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상복부 수술 환자에서 Fentanyl, Bupivacaine 및 Clonidine혼용에 의한 경막외 제통에 대한 평가
임웅모(Woong Mo Im),윤명하(Myung Ha Yeon),한상도(S 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1
N/A Background: Epidural analgesia has been widely used for postoperative pain relief. How- ever, it is not known which regimen provides the best result due to many variety. The aim of this study is to evaiuate the analgesia and side effects of epidural mixute of fentanyl, bupivacaine and clonidine, as one kind of regimen. Methods: One hundred adult patients scheduled for upper abdominal surgery under gener- al anesthesia were evaluated. Epidural catheterization was done after operation. A bolus, 0. 1% bupivacaine 10ml containing fentanvl 100 μg, was administered and followed up with continuous infusion of mixture of fentanyl 600μg, 0.5% bupivacaine 20ml and clonidine 150 μg at a rate of 2 ml, hr for 50 hours. Analgesia was assessed using VAS, PHS and PRS. Side effects and number of patients who took additional analgesics were evalutated Plas- ma samples were obtained to determine fentanyl concentration. Results: After the administrations of drugs, patients pain scores decreased notably, and pain relief scores increased significantly. Minimum side effects were noted. Twenty-one pa- tients required additional analgesics. Plasma concentration of fentanyl was 0.07-0.14 ng/mL Conclusion: Epidural infusion of mixture of fentanyl, bupivacaine and clonidine is an ef- fective regimen for postoperative pain relief after upper abdominal surgery.
항응고제 사용 환자에서 지속적 경막외 제통술후 발생한 경막외 혈종 - 증례보고 -
유경연(Kyung Yeon Yoo),임웅모(Woong Mo Im),박준서( 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1
Epidural hematoma during anticoagulant therapy is a rare complication of central neural blockade, but it may result in serious neurologic sequelae. A 61-year-old male receiving warfarin due to heart failure was referred to the pain clinic for control of severe herpetic neuralgia. Epidural catheterization was done at T,, interspace. At that time, PT and aPTT were extremely prolonged. The next morning, severe back pain, motor paralysis and urinary difficulty developed. On spine MRI, epidural hematoma was detected at T, inter- space. Four days later, he died due to underlying diseases. Central neural blockade in pa- tient with anticoagulant therapy is contraindicated in most cases. If it is undertaken, close observation of patients neurologic functions and monitoring of coagulation profiles(PT, aPTT, etc) are necessary. If epidural hematoma develops, early surgical decompression is mandatory.
Succinylcholine 이 Atracurium 의 작용시간에 미치는 영향
임웅모,윤명하,류경연,박수택 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.7
For the assessment the effect of succinylcholine (SCh) on atracurium, 59 adult patients undergoing elective surgery under general anesthesia were subjected to this study in which the nEMG response (twitch height) of the hand to TOF stimulation (0.2 Hz) of ulnar nerve was monitored and recorded with Datex Relaxograph. According to the amount and mode of the drugs administered, the patients were divided into four experimental groups; 1) Group I, a bolus injection of atracurium in dose of 0.5 mg/kg 2) Group II, atracurium 1.0 mg/kg, a double dose of group I 3) Group III, atracurium 0.5 mg/kg after 25 to 50% recovery of initial twitch height from twitch height depression induced by SCh (1 mg/kg) 4) Group IV, mixed injection of SCh (1 mg/kg) and atracurium (0.5 mg/kg) Followings were the results. 1. Mean onset time of the atracurium, which was 4.5±0.6 minutes in group I and 4.00.7 minutes in group II, changed to 2.7±0.6 and 4.0+0.8 minutes in group III and IV respectively, showing no significance. 2. Mean action ration of atracurium was 49.1±3.4 minutes in group I and 72.0±3.7 minutes in group II, the latter being significant (p$lt;0.001). It was, however, 49.0±3.6 minutes in group III, indicating that SCh shnwed a little effect, while it was 38.1±1.8 minutes in group IV, being significantly shorter than those of group I and IlI (p$lt;0.01). 3. Mean potency of atracurium expressed by the percentage change of initial twich height was 0.7±0.5% in group I and it was decreased to 0% in group II but it was not sinificant. In group III, it was increased to 0.9±0.6% but it was also no significance. In group IV, it was decreased to 0.4±0.2% which was not significant. 4. Presence of atracurium (0.5 mg/kg) in group IV did not have any effect on the intensity of fasciculation induced by SCh. These results indicate that succinylcholine did not attect the onset time and action potency of atracurium. However, in group of the mixed injection, SCh shortened only the duration of action of atracurium.