cases(56.2%) were male. 4) The mean value of hemoglobin measured preoperatively was 10-15g/dl (72.19%). 5) The most frequent cases of transfusion were done in operations requiring 2-3 hours. 6) Blood component therapy was preformed 11 percent in 1985, 26.73 percent in 1986, and 80.72 percent in 1987. The numver of cases receiving blood component therapy has tended to increase year by year.

Aprotinin의 체외순환에 따른 출혈억제효과

이정은,전대근,김종렬 충남대학교 의과대학 지역사회의학연구소 1992 충남의대잡지 Vol.19 No.2

CPB(cardiopulmonary bypass) is a very complex process ad activated many humoral system which include the coagulation system, firbrinolytic system, kallikrein system, and the complement system, are probably all very important and closely interrelated. It has profound effects the number and especially function of platelets because of contact between blood and gaseous or synthetic solid surface during CPB. These changes increase blood loss after cardiac operations and may transfuse a large amounts of banked blood inevitably which may cause very serious complications including hepatitis and AIDS, etc. Aprotinin is a proteolytic enzyme inhibitor and depress the activation of fibrinolytic system via a powerful antiplasmin activity and may preserve von Willebrand platelet interaction. Two groups of patients were prospectively studied to evaluate the hemostatic effects of high dose aporotinin in open heart operation, first group patients(n=10), at the start of anesthesia 2,000,000 kallikrein inactivator units(KIU) of aprotinin was infused over 20 to 30 minutes. Subsequently, 500,000 KIU/h aprotinin was given untill the end of operation. Additionally, 1,000,000 KIU of aprotinin was in the priming solution of the extracorporeal circuit. Second group patients(n=10) served as controls. The results were as follows, 1. The decrease of hemoglobin and serum protein following CPB was reduced significantly(p<0.05) in aprotinin group. 2. The decrease of platelet number and increase of bleeding time following CPB were reduced in aprotinin group. 3. The intraoperative and postoperative blood loss and the amounts of transfusion of banked blood were reduced significantly(p<0.05) in aprotinin group. In the conclusion, we believe that the use of high dose aprotinin decreases blood loss and reduced the need for banked blood in cardiac patients.

Fentanyl 마취유도시 기관내 삽관에 따른 심혈관계 및 혈당치의 변화

최세진,이정은,김종렬 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.1

We selected at random 30 normotensive patients who had received operation under the general anesthesia with intubation at Chungnam national university hospital. They were divided into 3 groups. group I (Control) had received tracheal intubation with thiopental 5mgkg^(-1). (n=10), group II had received tracheal intubation with fentanyl 15 ugkg^(-1). (n=10), group III had received tracheal intubation with fentanyl 15ugkg-1 and diazepam 0.05mgkg-1 (n=10). The changes of systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial blood pressure (MAP), heart rate (HR), and blood sugar were compared in each group. The results were as follows: 1) In group I, endotracheal intubation caused a significant riae in SBP(p$lt;0.01) and blood glucose (p$lt;0.01). 2) In group Il, endotracheal intubation caused a significant rise in SBP (p$lt;0.05) and blood glucose (p$lt;0.01). 3) In group III, endotracheal intubation cauaed little changes in SBP, DBP, MAP, HR and blood glucose.

백서 신경장애성 통증시 c-Fos 유전자 발현에 대한 NMDA 길항제와 교감신경차단 효과

한규철,김상수,이원형,김종렬,임규,황병두,허동식 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.1

Background : Neuropathic pain produced by nerve injury has the characteristics of enhanced pain responses - allodynia. To understand the pathophysiology of the neuropathic pain, We evaluated the effect of NMDA antagonists and chemical sympathectomy on the c-fos mRNA expression. Methods : We have divided rats(Sprague-Dawley, N=24) that their left L5 and L6 nerve were tightly ligated into two groups. In NMDA antagonist group(N=17), We injected 10ug MK801 and 10ug 5-amino-phosphonovalerate in three ways, intrathecally before the ligation, after ligation and subcutaneous continuously. Then behavioral tests for mechanical allodynia and cold allodynia were performed. After the test of allodynia,the expression of c-fos were assessed by Northern blot hybridization. In chemical sympathectomy group(N=7), We injected 70 mg/kg guanethidine into the peritoneum in two ways, before the ligation and after ligation. Then same methods were performed in NMDA antagonist group as well. Results : Intrathecal NMDA antagonists before the ligation supressed the elevation of c-fos mRNA expression. Intrathecal NMDA antagonists on the 7 days after the ligation reduced the c-fos mRNA expression and neuropathic pain. Continuous treatment of subcutaneous NMDA antagonists supressed the development of neuropathic pain and the elevation of c-fos mRNA expression. Chemical sympathectomy before the ligation did not supress the elevation of c-fos mRNA expression. Chemical sympathectomy on the 7 days after the ligation reduced neuropathic pain and the elevation of c-fos mRNA expression. Conclusions : NMDA receptor is related to the induction and maitenance of neuropatic pain, and sympathetic nervous system has a main role in the already induced neuropathic pain. (Korean J Anesthesiol 1998; 35: 29∼39)

상박신경총 차단을 위한 Parascalene Technique(전사각근 측부접근법)의 임상고찰

이명우,김경희,박규호,강준구,윤건중,김종렬,임정혁,한원희 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.5

Background : Brachial plexus is invested by a fascial envelope, which forms a perineural and perivascular space that extends all the way from the cervical intervertebral foramen to the distal axilla. Therefore a single injection of a local anesthetic into any sites of this space can provide anesthesia of the entire brachial plexus. Nowadays many methods of brachial plexus block have been developed but there are some severe complications and they can't prevent tourniquet pain completely. Methods : We have performed parascalene technique for brachial plexus block in 206 cases from Jan., 1992 to Dec.,1994. We studied the cases retrospectively by reviewing patients' anesthesia records. The technique for parascalene block is the injection of local anesthetic solution into the lower part of the posterior triangle of the neck at the point 1.5∼2.0 cm above the clavicle at the lateral border of the anterior scalene muscle. Results : We could provide the proper anesthesia for the upper extremity and shoulder operationwithout any remarkable complications except Honor's syndrome of 3 cases. And there were no tourniquet pain in all 96 cases who had used tourniquet. Conclusions : The parascalene approach is the useful, safe and reliable method for brachial plexus block. (Korean J Anesthesiol 1997; 32: 782∼786)