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혈관성 원인이 복합부위통증증후군에서의 Triamcinolone 을 사용한 반복적 요부교감신경절차단의 효과 - 증례 보고 -
정성미(Sung Mee Jung),한경림(Kyung Ream Han),옥경종(Kyung Jong Ock),박수경(Soo Kyeong Park),김찬(Chan Kim),김진수(Jin Soo Kim),황혁이(Hyuk E . Hwang) 대한통증학회 2001 The Korean Journal of Pain Vol.14 No.1
Complex regional pain syndrome type I of vascular origin is difficult to detect unless the classic symptoms and signs exist and/or overt extremity trauma has precipitated the pain. The diagnosis is confirmed by relief of pain following a sympathetic nerve blockade. A 36-year-old woman with arterial occlusive disease of the right lower extremity presented with burning pain and hyperesthesia after sprain had occurred which was accompanied by motor weakness of right ankle. A lumbar sympathetic ganglion blockade with 2% lidocaine 10 ml and triamcinolone 80 mg produced prompt improvement of the pain and motion.
양정경 ( Jung Kyung Yang ),이정호 ( Jung Ho Lee ),권미혜 ( Mi Hye Kwon ),정지현 ( Ji Hyun Jeong ),이고은 ( Go Eun Lee ),조현민 ( Hyun Min Cho ),김영진 ( Young Jin Kim ),정성미 ( Sung Mee Jung ),최유진 ( Eu Gene Choi ),손지웅 ( Ji 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.3
배경: 삼출성 흉수 환자의 적지 않은 빈도에서 원인이 불명확하다. 삼출성 흉수를 진단하기 위한 다양한 방법 중에서 내과적 흉강경은 국소마취 하에서 시행할 수 있으며 악성 종양이나 결핵에서 진단율이 높으며, 진정제와 국소마취상태에서 시행할 수 있다. 본 연구의 목적은 내과적 흉강경의 진단적 정확성과 안전성에 대해 알아보고자 하였다. 대상 및 방법: 2005년 10월부터 2006년 9월까지 25명의 원인을 알 수 없는 삼출성 흉수 환자를 대상으로 내과적 흉강경을 시행하였다. 성별, 연령 시술 전 폐기능, 흉부 측와위 사진에서 흉수의 두께(LDR) 등의 정보를 얻었다. 내과적 흉강경 시행도중 활력징후를 기록하였고 동맥혈 가스 분석을 5차례 시행하여 혈역학적 상태와 산-염기 균형 상태를 파악할 수 있도록 하였다. 결과: 환자의 평균 연령은 56.8(22-79)세였고, 흉부 측와위 사진에서 흉수의 두께는 27.49 mm이었다. 내과적 흉강경을 이용한 흉막 조직 생검으로 24명(96%)이 진단되었으며, 결핵성 흉막염이 9명(36%), 악성 흉수가 8명(32%), 부폐렴성 흉수가 7명(28%)이었다. 내과적 흉강경으로 흉수의 원인을 알아낼 수 없었던 1명(4%)은 추후에 심장막 조직 생검으로 결핵으로 진단되었다. 내과적 흉강경 중 혈압, 심박동수, 산-염기 상태의 변화는 보이지 않았다(p>0.05). 결론: 내과적 흉강경은 진단율이 높으면서도 안전한 시술이다. Background: The causes of the pleural effusion are remained unclear in a the substantial number of patients with exudative effusions determined by an examination of the fluid obtained via thoracentesis. Among the various tools for diagnosing exudative pleural effusions, thoracoscopy has a high diagnostic yield for cancer and tuberculosis. Medical thoracoscopy can also be carried out under local anesthesia with mild sedation. The aim of this study was to determine diagnostic accuracy and safety of medical thoracoscopy. Methods: Twenty-five patients with exudative pleural effusions of an unknown cause underwent medical thoracoscopy between October 2005 and September 2006 in Konyang University Hospital. The clinical data such as age, gender, preoperative pulmonary function, amounts of pleural effusion on lateral decubitus radiography were collected. The vital signs were recorded, and arterial blood gas analyses were performed five times during medical thoracoscopy in order to evaluate the cardiopulmonary status and acid-base changes. Results: The mean age of the patients was 56.8 years (range 22-79). The mean depth of the effusion on lateral decubitus radiography (LDR) was 27.49 mm. The medical thoracoscopic pleural biopsy was diagnostic in 24 patients (96.0%), with a diagnosis of tuberculosis pleurisy in 9 patients (36%), malignant effusions in 8 patients (32%), and parapneumonic effusions in 7 patients (28%). Medical thoracoscopy failed to confirm the cause of the pleural effusion in one patient, who was diagnosed with tuberculosis by a pericardial biopsy. There were no significant changes in blood pressure, heart rate, acid-base and no major complications in all cases during medical thoracoscopy (p>0.05). Conclusions: Medical thoracoscopy is a safe method for patients with unknown pleural effusions with a relatively high diagnostic accuracy. (Tuberc Respir Dis 2007; 63: 261-267)
임상연구 : 제왕절개술을 위한 경막외 마취 시 0.5% Levobupivacaine과 0.5% Ropivacaine 비교
양춘우 ( Chun Woo Yang ),정성미 ( Sung Mee Jung ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),류승훈 ( Seung Hun Ryu ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3
Background: Ropivacaine and levobupivacaine, both single S-enantiomers, show less toxicity on the central nervous and cardiovascular system than racemic bupivacaine. Earlier studies have shown that levobupivacaine and bupivacaine are almost equipotent while ropivaciane was 60% less potent than bupivacaine. The aim of this prospective, double blinded study was to compare the clinical efficacy and safety of epidural anesthesia produced by 0.5% levobupivacaine and 0.5% ropivacaine for a cesarean section. Methods: Sixty-two parturients undergoing an elective cesarean section were randomized to receive either epidural levobupivacaine 0.5% 20 ml (n = 31) or epidural ropivacaine 0.5% 20 ml (n = 31). Surgery was commenced when the sensory block had reached the dermatome level, T6. The onset, duration, quality of the sensory and motor block and abdominal muscle relaxation were evaluated. The blood pressure and heart rate of the mother and neonatal outcome, as assessed by the Apgar score and umbilical pH, were also recorded. Results: There was no difference in the onset time, the segmental spread of sensory block and analgesic supplement between the two groups. However, levobupivacaine produced a longer duration of sensory block than ropivacaine (levobupivacaine 224.1 ± 66.6 min, ropivacaine 176.5 ± 32.8 min, P < 0.05). The onset time (except Bromage scale 2), intensity and duration of the motor block and muscle relaxation were similar in both groups. There was no difference in the maternal and neonatal outcomes between the two groups. Conclusions: 0.5% levobupivacaine and 0.5% ropivacaine produced equivalent efficacy and safety in epidural anesthesia for a cesarean section, but levobupivacaine resulted in a longer duration of sensory block. (Korean J Anesthesiol 2007; 52: 284~90)
빗장 아래 팔신경얼기 차단 환자에서의 0.75% 또는 0.5% Ropivacaine의 비교
박정민 ( Jeong Min Park ),정성미 ( Sung Mee Jung ),조춘규 ( Choon Kyu Cho ),임영수 ( Young Su Lim ),구자현 ( Ja Hyun Ku ),허윤무 ( Youn Moo Heo ),송장호 ( Jang Ho Song ),양춘우 ( Chun Woo Yang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Background: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.75% vs 0.5% ropivacaine for upper limb surgery. Methods: We included 80 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.75% or 0.5% ropivacaine. By observation, we determined nerve type was stimulated and scored the level of sensory block and motor block. The quality of blocks was assessed intra-operatively. The duration of sensory block and motor block and their complications were assessed. Results: There were no significant differences in the frequency of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant differences in the duration of sensory block and motor block. Vascular puncture was noted in 1 patient in the 0.75% ropivacaine. Conclusions: Both the 0.75% and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block. (Korean J Anesthesiol 2009;57:572∼8)
정중법을 이용한 빗장 아래 상완 신경총 차단 환자에서의 0.5% Levobupivacaine과 0.5% Ropivacaine의 비교
조춘규 ( Choon Kyu Cho ),김중연 ( Joong Yeoun Kim ),정성미 ( Sung Mee Jung ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),김철웅 ( Chul Woung Kim ),한정욱 ( Jeong Uk Han ),양춘우 ( Chun Woo Yang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.2
임상연구 : 소아에서 술 전 미추차단은 적절한 마취 심도 유지를 위한 Sevoflurane의 요구량을 감소시킨다
송장호 ( Jang Ho Song ),이홍식 ( Hong Sik Lee ),김병건 ( Byung Gun Kim ),임현경 ( Hyun Kyoung Lim ),신혜란 ( Helen Ki Shinn ),정성미 ( Sung Mee Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.1
Background: It is generally known that neuraxial anesthesia for adults reduces the demand for hypnotics needed for adequate sedation. Therefore, this study examined the effect of a preoperative caudal block on the general anesthetic requirements for an adequate depth of anesthesia in children. Methods: Twenty children aged 3-5 years, who were set to undergo inguinal herniorraphy, were divided into 2 groups of 10 children each, normal saline and lidocaine groups. Tracheal intubation was performed. After setting up the bispectral index (BIS) monitor, a caudal block was administered to both groups differently, normal saline 0.7 ml/kg was administered to the normal saline group and 1.5% lidocaine 0.7 ml/kg was administered to lidocaine group. The end-tidal concentration of sevoflurane was maintained at 1.5 vol% for 10 minutes in the first patient in both groups, and the BIS value, was measured 6 times every 10 seconds, and averaged. When the BIS was ≥ 50, the end-tidal concentration of sevoflurane was increased by 0.2 vol% in the subsequent patient. When the BIS was less than or equal to 50, the end-tidal concentration of sevoflurane was decreased by 0.2 vol% in the subsequent patient. The MACBIS50 in both groups was calculated using probit analysis. Relative median potency analysis was used to compare the results in both groups. Results: The MACBIS50 of sevoflurane was significantly lower with a 1.5% lidocaine caudal block (1.40 vol% [95% CI, 1.25- 1.55 vol%]) compared with the normal saline group (1.77 vol% [95% CI, 1.61-2.00 vol%]). Conclusions: A preoperative caudal block reduces the demand for sevoflurane required for an adequate depth of anesthesia, as measured by the BIS in children. (Korean J Anesthesiol 2007; 52: 29~33)