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임상연구 : 개흉술 후 통증 조절을 위한 지속적 척추주위 차단시 Bupivacaine의 농도 비교
진희철 ( Hee Cheol Jin ),최상구 ( Sang Gu Choi ),김상현 ( Sang Hyun Kim ),채원석 ( Won Seok Choi ),이정석 ( Jeong Seok Lee ),김용익 ( Yong Ik Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.2
Background: There are many reports showing that a thoracic paravertebral block (TPB) can be used for post-thoracotomy pain control. However, the proper concentration of local anesthetics for TPB has not been established. The aim of this study was to define the proper concentration of bupivacaine for TPB after a thoracotomy. Methods: Sixty patients were allocated randomly into one of the following three groups: thoracic paravertebral 0.5%, 0.25%, or 0.125% bupivacaine at a rate of 0.1 ml/kg/h (kg: ideal body weight). The resting and coughing visual analogue scale (VAS) score, cumulative dose of fentanyl, and the 5 point satisfaction scale were checked. Results: 0.5% and 0.25% bupivacaine showed lower VAS score and cumulative dose of fentanyl than 0.125%. There was no difference in the satisfaction scale between the 3 groups. There was no difference between the 0.5% and 0.25% bupivacaine in all parameters measured. Conclusions: 0.25% bupivacaine used for TPB is more effective when used for pain control after a thoracotomy than 0.5% and 0.125% bupivacaine. (Korean J Anesthesiol 2007; 53: 212~6)
박 욱(Wook Park),진희철(Hee Cheol Jin),조명현(Myun 대한통증학회 1993 The Korean Journal of Pain Vol.6 No.2
N/A In 1984, a magnetic resonance spectrometer(magnetic resonance analyser, MRA I TM) was de- veloped by Sigrid Lipsett and Ronald J. Weinstock in the USA, Biomedical applications of the spectrometer have been examined by Dr. Hoang Van Duc(pathologist, USC), and Nakamura, et al(Japan). From their theoretical views, the biophysical functions of this machine are to analyse and synthesize a healthy tissue and organ resonance pattern, and to detect and correct an abnormal tissue and organ resonance pattern. All of the above functions are based on Quan- tum physics. The healthy tissue and organ resonance patterns are predetermined as standard magnetic resonance patterns by digitizing values based on peak resonance emissions(response levels or high pitched echo-sounds amplified via human body). In clinical practice, a counter or neutralizing resonance pattern calculated by the spectrome- ter can correct a phase-shifted resonance pattern(response levels or low pitched echo-sounds) of a diseased tissue and organ. By administering the counter resonance pattern into the site of pain and trigger point, it is possible to readjust the phase-shifted resonance pattern and then to alleviate pain through regulation of the neurotransmitter function of the nervous system. For assessing clinical effectiveness of pain relief with MRA ITM this study was designed to estimate pain intensity by the patients subjective verbal rating scale(VRS such as graded to no pain, mild, moderate and severe)21 before application of it, to evaluate an amount of pain re- lief as applied the spectrometer by the patients subjective pain relief scale(visual analogue scale, VAS, 0-100%), and then to observe a continuation of pain relief following its applica- tion for managing acute and chronic pain in the 102 patients during an 8 months period begin- ning March, 1993. An application time of the spectrometer ranged from 15 to 30 minutes daily in each patient at or near the site of pain and trigger point when the patient wanted to be treated. The sub-jects consisted of 54 males and 48 females, with the age distribution between 23-40 years in 29 cases, 4l-60 years in 48 cases and 61-76 years in 25 cases respectively(Table 1). The kinds of diagnosis and the main site of pain, the duration of pain before the application, and the fre- quency of its apylication were recorded on the Table 2, 3 and 4. A distinction between acute and chronic pain was defined according to both of the pain intervals lasting within and over 3 months. The results of application of the spectrometer were noted as follows; In, 5l cases of acute pain before the application, the pain intensities were rated mild in 10 cases, moderate in 15 cases and severe in 26 cases. The amounts of pain relief were noted as between 30-50% in 9 cases, 51-70% in l3 cases and 71-95% in 29 cases. The continuation of pain relief appeared between 6-24 hours in two cases, 2-5 days in 10 cases, 6-14 days in 4 cases, 15 days in one case, and completely relived of pain in 34 cases(Table 5-7). In 51 cases of chronic pain before the application, the pain intensities were rated mild in 12 cases, moderate in l8 cases and severe in 21 cases. The amounts of pain relief were noted as between 0-50% in 10 cases, 51-70% in 27 cases and 71-90% in 14 cases. The continuation of pain relief appeared to have no effect in two cases. The level of effective duration was be- tween 6-12 hours in two cases, 2-5 days in 1l cases, 6-14 days in 14 cases, l5-60 days in 9 cases and in 13 cases the patient was complete)y relieved of pain(Table 5-7). There were no complications in the patients except a mild reddening and tingling sensation of skin while ap- plying the spectrometer. Total amounts of pain relief in all of the subjects were accounted as poor and fair in 19(l8.6%) cases, good in 40(39.2%) cases and excellent in 43(42.2%) cases. The clinical effectiveness of MRA h showed variable distributions from no improvements to complete relief o
증례보고 : 여호와의 증인 환자에서 무수혈치료 경험 2예
조성환 ( Sung Hwan Cho ),구본성 ( Bon Sung Koo ),김상현 ( Sang Hyun Kim ),채원석 ( Won Seok Chai ),진희철 ( Hee Cheol Jin ),김용익 ( Yong Ik Kim ) 대한마취과학회 2008 Korean Journal of Anesthesiology Vol.55 No.5
We report two cases of Jehovah`s Witness patients who had massive bleeding after surgery. The first case was a 37-year-old woman who underwent an emergency cesarean section; the other was a 48-year-old man with chronic anemia who underwent removal of a large mass. After the operation, their Hb levels were nearly 3.1 g/dl. They were treated with blood conserving methods, divided into 3 periods (pre, post and operative). Both patients completely recovered uneventfully and were discharged on the 19th and 21st postoperative day. (Korean J Anesthesiol 2008;55:621~4)
경막외강으로 투여된 마그네슘이 개흉술 후 자가통증조절을 받는 환자에서 수술 후 통증 관리에 미치는 영향
김선민 ( Sun Min Kim ),조성환 ( Sung Hwan Cho ),김상현 ( Sang Hyun Kim ),이동기 ( Dong Gi Lee ),채원석 ( Won Seok Chae ),진희철 ( Hee Cheol Jin ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.4
Background: Magnesium presents analgesic effects by blocking the non-competitive N-methyl-D-aspartate receptor in the spinal cord. The purpose of this study was to evaluate the effects of epidural magnesium on cumulative dose of ropivacaine in patients with patient-controlled epidural analgesia (PCEA) after a thoracotomy. Methods: In a randomized, prospective, double-blind trial, we enrolled 40 patients undergoing PCEA after a thoracotomy. Control group (n=20) received an initial dose of 0.375% ropivacaine 0.1 ml/kg, and following demand doses of 0.2% ropivacaine 2 ml with 15 min lockout interval on the patient demand. Magnesium group (n=20) additionally received MgSO4 100 mg in the initial dose and 4 mg in the demand doses. Cumulative dose of ropivacaine, the resting and coughing visual analog scale (VAS) score were measured at 3, 6, 12, 24, and 48 hours after surgery. Results: Magnesium group showed lower cumulative dose of ropivacaine than control group at 12, 24, and 48 hours after the surgery (P<0.05), but not at 3 and 6 hours (P<0.05). The VAS score was not different between 2 groups (P<0.05). Conclusions: Epidural magnesium may be useful as an adjuvant to ropivacaine after a thoracotomy. However, because magnesium showed no beneficial effect at the early period after the surgery, more investigation about proper initial dose is required. (Korean J Anesthesiol 2009;57:466∼71)
당뇨병 환자에서 Rocuronium이 심박수 변이도에 미치는 영향
공형윤 ( Hyung Youn Kong ),이정석 ( Jeong Seok Lee ),서상원 ( Sang Won Seo ),조성환 ( Sung Hwan Cho ),김상현 ( Sang Hyun Kim ),채원석 ( Won Seok Chae ),진희철 ( Hee Cheol Jin ),김용익 ( Yong Ik Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.2
Background: Clinically rocuronium, a muscle relaxant, has no significant inhibitory effect on the autonomic nervous system in the healthy population. However, there has been no study done on rocuronium in diabetic patients. Therefore, we used heart rate variability (HRV) as a biomarker to investigate cardiac autonomic function after rocuronium administration to diabetic patients. Methods: In 21 diabetic adult patients, heart rate (HR), mean arterial blood pressure (BP), low frequency (LF, 0.04-0.15 Hz) power, high frequency (HF, 0.15-0.4 Hz) power, LF/HF ratio, SD1 and SD2 in the Poincare plot before induction of anesthesia, and immediately before and after rocuronium administration were calculated and compared. Results: HR, mean BP, LF, LF/HF ratio and SD2 after rocuronium administration did not differ significantly from the measurements taken before rocuronium administration. HF and SD1 decreased significantly after rocuronium administration (P=0.022, P=0.019 respectively). Covariates such as age, gender, weight, duration of diabetes mellitus and hypertension did not alter the effect of rocuronium on the autonomic nervous system. Conclusions: Rocuronium produced a significant decrease in parasympathetic activity. Therefore, further study will be needed to determine whether vagal reduction caused by rocuronium could have potential to deteriorate hemodynamics in diabetic patients. (Korean J Anesthesiol 2009;57:165∼9)
이준호 ( Joon Ho Lee ),유재화 ( Jae Hwa Yoo ),조성환 ( Sung Hwan Cho ),김상현 ( Sang Hyun Kim ),채원석 ( Won Seok Chae ),이동기 ( Dong Gi Lee ),진희철 ( Hee Cheol Jin ),김용익 ( Yong Ik Kim ),고윤우 ( Yoon Woo Koh ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3
Background: Thyroid surgery is usually performed under general anesthesia, but thyroid surgery under monitored anesthesia care (MAC) has become re-introduced. We report our experiences of 40 cases of thyroid surgery under MAC. Methods: Forty patients were enrolled in this study. Bilateral superficial cervical plexus block (BSCPB) was performed by using 1% mepivacaine with 1: 200,000 epinephrine. After BSCPB, patients were sedated with propofol and fentanyl. Postoperative pain, sore throat, hoarseness, and postoperative nausea and vomiting (PONV) were assessed. Results: Mean postoperative pain VAS were 1.3, 1.2, 1.0, 0.8 and postoperative sore throat VAS 1.4, 1.4, 1.1, 0.9 at PACU (post-anesthesia care unit) and postoperative 3, 6, 12 h, respectively. The incidence of hoarseness was 25, 5, 2.5%, and 0% and PONV were 0, 5, 10%, and 7.5% at PACU and postoperative 3, 6, 12 h, respectively. Conclusions: Thyroid surgery under MAC may be a suitable alternative to general anesthesia. (Korean J Anesthesiol 2009; 56: 284~9)