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경막외 카테터 거치후 발생한 척추 경막외 · 경막하 농양 - 증례보고 -
임경준(Kyung Joon Lim),김훈정(Hun Jeong Kim) 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1
The placement of epidural catheter may cause complications such as epidural hematoma, ep- idural abscess and neural damage. Among the above complications, epidural abscess is a rare but serious complication. This report pertains to a diabetic metlitus patient who developed spinal epidural and subdu- ral abscess after continuous epidural catheterization for management of pain caused by reflex sympathetic dystrophy. The patient experienced urinary incontinence, as a neurologic sign, 8 days after epidural catherization. It was considered that the poor prognosis was due to a com- bination effects of a delayed visit to the hospital for treatment, rapid progression of abscess and uncontrolled blood sugar level. We therefore recommend aseptic technique and proper control of blood sugar level to pre- vent infection during and after epidural catheterization for diabetic patients. Early diagnosis of epidural abscess following surgical procedure must be required to avoid sequelae.
골관절염 환자에서 관절내 Sodium Hyaluronate(Hyruan®)의 투여가 슬관절통에 미치는 영향
김훈정,임경준,위상우,정종달,유벙식,안태훈,소금영 조선대학교 2000 The Medical Journal of Chosun University Vol.25 No.2
Background : Sodium Hyaluronate has been found to be deficient in the synovial fluid of patients with osteoarthritis. We evaluate the effect of intraarticular Sodium Hyaluronate(Hyruan®) on the knee joint pain in patients with osteoarthritis. Method : Ten patients with osteoarthritis of the knee were participated in this study. Sodium Hyaluronate was injected into knee joints weekly for 5 weeks consecutively. Clinical evaluations were performed using visual analogue scale(VAS) for pain, tenderness and swollen joint counts weekly for the first 5 weeks and at 10 weeks postinjection. Result : VAS, tenderness and swollen joint were all significantly improved from 2 weeks to 10 weeks. There was no complication, except pain on injection site in two patients. Conclusion : Intraarticular injection of Sodium Hyaluronate has been shown to be effective on the treatment of patients with osteoarthritis of the knee.
관절강내 투여된 Tramadol 과 Neostigmine 이 슬관절경 수술 후 통증완화에 미치는 영향
김승수,오경희,임경준,유병식,소금영,김훈정,정종달,안태훈 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.4
The Effects on Pain Relief of Intraarticular Tramadol and Neostigmine after Knee Arthroscopic Surgery Kyung Joon LIM, M.D., Hun Jeong Kim, M.D., Kyung Hee Oh, M.D. Tae Hun An, M.D., Keum Young So, M.D., Byung Sik Yu, M.D. Chong Dal Chung, M.D., and Seung Soo Kim, M.D.^* Department of anesthesiology, College of Medicine, Chosun University, Gwangju, Korea, and ^*Seoul Pain Clinic, Gwangju, Korea Background: Evidence has accumulated that tramadol hydrochloride can produce relief of moderate to severe pain across the range of acute and chronic pain states by combining a synergistically weak opioid and a monoaminergically mediated antinociceptive mechanism. Neostigmine can produce anti-nociceptive effects by interacting with muscarine receptors in peripheral tissues. This study was designed to determine whether intraarticular tramadol results in better analgesic effect and whether tramadol and neostigmine would provide superior analgesia to tramadol alone, after knee arthroscopic surgery. Methods: Forty-five ASA class 1 or 2 patients undergoing arthroscopic knee surgery were randomly allocated to three treatment groups. All patients received general anesthesia with nitrous oxide, O_2 and inhalational agents. When the surgical procedure was completed, the study drug was injected into the patient's knee joint through the arthroscope. Patients in group 1 (n = 15) received 30 ml of 0.5% mepivacaine; patients in group 2 (n = 15) received tramadol 50 mg and 30 ml of 0.5% mepivacaine; patients in group 3 (n = 15) received a combination of tramadol 50 mg, neostigmine 100 ㎍ and 30 ml of 0.5% mepivacaine. Postoperative pain was assessed using the visual analogue scale (VAS) at 1, 2, 4, 6, 12 and 24 hours after the intraarticular injection. Results: There were no significant differences among the three groups in the 1 to 2 hour postoperative period and groups 2 and 3 showed singificantly lower VAS score than group 1 from 4 to 24 hours postoperatively. Conclusions: It is concluded that after knee arthroscopy, intraarticular injection of tramadol had a good analgesic effect, whereas neostigmine added to tramadol did not show superior analgesic effects over tramadol alone. (Korean J Anesthesiol 2001; 41: 461~466)
정맥부위마취 시 Mepivacaine 에 첨가한 Tramadol 의 효과
소금영,김훈정,고우석 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.42 No.2
Background : Tramadol, an opioid ?? receptor agonist and monoaminergic reuptake inhibitor, has been studied as an adjunct to general and regional anesthesia. Tramadol has been added to local anesthetic regimens for various peripheral nerve blocks, resulting in prolonged anesthesia and analgesia. The purpose of this study was to evaluate the effectiveness of using tramadol as a component of intravenous regional anesthesia (IVRA) to enhance postoperative analgesia. Methods : Thirty-six patients undergoing hand surgery received IVRA with mepivacaine 0.5%, and were assigned randomly and blindly to one of the following groups: Group Ⅰ (n = 12) received only 0.5% mepivacaine 40 ㎖, Group Ⅱ (n = 12) was given 0.5% mepivacaine 40 ㎖ and 50 ㎎ tramadol, and Group Ⅲ (n = 12) recived 0.5% mepivacaine 40 ㎖ and 100 ㎎ tramadol. After the completion of the operations, analgesic effects were evaluated by using the visual analogue scale (0-10). Sedation scores (0-3), supplemental analgesic use, and side effects were also evaluated. Results : Patients who received IVRA with 100 ㎎ tramadol reported a significantly lower pain score after tourniquet deflation compared with other group, and a decreased need for analgesics in the postanesthesia care unit. No significant postoperative sedation, nausea, vomiting, or headache developed in any of the patients. Conclusions : The addition of 100 ㎎ tramadol to 0.5% mepivacaine for IVRA provided improved analgesia in the postanesthesia care unit after the operation and decreased the need for analgesic supplements after the operation. (Korean J Anesthesiol 2002; 42: 172~176)
Ketamine 마취유도시 Esmolol 지속적 정주가 기관내삽관에 의한 심박수와 혈압에 미치는 영향
임경준,김훈정 대한마취과학회 1996 Korean Journal of Anesthesiology Vol.31 No.1
Background: This study was designed to evaluate the effect of continuous intravenous infusion of esmolol on the heart rate and blood pressure, after ketamine induction and endotracheal intubation. Methods: With informed consent, forty patients with ASA physical status 1 were randomly divided into two groups. Esmolol group received the continuous intravenaus infusion of esmolol (at 500 ㎍/kg/min for 1 minute as a loading dose and at 300 ㎍/kg/min until 7 minutes after endotracheal intubation as a maintenance dose) and saline group received normal saline at the same volume-rate. 2 mg/kg of ketamine and 0.15 mg/kg of vecuronium were given at 4 minutes after the test drugs. Intubation was performed at 3 minutes after the induction. The changes of blood pressure, heart rate and rate pressure product were measured at different time intervals (preinduction, preintubation, immediately after intubation and postintubation 1, 3, 5 and 7minutes). Results: In the esmolol group, the changes of systolic blood pressure, ditolic blood pressure, heart rate and rate pressure product were significantly attenuated when compared with the saline group. The changes in heart rate at preintubation and intubation were not statistically significant when compared with the baseline value within the esmolol group. Conclusions: It is concluded that the infusion of esmolol attenuated the hemodynamic changes following ketamine induction and endotracheal intubation, but it is still needed to find the dosage of esmolol.