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항문 주위 수술후 통증관리를 위한 지주막하강내 Morphine 의 유효량
원종인(Jong In Won),조인찬(In Chan Cho),박영철(You 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1
N/A Background: Contraction of anal sphincter muscle produces severe pain in perianal surgery post- operatively. Recent reports have indicated that effective and prolonged pain relief can be obtained by the injection of small doses of morphine into the subarachnoid space. We attempted to use this technique for perianal surgery and investigated postoperative pain control and its side effects. Methods: Forty five patients scheduled for hemorrhoidectomy and anal fistulectomy were studied to determine the minimal effective dose of intrathecal morphine for postoperative analgesia. In order to control the pain, 7 mg of 0.5% hyperbaric bupivacaine with 0.05 mg (group I), 0.1 mg (group II) and 0.15 mg (group lII) of morphine hydrochloride was injected with a 25 gauge spinal needle into the subarachnoid space. We estimated the duration of analgesia until the pain score attained to above 3 in 10 cm VAS (visual analogue scale) and incidence of itching, nausea and vomiting by percentage, headache, backpain and respiratory depression by positive and negative. We also checked the time of self-voiding. Results: The mean time of analgesia was 10.3+1.54, 19.7+2.22 and 20.3+2.29 hours in group I, II and III respectively. Urinary retention of group I, II and III after block persisted for an average of 20.3+2.31, 21.2+2.51 and 23.3+ 3.74 hours. Nausea and vomiting were observed 33%, 53%, 67% and itching was observed 53%, 67%, 80% in group I, II and III respectively and respiratory depression did not occur in all groups. Conclusions: It is not necessary to use more than O. 1mg of intrathecal morphine in perianal surgery because analgesia is not prolonged and side effects are increased.
경막외 Morphine에 의한 통증 조절 환자에서 Butorphanol의 첨가시 부작용 감소 효과
이종남(Jong Nam Lee),조인찬(In Chan Cho),박영철(Yo 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2
N/A Background: Nowadays, epidural morphine is commonly used in postoperative pain con- trol. But epidural morphine may produce some side-effects, e.g. pruritus, nausea, vomiting, urinary retention and respiratory depression. Especially, pruritus is the most common com- plaint in pain-controlled patients by epidural morphine. So we evaluated whether addition of epidural butorphanol affects the degree of pruritus and pain score in pain controlled pa- tients who by epidural morphine after hysterectomy. Methods: Group l(N=15) received postoperative epidural 0.1% bupivacaine 100ml plus morphine 10mg, group 2(N=15) received the mixture of butorphanol 2mg with same re- gime as in group 1, group 3(N=15) received the mixture of butorphanol 4mg with same re- gime as in group l. All of the three groups received these solutions by infusion pump, l ml /hour, for postoperative 4 days. All groups received additional morphine 1.2 mg in 0.2% bupivacaine 6 ml epidurally when the peritoneum was closed under general anesthesia. The severity of pain, pruritus, nausea and vomiting was estimated by 10cm VAS(visual ana- logue scale) and somnolence by positive or negative during postoperative 4 days. Results: Severity of pruritus, but not nausea and vomiting was decreased in group 2 and 3 compared with group 1(p<0.05). Pain score was increased in group 3 at postoperative day (POD) 0 and 2 compared with group 1(p<0.05). Incidence of somnolence in group 1, 2 and 3 were 2.7±0.7, 5.3±0.7 and 10.0±1.0 respectively. Conclusions: These results suggest that butorphanol reduce the degree of pruritus, the most common side effect of morphine, but increase the incidence of somnolence.
조은하,조인찬,박영철,최영환 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.4
We experienced a case of unilateral vocal cord paralysis following tracheal extubation. The patient was a 60-year-old man undergoing subtotal gastrectomy. He had no laryngeal symptoms prior to operation and the trachea was intubated with a cuffed endotracheal tube. The surgical procedure lasted 6 hours and was uneventful. Three days later after operation, he began to complain of hoarseness and mild aspiration symptom. On endoscopic examination, left vocal cord paralysis was found. Fifteen weeks later the voice and left vocal cord function return to normal without specific management. In this case, we suggested that possible causes of unilateral vocal cord paralysis are compression of recurrent laryngeal nerve by overexpanded endotracheal cuff, laryngeal trauma during difficult intubation, stretching of the nerve as a result of traction on distant organ, decreased elasticity of trachea and surrounding tissues in the older age group and long operating time. (Korean J Anesthesiol 1997; 33: 788∼791)
상복부 수술환자의 술후 장운동 회복에 대한 경막외강내 Bupivacaine 과 Morphine 의 혼주의 효과
박영철,조은하,조인찬 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.3
Background: The stress of operation inhibits bowel motility. The blockade of efferent sympathetic nerve is helpful to recovery of bowel motility. So we tried to examine that the extent of sympathetic blockade by alterations of bupivacaine infusion rate affected the recovery of bowel motility. Methods: Group l (N = 25) received postoperative meperidine intramuscular injection on demand as a control group, group 2 (N = 25) received postoperative epidural 0.125% bupivacaine 100 ml plus morphine lOmg by infusion pump, I ml/hour, for 4days, group 3 (N = 25) received 0.125% bupivacaine 400 ml plus morphine lOmg by infusion pump, 4 ml/hour, for 4days. The Group 2 and 3 received additional morphine 2mg in 0.2% bupivacaine 10 ml epidurally as a single bolus when the peritoneum was closed. The time interval from termination of operation to the first passage of flatus was estimated. Results: In group l, bowel motility was regained at 92±23 hours, group 2; 90+ 19 hours and group 3; 91±19 hours. All values are not signicantly different among the groups (p$gt;0.05). Conclusions: The alteration of epidura1 bupivacaine and morphine infusion rate did not affect the recovery of postoperative bowel motility.
박영철,이종남,조인찬,하지봉 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.4
The major risk factors for diabetics undergoing surgery are the end-organ diseases associated with diabetes. Autonomic neuropathy is relatively common in diabetic patients and associated with an increased risk of perioperative cardiovascular instability. We experienced a case of severe bradycardia and hypotension during general anesthesia for subtotal gastrectomy in a 59 year-old male diabetic patient. Anesthesia was induced with thiopental and vecuronium, and was maintained with nitrous oxide, oxygen and enflurane. Five minutes after induction, severe bradycardia and hypotension developed without specific events. The bradycardia was unresponsive to intravenous atropine and ephedrine, but the blood pressure was restored by administration of ephedrine. During operation his blood pressure was maintained in normal range but the bradycardia was not restored by additional administration of atropine. Postoperatively, myocardial infarcton was ruled out. The test performed after operation suggested that his cardiovascular autonomic nervous system was severely impaired. We think that cardiovascular autonomic dysfunction should be evaluated during preoperative period to plan the anesthetic management and to prevent severe cardiovascular complications in diabetic patients.