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암성 통증 관리에 사용된 부가적 진통제로서의 Propofol
한태형(Tae Hyung Han),황원균(Won Gyoon Hwang) 대한통증학회 1997 The Korean Journal of Pain Vol.10 No.1
Cancer is a devastating disease, and the treatment of related pain is an extremely challenging task. Providing adequate analgesia while avoiding unnecessary drug effects often requires a polypharmacologic approach in cancer pain management. A 36-year old woman with breast cancer metastatic to the axial skeleton and bilateral hip joints was admitted to hemato-oncology service with complaints of intractable abdominal and hip pain. Despite rapidly increasing doses of intravenous morphine up to 350 mg per day; transderma1 fentanyl; midazolam; ketorolac; lorazepam; dexamethasone, the patient continued to describe her pain as 10 of 10, refusing all surgical /diagnostic interventions not directly related to pain control. She did, however, consent to lumbar epidural catheter placement. The patient was sedated with titrating doses of propofol to assist with positioning. Even though the procedure was not successful due to significant thoracolumbar scoliosis, the patient admitted feeling better than she has in months during attempted placement. After continuous infusion of propofol was initiated at subhypnotic dose, the patients analgesic demand was drastically reduced and described her pain as 1 to 3 of l0. Approximately 96 hours after the propofol infusion was started, the patient expired comfortably. There had been no change in her medical regimen during final 48 hours. In the case described, propofol was extremely advantageous as an adjuvant in the management of cancer related pain.
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Bullard 후두경과 직접후두경을 이용한 기관내 삽관시 경부신전의 방사선학적 측정
이상민,한태형,황원균,이정진,강양자,신백호 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.5
Background: Conventional laryngoscopy with Macintosh blade requires a movement of the head, neck and cervical spine. The Bullard laryngoscope is an anatomically shaped, potentially eliminating the need for cervical spine extension. Bullard and Macintosh laryngoscopes were compared by measuring the degree of cervical spine extension by radiological measurement. Methods: Eighteen patients requiring endotracheal intubation were studied. Anesthesia was induced in neutral head position followed by laryngoscopy. Each patients was intubated two times by Macintosh and Bullard laryngoscope in random order. Radiographic evaluation was performed to determine the degree of cervical spine extension on four occasions; before induction, during facial mask ventilation, and during Bullard and Macintosh laryngoscopy. Results: The extension of cervical spine was significantly less following Bullard laryngoscopy than Macintosh laryngoscopy for best view (p<0.05). Conclusions: The Bullard laryngoscope can be used with less cervical spine extension than Macintosh laryngoscope. It may be useful in patients in whom cervical spine movement is limited or undesirable. (Korean J Anesthesiol 1998; 35: 890∼894)
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