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상박신경총 차단에 있어서 Bupivacaine 의 용량 변화에 따른 임상적 고찰
김영대,이홍식,김필곤,엄인호,신건선 대한마취과학회 1989 Korean Journal of Anesthesiology Vol.22 No.4
Brachial plexus block is frequently used for surgery on the upper extremity. Unsuccessful brachial plexus block is usually caused either by injection outside the neurovascular sheath or by incomplete blockade inspite of injection within the neurovascular sheath. Studied by Winnie and Collines suggested that the extent of blockade following injection in the sheath surrounding the brachial plexus also should be directly proportional to the volume of local anesthetic injected. We therefore investigated the extent of blockade using different volume of bupivacaine with supraclavicular approach. The results were as follows. 1) Complete analgesia was observed between the group of 15 ml and 30 ml. 2) The interval of complaint of pain after a single injection ranged from 14.3 to 16.4 hours. Insignifi-cant difference was found between the group of 15 ml and 30 ml (p$gt; 0.1) 3) There was no hematoma, shivering, but there was Horner's syndrome in 13, phrenic N.paralysis in 2, pneumothorax in 1 cases. No general seizure or other side effects were observed. Therefore we come to the conclusion that above the volume of 15 ml is sufficient to brachial plexus block with supraclavicular approach.
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방광종양 생검을 위한 경뇨도방광경술 도중 발견한 갈색세포종 증례
이현숙,문숙희,신정순,신건선 대한마취과학회 1980 Korean Journal of Anesthesiology Vol.13 No.2
Unsuspected pheochromocytoma in a surgical patients may lead to serial complications. These include extreme hypertension, taehycardia and cardiac arrythmias which lead to cardiac arrest, cerebrovascular accident and renal failure in the postoperative period. Pheochromocytoma arising in the urinary bladder is a rare tumor. We recently experienced a case of pheochromocytoma which was found during transurethral resection for biopsy of bladder tumor under spinal anesthesia. The blood pressure suddenly rose during resection. of the tumor. It was difficult to arrive at a correct diagnosis in this case because of the predominant bladder symptams without hypertenaive attack. Therefore, final diagnosis was made as the pheochromocytoms after histological examination. The resection of the tumor was performed under general anesthesia after careful studies. The patient was not treated during the preoperative period as she had no particular symptoms, but Regitine was glven during surgery. Regitine was used twice to control the transient hypertension during manipulation of the tumor. After removal of the tumor, the blood pressure was well regulated without vasopressor drugs. We report a case of pheochromocytoma of urinary bladder with successful anesthesia management and the use of neuroleptanesthetics.
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이현숙,신정순,안동애,신건선 대한마취과학회 1979 Korean Journal of Anesthesiology Vol.12 No.3
This report concerns a child who developed left ; Iung collapse during induction of anesthesia for suture ligation of patent ductus arteriosus. Acute massive collapse of a lobe, a whole lung or even both lungs in the space of a few minutes without apparent cause is said to be a rare elinical entity. Clinically this condition is msnifested by difficulty in breathing or in inflation of the lung. On auscultation, there may be rhonchi or no sound of any air entry into the lung. If unrelieved, this condition will progress, with hypoxia and cardiac arrest. $quot; We observed that the affected lung expanded during inflation with very high pressure ventilation, and then the collapsed lung was smoothly inflated after suture ligation of patent ductua arteriosus without any speeific management. It appears that the develpment of lung collapse is not through the wrong choice of agents or technics of anesthesia,but from failure to appreciate the hemodynamics of ductus arteriosus or unknown factors. We could not find a definite mechanism of lung collapse, but there are contributing factors including compression of a main brobchus, bronchial secretion, decrease of surfactant and others. The operation was successful and she recovered satisfactorily.
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