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류시정(Sie Jeong Ryu),한상미(Sang Mi Han),김두식(D 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1
N/A Background: About 75% of terminal cancer patients have severe pain. For the treatment of these patients, physicians usually use potent opioid analgesics. But many of the cancer patients were not controlled by IV or IM injection of opioids. In spite of the untreatable nature of the patient's illness, they should be hospitalized only for pain control. In that case, epidural opioid injection is one of the most effective methods in pain management. Methods: We retrospectively analyzed 126 terminal cancer patients who were treated with epidural morphine for pain management from 1993-97. In the routine procedure, an epidural catheter was inserted into the epidural space and tunnelled subcutaneously, exiting out from the anterior chest or abdomen. Morphine was used as the main analgesic and Multiday Infusor® (Baxter, 0.5 ml/h) as a continuous infusion system, Results: 1. Mean treatment time was 55 days (range; 3-373). 2. Mean daily epidural start mg dose of morphine was 8 mg (range; 2-20). 3. Mean daily dose at termination was 19 mg (range; 4-60) 4. 94 patients were controlled with continuous infusion but 32 patients needed additional bolus doses of morphine. 5. Catheter-associated subcutaneous infection occurred in 2 patients (1.6%). Conclusion: Terminal cancer pain management administered by a tunnelled epidural catheter is a simple, inexpensive method with a very small rate of infection.
증례보고 : 내경정맥 카테터 제거 후 발생한 뇌 공기색전증
유수봉 ( Soo Bong Yu ),류시정 ( Sie Jeong Ryu ),윤상호 ( Sang Ho Yoon ),강효석 ( Hyo Suk Kang ),김두식 ( Doo Sik Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Air embolism can occur during central venous catheter removal. We encountered a patient diagnosed with cerebral air embolism associated with the removal of an internal jugular venous catheter. The patient was 65 years old and was admitted to the intensive care unit due to pneumonia. He had a catheter placed in the right internal jugular vein. Five days thereafter, the catheter was removed in semi-Fowler`s position using the Valsalva maneuver. Immediately after the catheter removal, the patient became pale, felt dyspneic, lost consciousness and exhibited seizure activity. A neurological examination, revealed left upper arm (grade I) and lower leg paralysis (grade II) as well as left facial palsy. A brain computed tomogram showed that, air was trapped in the cavernous sinus. In diffusion weighted magnetic resonance imaging, signal changes were reported in the right frontal cortex, indicating acute cerebral infarction. Hyperbaric oxygen therapy and ventilatory support with synchronized intermittent mandatory ventilation mode was applied. Twenty days thereafter, consciousness and motor functions were recovered completely except for mild weakness of the upper arm (grade IV). (Korean J Anesthesiol 2009;57:673∼7)
Remifentanil과 Lidocaine이 고혈압 환자에서 기관내삽관 시 심혈관계 반응에 미치는 효과
강효석 ( Hyo Suk Kang ),유수봉 ( Soo Bong Yu ),김두식 ( Doo Sik Kim ),류시정 ( Sie Jeong Ryu ),장태호 ( Tae Ho Chang ),김세환 ( Se Hwan Kim ),김경한 ( Kyung Han Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.1
Background: Hypertensive patients are more prone to exhibit an exaggerated hemodynamic responses to laryngoscopy and tracheal intubation. We compared the effects of remifentanil and lidocaine on the cardiovascular responses during intubation in hypertensive patients. Methods: Fifty adult hypertensive patients (>140/90 mmHg) were divided into 2 groups (remifentanil group; 1.0 μg/kg, n=25, lidocaine group; 1.5 mg/kg, n=25). After 3 minutes`oxygenation, anesthesia was induced using 0.2 mg glycopyrrolate, 1.5 mg/kg propofol, and 1 of experimental drugs (30 seconds) bolus administration. Tracheal intubation was facilitated 90 seconds after administration of rocuronium; anesthesia was maintained with 2% sevoflurane and air in oxygen. Arterial blood pressure and heart rate were measured at the following times: resting state (baseline), after oxygenation; before intubation; just after intubation; and at 1, 3, and 5 minutes after intubation. Results: There was significant attenuation of mean systolic and diastolic arterial blood pressures, after intubation of the remifentanil group compared to the lidocaine group at just after intubation and at 1 minute after intubation (P<.05). The difference in heart rate was not significant between both groups. Conclusions: Bolus administration of remifentanil was found to be superior to lidocaine in the attenuation of the blood pressure during intubation in hypertensive patients. (Korean J Anesthesiol 2009; 57: 20~5)
전정맥마취 시 기관 내 삽관에 의한 심혈관계 반응을 최소화하기 위한 Remifentanil과 Propofol TCI의 적정 용량
심민성 ( Min Seong Shim ),김주덕 ( Joo Duk Kim ),최형규 ( Hyung Kyu Choi ),유수봉 ( Soo Bong Yoo ),류시정 ( Sie Jeong Ryu ),김경한 ( Kyung Han Kim ),김세환 ( Se Hwan Kim ),장태호 ( Tae Ho Chang ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.54 No.4
임상연구 : 위아전절제술 후 정맥자가통증조절 시 Butorphanol의 용량별 진통효과
김성택 ( Sung Taek Kim ),김경한 ( Kyung Han Kim ),김세환 ( Se Hwan Kim ),장태호 ( Tae Ho Chang ),류시정 ( Sie Jeong Ryu ),김두식 ( Doo Sik Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2
Background: Butorphanol, a synthetic partial agonist-antagonist narcotic, produces adequate analgesia for postoperative pain. This study was designed to determine the appropriate dosage of butorphanol when administered with ketorolac by intravenous patient controlled analgesia (IV -PCA) after subtotal gastrectomy. Methods: Ninety ASA physical status I or II patients undergoing subtotal gastrectomy were randomly allocated into one of three groups according to type of drug used (n = 30 for each group). The patients were divided into group B6 (butorphanol 6 mg), group Bl0 (butorphanol 10 mg) and group B14 (butorphanol 14 mg). Drugs for each group were mixed with 300 mg of ketorolac and normal saline (total amount: 100 ml) for infusion. Bolus dose, maintenance dose and lockout interval were 0.5 ml per each press, 1 ml/hr and 15 minutes, respectively. In each group, numerical rating scale (NRS) score, sedation score and incidence of side effect were checked. Results: There were no significant differences in analgesic effects and sedation score among three groups but the NRS score of group B14 is lower than that of group B6 (P < 0.05) 3 hrs after the recovery room. Conclusions: We recommend 6 mg butorphanol, mixed with 300 mg of ketorolac, and normal saline for postoperative pain relief using IV-PCA. (Korean J Anesthesiol 2006; 51: 190~4)