제왕절개술에서 경막외 Fentanyl의 술전투여와 수술종료전 투여의 술후진통효과 비교

채준석(Jun Seuk Chea),이병호(Byung Ho Lee),정미영( 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.2

N/A Many clinical and laboratory experiments have been developed to prevent or decrease post-operative pain. One of these methods is pre-operative administration of opioid. Re- cently there have been differing and debatable results reported of pre-operative treatment for post-operative pain management. It was our study to determine whether pre-operative epidural fentanyl prevented central facilitation or wind up of spinal cord from nociceptive afferent input through c-fibers. We evaluated the effect of epidural fentanyl 50 mcg 10 minutes before operation and 10 minutes before the end of surgery. 28 parturient women for Cesarean Section were ran- domly allocated to receive the epidural fentanyl either at l0 minutes before operation (Group 1, n=14) or 10 minutes before the end of surgery(Group 2, n=14). All of the 28 parturient women were anesthetized with epidural block using (22 ml of) 2% lidocaine sup- plemented with light general anesthesia(N2O 2 L/min-O, 2 L/min). We controlled post-ope- rative pain with epidural PCA(patient controlled analgesia) infusion of meperidine and 0.07 % bupivacaine. The action duration of epidural fentanyl from the end of surgery to the first requirement of analgesics with epidural PCA were not significantly different between the two groups. No significant differences between two groups were observed in VAS pain score at 1, 2, 3, 6, 12, 24, and 48 hours after the operation. The number of self admini- stration of narcotics with PCA during 48 hours after surgery were the same between the two groups. The hourly infusion rates of demerol were the same. Pre-operative administration of fentanyl was not clinically effective compared to administration just before the end of surgery for postoperative pain control.

제왕절개 수술후 통증조절을 위해 PCA를 이용한 정맥과 경막외 Meperidine 투여효과의 비교

이병호(Byung Ho Lee),채준석(Jun Seuk Chea),정미영( 대한통증학회 1995 The Korean Journal of Pain Vol.8 No.2

N/A Patient-Controlled Analgesia (PCA) has been widely used for postoperative pain relief. Meperidine is useful for PCA and has efficient analgesia, rapid onset, and low incidence of adverse effect. To compare the analgesic effect, total dose and hourly dose, side effect and neonatal status of breast feeding with meperidine via intravenous or epidural PCA for 48 hours after Cesarean Section, 40 parturient women undergoing elective Cesarean Section were randomly divided into two groups. Each respective group of 20 parturient women received meperidine via one of the intravenous PCA after general anesthesia with enflurane (IVPCA group) and the epidural PCA after epidural block with 2% lidocaine 20ml combined with general anesthesia with only N2O and O2 (EpiPCA group) when they first complained of pain in recovery room. Following the administration of analgesic initial dose, parturient women of lVPCA group were allowed intravenous meperidine l0 mg every 8 minutes when they felt pain. The EpiPCA group received additional bolus dose of meper- idine 2 mg and bupivacaine 0.7 mg were administered every 8 minutes as requested the pa- tients with hourly continuous infusion of meperidine 4 mg and bupivacaine 1.4 mg. Data was collected during the 48 hours observation period including visual analog scale (VAS) pain scores, total meperidine dose, hourly dose during 48 hours and each time inter- val, incidence of adverse effect, satisfaction, and neonatal status with breast feeding. VAS pain scores of analgesic effect in EpiPCA group was significantly lower than in IVPCA group at 2 hours after the initial pain after Cesarean Section. Total dose and hourly dose of meperidine significantly reduced in EpiPCA group. Hourly dose of meperi- dine at each time interval significantly reduced during first 6 hours and from 12 hours to 24 hours in EpiPCA group. The side effects in IVPCA group were mainly sedation, nausea, and local irritation of skin. And EpiPCA group experienced numbness and itching. The de- gree of satisfaction of parturient women was 88.2 in IVPCA group and 85.7 % in EpiPCA group. We did not observe any sedation, abnormal behavior, or seizure like activity in any neonates of breast feeding. From the above results we conclude that epidural PCA was more efficiently analgesic, less sedative, and consumptional, and safer for neonate than intravenous PCA, and could be an alternative method to intravenous PCA.

증례보고 : 요추 경막외 차단 후 발견한 경막외 농양과 요근 농양 -증례보고-

김창재 ( Chang Jae Kim ),정미영 ( Mee Young Chung ),채준석 ( Jun Seuk Chea ),이병호 ( Byung Ho Lee ),정재철 ( Jae Chul Chung ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1

Epidural block is widely used for the diagnosis and treatment of the acute and chronic pain in pain clinic. But, it has several complications like as headache, spinal injury, epidural hematoma and infection including epidural abscess, meningitis and osteomyelitis. Among them, the simultaneous occurrence of psoas and epidural abscesses is extremely rare. We report a patient diagnosed as epidural and psoas absesses one month after lumbar epidural block and treated successfully with surgical decompression and drainage. (Korean J Anesthesiol 2006; 51: 109~11)

증례보고 : 미추마취 후 인지된 폐 샘암종의 천미골 전이 -증례보고-

정미영 ( Mee Young Chung ),정재철 ( Jae Cheol Jeong ),채준석 ( Jun Seuk Chea ),이병호 ( Byung Ho Lee ),김창재 ( Chang Jae Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.5

The caudal block has been used as an alternative to general anesthesia in specific circumstances such as anal surgery, perineal surgery or surgery of lower extremity etc. It has been also used as an adjunct to general anesthesia, administered at the completion of surgery to provide postoperative analgesia especially in children. But, it has variable complications such as generalized intoxication, pain on the injection site, infection or urinary retention etc. We report an unusual case of metastatic sacrococcygeal tumor from adenocarcinoma of lung presenting as severe anal pain and sciatica which was aggravated after the trial of caudal anesthesia. (Korean J Anesthesiol 2006; 50: 588~91)

당뇨병성 신경병증을 동반한 만성 신부전증 환자의 마취 유도 후 발생한 불응성 저혈압(증례보고)

김창재 ( Chang Jae Kim ),정미영 ( Mee Young Chung ),정고운 ( Go Un Jung ),채준석 ( Jun Seuk Chea ),이병호 ( Byung Ho Lee ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.54 No.6

임상연구 : 제왕절개술을 위한 산모의 전신마취시 마취전 산소화의 평가

이병호 ( Byung Ho Lee ),정미영 ( Mee Young Chung ),채준석 ( Jun Seuk Chea ),김창재 ( Chang Jae Kim ),정동석 ( Dong Suk Chung ),박희상 ( Hee Sang Park ) 대한마취과학회 2003 Korean Journal of Anesthesiology Vol.44 No.5

실험연구 : 흰쥐 뇌에서 고속원심 분리법을 이용한 신경줄기세포 추출 및 배양

김현숙 ( Hyun Sook Kim ),정미영 ( Mee Young Chung ),김창재 ( Chang Jae Kim ),채준석 ( Jun Seuk Chea ),임용걸 ( Yong Gul Lim ),문세호 ( Se Ho Moon ),최봉철 ( Bong Chul Choi ),이병호 ( Byung Ho Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3

Background: During recent two decades of crucial revision of some cornerstone concepts has opened new horizons in neurosciences. Modern basic viewpoints include the idea of high CNS plasticity which means not only rearrangement of neurons and their interconnections, but also the formation of new neural cells in humans and animals during their whole life span. The purpose of this study is to harvest neural stem cell from the adult rat brain using the high speed centrifugation method and study the characteristics of these cell. Methods: 60 rats (Fisher 344, 150-160 g) brain were saved under inhalation anesthesia and dissect the subventricular zone under the microscope. The brain tissue was digested with enzyme to make a cell suspension. The cell suspension was processed high speed centrifugation to separate the neural stem/progenitor cells according to the buoyancy. After 2 weeks culture, immuno-staining (O4, GFAP, Nestin, beta-tubulin III and DAPI) were performed and replated the cultured cells. Results: The 2 weeks culture cells were positive 92.8% in Nestin, 91.5% in O4 and 87.6% in Gal-C. But only positive 1.4% in β-tubulin III and 5.5% in GFAP. And replated cell culture shows similar results compared to the primary culture. Conclusions: With this high speed centrifugation method, authors can harvest neural stem/progenitor cells from the adult rat brain. Although we have many limitations using these cell in clinical trial, but we can afford to next step on neural stem cell research. (Korean J Anesthesiol 2006; 51: 343~9)

증례보고 : 노인환자에서 고관절 치환술 수술 후 발견된 뇌경색

최용우 ( Yong Woo Choi ),정미영 ( Mee Young Chung ),김창재 ( Chang Jae Kim ),이병호 ( Byung Ho Lee ),이효정 ( Hyo Jung Lee ),채준석 ( Jun Seuk Chea ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1

Perioperative cerebral infarction is uncommon and its mechanism is often uncertain. This is a report of an unusual case of acute cerebral infarction following general anesthesia. The patient was a 83-year-old female admitted for total hip replacement arthroplasty (THRA). There were no previous cerebro- and cardio-vascular symptoms and history. During introduced general anesthesia with sevoflurane, there was a persistent low systolic BP of 80-100 mmHg (preoperative BP was 140/85 mmHg). On emerging from anesthesia, confusion and dense right hemiparesis were observed. Emergency CT brain scan showed early cerebral infarction in the middle cerebral artery (MCA) territory. Even though prompt supportive neurosurgical intensive care was initiated, the patient died at postoperative 4 days. (Korean J Anesthesiol 2007; 52: 119~22)

N2O-O2 전신마취를 병용한 흉추경막외차단과 Enflurane 전신마취간의 술후 간기능검사의 비교

이병호,정미영,채준석,김범식 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.30 No.5

Background: Hepatic dysfunction may occur after single, or more usually repeated, exposures to the halogenated inhaled anesthetics. The cause may be free radical snd metabolites of inhaled anesthetics, immune reaction and hypoxic damage by decreasing total flows. The purpose of this study is to evaluate postoperative liver function between the general anesthesia and the thoracic epidural blockade supplemented with the light general anesthesia. Methods: Thirty patients were divided into two groups; 15 patients were aneshtetized with 2 vo1% of enflurane combined with nitrous oxide(2 I/min) and oxygen(1.5 l/min) in the general anesthesia group, and in 15 patients of the thoracic epidural blockade group thoracic epidural blockade with 2% lidocaine and light general anesthesia using nitrous oxide(2 l/min) and oxygen(1.5 l/min) were performed. Serum glutamic oxalacetic transaminase(SGOT), serum glutamic pyruvic transaminase(SGPT) and alkaline phosphatase were evaluated before anesthesia, 1, 3, 5 and 7 days after gastric surgery on both groups. Results: In the general anesthesia group, postoperative SGOT levels were increased above normal range but were within normal limits in the thoracic epidural blockade group. SGPT level was increased above normal range on postoperative one day in the general anesthesia group but no increase of postoperative SGPT levels was observed in the thoracic epidural blockade group. On postoperative seven days the level of alkaline phosphatase was increased within normal range in the general anesthesia but in the thoracic epidural blockade group the levels of alkaline phosphatase were not increased. Conclusions: We consider that postoperative liver function is not influenced with thoracic epidural blockade supplemented with light general anesthesia for upper abdominal surgery.

제왕절개술시 억제된 신생아에 대한 임상적 고찰

이종호,김영택,채준석,송호경 대한마취과학회 1987 Korean Journal of Anesthesiology Vol.20 No.6

Between january 1, 1981 and December 31, 1986, 1,310 Cesarean sections (26.7%) were performed among 4,898 paturient women at St. Mary's pospital, Catholic Medical College. The perioperative condition of the newborns along with morbidity and mortality after Cesarean section wha analyzed. The incidencea of Cesarean sections between 1981 and 1986 were 25.0% 27 .6%, 23.4%, 29.5%, 31.2% and 27.1%, respectively. The anesthetic methods employed were inhalation anesthesia with thiopental sodium for induction and nitrous oxide-oxygen·halothane for maintenance of anesthesia. This study did net include the 96 cases of lumbar epidural or spinal technique performed during this Period. Based on one minute Apgar scores, 82 infants (6.26%) were assessed as moderately (score 4-6) depressed, and 44 infants (3.36%) were rated as severely (score 0∼3) depressed. Twenty (45.5%) of the severely depressed newborns were promptly resuscitated and given adequate treatement, but 11 infants (25.0%) did not survive. The incidence of idiopathic respiratory distress syndrome (IRDS) in this study was 9 cases (0.79%) Ammong 7he total 1,310 cases; this induded 7 cases of premature birth or low birth weight and 2 cases of aspiration pneumonia. The mortality of the IRDS group was 4 of 9 cases (44.4%). Among the severely depressed group, the time from induction to delivery was five minutes in 8 case? (18.2%) , six to ten minutes in 22 cases (57.777) and more than 11 minutes in 14 cases (31.8%) . The prognostic status of newborn babies was evaluated with respect to the anesthetic procedure and the outcome of deliveries by Cesarean sections performed between 1981 and 1986 at St. Mar's Hospital, Catholic Medical College, Seoul, Korea.