자기공명분석기와 성상교감신경절 차단요법을 병용한 안면신경마비의 치험

곽수달(Su Dal Kwak),김일호(Il Ho Kim),차영덕(Young 대한통증학회 1994 The Korean Journal of Pain Vol.7 No.1

N/A A 37 years old man who suffered from right facial palsy was treated successfully with the application of both magnetic resonance diagnostic analyser(MRA) and stellate Ganglion block (SGB). SGB is effective in treatment of facial palsy resulting from abolishing cerebral vascular spasm and increasing cerebral blood flow. Short daily period of exposure to appropriate MRA can also modulate the balance of autonomic nervous system that are responsible for sympa- thetic overflow resulting the edema and poor circulation on the course of the facial nerve. It was seemed that recovery of facial palsy by application of both MRA and SGB was faster than by SGB only.

자기공명분석기에 의한 반사성 교감신경성 위축증의 치험

김진수,곽수달,김정순,옥시영,차영덕,박욱,Kim, Jin-Soo,Kwak, Su-Dal,Kim, Jun-Soon,Ok, Sy-Young,Cha, Young-Deog,Park, Wook 대한통증학회 1993 The Korean Journal of Pain Vol.6 No.2

Reflex sympathetic dystrophy is a syndrome characterized by persistent, burning pain, hyperpathia, allodynia & hyperaesthesia in an extremity, with concurrent evidence of autonomic nervous system dysfunction. It generally develops after nerve injury, trauma, surgery, et al. The most successful therapies are directed towards blocking the sympathetic intervention to the affected extremity by regional sympathetic ganglion block or Bier block with sympathetic blocker; other traditional treatments include transcutaneous electrical stimulation, immobilization with cast & splint, physical therapy, psychotherapy, administration of sympathetic blocker, calcitonin, corticosteroid and analgesic agents. The purpose of this report is to evaluate and describe the effects of magnetic resonance following unsatisfactory results with traditional treatments of RSD. A 17 year old female patient, 1 year earlier, had received excision and drainage of pus at the right femoral triangle due to an injury caused by a stone. Afterwards, she experienced burning pain, knee joint stiffness, and muscle dystrophy of the right thigh, especially when standing and walking. Despite a year of number of traditional treatments such as: lumbar sympathetic block, continuous epidural analgesia, transcutaneous electrical stimulation, & administration of predisolone, her pain did not improve. Surprisingly, the patients was able to walk free from pain and difficulty after just one application of magnetic resonance. The patient has been successfully treated with further treatment of two to three times a week for approximately ten weeks. More recently, magnetic resonance has been demonstrated to produce effective results for the relief of pain in a variety of diseases. From our experiences we recognize magnetic resonance as a therapeutic modality which can provide excellent results for the treatment of RSD. It has been suggested that polysynaptic reflex which are disturbed in RSD may be modulated normally on the spinal cord level through the application of magnetic resonance.

자기공명분석기에 의한 반사성 교감시경성 위축증의 치험

김진수(Jin Soo Kim),곽수달(Su Dal Kwak),김정순(Jun 대한통증학회 1993 The Korean Journal of Pain Vol.6 No.2

Reflex sympathetic dystrophy is a syndrome characterized by persistent, burning pain, hyperpathia, allodynia & hyperaesthesia in an extremity, with concurrent evidence of auto- nomic nervous system dysfunction. It generally develops after nerve injury, trauma, surgery, et al. The most successful therapies are directed towards blocking the sympathetic intervention to the affected extremity by regional sympathetic ganglion block or Bier block with sympa- thetic blocker, other traditional treatments include transcutaneous electrical stimulation, immobilization with cast & splint, physical therapy, psychotherapy, administration of sympa- thetic blocker, calcitonin, corticosteroid and analgesic agents. The purpose of this report is to evaluate and describe the effects of magnetic resonance fol- lowing unsatisfactory results with traditional treatments of RSD. A l7 year old female patient, 1 year earlier, had received excision and drainage of pus at the right femoral triangle due to an injury caused by a stone. Afterwards, she experienced burning pain, knee joint stiffness, and muscle dystrophy of the right thigh, especially when standing and walking. Despite a year of number of traditional treatments such as: lumbar sympathetic block, continuous epidural analgesia, transcutaneous electrical stimulation, & administration of predisolone, her pain did not improve. Surprisingly, the patients was able to walk free from pain and difficulty after just one appli- cation of magnetic resonance. The patient has been successfully treated with further treat- ment of two to three times a week for approximately ten weeks. More recently, magnetic resonance has been demonstrated to produce effective results for the relief of pain in a variety of diseases. From our experiences we recognize magnetic resonance as a therapeutic modality which can provide excellent results for the treatment of RSD. It has been suggested that polysynaptic reflex which are disturbed in RSD may be modu- lated normally on the spinl cord level through the application of magnetic resonance.

누두흉환자에서 Nuss 방법에 의한 수술 중 환기방법에 따른 호기 일회호흡량, 흡기 최대압력 및 활력징후의 변화

조수현,이선학,안기량,박욱,박형주,곽수달,백남순,김천숙 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.41 No.2

Changes of Vital Signs, Expired Volume and Maximal Pressure by Mode of Ventilation during a Nuss Operation in Patients with Pectus Excavatum Soo Dal Kwak, M.D., Nam Soon Baek, M.D., Su Hyun Cho, M.D. Ki Ryang Ahn, M.D., Sun Hak Lee, M.D., Chun Suk Kim, M.D. Wook Park, M.D., and Hyung Joo Park, M.D. Departments of Anesthesiology, ??Chest Surgery, College of Medicine, Soonchunhyang University, Cheonan, Korea Background: This study was undertaken in order to investigate any cardiopulmonary changes caused by the surgical procedure during a Nuss operation in patients with pectus excavatum. Methods: Thirty patients undergoing the Nuss operation were divided into two groups. The patients were randomly assigned to either Group-V (n = 15) which volume controlled ventilation was applied, or to Group-p (n = 15) where pressure controlled ventilation was applied. Mechanical ventilation provided a tidal volume to be set at approximately 10 ml/kg and a frequency set to keep ETCO_2 in range, between 32 mmHg and 38 mmHg. During the surgical procedure, we recorded expired volume (V_E) and inspired maximal pressure (Pmax) changes according to the ventilator mode, and then also recorded changes in vital signs. Results: Heart rate and blood pressure had no significant changes in either groups. In Group-V, during rotation of the metal bar, there was a significant decrease in expired volume (P < 0.001), changes of inspired maximal pressure gradually increased with the operation (P < 0.001). In Group-P, rotation of the metal bar caused a significant decrease in expired volume (P < 0.001). Conclusions: During the Nuss operation, there should be careful observation of changes in the vital signs, expired volume and maximal pressure during insertion and rotation of the metal bar. (Korean J Anesthesiol 2001; 41: 178~183)

Vecuronium 의 신경근 작용에 대한 척골, 안면 및 경골신경 반응사이의 근전도 비교

김용익,김영아,김순임,김성열,곽수달,이성근 대한마취과학회 1992 Korean Journal of Anesthesiology Vol.25 No.4

This study investigated the comparison of electromyographic change of neuromuscular blocking effect induced vecuronium between the ulnar, facial and tibial nerve in 24 healthy adult patients anesthetized with thiopental, N_2O and enflurane. Neuromuscular monitoring commenced immediately after administration of thiopental. After supramaximal stimulation was achieved, a bolus of vecuronium 0.08 mg/kg was injected intravenously. And then single twitch nerve stimulation(T_1) was applied to the nerves using surface electrodes and the electrical response of muscles recorded using the RELAXOGRAPH(Datex Co.). The patients were allocated randomly to 3 groups of 8 patients respectively; the ulnar nerve group was the control, and the facial nerve group and the tibial nerve group were the studing group. We assessed electromyographic responses from abductor digiti minimi muscle in the ulnar nerve, orbicularis oris muscle in the facial nerve and flexor hallucis brevis muscle in the tibial nerve to single twitch nerve stimulation respectively. And the onset time, the time from injection of vecuronium to 25% and 75% recovery of T_1, and recovery index of the ulnar, facial and tibial nerve groups were measured. The obtained results were as follows: 1) The onset time was faster in the facial nerve group compared with the ulnar nerve group. 2) The time from injection of vecuronium to 25% recovery of T_1 was more prolonged in the facial nerve group compared with the ulnar nerve group. 3) The time from injection of vecuronium to 75% recovery of T_1 and recovery index were more shorter in the tibial nerve group compared with ulnar nerve group.

Lidocaine, Verapamil 및 이들의 혼합액이 신경근차단에 미치는 영향

이정석,김진수,김순임,조수현,김성열,곽수달,강규식 대한마취과학회 2001 Korean Journal of Anesthesiology Vol.40 No.4