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만성 추간판성 요통에 대한 고주파를 이용한 추간판내 윤상성형술
오완수,강호정,김광민 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.4
Chronic discogenic low back pain remains a difficult treatment chanllenge. Also, Internal disc derangement in the lumbar spine is a common yet difficult clinical condition to treat. The reported prevalence of chronic low back pain due to intrinsic disc mediated pain is at least 40%. Internal disc derangement has characteristics such as degeneration of the collagen of the disc annulus, fissures, global disc degeneration, and herniation with or without root compression. The common treatment for chronic discogenic low back pain has been conservative, including physical therapy and pharmacological management but the effectiveness reminans controversial. Surgical fusion offers modest results at best, but ofter fails, and is associated with complications and postoperative continued pain. The intradiscal electrothermal annuloplasty has become known as a safe and effective treatment for patients suffering from discogenic pain and offers the advantage of potentially reparing the damaged disc while maintaining normal disc function. We applied a navigable catheter with a temperature controlled thernal resistive coil, deployed intradiscally through a percutaneous extrapedicular approach under two plane fluoroscopic guidance in chronic low back patients. The authors experienced tow cases of chronic discogenic pain that had failed to respond to any kind of conservative treatment but which was successfully relieved by the intradiscal electrothermal annuloplasty.
TCI(Target Controlled Infusion)를 이용한 Propofol 의 수면 상태하 신경차단술
오완수,홍기혁,안우용 대한마취과학회 2000 Korean Journal of Anesthesiology Vol.39 No.1
Background : The use of sedative and analgesic adjuncts during local and regional anesthesia can enhance patieet comfort and improve operative conditions. Because propofol has well-known rapid recovery characterized by clear-headedness$quot;, its use intraoperatively may result in less postoperative sedation and thus shorten the time for discharge from the hospital. The purpose of this study was designed to evaluate the patients satisfaction of hypnotic neural blockade using target controlled infusion (TCI) of propofol. Methods: Sixty-two patients scheduled to undergo elective neural blockade in the operating room were selected for this study. They had taken previous neural blockade in the awakening state. Without premedication, they amved at the operating room via pain clinic. After proper positianing, vital signs, pulse oximetry and respiratory rate were monitored. TCI of propofol was started at a target concentration of 3.0 μg/ml and an induction time of 3 minutes. We regarded loss of hand grasping power as iduction of hypnosis. Subsequently, target concentration was adjusted to a range of 0.8-1.6 times the effector site concentration at induction. Propofol infusion was stopped when the procedure was finished and the patients were transported to the recovery room and discharged. The satisfaction of patients conceming hypnotic neural blockade were evaluated by a six point numerical rating scale (6: best-1: worst). Results : Patient withdrawal movement during local anesthetic infiltration occured in 17 patients. Recovery time was 4.7 ± 3.0 min (mean ± S.D.). Patient's satisfaction for hypnotic neural blockade was 5 [3-6] (median [rangeJ]. Conclusion : Patient's satisfaction for hypnatic neural blockade was high. TCI of propofol serves as a safe sedation model during neural blockade without any residual sequelae. (Korean J Anesthesiol 2000; 39: 56~60)