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각성상태하 언어피질 지도화시 후두마스크를 이용한 마취관리
이상귀,오광조 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.2
Epilepsy surgery is performed in patients with epilepsy of focal origin and seizures which are refractory to medical treatment. Electrophysiologic mapping of the epileptic foci and other cortical areas (e.g., language, memory, sensorimotor) is frequently used to maximize the resection of the epileptogenic lesion while minimizing the neurologic deficits. For language area mapping, general endotracheal anesthesia can not be used because a patient can not vocalize. So awake craniotomy is frequently used. However, during awake craniotomy for language area mapping with local infiltration anesthesia and intravenous sedation and narcotics supplementation analgesia, respiratory arrest or depression and hypoxemia may occur. The airway securement is crucial to the patients. As an alternative to tracheal tubes, laryngeal mask airway can secure the airway and does not interference the vocalization. We could successfully performed the language area mapping in a 17-year-old male patient with laryngeal mask airway under deep intravenous anesthesia with local infiltration anesthesia of the scalp. (Korean J Anesthesiol 1999; 36: 340∼344)
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전자궁적출술 후 통증에 대한 마그네슘의 선행 진통 효과
최훈,고성훈,오광조,허문수,한영진 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.37 No.3
Background : Recent studies suggest that preoperative block of the N-Methyl-D-Aspartate (NMDA) receptor with NMDA antagonists may reduce postoperative pain. We infused magnesium sulfate, anatural NMDA receptor antagonist, preoperatively to evaluate the preemptive analgesic effect of magnesium. Methods : Sixty healthy patients who underwent total abdominal hysterectomy under general sthesia were randomly divided into three groups. Group 1 was the control group, while Groups 2 and 3 received intravenous magnesium (Group 2 : 0.1 mg/kg bolus, 0.015 mg/kg/hr for 6hr, Group 3 : 0.2 mg/kg bolus, 0.03 mg/kg/hr for 6hr). Postoperative pain scorers (Visual Analog Scale: VAS and Prince Henry Score: PHS) and the amount of analgesic consumption were evaluated at 6, 24, 48 and 72 hours by a double blind manner. Results : The patients in Group 3 had lower pain scores at 6 and 24 hours compared to those in Group 1, but there were no significant differences in PHS and cumulative amounts of analgesic consumption among the three groups. Conclusions : The preoperative administration of intravenous magnesium reduced postoperative pain scores. However, further study is needed before its clinical use for postoperative analgesic purposes. (Korean J Anesthesiol 1999; 37: 447∼452)
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위절제술 환자에서 술후 통증에 대한 마그네슘의 선행진통 효과
최훈,한영진,고성훈,오광조,허문수 대한마취과학회 1999 Korean Journal of Anesthesiology Vol.36 No.5
Background : Recent studies suggested that preoperative block of N-methyl-D-aspartate (NMDA) receptor with NMDA antagonists may reduce postoperative pain. In this double-blind study, we administered magnesium sulfate, a natural NMDA receptor antagonist, to investigate the preemptive effect of magnesium sulfate on postoperative pain. Methods : Seventy-three patients scheduled for gastrectomy were randomly assigned to one of three groups. Groups 2 and 3 received intravenous magnesium sulfate (Group 2: 50 mg/kg bolus, 7.5 mg/kg/h for 20 h, preoperatively, Group 3: 50 mg/kg bolus, 7.5 mg/kg/h for 20 h, postoperatively). Group 1 received normal saline as the control group. Visual analog scale (VAS) for postoperative pain and mood, cumulative analgesic comsumption, recovery of pulmonary function and side effects were evaluated at 6, 24, 48 and 72 hours after the operation. Results : In groups 2 and 3, plasma concentration of magnesium were significantly higher than group 1 after 6 and 20 hours after infusion. There were no significant differences in the pain, mood, cumulative analgesic comsumption, and recovery of pulmonary function and the incidence of side effects at 6, 24, 48 and 72 hours after the operation among the three groups. Conclusions : We conclude that intravenous infusion of magnesium is not effective in reducing postoperative pain. (Korean J Anesthesiol 1999; 36: 856∼861)
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김우선,최훈,황영섭,오광조 대한통증학회 2000 The Korean Journal of Pain Vol.13 No.1
Pain around the posterior iliac crest area is usually attributed to disorders of the lower lumbar or lumbosacral spine. However, low back pain arising from the thoracolumbar region is common and it is very similar to low back pain of lumbosacral origin. Low back pain of thoracolumbar origin is clinically distinguished from other nonspecific low back pain syndrome. It is characterized by symptoms localized at one posterior iliac crest innervated by posterior branch of Tu spinal nerve. Patients never complain of T12 spontaneous pain at the thoracolumbar junction. Only localized tendemess over involved segments of thoracolumbar junction can be noted. We report two cases of posterior iliac crest pain of thoracolumbar origin which was relieved by the treatment on the thoracolumbar junction.
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장영익,최훈,이민승,손지선,오광조 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.3
Background: The purpose of this study is to compare the effectiveness of thoracic epidural anesthesia (TEA) and general anesthesia (GA) in terms of side effects, postoperative pain control and the cost of anesthesia for breast mass excision surgery. Methods: Forty-three patients rated as ASA physical status class 1 or 2 who underwent breast mass excision surgery were included in the study. In the TEA group (n = 20), 2% lidocaine (3 ml) and 0.5% bupivacaine (3 ml) were administered via the epidural route. Blood pressure and heart rate were measured before and at 3, 6, 9, 12, 15, 18 21, 24, 27 and 30 minutes after epidural injection. In the GA group (n = 23) patients were maintained by general anesthesia with enflurane and 50% nitrous oxide in oxygen. After the operation, patients were given NSAID-diclofenac sodium as they wanted. Analgesic requirement, satisfaction score, and anesthesia-related side effects were recorded 1 day after surgery. Satisfaction scores of the surgeons and patients were recorded as excellent (4 point), good (3 point), fair (2 point), and unacceptable (1 point). Results: Overall satisfaction scores and side effects were not significantly different between the TEA group and the GA group. Anesthesia cost (80,883.2 ± 3956.9 vs 32,284.8 ±1209.4 won) were significantly lower in the TEA group than in the GA group. Conclusions: There were not significant differences in satisfaction scores and postoperative side effests between the TEA and GA groups. TEA provided lower anesthesia cost than GA for breast mass excision surgery.
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