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제왕절개술후 통증치료를 위한 지속적 경막외 Morphine-Bupivacaine 주입법과 정맥내 Nalbuphine 주입법의 진통효과와 부작용의 비교
백금철(Keum Cheol Paek),김상현(Sang Hyun Kim),김기 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2
N/A Background: Various pain treatments have been administered to relieve patients suffering from postoperative pain. Among these, epidural or intravenous opiate administration is by far the most widly applied treatmeat in recent times. However it was our objective to device a more effective and safe means of postoperative analgesia. Methods: We studied 110 healthy pregnant women scheduled for delivery by elective cesarean section. EPI(epidural)-group is administered morphine 1.5 mg and 0.25% bupivacaine 8 ml as bolus dose, then, a mixture of marphine 6 mg and 0.125% bupivacaine 95 ml as continuous dose via epidural route. IV(intravenous)-group is administered nalbuphine 6-7 mg as bolus dose and nalbuphine 60-70 mg with 0.9% normal saline 90 ml as continuous dose via intravenous route, at the rate of 2 ml/hr for 2 days. We compared the analgesic efficacy and side effects of these two groups using VAS pain score and time duration of constant pain level. Results: VAS pain score was similar between the two groups, but pain duration was significantly shorter in EPI-group. Incidence of pruritus was significantly lower with the IV-group, of nausea and vomiting were similar for both groups, no respiratory depression for either groups. Conclusions: Although the EPI-group had better analgesic efficacy, the IV-group had lower incidence of side effects, and simplicity and safety methods of operation. Therefore, We propose further research and consideration of administering the kinds and doses of those medications prescribe to the IV group in conjunction with other drugs for safer and better efficacy of postoperative analgesia.
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양홍석,백금철,김상현 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.6
Background : Endotracheal intubation is accomplished for safe airway establishment, anaesthesia and operation in operating room, intensive care unit and emergency room mostly. Therefore, it will be beneficial that we predict and provide against difficult airway. With this view, our study was planned and carried out. Methods : For 251 patients with ASA physical status I or II undergoing general aneathesia, the correlation between their age, sex, height, weight, BMI(body mass index), Samsoon & Young classification and laryngoscopic grades by Cormack & Lehane was investigated. Results: Laryngoscopic grades were correlated significantly with patients' age and Samsoon & Young classification. Endotracheal intubation succeeded all, but, 8 patients(3.2%) were difficultly intubated with cricoid cartilage compression and stylet-using. Conclusions: Before intubating the trachea, it is desirable that patient' age, Samsoon & Young classification and the extent of neck's movement are assessed. (Korean J Anesthesiol 1997; 33: 1049∼1053)
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김상현,김기성,강순호,백금철 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.1
A 35 years old female patient was admitted to our neuro-pain clinic with symptoms of low back pain(L4, L5 level) radiated to both lower(L3, L4, L5 level) extremities that developed 6 years prior to admission. Upon initial physical examination, motor weakness or sensory deficit was absent. But on straight leg raising test, it was restricted to 60 degree in both lower extremities. Low back pain and radiating pain improved significantly after we performed epidural steroid injection. However on the next day of procedure the patient complaints more pain and started to experience severe pain during overnight for 3 days. On computer tomography(CT, L3-S1 level), we find suspicious lesion of herniated nucleus pulposus at L5-S1. Otherwise were within normal limits. Based on these symptoms, to find the other lesions, subsequently magnetic resonance imaging(MRI) was performed. Spinal tumor was seen at L2-3 level(2 2 4 cm). Neurosurgical surgery was recommended, and operation was performed. The patient was diagnosed to ependymoma after excision and cytologic studies. Even if one lesion was diagnosed, it must be put off until any other diseases or underlying cancer are ruled out. We report a patient with spinal cord tumor missed on CT, but revealed on MRI in the evaluation and management of herniated nucleus pulposus related(L5-S1) low back pain. (Korean J Anesthesiol 1997; 32: 144∼148)
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컴퓨터 단층촬영을 이용한 상부기도의 해부학적 측정에 관한 연구
김상현,김영대,강순호,백금철 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 obtained in 71% of the patients but the response was poor in the remaining 28% of the patients. It seems that the earlier the patients were referred to the pain clinic, the better the results were.
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