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Propofol 목표농도 주입법과 Fentanyl 지속적 병용투여를 이용한 갈색세포종 적출술의 마취관리 : 증례보고
윤채식,홍성주,이수종,이준학,이기남,문준일 대한정맥마취학회 2000 정맥마취 Vol.4 No.1
갈색세포종 적출을 위한 마취시 심한 혈압변동 및 부정맥으로 치명적인 합병증이 초래될 수 있으므로 적절한 마취전 약물처치, 다양한 마취방법, 그리고 마취중 효과적인 심혈관계 조절 등의 세심하고 적극적인 마취관리가 요구된다. 최근에는 마취중 감시장치들의 발달과 함께 컴퓨터를 이용한 조절주입장치가 개발되어 마취중 일정한 마취 효과를 위한 약제의 목표혈중농도를 조절하여 마취깊이를 조절할 수 있는 목표농도조절주입(Target Controlled Infusion, TCI)이 가능하게 되었다. 본 증례는 갈색세포종의 적출술을 위해 propofol TCI와 fentanyl의 지속적 병용투여를 이용한 정맥마취 방법으로 안전하고 효과적으로 마취관리를 하였기에 보고하고자 한다. Prevention of life-threatening perioperative fluctuations of blood pressure or dysrhythmias is an important component of anesthetic management for resection of pheochromocytomas. It is desirable to use an anesthetic management of preoperative adrenergic blockade and intraoperative control of hemodynamic instability associated with endogenous catecholamine release. Target controlled infusion is designed to achieve a predicted target blood concentration based on population pharmacokinetics and provides the better approximation than other techniques for any individual patients. We report a new anesthetic techniques of pheochromocytoma resection using a target controlled infusion of propofol combined with a continuous infusion of fentanyl.
HELLP 증후군 산모에서 무통분만을 위해 시행한 경막외 진통법
윤채식(Chae Sik Yoon),이정윤(Jung Yun Lee),홍성주( 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.2
Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, a variant presentation of severe preeclampsia/eclampsia is associated with high maternal morbidity and mortality. Despite several advantages to the use of epidural analgesia for the management of labor pain in preeclamptic parturients, this procedure is relatively contraindicated in the presence of severe thrombocytopenia. Determining the pain management of choice depends on the parturients condition, fetal well-being, and the urgency of the situation. We report a safe case of epidural analgesia in a HELLP syndrome parturient with severe thrombocytopenia for labor pain management without any neurologic complications or epidural hematoma.
고엽제 후유증환자에서 척추마취중 발생한 심한 서맥과 저혈압
이정윤,이기남,이준학,윤채식,문준일 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.3
Various defoliant herbicides were sprayed to kill vegetation and thereby denied cover to enemy forces in Vietnam war, and the defoliant was later alleged to have caused long-lasting health problems such as cancers, birth defects, skin disorders, hepatic dysfunction, porphyria, peripheral neuropathy, and impaired immune function. We experienced a case of severe bradycardia and hypotension during spinal anesthesia for diagnostic arthroscopy in a 53-year-old Vietnam veteran with peripheral neuropathy. We concluded that it should require constant monitoring and vigilance to prevent severe cardiovascular complications during spinal anesthesia in Agent Orange sequela patients with peripheral neuropathy. (Korean J Anesthesiol 1998; 34: 650∼654)
만성 안전형 협심증을 가진 대상포진 환자에서 요부 경막외 차단 후 발생한 불안전형 협심증
이준학(Jun Hak Lee),윤채식(Chae Sik Yoon),정은배(E 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1
Herpes zoster is a viral disease characterized by skin rash and persistent pain. Early treatment with epidural analgesia provides very effective pain relief and reduces the incidence of postherpetic neuralgia. However, epidural analgesia in elderly, deliberated or hypovolemic patients may complicate circulatory depression such as hypotension and bradycardia. Even if temporary, a major decrease in blood pressure may decrease coronary blood flow of patients with arteriosclerosis and ischemic accident may occur. We experienced a case of unstable angina pectoris after lumbar epidural blockade in a herpes zoster patient with chronic stable angina pectoris.
대상포진후신경통 환자에서 안와상신경과 활차상신경에 Pulsed Radiofrequency에 의한 치료 경험 증례 보고
이준학,김태윤,하수호,권영은,윤채식 대한통증학회 2004 The Korean Journal of Pain Vol.17 No.2
Postherpetic neuralgia (PHN) is commonly defined as the pain that persists after a rash has healed, and may last months or sometimes even years. Multiple pharmacological agents and various nerve blocks have been used. Nerve blocks are a reliable and effective technique for the prevention and treatment of PHN. However, they require repeated injections as nerve blocks under local anesthetic sometimes only give the patient temporary relief from the pain of PHN. Recently, the advent of pulsed radiofrequency (PRF) lesioning has proved a successful treatment for refractory pain disorders. Two patients suffering from PHN presented at our clinic with a sharp and stabbing pain over the eye and forehead up to the vertex. Supraorbital and supratrochlear nerve block, with local anesthetic-steroid injections, gave good, but relatively short relief of the pain for several days, but there relief of pain, for more than 4 months, was longer and better with PRF lesioning.