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상복부 수술후 진통을 위한 경막외 Buprenorphine의 효과
신감진(Kam Jin Shin),최 훈(Huhn Choe),한영진(Young 대한통증학회 1993 The Korean Journal of Pain Vol.6 No.2
N/A The use of buprenorphine by epidural route in the prevention of postoperative pain has been controversial. High lipid solubility of buprenorphine caused the same parenteral/epidural anal- gesic dose ratio, and the analgesic effect of epidural buprenorphine possibly due to systemic absorption, which revealed no advantages of epidural administration against parenteral injec- tion. On the contrary, epidural buprenorphine had longer duration of action and fewer side ef- fects than parenteral buprenorphine, which advocated the epidural use of buprenorphine. We studied the efficacy of epidural buprenorphine by comparing epidural buprenorphine with epi- dural morphine in terms of latency and the duration of analgesic action, and the incidence of side effects. 0.15mg and 0.3mg of epidural buprenorphine had shorter latency than 2mg of morphine. 0.3 mg of buprenorphine had longer duration of action than 4 mg of morphine. The incidence of nausea and vomiting were slightely higher in buprenorphine group than in mor- phine group. Voiding difficulty and pruritus were little in buprenorphine group, while the inci- dence of somnolence was markedly higher in buprenorphine group. Form our results we con- clude that epidural buprenorphine may be useful in the treatment of postoperative pain, and but recognize both advantages and disadvantages as compared epidural morphine.
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Epinephrine 과 Clonidine 에 의한 T-Cain 척수마취의 연장 효과
송희선,한영진,이상귀,최현규,신감진 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.3
Vasoconstrictors such as epinephrine or phenylephrine have been used as an adjunct to local anesthetics to prolong the duration of spinal anesthesia. Recently, clonidine, an areceptor agonist, has been proved to have analgesic effect and to prolong epidural and spinal anesthesia. We used 0.3mg of epinephrine, 75 μg and 150 μg of clonidine in spinal anesthesia with 12 mg of T-Cain respectively and compared hemodynamic and analgesic effects of each drug. Heart rate and blood pressure were checked before, during and after anesthesia. Sensory level was checked by pin-prick method and motor blockade was measured by Bromages scale. The results were as follows. 1) Heart rate changed little in the epinephrine group and decreased significantly in all other groups. 2) Systolic blood pressure decreased significantly in all groups except the epinephrine group. Both 75 μg and 150 μg of clonidine caused a significant fall in diastolic pressure. 3) The onset time for sensory and motor blockade varied little among all gro 4) Sensory blockade was significantly higher in the 150 μg of clonidine group than the control group. Time to achieve the maximum level of sensory blockade was significantly faster in control group than 150 μg of clonidine group. 5) The duration of sensory and motor blockade was significantly prolonged in epinephrine and clonidine group than control group. The results indicate that clonidine, when used as an adjunct to T-Cain spinal anesthesia, is as effective as epinephrine in prolongation of motor and sensory blockade.
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송희선,이상귀,윤용주,홍기환,최현규,신감진,권삼현 대한마취과학회 1991 Korean Journal of Anesthesiology Vol.24 No.6
N₂O can diffuse in and/or out the middle ear cavities and it may alter the middle ear pres-sure. This study was performed to investigate the effect of N₂O discontinuation on the changes in middle ear pressure during general endotracheal anesthesia. We measured middle ear pres-sures and end-tidal NO concentrations at preanesthesia, immediately after N₂O discontinuation and then at every five minutes for 60 minutes under either halothane or enflurane an- esthesia in two groups(group 1=50% administration of N₂O in O₂; group 2=60% administration of N₂O in O₂). The middle ear pressures after N₂O discontinuation decreased slowly but they did not returned to the preanesthetic value in both groups. The end-tidal N₂O concentrations decreased rapidly until five minutes and then they decresed slowly to the zero leve1 until 30 minutes after N₂O discontinuation in both groups. The expected time of the middle ear pres-sure of preanesthesia value was 89.4 minutes in group 1 and 80.9 minutes in group 2 respectively. The middle ear pressure do not return to the level of preanesthesia at 60 minutes after N₂O discontinuation while the end-tidal N₂O concentration decrease to the zero level via 30 minutes after its discontinuation. Thus it is recommended that N₂O administration should be discontinued at least 30 minutes before an application of tympanic membrane patch on the ear drum and N₂O is carefully administered in patients with middle ear and/or upper airway disesses.
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