경추성 두통 환자에서 제3 후두신경의 양극탐침을 이용한 박동성 고주파 신경차단술

이숙영 ( Suk Young Lee ),심우석 ( Woo Seog Sim ),이상민 ( Sang Min Lee ),장인영 ( In Young Chang ) 대한통증학회 2008 The Korean Journal of Pain Vol.21 No.2

다한증 환자에서 양극탐침을 이용한 허리교감신경의 고주파열응고술 - 증례 보고 -

이지현 ( Ji Hyun Lee ),김대원 ( Dae Won Kim ),심우석 ( Woo Seog Sim ) 대한통증학회 2005 The Korean Journal of Pain Vol.18 No.1

난치성 흉통 환자에서 발견된 양성 및 악성 종양

권민아 ( Min Ah Kwon ),박정헌 ( Jeong Heon Park ),유래근 ( Rea Geun Yoo ),김태형 ( Tae Hyung Kim ),심우석 ( Woo Seog Sim ) 대한통증학회 2005 The Korean Journal of Pain Vol.18 No.2

경막외 마취하 제왕절개술시 술중 경막외 모르핀의 투여가 술후 정맥내 자가통증조절(IV-PCA)에 미치는 영향

최덕환,김지애,심우석 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.1

Background : Intravenous patient-controlled analgesia (IV-PCA) has been widely used for pain relief after cesarean delivery under epidural anesthesia. However, IV-PCA alone has a limited effect on early postoperative pain relief. Epidural morphine injected intraoperatively could alleviate the early post-cesarean pain. We evaluated the effects and side effects of intraoperative epidural mo17hine on post-operative IV-PCA. Methods : Forty patients scheduled for cesarean section under epidural anesthesia were randomly assigned to one of two groups. The patients in the intravenous group (IV group, n=20) received intra-venous morphine 3-5 mg after the operation in the recovery room when patients complain of pain, and the patients in the epidural group (EPI group, n = 20) received intraoperative epidural morphine 3 mg afrer fetus delivery. After that, both groups received morphine IV-PCA (no basal infusion, bolus 1.0 mg, lock-out time 6 min). Analgesic efficacy, degree of patient satisfaction, drug consumption and side effects were compared at 4 and 24 hours after surgery. Results : The EPI group had significantly lower VAS for pain at 4h after surgery on movement and resting than the IV group, whereas no significant difference was observed at 24h after surgery. The cumulative morphine consumptions at 4h and 24h after surgery were more in the IV group (each, p $lt; 0.001). Fewer patients in the EPI group had drowsiness at 24h after surgery, but there were no significant differences in other side effects and degree of satisfaction between the two groups. Conclusions : We conclude that intraoperative epidural morphine was effective with less side effects for postoperative IV-PCA in the cesarean patients under epidural anesthesia. (Korean J Anesthesiol 2000; 38: 112 ∼ 117)

최소침습적 관상동맥우회술 마취 시 유도저혈압과 서맥유발을 위한 Esmolol 단독투여와 Neostigmine 과의 겸용방법의 비교

문현수,함병문,심우석 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.3

Background : Esmolol has been applied to lower myocardial oxygen consumption and creates a quieter operative field by reducing systemic blood pressure and heart rate but can cause a certain amount of hemodynamic instability during minimally invasive direct vision coronary artery bypass graft (MIDCAB). The aim of this study was to compare the hemodynamic differences between two methods; inducing hypotension and bradycardia between esmolol infusion alone, and concomitant use of neostigmine during MIDCAB anesthesia. Methods : Twenty MIDCAB patients were randomly allocated into two groups, group E (n =10) receiving esmolol 0,3 mg/kg/min, group EN (n = 10) receiving esmolol 0.2 mg/kg/min and neostigmine 1.0 mg for induced hypotension and bradycardia during coronary anastomosis. The hemodynamic parameters were evaluated 10 minutes after induction of anesthesia (Tl), 10 minutes after beginning of operation (T2), 5 minutes before the end of anastomosis (T3) and 10 minutes after the end of anastomosis (T4), Data were analyzed by ANOVA test for intragroup comparisons, and by T-test for intergroup comparisons with significance set at a P value of $lt; 0.05. Results : Heart rate significantly decreased at T3 in both groups and more in group EN. Systolic blood pressure decreased at T3 in both groups and there were no group differences but more episodes of extreme hypotension in group E. The cardiac index significantly decreased at T3 in both groups and more in group E. There was a small but significant increase in pulmonary capillary wedge pressure at T3 and T4 in group E and no change of central venous pressure in both groups. Conclusion : Concomitant use of neostigmine during esmolol infusion produces more reliable induced hypotension and bradycardia than esmolol infusion alone for MIDCAB anesthesia in terms of prevention of myocardial ischemia and easiness of anastomosis technique. (Korean J Anesthesiol 2000; 38: 450~456)

척추-경막외 병용마취를 이용한 제왕절개술시 경막외 Top-up 의 효과

최덕환,김지애,심우석,박남기 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.1

Background : Epidural $quot;top-up$quot; has been blown to enhance spinal anesthesia in combined spinal-epidural anesthesia. Saline and local anesthetics were reported to have a volume effect when infused as epidural $quot;top-up$quot;. In cesarean deliveries where high sensory block has been achieved using a combined spinal-epidural technique, we evaluated the effects of epidural $quot;top-up$quot; on the underlying spinal block. Methods: Sixty-six parturients were allocated randomly into group C (control, n = 21), S (saline, N= 21), or B (bupivacaine. n = 24), Ten minutes after they received 8 mg of 0.5% hyperbaric bupivacaine intrathecally, nothing, 10 ml saline, or 10 ml of 0.25% bupivacaine were infused, respectively. The sensory level at 10 min, the maximal level and the time to reach it, and degrees of motor block and muscle relaxation were compared. We also investigated intraoperative side effects and postoperative findings in the PACU. Results : There were significant changes in sensory level after epidural top-ups in the group S and B, but no differences in maximal height of sensory block and degree of muscle relaxation among the groups. Intraoperative pain was complained in fewer patients in the group B. Times to sensory and motor recovery were longer in patients of the group B. Conclusions : Eight milligrams of hyperbaric bupivacaine using a combined spinal-epidural technique was not sufficient for cesarean section. Epidural saline top-up showed volume effect, which didn't improve the spinal block. Epidural $quot;top-up$quot; of 0.25% 10 ml bupivacaine enhanced the spinal block and sustained the black postoperatively (Korean J Anesthesiol 2000; 38: 69~75)

제왕절개술을 위한 척추 혹은 경막외 마취시 오심과 구토의 예방 : Metoclopramide와 Droperidol의 효과 The Efficacy of Metoclopramide and Droperidol

김수창,최덕환,심우석 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.6

Background : Regional anesthesia for cesarean section is associated with a high incidence of nausea and/or vomiting (N&V) during the operation. Metoclopramide and droperidol have been known to be effective in the prevention of N&V. However, they have been reported to induce some adverse effects such as sedation. We evaluated the efficacy of metoclopramide and droperidol in the prevention of N&V in spinal and epidural anesthesia for cesarean section. Methods : A prospective randomized double-blind study was performed on 180 parturients scheduled for elective cesarean section. They were allocated into spinal or epidural (n = 90, each) anesthesia groups and each group into either a placebo, metoclopramide, or droperidol drug group (n = 30, each). After delivery, 2 ml saline, 10 mg metoclopramide, or 0.625 mg droperidol was given to the parturients, respectively. Incidences of N&V and sedation during the operation were checked, and the other adverse effects of the anesthesias such as hypotension and visceral pain were compared among the groups. The height of sensory blockade was also checked. Results : Epidural anesthesia was more related with N&V than spinal (P = 0.030). Among the groups there was a significant difference in the incidence of N&V (P = 0.002). There were fewer parturients with N&V in the droperidol group than in the placebo group during epidural anesthesia (P = 0.021). During both spinal and epidural anesthesia more parturients in the droperidol group had sedation than placebo or metoclopramide groups (P = 0.0001) and more in the metoclopramide group than in the pacebo group (P = 0.01). No differences were found in incidences of hypotension and in the height of sensory block among the groups. There were more parturients with visceral pain during epidural anesthesia (P = 0.031). Conclusions : Epidural anesthesia provoked N&V more frequently than spinal anesthesia for cesarean section. Only droperidol was effective in the prevention of N&V during epidural anesthesia, but had a more sedative effect than metoclopramide during either spinal or epidural anesthesia. (Korean J Anesthesiol 1999; 37: 1054∼1059)

개심술 후 시행한 최소 침습적 경후두 기관절개술(Translaryngeal Tracheostomy)의 경험

문현수,이영탁,심우석 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.38 No.2

Open tracheostomy has been indicated for patients who require prolanged mechanical ventilation or respiratory care in order to avoid lots of complications during long-term endotracheal intubation. Because there are a number of disadvantages and serious complications in standard open tracheostomy, a simpler, safe and minimally invasive procedure such as percutaneous dilatational tracheostomy (PDT) and translaryngeal tracheostomy (TLT) were introduced as an appropriate procedure that can be administered at bedside. In terms of prevention of complications, minimal invasive tracheostomy techniques are more advisable for post open heart surgery patients. After two failed attempts at respirator weaning, we experienced a successful TLT for a 71-year-old male patient with intractable post CABG pneumonia post-op 15 days in an intensive care unit. During and post-TLT courses were not eventful. The cannula was removed 2 weeks after TLT and the patient was subsequently discharged to ward. (Koreaq J Anesthesiol 2000; 38: 365~369)

분리형 기관지 Blocker 에 관한 연구

양미경,정익수,곽미숙,김갑수,심우석,함태수 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.5

Background: Compared with blockers mounted on the endotracheal tube, (a conjugated blocker), studies about blockers that are independent of a single-lumen tube, (a separated blocker) are rare. This study's object was to find several characteristics about these new blokers. Methods: We compared the peak and plateau airway pressures in intubated patients (n = 30) with, (group EB) and without, (group E) blockers. We measured the depth of the blockers and the pressures of the balloon of the blockers. Balloon pressures were measured twice outside and inside of the E-tube with 7 ml of air. All of these measurements were done in the supine position with 1 L/min flow rate. The frequency of malposition, the score of the lung collapse, and bronchial mucosa change were checked thereafter. Results: The peak airway pressures of group EB were significantly higher than those of group E (P<0.05). However, the plateau pressures of both groups were not different. The depth of the blockers was 52.0±1.8 cm, and the balloon pressures of the blockers were 124±22 and 139±20 mmHg, respectively. Six patients needed additional bronchoscopy because of malposition. The lung collapse score was good in 17 patients, fiar in 10 patients, and poor in 3 patients. There was not any severe bronchial mucosa damage. Conclusions: Understanding the characteristics of these new blockers, we can consider the use of them in some situations in which the use of a double-lumen tube is impossible or inconvenient.

Pencil-Point Needle 을 이용한 척추마취에서고비중 Tetracaine 의 주입방향의 효과

이상철,김덕경,최익현,노창준,심우석,김성오 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.5

Background : Pencil-point needle currently are used for spinal anesthesia because of an alleged lowered incidence of postdural puncture headache. Although the direction of the side hole is one of the important factors that might affect the level and the duration of anesthesia, those data are not readily available. The aim of this study was to assess if the side hole direction of pencil-point needle during hyperbaric tetracaine injection affects the level and the duration of anesthesia. Methods : We induced spinal anesthesia in 80 young men presenting for elective orthopedic surgery. Patients were allocated randomly with the side hole direction of the 25 gauge pencil-point needle in one of the four directions; cephalad, caudad, left lateral, right lateral. Hyperbaric 0.5% tetracaine 15∼17 mg(3 to 3.4 ml) was injected with the speed of 0.75 ml/sec. Maximum sensory block level, time to maximum sensory block level, duration of sensory block(2 segments regression time) were assessed by a blinded observer with thepin-prick test and degree of motor block were measured by Bromage motor scale. Data were analysed using the Kruskal-Wallis test followed by the Mann-Whitney U test and chi-square test as appropriate(SAS v. 6.04). Results : Time to maximum sensory block level was significantly fast in group 'cephalad'. Other values have no statistical differences. Post-spinal headache was observed in one case in group 'caudad'. Conclusions : Using the pencil-point needle, the time to maximum sensory block level was fast in group cephalad but there were no differences in the maximum sensory block level and the duration of sensory block among the four groups. (Korean J Anesthesiol 1998; 34: 967∼971)