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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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흰쥐의 분리 폐장 관류 모델에서 Nitroglycerin의 폐장 보존 효과
전상훈,이섭,이종훈,손복경,조공래,정진용,조성경,김봉일,이영만,조중행 대한흉부외과학회 2003 Journal of Chest Surgery (J Chest Surg) Vol.36 No.12
배경: 체내에서 발생하는 산화 질소는 허혈-재관류에 따른 폐혈관 저항을 감소시키고 혈관의 미세 투과도를 줄이고 세포손상을 방지하여 이식 후 폐장 기능의 보전에 도움이 된다고 알려져 있으나, 산화질소 자체의 세포독성으로 인해 재관류 동안 폐 부종을 오히려 증가시킬 수도 있다고 한다. 저자들은 산화 질소의 공여물질인 nitroglycerin을 투여한 분리 폐장 관류 모델을 이용하여 폐장 보존에 이점과 단점을 동시에 가지고 있는 산화질소가 허혈-재관류 과정에서 폐장의 기능에 미치는 영향을 알아보기 위하여 본 연구를 시행하였다. 대상 및 방법: Sprague-Dawley종의 수컷 흰쥐 35마리를 사용하였다. Nitroglycerin (NTG)군(n=18)은 NTG를 정맥 주사하고 University of Wisconsin용액에 혼합하여 폐장 관류를 시행하였고, 대조군(n=17)은 NTG 대신 같은 양의 생리 식염수를 사용하였다. 구득한 심폐블록을 10oC에서 24시간 동안 보관한 후, 분리 폐장 관류 모델에서 인체 혈액을 Krebs-Hensleit용액으로 희석하여 60분간 재관류하였다. 재관류하는 동안 기도내압과 폐동맥압을 지속적으로 측정하였고, 관류 후 30분과 60분에 혈액 내 산소와 이산화탄소 분압을 측정하였다. 재관류가 끝난 후 기관지폐포세척을 통해 폐포 내 단백함량을 측정 하였으며, 중성구 침착 정도를 알기 위해 myeloperoxidase (MPO) 활성도를 측정하였다. 결과: 두 군 간의 기도내압과 폐동맥압은 통계적으로 유의한 차이는 없었으나, NTG군에서 관류기간 중 폐동맥압이 상대적으로 낮게 유지되는 경향이 있었다. 이산화탄소 분압, 기관지폐포세척액 내의 단백질 함량, MPO의 활성도는 두 군에서 유의한 차이는 없었으나, 산소 분압은 NTG 군에서 통계적으로 유의하게 높게 나타났다(p<0.05). 전자현미경 검사에도 대조군에 비해 NTG군에서 폐포구조, 폐포상피세포, 모세혈관배열 등 미세구조의 손상이 적게 나타났다. 결론: 폐장 구득 전 NTG의 투여는 폐장의 기능과 미세구조의 유지에 도움이 된다고 판단되며, 임상 폐이식에도 적용이 가능하리라 생각된다.
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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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