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고혈압 환자 마취시 Transdermal Clonidine (St 155 BS) 의 임상적 유용성
이현화(Hyun Hwa Lee),김동옥(Dong Ok Kim),김건식(Ke 대한통증학회 1993 The Korean Journal of Pain Vol.6 No.2
N/A Clonidine, a centrally-acting antihypertensive agent known to reduce central sympathetic outflow and modulate presynaptic transmitters release, has shown to suppress central noradrenergic hyperactivity induced by immobilization stress in animals, by decreasing the MAC of halothane and the dose of narcotics required to prevent reflex cardiovascular response to noxious stimuli, and to have potent analgesic properties in humans. These characteristics suggest that clonidine might be a useful adjunct to the anesthetic management of patients with preexisting hypertension. Accordingly, we determined the clinical efficacy and safety on analgesia, sedation and hemo- dynamic stability in the perioperative period. Thirty patients(ASA physical status II-III) with a history of arterial hypertension, scheduled for elective orthopedic surgery were randomly assigned to two groups. We applied CPA-cloni- dine patch(6.9 mg/cm2, 0.2 mg delivered daily) or placebo patch to each groups, 48 hours prior to induction of anesthesia. Antihypertensive medication was continued until the morning of the scheduled surgery. All patients received premedication of atropine and lorazepam, and induced anesthesia with thiopental and succinylcholine, and maintained with enflurane and 50% ni- trous oxide, while sustaining the BP and pulse rate at acceptable range. For the relief of pain postoperatively, diclofenac and fentanyl were administered intramuscularly on demand. The results were as follows. 1) The change of hemodynamic responses in clonidine group was less compared to the place- bo group. 2) Intraoperative anesthetic requirement for enflurane in clonidine group were significantly lower than placebo group. 3) Postoperative analgetic requirement in clonidine group were significantly lower than pla- cebo group. In clonidine group, 5 cases out of 15 cases were required no analgetics, and the inci- dence of administration of additional fentanyl was decreased to 5 cases, comparing with 10 cases in placebo group.
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소아 고환고절술 및 탈장수술후 통증감소를 위한 장골서혜 / 장골하복 신경차단과 미추차단의 비교
문선애(Sun Ae Moon),이현화(Hyun Hwa Lee),김건식(Ke 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.1
N/A The purpose of this study was to evaluate and compare the effectiveness of ilioinguinal- hypogastric nerve blocks(IHNB) and caudal block in producing post-orchiopexy and post- herniorrhaphy analgesia in children. Forty consenting healthy children, ages 3-10yr, were randomly assigned to receive caudal bupivacaine(0.l25%, 0.5 ml/kg), or IHNB bupivacaine(0.25%, 0.3ml/kg). Blocks were performed following the induction of general anesthesia, be- fore the operation. Pre-anesthetic medication in form of atropine 0.01 mg/kg, droperidol 0.05 mg/kg were given intramuscularly one hour before induction to 40 children. Children were induced with thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg intravenously. Anesthesia was maintained with oxygen-nitrous oxide(FiO 0.3) and ethrane. When the patients stabilized after induction, IHNB was done in the supine position and caudal block was done in the lateral position. The local anaesthetic was injected after negative aspiration. Postoperative pain was assessed with face pain rating scale(FPRS) at rest on discharge of recovery room, and 5 hours after discharge of recovery room, and the red and white visual analogue scale(VAS) at rest and mobilization from supine to sitting position on dis- charge of recovery room, and 5 hours after discharge of recovery room. Post-operative recovery was quiet and comfortable. without side effect. Relief of pain was complete in both IHNB group and caudal group. Surgeons, parents and recovery room personnel were satisfied. There were no surgical or anesthetic complications. In our study, the postpoerative pain scores were similiar in both IHNB group and caudal group. In conclusion, we found that both IHNB and caudal blocks before the start of surgery for orchiopexy & herniorrhaphy are safe and effective in controlling the postoperative pain of children.
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