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복식전자궁적출술에서 술전 저용량 국소마취제와 Morphine을 이용한 경막외차단이 술후통증, 혈장 Cortisol, 혈당에 미치는 영향
박한석,이승철,차문석,Park, Han-Suk,Lee, Sung-Chul,Cha, Moon-Seok 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1
Background: Preoperative blocking of surgical nociceptive inputs may prevent sensitization of central nervous system (CNS) and reduce postoperative pain. The stress responses to surgical trauma consist of increase in catabolic hormones and decrease in anabolic hormones. We studied whether preoperative low dose epidural bupivacaine and morphine could affect postoperative pain, changes plasma cortisol, and serum glucose. Methods: Thirty patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups. General anesthesia was induced in all patients and after that, epidural blocks were done except the control group (n=10) patients. Preoperative block group (n=10) received 0.5% bupivacaine 50 mg and morphine 2 mg epidurally as a bolus before operation and followed by 0.1% bupivacaine $5\;mghr^{-1}$ and morphine $0.2\;mghr^{-1}$ for 10 hours. Postoperative block group (n=10) received the same doses of bupivacaine and morphine under the same method postoperatively. Postoperative pain relief was provided with i.v. fentanyl through Patient-Controlled-Analgesia Pump. Postoperative pain by visual analogue scores (VAS), analgesic requirement (first requirement time, total amounts used), side effects, plasma cortisol level and serum glucose level were compared. Results: Until postoperative 6 hrs, VAS of control group was higher than those of the epidural groups. No difference was observed in VAS between the two epidural groups. First analgesics requirement time and total amounts of used analgesics were not different between the two epidural groups, but first analgesic requirement time of preoperative block group was significantly prolonged compared with control group. Plasma cortisol and serum glucose levels were not different among groups. Conclusions: Low dose preoperative epidural bupivacaine and morphine could not reduce postoperative pain, plasma cortisol level and serum glucose level compared with postoperative block group.
복식전자궁적출술에서 술전 저용량 국수마취제와 Morphine을 이용한 경막외차단이 술후통증, 혈장 Cortisol, 혈당에 미치는 영향
박한석(Han Suk Park),이승철(Seung Cheol Lee),차문 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1
N/A Background: Preoperative blocking of surgical nociceptive inputs may prevent sensitization of central nervous system (CNS) and reduce postoperative pain. The stress responses to surgical trauma consist of increase in catabolic hormones and decrease in anabolic hormones. We studied whether preoperative low dose epidural bupivacaine and morphine could affect postoperative pain, changes plasma cortisol, and serum glucose. Methods: Thirty patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups. General anesthesia was induced in all patients and after that, epidural blocks were done except the control group (n=10) patients. Preoperative block group (n=10) received 0.5% bupivacaine 50 mg and morphine 2 mg epidurally as a bolus before operation and followed by 0.1% bupivacaine 5 mghr-1 and morphine 0.2 mghr-1 for 10 hours. Postoperative block group (n=10) received the same doses of bupivacaine and morphine under the same method postoperatively. Postoperative pain relief was provided with i.v. fentanyl through Patient-Controlled-Analgesia Pump. Postoperative pain by visual analogue scores (VAS), analgesic requirement (first requirement time, total amounts used), side effects, plasma cortisol level and serum glucose level were compared. Results: Until postoperative 6 hrs, VAS of control group was higher than those of the epidural groups. No difference was observed in VAS between the two epidural groups. First analgesics requirement time and total amounts of used analgesics were not different between the two epidural groups, but first analgesic requirement time of preoperative block group was significantly prolonged compared with control group. Plasma cortisol and serum glucose levels were not different among groups. Conclusions: Low dose preoperative epidural bupivacaine and morphine could not reduce postoperative pain, plasma cortisol level and serum glucose level compared with postoperative block group.
상부위장관 내시경시 수면유도법으로 사용된 Propofol + Fentanyl 과 Midazolam 의 비교연구
박한석(Han Suk Park),한상영(Sang Young Han),오일환(Il Hwan Oh),최대현(Dae Hyun Choi),노명환(Myung Hwan Roh),최석렬(Seok Ryeol Choi),신우원(Woo Won Shin),김봉관(Bong Kwan Kim),이종훈(Jong Hun Lee) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.2
Background/Aims: Midazolam is generally used for sedation during gastroscopy, while propofol is usually used for outpatients’ day surgery anesthesia. We compared propofol plus fentanyl with midazolam for sedation during gastroscopy. Methods: One hundred and fifty three patients who had requested sedation during diagnostic gastroscopy were randomly divided into two groups. One group (n=98) received an initial bolus dose of propofol (40 mg) plus fentanyl (50 μg) intravenously, followed by additional doses of propofol (10 mg) at one minute interval (PF group) until achieving sedation. The other group (n=55) received an initial bolus dose of midazolam (3 mg) intravenously, followed by additional doses of midazolam (1 mg) at two minutes interval (M group). Results: Sedation was achieved faster in PF group than in M group. Time to regiain orientation and recover warking was also shorter in PF group than in M group. Gag reflex and procedure difficulty were less in PF group than in M group. Incidences of complications were not different between the two groups. Degree and frequency of oxygen desaturation were higher in PF group than in M group. Conclusions: Propofol plus fentanyl seems to be more acceptable and suitable than midazolam for sedation during gastrointestinal endoscopic examination. (Korean J Gastroenterol 2001;38:98-105)
경막외 Lidocaine의 최대사용량과 혈중농도에 대한 고찰
박한석(Han Suk Park),정찬종(Chan Jong Jeong),진영 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1
N/A Background: The current maximal recommended doses of lidocaine are 7 mg/kg with 5 μg/ml of epinephrine. But in clinical practice, sometimes more doses of lidocaine are required to produce adequate regional anesthesia. Method: Twenty-two healthy women patients were divided into two groups and pretreated with valium 5 mg p.o, morphine 5 mg i.m., and midazolam 2 mg i.v. before operation. Of these, 7 mg/kg of 2% lidocaine with 5 μg/ml of epinephrine were given to 11 patients epidurally. Initial 3 ml of epinephrine mixed lidocaine was given as a test dose and remaining doses were given 5 ml/30 sec with 3 min intervals. Radial arterial blood were drawn at 5, 10, 15, 20, 30, 45, 60, 90, 120 min to measure plasma lidocaine concentrations. After confirming all of the peak plasma concentrations of 7 mg/kg lidocaine were absolutely under 5 μg/ml, the other 11 patients were given 10 mg/kg of 2% lidocaine with 5 μg/ml of epinephrine epidurally and blood samplings were taken according to the same method of 7 mg/kg group. The peak plasma concentration (Cmax ), time to reach to Cmax (Tmax ), time to reach to T4, maximal sensory block level, systemic toxicity, and vital sign changes were investigated. Result: C was significantly higher in 10 mg/kg group (5.1±1.3 μg/ml) than 7 mg/kg group(3.3±0.5 μg/ml), but T (10.5±2.7 min vs 10.9±3.1 min) was not different. Time to reach T4 was significantly shorter in 10 mg/kg group (9.5±2.7 min) than 7 mg/kg group (12.7±3.2 min) but maximal sensory block level (T3.7±0.7vsT2.7±10) was not different. In four patients of 10 mg/kg group, peak plasma concentrations exceeded 5 μg/ml, but no systemic toxicities appeared. No significant vital sign changes were observed. Conclusion: The current maximal recommended doses of lidocaine, merely based on body weight are not always appropriate. Further studies are needed to determine more precise guideline of maximal doses that include various pharmacokinetic components.
술전 Morphine 정주가 술후통증과 혈장 Cortisol 및 혈당치에 미치는 영향
이승철(Seung Cheol Lee),박한석(Han Suk Park),정찬 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.2
N/A Background: Preoperative blocking of surgical nociceptive inputs may prevent sensitization of CNS and reduce postoperative pain. The stress responses to surgical trauma consist of increase in catabolic hormones and decrease in anabolic hormones. We studied whether preoperative intravenous morphine could affect postoperative pain and change plasma cortisol and serum glucose levels. Methods: Thirty eight patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups. Control group (n=11) did not received intravenous morphine, preoperative group (n=13) received intravenous morphine (0.1 mg/kg as a bolus 10 min before operation and followed by 1.5 mg/hr for 10 hours), postoperative group (n=14) received the same doses and method of intravenous morphine of preoperative group postoperatively. Postoperative pain relief was provided with i.v. fentanyl through Patient-Controlled-Analgesia Pump. Postoperative visual analogue scores (VAS), analgesic re- quirement (first request time, total amounts used), side effects, plasma cortisol and serum glucose levels were compared. Results: VAS were different between control group and the other two goups, but were not different between preoperative and postoperative group. Total amounts of used fentanyl were not different among groups, but first request time were significantly delayed in the preoperative group compared with the other two groups (66.2+33.9 vs 39.0+15.4 and 45.0+14.9 min respectively, p<0.05), Plasma cortisol and serum glucose levels were not different among groups. Conclusions: Above dosage of preoperative and postoperative morphine has analgesic effect, but could not block surgical stress induced plasma cortisol and serum glucose increase.