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Cauda Equina Syndrome Following Intrathecal Hypertonic Saline Administration
최훈,Choe, Huhn The Korean Journal of Pain 1990 The Korean Journal of Pain Vol.3 No.1
대상포진 후 신경통은 통증치료실에서 당면하는 가장 치료하기 어려운 질환중의 하나로서 현재까지 교감신경 차단, 경피적 전기자극, 약물요법 등 여러 방법이 소개되어 있으나 어느것이나 만족스럽지 못하다. 저자는 상기의 모든 방법을 동원하여 통증의 제거에 실패한 60세의 여자환자에 지주막하로 45 ml의 냉식염수를 주입하여 폐부종, cauda equina syndrome 등을 포함한 심한 합병증을 경험하였기에 문헌과 함께 고찰해 보고자 한다. A case of severe complications following intrathecal administration of 45 ml of hypertonic saline solution for the treatment of postherpetic neuralgia was presented. Transient immediate complications included were tachycardia, hypertension, neck stiffness and muscle twitch. Pulmonary edema, paralytic intestinal obstruction, and the cauda equina syndrome including sphincter disorder with atonic urinary bladder developed shortly after the injection. Tenesmus and sensory abnormality around perineum and soles were the longlasting complications.
최훈,김동찬,Choe, Huhn,Kim, Dong-Chan 대한통증학회 1990 The Korean Journal of Pain Vol.3 No.1
급성 대상 포진환자 51예를 분석하여 다음과 같은 결과를 얻었다. 1) 발생 빈도는 50대 이상 고령층의 여자에서 높았다. 2) 이환 부위는 흉추부가 가장 많았다. 3) 통증 성격은 매우 다양하였으나 쏜다, 찌른다, 쑤신다가 가장 많았다. 4) 진통제는 aspirin과 phenobarbital을 가장 많이 사용하였다. 5) 스테로이드는 전신적으로 사용한 예가 가장 많았고 전신적 및 경막외로 병용했던 예가 많았다. 6) 신경차단으로 두경부 질환에는 성상 신경절 차단, 그 이하는 경막외 차단이 가장 많았다. 7) 대상 포진후 신경통으로 이행하는 율은 11.8%였다. 이상의 결과는 급성 대상 포진의 치료에 탁월한 효과를 갖는 단독적인 방법이 없다는 것을 의미하며 통계적으로 명확히 증명되지는 않았으나 국소 마취제에 스테로이드를 혼합하여 경막외에 주입하는 것이 확실한 교감신경 차단과 병소 및 전신적인 약물 효과를 얻을수 있다는 점에서 유리할 것으로 사료된다. Fifty-one cases of acute herpes zoster infection were analyzed to search for the most effective management strategy of the disease, including pain relief and decreasing the incidence of postherpetic neuralgia. Anti-viral treatment was not included. Analgesics and nerve blocks, such as stellate ganglion block or epidural block, were helpful. Corticosteroid was administered in most of the cases either systemically or epidurally or both. Epidural administration of local anesthetic in combination with corticosteroid seemed to have certain advantages of excellent pain relief as a result of sympathetic blockade and regional plus systemic anti-inflammatory effects of the steroid, although this was not proved by definite statistical evidence.
Buerger법 치료를 위한 국소 정맥내 Prostaglandin E1 주입
최훈,김동찬,한영진,Choe, Huhn,Kim, Dong-Chan,Han, Young-Jin 대한통증학회 1992 The Korean Journal of Pain Vol.5 No.1
Buerger's disease is a chronic occlusive arterial disease in which a non-arteriosclerotic lesion involves medium-sized arteries, veins, and nerves of the distal leg or arm. Sympathetic interruption is indicated to improve blood flow to the involved extremity, although sympathetic blockade can provide temporally relief of vasospasm and pain. Chemical or surgical sympathectomy has been performed for this purpose and intravenous regional sympathetic block(IRSB) is an alternative. Guanethidine or reserpine has been administered for IRSB. Intraarterial or intravenous systemic administration of prostaglandin E1(PGE1) has been recommended for the treatment of Buerger's disease. We used PGE1 for intravenous regional administration as an IRSB with results as good as that of intraarterial injection. The advantages of the method include that it is less expensive than systemic administration, less invasive than intra-arterial injection, and simple in technical application.
폐쇄성 혈관 질환의 치료를 위한 Bier Block중에 발생한 Prostaglandin E1의 혈관의 유출
최훈,이용태,김동찬,한영진,Choe, Huhn,Lee, Yong-Tae,Kim, Dong-Chan,Han, Young-Jin 대한통증학회 1994 The Korean Journal of Pain Vol.7 No.2
Prostaglandin E1(PGE1) is a potent vasodilator and is a useful drug for the treatment of occlusive peripheral vascular disease. It has been used systemically via intravenous route or regionally via intraarterial route. We tried intravenous regional administration of PGE1 for the treatment of a patient with occlusive arterial disease involving left fingers. During the 13th injection, the patient complained of severe pain at the injection site during the drug administration. Thereafter, the patient developed painful and severe swelling with blebs on his left hand. Systemic antibiotics were given together with stellate ganglion block of the affected left side. PGE1 was substituted to reserpine, which is subcutaneously injectable, for the second term treatment.
Influences of Several Vasodilators on the Pain Threshold in Healthy Men
박명,최훈,마시모 다께시,야기 마사하루,사사키 시게타,토미 카츠지,요시야 이쿠토,Pak, Myong,Choe, Huhn,Mashimo, Takashi,Yagi, Masaharu,Sasaki, Shigeta,Tomi, Katsuji,Yoshiya, Ikuto The Korean Journal of Pain 1990 The Korean Journal of Pain Vol.3 No.2
정상인에서 Guanethidine Nicardipine Nitroglycerine Prostaglandin $E_1$을 피하주사하고 지속적인 복사열을 주사한 후에 Pain Meter NYT-5를 이용하여 동통역치를 측정하였다. 통증역치는 Guanethidine과 Nicardipine에 의해 상승되었으며 Nitroglycerine에 의해서는 거의 변화가 없고 Prostaglandin $E_1$에 의해서는 감소되었다. 이러한 변화는 지각신경섬유의 말단 감각수용체에 대한 감수성이 이들 혈관확장제에 대하여 서로 다른 작용을 나타내는것 같다.
김갑동,최현규,윤영무,최훈,Kim, Gab-Dong,Choe, Hyun-Kyu,Yun, Young-Moo,Choe, Huhn 대한통증학회 1989 The Korean Journal of Pain Vol.2 No.2
통증치료의 분야에서 뿐 만 아니라 환자를 진단하고 치료하는 의학의 전반에 걸쳐 예기치 못한 합병증의 발생은 어쩌면 피할 수 없는 것인지도 모른다. 따라서 환자를 진료하는 의사는 합병증의 발생에 대한 잠재적 가능성을 언제고 염두에 두어야하고, 일단 합병증이 발생하였더라도 임기응변으로 적절히 대처할 수 있는 지식과 기술을 폭넓게 갖추고 있어야 한다고 생각된다. 저자들은 통증치료목적으로 지주막하 alcohol차단, 경천추차단, 경막외 catheter 거치중 폐기종, 약물의 이상확산, catheter 절단을 각각 경험하였으므로 이에 관하여 고찰하였다. Anesthesiologists are usually responsible for the major works in pain clinics and are often called for many sophisticated nerve blocks in the management of acute or chronic intractable pain. It is, therefore, not uncommon for the anesthesiologists to meet some unexpected and unusual complications during his or her performance. We experienced a case of a pneumothorax following a thoracic intrathecal alcohol block. There was an unusual and yet unexplainable cephalad spread of alcohol following an injection through the 4th sacral foramen, and a shearing off of the catheter by a Tuohy epidural needle following the epidural catheterization. All these three cases are herein presented.
임상연구 : Propofol-Alfentanil 마취 시 Ephedrine 투여에 따른 혈압과 심박수의 변화: 각성 환자에서의 변화와 비교
문성신 ( Seong Shin Moon ),손지선 ( Ji Seon Son ),최훈 ( Huhn Choe ),한영진 ( Young Jin Han ),이상귀 ( Sang Kyi Lee ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5
Background: Hypotension and bradycardia in the propofol and alfentanil anesthesia are common during induction and maintenance. Ephedrine has been used to attenuate hypotension and bradycardia in the propofol and alfentanil anesthesia. We designed this study to determine whether propofol and alfentanil anesthesia could affect the blood pressure and heart rate response to intravenous ephedrine when compared with the awake state. Methods: Forty patients of ASA physical status 1 or 2 were assigned to one of two groups (Awake vs Propofol-alfentanil [P-A] group). Each patients received ephedrine 0.15 mg/kg after assessment of baseline hemodynamic values. In the awake patients, ephedrine were administered after hemodynamic parameters are stabilized. If hemodynamic parameters are stabilized after intubation, ephedrine were administered in the propofol-alfentanil anesthesia patients. The changes in systolic/diastolic blood pressure (SBP/DBP), mean blood pressure (MBP), and heart rate (HR) were recorded every one minute for 10 minutes. Results: Ephedrine increased the heart rate significantly in Awake group but not in P-A group. In the P-A group, 3 min after the administration of ephedrine, MBP increased 25.3%. In Awake group, 2 min after the administration of ephedrine, MBP increased only 6.3%. Conclusions: We conclude that propofol and alfentanil anesthesia augments the BP response to intravenous ephedrine but not HR. (Korean J Anesthesiol 2008;55:560~4)