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초산모에서 경막외 L1-2 와 L3-4 차단 시 제통효과와 분만기간의 비교
강규식(Kyu Sik Kang),이상윤(Sang Yoon Lee),김정순(Jung Soon Kim),남계현(Kae Hyun Nam),박욱(Wook Park) 대한통증학회 2001 The Korean Journal of Pain Vol.14 No.1
N/A Background: Usually, lumbar epidural block is performed on the L3-4 interspace. This study was designed to evaluate the analgesic efficacy and shortening of labor duration comparing the L-z and L3-4 interspace epidural blocks in nulliparous normal vaginal deliveries and then investigates side effects following the blocks. Methods: Eighty healthy nulliparous women were divided into two groups, L z (n = 40) and L3-4 (n = 40). Epidural blocks, lumbar epidural block were performed at the L z and L3-4 interspace with a catheter advancing 3 cm cephalad. The initial dose of 12 ml (0.167% bupivacaine, fentanyl 50㎍ and clonidine 75 ㎍) was injected epidurally at 4 cm dilatation of cervix and severe pain of labor. If a visual analogue scale (VAS) score was more than 4 points, an additional dose was administered cpidurally using the same volume as the above mentioned, but with the exception that the bupivacaine was diluted to 0.1 percentage. The maternal blood pressure, pulse rate, respiration rate and fetal heart rate were measured at 10 min intervals for the first 30 min, at 15 min interval for the next 30 min and at 30 min interval for the last one hour following the blocks. The duration of the first (active) and second stages of labor was counted and the neonatal Apgar score was recorded at one and five min after delivery. The degree of motor block, pruritus, nausea and vomiting were also noted. Results: The patients in group L1-2 had lower pain scores than group L3-4 at 5, 20, 30, 60 mins. The duration of 1st and 2nd labor stage in the L3-4 epidural block were 272 ± 33.5 min, 49.2 ± 27.4 min respectively but those in the L1-2 epidural block were 253.5 ± 32.5 min, 37.3 ± 22.3 min, respectively. Conclusions: We concluded the analgesic efficacy and shortening of labor duration in L1-2 epidural block was better than those in L3-4 epidural block. Maternal hemodynamic change, motor block. pruritus, nausea, vomiting and Apgar score showed no significant differences between the two groups.
유방절제술 후 광배근 근피판을 이용한 즉시 유방재건술 환자에서 경추 경막외 및 정맥내 자가통증조절의 효과 비교
강규식 ( Kyu Sik Kang ),김창원 ( Chang Won Kim ),안기량 ( Ki Ryang Ahn ),김천숙 ( Chun Sook Kim ),유시현 ( Sie Hyeon Yoo ),정진헌 ( Jin Hun Chung ),정지원 ( Ji Won Chung ),김상호 ( Sang Ho Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Background: Breast reconstruction following mastectomy has become increasingly popular in recent years. The purpose of this study was to compare the efficacy of cervical epidural patient-controlled analgesia (CEA) and intravenous patient-controlled analgesia (IV-PCA) for controlling the postoperative pain and the side effects after mastectomy with immediate Latissimus dorsi (LD) flap breast reconstruction. Methods: Sixty patients who were to undergo mastectomy with immediate LD flap breast reconstruction were randomly assigned to receive CEA [Group CEA, (n=30), 0.15% ropivacaine+fentanyl 4 μg/ml] or IV-PCA [Group IV-PCA (n=30) fentanyl 20 μg/kg+ketorolac 3 mg/kg] for postoperative pain control via a PCA pump (basal rate: 2 ml/h, bolus: 2 ml, lock out interval: 15 min) after their operation. Before general anesthesia, an epidural catheter was inserted at the cervical (C) 7-thoracic (T)1 level in the patients of the CEA group. The resting visual analogue scale (VAS) for pain, the systolic blood pressure, the heart rate and the side effects were recorded for 48 hours after operation. Results: The VAS at rest was significantly lower in the CEA group than that in the IV-PCA group at 16 hours after surgery. The CEA group required less additional analgesics as compared with the group IV-PCA. There were no significant differences in the systolic blood pressure, the heart rate and the incidence of side effects between the two groups. Conclusions: We conclude that cervical epidural analgesia, as compared with intravenous patient-controlled analgesia, provides effective pain control and it shows a similar incidence of side effects after mastectomy with immediate LD flap breast reconstruction. (Korean J Anesthesiol 2009; 56: 669~74)
증례보고 : Nuss 방법에 의한 오목가슴 술 후 발생한 수축성심막염 환자에서 금속막대 제거 및 심막절제술에 의한 심장천공과 혈흉
서은정 ( Eun Jung Seo ),안기량 ( Ki Ryang Ahn ),김천숙 ( Chun Sook Kim ),강규식 ( Kyu Sik Kang ),유시현 ( Sie Hyun You ),정진헌 ( Jin Hun Chung ),정지원 ( Ji Weon Chung ),이승진 ( Seung Jin Lee ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4
Nuss procedure offers excellent outcome effect in the cosmetic point of view, but the complications such as cardiac perforation, pericardial effusion, constrictive pericarditis, hemothorax, pneumothorax and bar displacement sometimes occur. We experienced a 13-year-old-male, who showed the profound hypotension with bradycardia due to the cardiac perforation and the lung laceration during the pericardiectomy and the removal of pectus bar. Emergent partial cardiopulmonary bypass was initiated and then, ruptured right atrium and lung laceration were repaired without the remarkable complications. In anesthetic management of the pectus excavatum. This case reveals that special attention should be paid to those with cardiac perforation and lung laceration. (Korean J Anesthesiol 2007; 53: 539∼43)
증례보고 : Methylprednisolone 투여 후 발생한 알레르기 반응
정진헌 ( Jin Hun Chung ),안기량 ( Ki Ryang Ahn ),전혜정 ( Hye Jung Chun ),김천숙 ( Chun Sook Kim ),강규식 ( Kyu Sik Kang ),유시현 ( Sie Hyeon Yoo ),정지원 ( Ji Won Chung ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4
Corticosteroid preparations have anti-inflammatory and immunosuppressive properties and are used widely for the treatment of allergic disorders and asthma. Steroids themselves, however, can induce hypersensitivity reactions. In this study, we report the case of a 66-year-old man with chronic obstructive pulmonary disease who exhibited an allergic reaction (rash, bronchospasm, bradycardia, severe hypotension and cardiac arrest) immediately after the intravenous injection of methylprednisolone sodium succinate. Despite cardiopulmonary resuscitation, sinus rhythm was not restored. The anesthesiologist should be aware that allergic reactions to corticosteroids can occur. (Korean J Anesthesiol 2009;57:499∼502)
소아에서 진단 복강경술과 복강경하 수술 시 심폐기능 변화
정진헌 ( Jin Hun Chung ),안기량 ( Ki Ryang Ahn ),신온섭 ( On Sub Shin ),김천숙 ( Chun Sook Kim ),강규식 ( Kyu Sik Kang ),유시현 ( Sie Hyeon Yoo ),정지원 ( Ji Won Chung ),구자욱 ( Ja Ug Koo ),이정석 ( Jeong Seok Lee ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Background: Information concerning the cardiopulmonary effects of pneumoperitoneum in children is lacking. Methods: Twenty eight patients were assigned to receive diagnostic laparoscopy (n=12) or laparoscopic surgery (n=16). Before insufflation of CO2, tidal volume was set at 10 ml/kg and respiratory rate was adjusted to achieve an end-tidal CO2 (P(ET)CO2) of 30-35 mmHg. Abdominal pressure was maintained at 10-15 mmHg by a CO2 insufflator. We measured the changes of systolic arterial pressure (SAP), heart rate (HR), P(ET)CO2 and peak airway pressure (PAP) at 5 min before (control value) and after CO2 insufflation and 5 min after CO2 deflation. Results: SAP and PAP were increased significantly after pnemoperitoneum compared with the control both in diagnostic laparoscopy and laparoscopic surgery (P<0.05). P(ET)CO2 was increased significantly after pneumoperitoneum and after CO2 deflation in laparoscopic surgery compared with the control and also with diagnostic laparoscopy (P<0.05). Driving pressure (the difference between peak airway pressure and abdominal pressure) was increased significantly after pneumoperitoneum in laparoscopic surgery compared with diagnostic laparoscopy (P<0.05). Conclusions: SAP, PAP and P(ET)CO2 increases during diagnostic laparoscopy and laparoscopic surgery, but this effect appears to be of smaller magnitude in diagnostic laparoscopy compared to laparoscopic surgery. We found that these changes had no clinically deleterious effects in healthy children. (Korean J Anesthesiol 2009;56:31~5)
임상연구 : 흉부 척추옆블록시 적절한 바늘거치를 위한 해부학적 고찰
유시현 ( Sie Hyeon Yoo ),서환주 ( Hwan Joo Seo ),김천숙 ( Chun Sook Kim ),안기량 ( Ki Ryang Ahn ),강규식 ( Kyu Sik Kang ),정진헌 ( Jin Hun Jung ),천경아 ( Kyung Ah Chun ),김종분 ( Jong Bun Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: Thoracic paravertebral blockade (TPVB) can be effective in many clinical settings. However, many clinicians are reluctant to use this technique due to its adverse effects such as pneumothorax. The aim of this study was estimate the appropriate depth and width for safe needle positioning. Methods: The depth from skin to the paravertebral space (PVS) and the width from the spinous process (SP) to the PVS and the lateral tip of the transverse process (LTTP) were measured in all available sections from 84 patients examined by chest computed tomography (CT). The correlation between age, gender, body mass index (BMI) and each measured value was analyzed. Results: All 828 sections from the 84 patients aged between 19 and 65 years old were evaluated. The minimum and maximum values of the mean depth from the skin to PVS were 40.3-52.4 mm in men and 41.2-55.9 mm in women. The minimum and maximum values of the mean width from the SP to LTTP were 29.2-34.6 mm in men and 23.7-31.0 mm in women. At every thoracic level, the depth to PVS was similar in both genders but the width from the SP to the NEP in men was significantly higher than in women. Weight significantly influenced the width from the SP to LTTP in men but height and BMI did not. Also weight and BMI significantly influenced the depth from skin to PVS in almost all of the thoracic region at both sex, but height did not influence the depth from skin to PVS in both sex. Conclusions: We report clinically useful estimates that may be used to help avoid side effects such as pneumothorax and achieve a successful thoracic paravertebral blockade. (Korean J Anesthesiol 2007; 53: 188~93)