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암성통증치료를 위한 경막외카테테르 거치술중 혈성천자로 발생한 경막외혈종
우성창(Sung Chang Woo),차동석(Dong Suk Cha),강 건( 대한통증학회 1998 The Korean Journal of Pain Vol.11 No.1
We report a case of epidural hematoma occuring after bloody tap during epi-dural catheter for cancer pain control in thrombocytopenic patient. Two hours after epidurl puncture, patient experienced severe back pain and numbness of both legs. Following day, patient complained of motor paralysis and urinary difficulty. Diagnosis utilizing magnetic reasonance imaging, showed epidural hematoma extending from T11 to T12. Thrombocytopenia prevented surgical intervention. Therefore we restored conservative therapy with packed red cell, platelet concentration, steroid and hemostatic, which provided complete neurologic recovery, spontaneously over several days without surgical intervention.
척수자극술을 이용한 특발성 횡단성 척수염 환자에서의 신경병증 통증 치료 -증례보고-
이청 ( Cheong Lee ),조정하 ( Jung Ha Cho ),양헌주 ( Heon Ju Yang ),이종혁 ( Jong Hyuk Lee ),우성창 ( Sung Chang Woo ),김영주 ( Young Ju Kim ),박동호 ( Dong Ho Park ),정지현 ( Ji Hyun Chung ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.3
We present a patient with intractable neuropathic pain because of idiopathic transverse myelitis unresponsive to medical treatment. After a successful trial of spinal cord stimulation, a permanent stimulator was implanted. Improvement was noted in visual analogue scale, medication usage and daily function. Spinal cord stimulation may offer a therapeutic option for patients with neuropathic pain resulting from transverse myelitis and should be considered when other treatments are failed. (Korean J Anesthesiol 2009; 56: 358∼61)
혈역학적 변화가 경막외 차단후 감각차단 범위감소에 미치는 영향
우성창 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.1
Background : The aim of this study was to compare the difference in regression of sensory analgesia on hemodynamic changes between bupivacaine and lidocaine in epidural blockade. Methods : The thirty-six patients (ASA physical status Ior II) scheduled for elective cesarean section, we performed lumbar epidural blockade using 2% lidocaine(group I, II) or 0.5% bupivacaine(group III, IV). Eighty minutes after surgery, we divided the patients into 4 groups: The group I, III received normal saline, 20 ml, for 30 min; the group II, IV received normal saline, 20 ml, containing ephedrine, 2 mg ml, for 30 min. We compared the regression of sensory analgesia at 80 min with that at 140 min. Results : The proximal extent of sensory analgesia at 140 min was significantly lower than that at 80 min in group II. However, no such significant changes occurred in group I, III, IV. Conclusions : The ephedrine-induced blood pressure increase accelerates regression of epidural blockade using lidocaine. We thought that even moderate and clinically insignificant cardiovascular activation by anxiety or pain can be a cause of reduction in the efficacy and duration of epidural blockade. (Korean J Anesthesiol 1998; 34: 67∼71)
우성창,차동석,강건,백종화,신제균 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.35 No.6
The laryngeal mask airway (LMA) is new method for maintaining the airway and has many advantages such as easy insertion without muscle relaxant, decreasing cardiovascular change, decreasing damage of pharynx and larynx and useful in difficult intubation. It has being increasingly used in the management of difficult airway problems, but has not been widely used in tracheal surgery. A 59 year old woman with tracheal stenosis due to tracheal tumor was admitted for tracheal reconstruction. The stenotic lesion was 5 cm above the carina and the length of the stenotic segment was 2 cm. Anesthetic management should be focus on maintenance of the airway and adequate ventilation with the number 3 sized LMA during the tracheal resection. The tracheal segmental resection and primary end-to-end anastomosis were performed without serious hypoxia and hypercarbia. We discuss the advantages and limitations of the LMA in tracheal surgery. (Korean J Anesthesiol 1998; 35: 1169∼1173)
Lidocaine 의 피내침윤시 용액의 알칼리화가 진통효과에 미치는 영향
강건,우성창,백종화,박순은,김영재 대한정맥마취학회 1999 정맥마취 Vol.3 No.4
서론: 혈관내에 카테테르를 거치전에 진통목적으로 lidocaine을 피내에 침윤한다. 이 때 Lidocaine에 sodium bicarbonate를 첨가하여 알칼리화시키면 lidocaine만 주사했을 때보다 통증완화의 발현속도가 빠르고 지각차단이 신속하다고 보고되어 왔었다. 이에 저자들은 lidocaine 단독과 lidocaine에 sodium bicarbonate의 혼합액을 피내에 침윤한 후 각각 통증점수를 통해 지각차단의 정도를 알아보고 진통발현의 신속성을 추정하였다. 방법: 선택수술이 계획된 환자 35명을 대상으로 연구의 목적과 방법을 설명하고 동의를 받았다. 전박 두군데를 설정하며 한쪽은 2% lidocaine 0.2 ㎖, 다른쪽에서 2% lidocaine 0.16 ㎖와 8.4% sodium bicarbonate 0.04 ㎖의 혼합용액 0.2 ㎖를 각각 26 gauge 주사침으로 피내주사하였다. 5초후 20 gauge 주사침으로 pin-prick test를 시행하여 visual analog scale (VAS)로 통증정도를 평가하였다. VAS 통증점수는 통증이 통증이 없는 것을 0으로 가장 아픈 것을 10으로 점수를 매기도록 교육시켜 표시하였다. 결과: 2% lidocaine을 피내주사 했을 때 VAS 통증점수는 2.6 ± 0.6이었고, lidocaine-sodium bicarbonate 혼합용액을 주사했을때는 0.7 ± 0.5이었다. lidocaine-solidum bicarbonate군에서 VAS 통증점수는 의미있게 낮았다(P<0.05). 결론: 혈관내 카테테르를 거치하기 전에 진통목적으로 lidocaine 단독주사보다는 sodium bicarbonate를 혼합해서 주사하는 것이 진통발현시간이 신속하다. 그러므로 현관내 카테테르를 거치하기 전 피내침윤시 lidocaine을 sodium bicarbonate로 알칼리화시키는 것이 추천된다. Background: It is common for anesthesiologists to use intradermal anesthesia to provide analgesia with lidocaine before IV catheter placement. The addition of sodium bicarbonate to 2% lidocaine has been reported to decrease the onset time of conduction blockade. The aim of this study was to compare the pain score of intradermal anesthesia with lidocaine alone and with the combination of lidocaine and sodium bicarbonate. Methods: We studied 35 patients. Each patient received intradermal injection at forearm with the following two solutions: 1) 2% lidocaine 0.2 ml (lidocaine group); 2) 2% lidocaine 0.16 ml mixed with sodium bicarbonate 0.04 ml (lidocaine-sodium bicarbonate group). Pin-prick test was done for appropriate analgesia using 20 gauge needle on the skin wheal. The visual analog scale during was recorded at 5 seconds after each intradermal injection. Subjects were instructed to score a pain-free injection as zero and the worst pain imaginable as 10. Results: The visual analog scale of lidocaine group (2.6 ± 0.6) was significantly higher than that of lidocaine-sodium bicarbonate group (0.7 ± 0.5) (P < 0.05). Conclusions: Our study demonstrates that the alkalinization of lidocaine produce more rapid spread of sensory blockade and potentiate neural blockade. Alkalinization of lidocaine is therefore recommended when intradermal infiltration of lidocaine is performed for IV catheter placement.