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Ketorolac의 지속적 정주가 Morphine 정맥 PCA 에 미치는 효과
최덕환(Duck Hwan Choi),정익수(Ik Soo Chung),김승오 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.2
N/A Background: Ketorolac(Tarasyn®) is a non-steroidal anti-inflammatory drug(NSAID) which has shown to be an effective postoperative analgesic available parenterally, and when combined with morphine can reduce its requirement. The analgesic efficacy and adverse effects of continuous infusion of ketorolac added to morphine IV PCA was evaluated in 60 women after abdominal hysterectomy. Methods: Patients were assigned to receive either morphine intravenous(IV) bolus followed by morphine IV patient controlled analgesia(PCA), or ketorolac 30mg IV and continuous IV infusion at 4.0mg/hr in combination with the above regimen. The authors evaluated PCA morphine used, pain assessment(verbal pain intensity score and visual analogue scale) and side effects at 2, 4, 6 and 24hrs during pain control. Results: Continuous infusion of ketomlac decreased the PCA morphine usage significantly(30.4 -> 19.6 mg: p 0.007) at 24hrs postoperatively. Significant differences were seen favoring ketorolac infusion in pain intensity and visual analogue scale both at rest and during inovement. There were no differences in incidences of deep sedation, nausea & vomiting. But the ketorolac group they complained of dizziness more than morphine only group. Little pruritus was recorded in either groups. Conclusions: The authors conclude continuous IV infusion of ketorolac in conjunction with morphine PCA provide effective analgesia after low abdominal surgery.
최덕환(Choi Duck-hwan) 한국역사연구회 2012 역사와 현실 Vol.- No.85
The Goryeo government continued its northern campaign ever since the dynasty was founded in 918, and successfully expanded its territory to the Daedong-gang river line and then to the Cheongcheon-gang river line. Such governmental efforts resulted in the Goryeo troops arrival at the Abrok-gang river area as well. Then the Jurchen troops in the region started to fight back. Goryeo’s attempt to crush them in 984 failed miserably. At the time, the Khitan government also began staging military actions against the Jurchen tribes, and the Khitans had some initial victories against the Jurchens. Yet after a couple of failed campaigns, the Khitans got really worried. With both the Goryeo and Khitan governments significantly concerned about the prospect of their future dealings with the Jurchen tribes, and neither of them being able to crush the Jurchen threat on their own, a compromise had to be made. Then, suddenly the Khitan government decided to launch an invasion upon Goryeo soil. So Hang-deok and his troops invaded Goryeo in 984, and argued that Goryeo was violating Khitan territory and should send an emissary of surrender to the Khitan court immediately. Seo Hi rebutted such claim, and insisted that the Goryeo government would send an emissary to Khitan once the Jurchen tribes blocking the pathway to Khitan were sufficiently neutralized. For some reasons, So Hang-deok decided to retreat, and later the Khitan government ’curiously’ acknowledged Goryeo’s claim on the soil they(the Khitans) once militarily demanded. It seems like the Goryeo government was able to use the ’Jurchen card’ to its advantage, which was a liability to the Khitan government even more so than to the Goryeo government. By promising to crush the Jurchen tribes living in the vicinity of the Abrok-gang river, and taking some pressure off the Khitan government’s shoulders, the Goryeo government seems to have succeeded in deflecting the Khitan invasion, and most of all obtaining the Khitan government’s official recognition of Goryeo’s right of owning the region south of the Abrok-gang river line.
임상연구 : 제왕절개술을 위한 저용량 척추-경막외 병용 마취 시 교질용액의 동시투여가 혈역학과 Phenylephrine의 요구량에 미치는 영향
이숙영 ( Suk Young Lee ),최덕환 ( Duck Hwan Choi ),박효원 ( Hyo Won Park ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.6
Background: Ephedrine has been recommended as the best vasopressor in obstetrics. But, recent clinical evidences show the possibility that phenylephrine has become more pertinent as a primary vasopressor. We think a phenylephrine infusion with colloid co-hydration will be more useful in maintaining baseline blood pressure in combined spinal-epidural anesthesia (CSEA) for cesarean section. Methods: CSEA was performed using 6 mg bupivacaine and 20 μg fentanyl as a spinal and 10 ml of 0.25% levobupivacaine as an epidural in randomized, colloid co-hydration (hydroxyethl starch, HES 500 ml) (group C, n = 34) or no colloid co-hydration (group N, n=34) parturients scheduled to undergo cesarean delivery. After an infusion of 100 μg phenylephrine following the spinal injection, phenylephrine was intermittently infused using a PCA-pump to maintain the baseline blood pressure (BP). Systolic BP and heart rate (HR) were checked and total phenylephrine amount was measured. Nausea and vomiting and fetal umbilical pH/base excess (BE) were also investigated. Results: There was a lower incidence of bradycardia in the C group compared with the N group (5.9% vs. 32.4%, p = 0.014), and total phenylephrine consumption was less in the C group (400 μg vs. 500 μg, p = 0.019). The incidence of reactive hypertension (11.8% vs. 55.9%, p < 0.001), and the hypotension (0% vs. 11.8%, p = 0.114) were lower in the C group, too. The others were comparable in both groups. Conclusions: Colloid co-hydration was effective in reducing the phenylephrine use and the incidences of abnormal hemodynamics such as hypotension, bradycardia and hypertension in low-dose CSEA for cesarean delivery. (Korean J Anesthesiol 2008; 55: 685~90)
증례보고 : 다발성 경화증 산모의 척추 경막외 병용 마취하 제왕절개
이애령 ( Ae Ryoung Lee ),현선지 ( Sun Ji Hyun ),최덕환 ( Duck Hwan Choi ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.3
The use of neuroaxial blocks in patients with multiple sclerosis has been controversial, because the effect of local anesthetic drugs on the course of the disease is unclear. We report an obstetric patient with multiple sclerosis whose caesarian section was performed successfully under combined spinal-epidural anesthesia and postoperative pain control was managed using patient-controlled epidural analgesia. There were no exacerbation of neurologic symptoms and no relapse of disease at two month follow-up. We suggest that the choice of anesthetic technique for patients with multiple sclerosis should be determined after evaluation of the course of the disease and informed consent. The obstetric patients with multiple sclerosis should not be denied the neuroaxial block for labor and caesarian section. (Korean J Anesthesiol 2009;57:367∼70)
증례보고 : 산후 두통 중 뇌내 출혈과 경막 천자에 의한 두통의 감별 -증례보고-
이숙영 ( Suk Young Lee ),권민아 ( Min Ah Kwon ),최덕환 ( Duck Hwan Choi ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.50 No.6
We report a patient with a postpartum headache, who was later diagnosed with an intra cerebral hemorrhage. She underwent a cesarean section under the combined spinal-epidural anesthesia, and complained of a suspicious post-dural puncture headache (PDPH) in the puerperium. The headache was partially improved with analgesics and she was discharged. The day after discharge, the headache became aggravated and she visited our labor floor for further treatment. An epidural blood patch (EBP) was performed because the headache regarded as aggravation of PDPH. However, hemiparesis and dysarthria developed 40 minutes after the EBP. Computed tomography was revealed an intracerebral hemorrhage in the right side basal ganglia. She was transferred to the neurosurgical intensive care unit. She was treated conservatively and has almost completely recovered. This case highlights the need to consider an intracranial hemorrhage, a cerebrovascular accident, nonspecific headache and PDPH when making a differential diagnosis of postpartum headache, particularly when an atypical postpartum headache is noted. (Korean J Anesthesiol 2006; 50: 727~30)