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임상연구 : 척추마취하 제왕절개술 시 Ephedrine과 Phenylephrinedml 지속주입이 산모와 태아에게 미치는 영향의 비교
정순우 ( Sun Woo Jung ),김은주 ( Eun Ju Kim ),민병우 ( Byung Woo Min ),반종석 ( Jong Suk Ban ),이상곤 ( Sang Gon Lee ),이지향 ( Ji Hyang Lee ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.3
Backgroud: Ephedrine has been most commonly used for the prevention and treatment of hypotension occurring frequently during spinal anesthesia for cesarean section. But recent studies reported that phenylephrine was more effective for treatment of maternal hypotension and for prevention of fetal acidosis than ephedrine. We compared effect of phenylephrine, ephedrine, and ephedrine combined with phenylephrine to maternal hypotension and fetal acidosis. Methods: This study compared ephedrine 2 mg/min infusion with 6 mg bolus (n = 30), phenylephrine 33.3μg/min infusion with 50μg bolus (n = 30), and ephedrine combined phenylephrine with half the dose infusion rate & bolus (n = 30). Hypotension, defined as systolic blood pressure less than 100 mmHg and less than 80% of baseline, was treated with additional bolus injection. Results: In ephedrine group, the number of bolus given for hypotension was larger than other groups (P < 0.001), the incidence of hypotension was also higher than other groups (P = 0.02). The heart rate was lower in phenylephrine group than other groups, but bradycardia which needs to be treated didn`t occur. Umbilical blood gas analysis and Apgar score were similar for three groups, but only one patient in ephedrine group had fetal acidosis (pH = 7.130). Nausea and vomiting were more frequent in ephedrine group than other groups. Conclusions: In our study, giving phenylephrine alone was more effective in the prevention and treatment of maternal hypotension and nausea & vomiting than giving ephedrine alone or combined phenylephrine. (Korean J Anesthesiol 2006; 51: 335~42)
척추-경막외 병용마취 중 Espocan(R) 바늘의 폐쇄 및 우발적인 경막 천자 -증례보고-
김보성 ( Bo Sung Kim ),이지향 ( Ji Hyang Lee ),민병우 ( Byung Woo Min ),반종석 ( Jong Suk Ban ),이상곤 ( Sang Kon Lee ),김은주 ( Eun Joo Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6
Here, we report a case of an occluded modified Tuohy needle (Espocan(R), B. Brown, Germany) due to the patient`s own tissue. A 70-year-old female with left knee osteoarthritis was admitted for a total knee replacement arthroplasty under combined spinal-epidural anesthesia. Insertion of the Tuohy needle proceeded from the skin to 6 cm and then 6.5 cm, but there was no loss of resistance. We removed the needle from the patient and discovered a fibrous, white tissue inside the needle. We tried again and did the spinal- epidural anesthesia in another interspinous space. This time, we could feel the loss of resistance at 4 cm, but permanent leakage of clear fluid was seen in the epidural catheter so we removed the catheter. We observed the patient closely in the recovery room and ward, and no further complications were found. We present this case to remind the operator the importance of checking the epidural needle that possible may be occluded by a foreign body. (Korean J Anesthesiol 2009; 57: 796∼9)
임상연구 : 수근관 증후군에서 요 수근 굴근을 통한 스테로이드 국소 주사법의 임상 경험
정순우 ( Sun Woo Jung ),이상곤 ( Sang Gon Lee ),민병우 ( Byung Woo Min ),반종석 ( Jong Suk Ban ),이지향 ( Ji Hyang Lee ),김은주 ( Eun Ju Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.5
Background: Local steroid injections for the treatment of carpal tunnel syndrome have become common, but median nerve injuries after the injections have rarely been reported. In our study, we checked the occurrence of a severe pain during local steroid injections through the flexor carpi radialis, and we evaluated the efficacy of injections for several short-term period. Methods: A total of 24 patients with 32 affected hands were studied. The patients who presented with known medical causes or thenar muscle atrophy or a previous trauma history at the affected wrist were excluded from the study. The diagnosis was made both clinically and electrophysiologically, and then the injections were performed through the flexor carpi radialis with the hand in the supine position. Triamcinolone Acetonide (TA) 40 mg was injected first, and TA 20 mg was reinjected when the recovery rate on a 100 mm visual analog scale (VAS) score was below 50% 1 week after the injection. The patients were reevaluated with the VAS score before and 1, 3 and 6 months after the injections. Results: In our study, no patients reported severe pain indicating there was median nerve injury during the injections. The mean VAS scores were 64.9, 9.5, 31.1 and 47.3 before and 1, 3 and 6 months after the injections respectively. As a result, the injections were deemed for the short-term period (P < 0.05). Conclusions: In our study, we concluded that local steroid injection through the flexor carpi radialis for treating carpal tunnel syndrome is a safe and effective method. (Korean J Anesthesiol 2006; 51: 563~7)
요추수술시 Andrews frame을 이용한 복와위에서 발생한 심정지 -증례보고-
김재영 ( Jae Young Kim ),김은주 ( Eun Joo Kim ),이지향 ( Ji Hyang Lee ),이상곤 ( Sang Kon Lee ),반종석 ( Jong Suk Ban ),민병우 ( Byung Woo Min ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.6
The prone position during anesthesia sometimes causes hemodynamic changes such as a decrease in blood pressure. These changes are caused by a decrease in venous return from venous pooling in the legs, and decreased left ventricular compliance secondary to increased intrathoracic pressure, when patients are placed prone with an Andrews frame. We report on a patient who experienced cardiac arrest in the prone position with the Andrews frame during lumbar laminectomy and posterior lumbar interbody fusion. After 1.25 h in the prone position, bradycardia and hypotension occurred. Ephedrine, atropine and epinephrine were infused intravenously, but bradycardia and hypotension progressed to asystole. Cardioinhibitory reflex was likely triggered by decreased venous return and increased intrathoracic pressure, and the patient developed cardiac arrest as a result. (Korean J Anesthesiol 2009; 57: 768∼72)