항문 주위 수술후 통증관리를 위한 지주막하강내 Morphine 의 유효량

원종인(Jong In Won),조인찬(In Chan Cho),박영철(You 대한통증학회 1999 The Korean Journal of Pain Vol.12 No.1

N/A Background: Contraction of anal sphincter muscle produces severe pain in perianal surgery post- operatively. Recent reports have indicated that effective and prolonged pain relief can be obtained by the injection of small doses of morphine into the subarachnoid space. We attempted to use this technique for perianal surgery and investigated postoperative pain control and its side effects. Methods: Forty five patients scheduled for hemorrhoidectomy and anal fistulectomy were studied to determine the minimal effective dose of intrathecal morphine for postoperative analgesia. In order to control the pain, 7 mg of 0.5% hyperbaric bupivacaine with 0.05 mg (group I), 0.1 mg (group II) and 0.15 mg (group lII) of morphine hydrochloride was injected with a 25 gauge spinal needle into the subarachnoid space. We estimated the duration of analgesia until the pain score attained to above 3 in 10 cm VAS (visual analogue scale) and incidence of itching, nausea and vomiting by percentage, headache, backpain and respiratory depression by positive and negative. We also checked the time of self-voiding. Results: The mean time of analgesia was 10.3+1.54, 19.7+2.22 and 20.3+2.29 hours in group I, II and III respectively. Urinary retention of group I, II and III after block persisted for an average of 20.3+2.31, 21.2+2.51 and 23.3+ 3.74 hours. Nausea and vomiting were observed 33%, 53%, 67% and itching was observed 53%, 67%, 80% in group I, II and III respectively and respiratory depression did not occur in all groups. Conclusions: It is not necessary to use more than O. 1mg of intrathecal morphine in perianal surgery because analgesia is not prolonged and side effects are increased.

경막외 Morphine에 의한 통증 조절 환자에서 Butorphanol의 첨가시 부작용 감소 효과

이종남(Jong Nam Lee),조인찬(In Chan Cho),박영철(Yo 대한통증학회 1996 The Korean Journal of Pain Vol.9 No.2

N/A Background: Nowadays, epidural morphine is commonly used in postoperative pain con- trol. But epidural morphine may produce some side-effects, e.g. pruritus, nausea, vomiting, urinary retention and respiratory depression. Especially, pruritus is the most common com- plaint in pain-controlled patients by epidural morphine. So we evaluated whether addition of epidural butorphanol affects the degree of pruritus and pain score in pain controlled pa- tients who by epidural morphine after hysterectomy. Methods: Group l(N=15) received postoperative epidural 0.1% bupivacaine 100ml plus morphine 10mg, group 2(N=15) received the mixture of butorphanol 2mg with same re- gime as in group 1, group 3(N=15) received the mixture of butorphanol 4mg with same re- gime as in group l. All of the three groups received these solutions by infusion pump, l ml /hour, for postoperative 4 days. All groups received additional morphine 1.2 mg in 0.2% bupivacaine 6 ml epidurally when the peritoneum was closed under general anesthesia. The severity of pain, pruritus, nausea and vomiting was estimated by 10cm VAS(visual ana- logue scale) and somnolence by positive or negative during postoperative 4 days. Results: Severity of pruritus, but not nausea and vomiting was decreased in group 2 and 3 compared with group 1(p<0.05). Pain score was increased in group 3 at postoperative day (POD) 0 and 2 compared with group 1(p<0.05). Incidence of somnolence in group 1, 2 and 3 were 2.7±0.7, 5.3±0.7 and 10.0±1.0 respectively. Conclusions: These results suggest that butorphanol reduce the degree of pruritus, the most common side effect of morphine, but increase the incidence of somnolence.

Jet의 위치에 따른 펠턴 수차의 성능 특성

박주훈(Joo Hoon Park),조인찬(In Chan Cho),박지수(Ji Su Park),신유환(Youhwan Shin) 대한기계학회 2014 대한기계학회 춘추학술대회 Vol.2014 No.5-2

척추성형술로 치유한 Kummell`s Disease 환자 -증례 보고-

배준석 ( Jun Seok Bae ),이종남 ( Jong Nam Lee ),박영철 ( Young Chul Park ),조인찬 ( In Chan Cho ) 대한통증학회 2002 The Korean Journal of Pain Vol.15 No.2

기관내 삽관시 Verapamil의 심혈관계 반응에 대한 연구

류흥현,조인찬,박영철,백승환,정규선 성분도병원 1991 성분도병원논문집 Vol.3 No.-

실험적 출혈을 일으킨 개에서 Crystalloid용액 투여 효과

이상태,조인찬,박영철,정규선 성분도병원 1993 성분도병원논문집 Vol.3 No.-

실험적 출혈을 일으킨 개에서 Crystalloid 용액 투여 효과

이상태,박영철,정규섭,조인찬 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.4

Although crystalloid solutions such as Ringer's lactate have become the standard for initial volume replacement after hemorrhage, it is controversy whether this fluid alone restores and maintains the depressed physiologic function after severe hemorrhage. Six anesthetized dogs were bled(35ml/kg) and resuscitated with Ringers lactate solution (100 ml/kg). Physiologic variables are measured initialy, after hemorrhage, after resucitation. Compared with initial value, after resuscitation data show marked reduction in hemoglobin, oxygen carrying capacity, vascular resistance, and electrolyte. But cardiac output and blood gas analysis data was not changed. Prothrombin time and partial thromboplastin time was prolongated. From this study crystalloid resuscitation in severe hemorrhagic shock restore cardiac output and perfusion, but fail to maintain adequate oxygen carrying capacity.

당뇨병 환자에서 전신마취중 발생한 서맥과 저혈압

박영철,이종남,조인찬,하지봉 대한마취과학회 1995 Korean Journal of Anesthesiology Vol.29 No.4

The major risk factors for diabetics undergoing surgery are the end-organ diseases associated with diabetes. Autonomic neuropathy is relatively common in diabetic patients and associated with an increased risk of perioperative cardiovascular instability. We experienced a case of severe bradycardia and hypotension during general anesthesia for subtotal gastrectomy in a 59 year-old male diabetic patient. Anesthesia was induced with thiopental and vecuronium, and was maintained with nitrous oxide, oxygen and enflurane. Five minutes after induction, severe bradycardia and hypotension developed without specific events. The bradycardia was unresponsive to intravenous atropine and ephedrine, but the blood pressure was restored by administration of ephedrine. During operation his blood pressure was maintained in normal range but the bradycardia was not restored by additional administration of atropine. Postoperatively, myocardial infarcton was ruled out. The test performed after operation suggested that his cardiovascular autonomic nervous system was severely impaired. We think that cardiovascular autonomic dysfunction should be evaluated during preoperative period to plan the anesthetic management and to prevent severe cardiovascular complications in diabetic patients.

개심술을 위한 마취유도시 Sufentanil 과 Vecuronium 이 심맥관류에 미치는 영향

박영철,신상욱,정규섭,김인세,조인찬,김성수 대한마취과학회 1990 Korean Journal of Anesthesiology Vol.23 No.1

Narcotics and Some Neuromuscular blockers are used for open heart sugery anesthesia. Rapid induction of intravenous narcotics techniques may cause some reductjon in blood pressure and systemic vascular resistance, however, the selection of a narcotic and neuromuscular blocker influences subsequent Hemodynamic responses. 72 patients having open heart surgery were investigated using three combination of a narcotic and neuromuscular blocker: Group I (fentanyl 50 ug/kg, pancuronium 100 ug/kg): Group II (fentanyl 50 ug/kg, Vecuronium 80 ug/kg) Group III (sufentanil 10 μ/kg, vecuronium 80 μ/kg), each combination being administered over 2 minutes. Hemodynamic functions were then monitored for 10 minutes before tracheal intubation. 1) Significant changes included increases in heart nate in the groups receiving pancuronium and decrease in those receiving vecuronium. 2) In all groups mean arterial pressure initially decreased: systemic vascular resistance index decreased significantly in all groups except sufentanil d vecuronium group. 3) Cardiac index decreased significantly only in ufentanil-Vecuronium groups. Time of onset of neuromuscular blockade did not differ among the three groups, but transient chest wall rigidity occurred significantly more often with sufentanil than with fentanyl. Overall, the fentanyl-Pancuronium combination afforded the greatest hemodynamic stability, whereas the sufentanil-Vecuronium Combination proved least Satisfactory because of bradycardia, hypotension, increase of chest wall rigidity.

기관내 튜브발관 후 발생한 일측 성대 마비

조은하,조인찬,박영철,최영환 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.33 No.4

We experienced a case of unilateral vocal cord paralysis following tracheal extubation. The patient was a 60-year-old man undergoing subtotal gastrectomy. He had no laryngeal symptoms prior to operation and the trachea was intubated with a cuffed endotracheal tube. The surgical procedure lasted 6 hours and was uneventful. Three days later after operation, he began to complain of hoarseness and mild aspiration symptom. On endoscopic examination, left vocal cord paralysis was found. Fifteen weeks later the voice and left vocal cord function return to normal without specific management. In this case, we suggested that possible causes of unilateral vocal cord paralysis are compression of recurrent laryngeal nerve by overexpanded endotracheal cuff, laryngeal trauma during difficult intubation, stretching of the nerve as a result of traction on distant organ, decreased elasticity of trachea and surrounding tissues in the older age group and long operating time. (Korean J Anesthesiol 1997; 33: 788∼791)