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간질이 있는 산모에서 간질의 예방 및 분만통 감소를 위한 경막외 진통의 경험
최소용(So Yong Choi),임성진(Sung Jin Rim),이정태(J 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.2
A 25-year-old epileptic female patient scheduled for vaginal delivery, was referred to the pain clinic for the relief of labor pain. She had been taking anticonvulsant drugs, but suffered from seizure attacks three or four times a month. We bad induced continuous lumbar epidural analgesia successfully and she subsequently gave birth to a healthy infant. So we report that continuous lumbar epidural analgesia should be considered as a safe method for reduction of labor pain and prevention of seizure attacks in epileptic pregnant women.
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이정태,임성진,최소용 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.4
Background : Despite many advantages of spinal anesthesia, hypotension after spinal anesthesia is a common complication. The practice of routine preemptive infusion of crystalloid before spinal anesthesia has been widespread acceptance. But the value of this practice has recently been questioned. This study was designed to determine whether preoperative administration of crystalloid decrease the incidence of hypotension after spinal anesthesia. Methods : Thirty ASA I and II patients for elective lower extremities operations under spinal anesthesia were randomized to receive either 500 ml Ringer's lactate solution prior to induction of spinal anesthesia (group I) or no prehydration (group II). Hypotension was defined as a 30% decrease from baseline systolic blood pressure or systolic <90 mmHg, and was treated with ephedrine 5 mg IV boluses. Results : The incidence of hypotension was not significantly different between the two groups. Baseline systolic blood pressure significantly decreased after 5 min in the roup I, 1 min in the group II, after induction of spinal anesthesia. The ephedrine dose requirement to maintain systolic pressure >70% of baseline, systolic blood pressure and heart rate were not significantly different between both groups. Conclusions : We conclude that, in normovolemic adult patients undergoing elective lower extremities surgery, an intravenous infusion of 500 ml of Ringer's lactate solution is ineffective in preventing hypotension during spinal anesthesia. (Korean J Anesthesiol 1998; 35: 704∼709)
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전신마취시 경막외강에 투여한 Clonidine의 술후 제통효과
이정태,유병식,소금영,최소용,정종달 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.3
Background : Epidurally administered clonidine produces analgesia by an alpha 2-adrenergic mechanism and may provide postoperative analgesia without nausea, pruritus and respiratory depression associated with opioid administration. Many studies have shown the beneficial effects of epidural clonidine in postoperative pain management. Pre-administered epidural analgesic agent before the skin incision may prevent the nociceptive input. We provided the pre-emptive analgesia and compared the postoperative analgesic effects of epidural clonidine when used as the sole analgesic agent with epidural fentanyl and epidural bupivacaine. Methods : Thirty-nine gynecologic patients, ASA physical status 1, 2, undergoing elective lower abdominal surgery under general anesthesia, were studied. They were not taking any premedications. Before anesthesia, an epidural catheter was inserted at the L2∼3 interspace. Patients were divided into 3 groups randomly. Group 1 received 0.125% bupivacaine 20 ml through the epidural catheter,group 2 received 100 g fentanyl in normal saline 20 ml, and group 3 received 150 g clonidine in normal saline 20 ml. During the operation, we recorded the vital signs and side effects. Just before suturing peritoneum, we injected the corresponding drugs on individual groups through the epidural catheter. In the recovery room, the postoperative analgesia was assessed by VAS(visual analogue scale). Vital signs, sedation score and side effects were also checked. Results : VAS and systolic blood pressure were significantly lower in group 3 than group 1 or group 2 at the recovery room. The diastolic blood pressure, heart rate and sedation score were not significantly different between three groups at the recovery room. Also the vital signs during the operation were not significantly different between three groups. The incidence of hypotension was 3 out of 13 in group 3 and 1 out of 13 in group 1. Conclusion : Epidural bolus clonidine 150 g produces more profound and longer postoperative analgesic effects than fentanyl 100 g or 0.125% bupivacaine at the lower abdominal surgery. But hypotension may occur more frequently. So, if we select the patient cautiously, epidural clonidine is a good alternative analgesic agent for the postoperative analgesia.
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