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Lidocaine 및 Morphine 경막외차단에 의한 뇨관 결석의 치험
조공래(Gong Lae Cho),허남진(Nam Jin Hur),노운석(Wo 대한통증학회 1989 The Korean Journal of Pain Vol.2 No.1
N/A For the simple operations of the perineal region, caudal, epidural and saddle blocks of analgesia are preferable anesthesia techniques in men. But, if the operations shoud be delayed or the physicians are willing to observe and manipulate the patients for a couple of days, as in the ureteral stone manipulation, continuous epidural analgesia will be a reliable method. The authors have observed 36 male patients of ureteral calculi with continuous lumbar epidural analgesia for the purpose of elimination of an undesirable pain sensation which was associated with the transurethral cystoscopic manipulation. The results were as follows: 1) In most cases, the anesthetics used were 1% lidocaine 20 ml through the L,, and L, interspace with 4-6 cm of catheter tip advancement mainly to cephalad. 2) There was no motor weakness or paralysis in the lower extremities except some numbness and paresthesia on the perineal area. 3) Besides the various minor complications, there were no problems in respiration with small doses of morphine extradurally. 4) Among them, four cases of ureteral calculi dropped into the bladder spontaneously due to the epidural technique during transportation of the patients from the pain clinic to the urology out-clinic. One case of calculi was dropped by the aid of instrumentation at the ward, and twelve cases of calculi were removed directly by Dormia stone basket in the scopic room. For the remaining patients, we deduced that their calculi was be evacuated out because there were no complaints were notified after discharge.
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전신마취시 병행한 경막외차단이 술후 간기능에 미치는 영향
이상화,김봉일,조공래,진선미,노운석 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.4
The common causes of postoperative liver dysfunction during anesthesia and surgery are due to the decreased cardiac output and/or systemic blood pressure as well as poor regional distribution of hepatic blood flow. It is well known that the surgical manipulation and the kinds of operation, especially around the hepatic area, are more important factors about the hepatic blood flow than anesthetics and anesthesia techniques. We postulated that the activity of sympathetic reflex initiated by surgical manipulation could be abolished by instituting epidural block on the peripheral operative field and consequently hepatic blood flow might be improved. We randomly selected 40 patients for upper abdominal surgery and divided them into 4 groups as follows: Group 1: Halothane anesthesia (10 cases, normal liver function test (LFT); contol) Group 2: Halothane anesthesia with epidural block (10 cases, normal LFT) Group 3: Enflurane anesthesia (10 cases, abnormal LFT; control) Group 4: Enflurane anesthesia with epidural block (10 cases, abnormal LFT) Epidural block was performed just before general anesthesia with 1% lidocaine, 2 ml/segment. Mean arterial pressure (MAP) was measured before anesthesia and at 5, 10, 15, 20, 30 and 60 min during surgery. And serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), alkaline phosphatase, total protein and albumin were measured before anesthesia and on the 1st, 3rd, 5th and 7th postoperative day. The results were as follows: 1) MAP was changed significantly at 20 min in group 2 (p $lt; 0. 01) and at 15 min in group 4(p $lt; 0. 05). 2) The values of postoperative LFT were changed similarly but no statistical difference between group 1 and 2. 3) The values of postoperative LFT were declined significantly (esp. SGOT and SGPT), but no statistical difference between group 3 and 4. 4) Even though the postulation is correct, the effects of epidural block combined with general anesthesia (group 2, 4) on postoperative liver function were not different statistically compared with that of general anesthesia alone (group 1, 3). It might be suggested that the amount of decreased blood flow caused by surgical manipulation would be similar with that by the epidural block. 5) Now we hope that the further evaluation will be expected about the hepatic blood flow such as direct measurement.
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허남진,이상화,김봉일,조공래,노운석 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.1
Since the epidural catheterization has been widely used for the purpose of anesthesia, diagnosis and pain control, there are various undesirable complications and hazards through the technical procedure or catheterization itself. Authors have experienced several hazards of location of the epidural catheter tip which were detected by epidurography performed the 1st. or 2nd. postoperative day with 50% Angiograffin. Hazards were as follows; 1) Single air bubble in the epidural space. 2) Inappropriate placement of the catheter tip. 3) Kinking of catheter in the epidural space. 4) Intravascular placement of the catheter.
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