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증례보고 : 난치성 개흉술후통증증후군 환자에서 시행한 척수자극술
이헌근 ( Heon Keun Lee ),이승화 ( Seung Wha Lee ),신일우 ( Il Woo Shin ),손주태 ( Ju Tae Sohn ),정영주 ( Yeong Ju Jeong ),정영균 ( Young Kyun Chung ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Post-thoracotomy syndrome is a condition characterized by pain that continues for more than 2 months after a thoracotomic procedure. Some patients suffer from devastating chest pain despite receiving multimodal treatment such as analgesics, antidepressants, anticonvulsants and nerve blockers. Spinal cord stimulation has been reported to be a promising relief for the intractable neuropathic pain. A 60-year-old man who had been suffering from post-thoracotomy pain for 20 years showed relief of pain after spinal cord stimulation. Spinal cord stimulation thus seems to be a viable option for patients who do not respond to conventional pain management therapy. (Korean J Anesthesiol 2009;57:678∼81)
Remifentanil은 흰쥐의 국소 허혈-재관류 모델에서 심근 보호 효과가 있는가?
신일우 ( Il Woo Shin ),조만석 ( Man Seok Cho ),장인석 ( In Seok Jang ),손주태 ( Ju Tae Sohn ),이헌근 ( Heon Keun Lee ),정영균 ( Young Kyun Chung ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.2
Background: It is known that some opioids protect the myocardial tissue from myocardial ischemia-reperfusion (I/R) injury. The aim of this study was to investigate whether remifentanil, at a clinically relevant concentration that`s during the peri-ischemic period, has a protective effect against a regional I/R injury in an in vivo rat heart model. Methods: Rats were subjected to 25 minutes of coronary artery occlusion and this was followed by 24 hours of reperfusion. A microcatheter was advanced into the left ventricle and the hemodynamic function was evaluated after 24 hours of reperfusion. The infarct size was determined by triphenyltetrazolium staining. The serum level of cardiac troponin-I (cTnI) was determined by ELISA (enzyme-linked immunosorbent assay). Results: Remifentanil administration during the peri-ischemic period didn`t show any identifiable protective effects for the hemodynamic function or to reduce the infarct size. In the control group, the peak rate of the ventricular pressure increase (+dP/dt(max)) (P<0.05) and the peak rate of the intraventricular pressure decline (-dP/dt(max) P<0.05) were significantly decreased as compared to those values for the sham group. In the remifentanil group, the +dP/dt(max) and -dP/dt(max) were not improved compared to those values of the control group. The infarct size was 45.6% of the area at risk in the control group, and the infarct size was reduced by administration of remifentanil to 43.2% in the remifentanil group. The I/R-induced serum level of cTn-I was not reduced by remifentanil infusion during the peri-ischemic period. Conclusions: Remifentanil, at a clinically relevant concentration that`s infused during the peri-ischemic period, has no myocardial protective effect after regional myocardial I/R injury in an in vivo rat heart model. (Korean J Anesthesiol 2009;57:190∼4)
경막하 지방종으로 오인될 수 있는 외상성 요천추부 아급성 경막하 출혈
황선철(Sun-Chul Hwang),김형간(Hyung-Kan Kim),조성희(Seong-Hee Cho),남대철(Dae-Chul Nam),이헌근(Heon-Keun Lee),박경언(Kyeong-Eon Park),나재범(Jae-Boem Na),김동희(Dong-Hee Kim) 대한정형외과학회 2013 대한정형외과학회지 Vol.48 No.5
외상성 요천추부 경막하 혈종은 해부학 및 병리학적인 원인으로 인하여 경막외 혈종에 비해 빈도가 극히 드문 것으로 알려져 있다. 외상의 시기가 불분명한 경우 시간 경과에 따른 혈종의 신호 강도가 두개강내 혈종과 척추강 내 혈종에서 일치하지 않는 경우가 많기 때문에 감별진단에 있어서 많은 혼돈을 주게 된다. 이에 지방억제 자기공명영상 및 컴퓨터단층촬영 등의 시도들이 행해지고 있다. 외상 시기를 정확히 알 수 없는 경막하 혈종을 자기공명영상과 컴퓨터단층촬영을 이용하여 경막하 지방종과 감별진단하여 조기에 수술적 감압술 시행 후, 좋은 예후를 보인 증례를 문헌 고찰과 함께 보고하고자 한다. Traumatic lumbosacral spinal subdural hematoma due to anatomical and pathological causes is rare, compared to epidural hematoma. If the time of trauma cannot be determined, intracranial and intraspinal signal intensity according to lapse of time are not coincident, resulting in confusion in terms of differentiation. Fat suppression magnetic resonance image (MRI) and computed tomography (CT) are utilized for differentiation. The intention of this study is to report on a case where spinal subdural hematoma of unknown time of occurrence is differentiated from subdural lipoma by taking advantage of fat suppression MRI and CT in order to perform an early surgical decompression with auxiliary review of literature demonstrating good prognosis of the procedure.
임상연구 : 척추마취 환자에서 차단높이가 진정을 위한 Propofol 요구량에 미치는 영향
신일우 ( Il Woo Shin ),고지은 ( Ji Eun Go ),박경언 ( Kyeong Eon Park ),손주태 ( Ju Tae Sohn ),정영균 ( Young Kyun Chung ),이헌근 ( Heon Keun Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
Background: It has been reported that spinal anesthesia has a sedative effect and so this decreases the hypnotic requirement of intravenous anesthetic. Therefore, we have conducted a prospective randomized study to investigate the effect of the spinal anesthesia level on the hypnotic requirements for conscious sedation. Methods: Forty adult patients were scheduled to undergo spinal anesthesia, and they were randomly allocated to one of the two groups. After subarachnoid injection of 0.5% hyperbaric bupivacaine 16 mg, the patients in group 1 and group 2 were maintained in a reversed Trendelenburg position and a Trendelenburg position, respectively. After fifteen minutes, the target controlled infusion of propofol was started for achieving a target concentration of 1μg/ml, and the mean BIS for 1 min was checked after an effect site concentration (Ce) of 1μg/ml was reached. The target controlled infusion of propofol was restarted at a target concentration (Tc) of 1.5μg/ml, and the mean BIS for 1 min was checked after the Ce level of 1.5μg/ml was reached. Results: The mean BIS at 1μg/ml Ce was 90.0 ± 8.5 and 77.8 ± 10.3 in group 1 and group 2, respectively. The mean BIS at 1.5 g/ml Ce was 73.6 ± 19.4 and 60.0 ± 13.1, respectively. Conclusions: There was a significant difference in the requirements of propofol for conscious sedation between the below T12 block group and the above T4 block group. (Korean J Anesthesiol 2006; 50: 642~5)