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Bretylium을 사용한 정맥 부위차단 : 반사성 교감신경성 위축증의 치료 Treatment of Reflex Sympathetic Dystrophy
김수관,홍순용,신근만,최영룡,조용노,김광민,문종선 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.4
Background: Interruption of efferent sympathetic fibers is the mainstay of therapy in reflex sympathetic dystrophies(RSD) and be accomplished by temporary or permanent anesthetic blockade of sympathetic ganglia, surgical lesions of the sympathetic trunk, intravenous injecton of guanethidine or reserpine, or by systemic administration of adrenergic blocking drugs. In this study, the effects and the side effects of intravenous regional bretylium for the treatment of RSD were studied. Methods: Seven patients have been administered with 2.0 mg/kg bretylium in 0.25% lidocaine with 100U of heparin three times weekly. A standard intravenous regional technique was used with 250∼300 mmHg tourniquet pressure for 30 minutes. Blood pressure and pulse rate were monitored before injection, 1 minute and 5 minutes after injection, immediately before deflation of tourniquet, 1 minute, 5 minutes and 30 minutes after deflation of tourniquet. Pain and temperature evaluations were made before injection and at 1 week after evey injection. Results: The increase in skin temperature and decrease in pain score of the affected limb were noted after the use of bretylium in 5 patients out of 7 patients. These clinical effects probably resulted from bretylium,s ability to accumulate in adrenergic nerves and block norepinephrine release. One patient had hypotension immediately after tourniquet deflation. Conclusions: Intravenous regional bretylium provides significant pain relief for treatment of RSD. (Korean J Anesthesiol 1997; 32: 642∼647)
경피적 기관절개술 : 표준 기관절개술과의 비교 a comparison with standard surgical tracheostomy
홍순용,신근만,최영룡,안명수,문종선,조용노 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.12
A prospective study was undertaken to compare, in intensive care patients, the safety and utility of a percutaneous tracheostomy teehnique with a surgieal tracheostomy technique. Between March of 1992 and June of 1993 we randomly selected 40 patients of the many who were in need of a tracheostomy. After dividing those patients into 2 groups, we per- formed the procedures. Twenty patients received a standard surgicsl traeheostomy, the other twenty received a percutaneous tracheostomy. We found complications occurring in 6 patients who received the standard surgical tracheostomy while only 1 patient suffered complications from the group having the percutaneous tracheostomy. The most common complications being subcutaneous emphysema, pneumothorax, pnemonia, and hemorrhage. Post-decannulation scar was 3.286±1.204mm in percutaneous group, 20.36±7.26mm in standard group. In comparison to standard surgical tracheoatomy, percutaneous tracheostomies were rapidly and easily performed and asaociated with significantlyewer complication and small post-decannulation scars.
김수관(Su Gwan Kim),안철수(Cheol Soo Ahn),조용노(Y 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1
Rectal tenesmus is a persistent, painful and ineffectual sensation of straining at stool or opening of the bowels. The pain is usually spasmodic in nature and most commonly en- countered in patients with carcinoma of the rectum or other pelvic organs. In 1988, Bristowand Foster reported that patients with severe spasmodic painful tenesmus were relieved with chemical sympathectomy. In 1990, Plancarte introduced block of Gangli- on impar. This technique is proposed as an alternative means of managin#g localized peri- neal pain of sympathetic origin. Ganglion impar block was performed on a 54-year-old female patient when analgesic or psychotropic drugs failed to control the symptoms of post-traumatic severe spasmodic pain- ful tenesmus. Postoperatively, patient was free of tenesmoid pain for only 7 days. We then performed neurotomy by RF lesion generator which provided complete pain relief.
회음부통증 환자를 위한 Ganglion Impar의 정위적 신경절제술
신근만(Keun Man Shin),김진수(Jin Soo Kim),조용노(Y 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2
The first reported the neural blockade of ganglion impar for pain control of perineal pain in l990 by Plancarte and his fellows. They used 6ml of 10 percent phenol. But the point of issues, same as other neurolytics, are that it is impossible to check and control its spreading, so it might be possible to destruct the coccygeal plexus and sacral nerve, and also it has only short aetion time. Because of these problems, it could be very dangerous to attempt this procedure especially not for relieving the pain on cancer terminal patient, but for the sympathectomy of ganglion impar on the other purpose. We used the RF generator which had the control ability to point out the destructive le- sion accurately. inserted We made the small burr hole on the sacrum near the sacrococc ygeal junction directly through the hole, and performed thermocoagulation to the gan- glion impar.