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정중법을 이용한 빗장 아래 상완 신경총 차단 환자에서의 0.5% Levobupivacaine과 0.5% Ropivacaine의 비교
조춘규 ( Choon Kyu Cho ),김중연 ( Joong Yeoun Kim ),정성미 ( Sung Mee Jung ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),김철웅 ( Chul Woung Kim ),한정욱 ( Jeong Uk Han ),양춘우 ( Chun Woo Yang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.2
임상연구 : 전슬관절치환술 후 지속적인 3-in-1 신경차단과 정맥내 통증자가조절의 술 후 진통에 관한 비교
박창길 ( Chang Kil Park ),조정하 ( Jung Ha Cho ),조춘규 ( Choon Kyu Cho ),김영주 ( Young Ju Kim ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.1
Background: Severe postoperative pain can delay knee rehabilitation and prolong the duration of convalescence after a total knee replacement (TKR). This study compared a continuous 3-in-1 block using a patient-controlled analgesia (PCA) technique and IV PCA for analgesia after a unilateral TKR. Methods: Forty patients scheduled for an elective TKR under spinal anesthesia were randomly divided into two groups. Group 1 received an IV PCA with butorphanol and ketorolac. Group 2 received a continuous 3-in-1 block performed with 20 ml of 0.25% bupivacaine and epinephrine 1:200,000, followed by a continuous infusion of 0.125% bupivacaine through a femoral catheter at a rate of 2 ml/h plus 1 ml PCA boluses of a lockout time of 10 min. The level of pain was assessed at rest and during continuous passive motion using a visual analog scale (VAS). The VAS pain scores, nausea and vomiting were recorded in the postanesthetic care unit, at 6 PM on the day of operation, and at 8 AM and 6 PM on postoperative days 1 and 2, respectively. The duration of surgery, anesthesia time, blood loss, and hospital stay were compared. Results: The patients in Group 2 reported lower VAS pain scores than those in Group 1 (P < 0.05). The duration of surgery, nausea and vomiting, blood loss, and hospital stay were similar in the two groups except for the anesthesia time. Conclusions: A continuous 3-in-1 block with a PCA technique provides better pain relief than IV PCA with butorphanol and ketorolac after TKR. (Korean J Anesthesiol 2006; 51: 76~81)
임상연구 : 부인과 수술환자에서 Sufentanil과 병용한 0.1% Levobupivacaine 또는 0.1% Ropivacaine의 술 후 경막외 진통 비교
양춘우 ( Chun Woo Yang ),박정민 ( Jeong Min Park ),임영수 ( Young Su Lim ),조춘규 ( Choon Kyu Cho ),김경식 ( Kyong Sik Kim ),김응균 ( Eung Kyun Kim ),정성미 ( Sung Mee Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.6
Background: Ropivacaine and levobupivacaine are recently introduced amide local anesthetics that are structurally similar to bupivacaine. In this study, we compared the quality of postoperative analgesia and the side effects of 0.1% ropivacaine/sufentanil and 0.1% levobupivacaine/sufentanil. Methods: Sixty patients scheduled for gynecologic surgery under general anesthesia were randomized to receive either 0.1% ropivacaine with sufentanil (ropivacaine group) or 0.1% levobupivacaine with sufentanil (levobupivacaine group) for postoperative epidural analgesia using a patient-controlled analgesia pump at a rate of 5 ml/h during the 48 hour period following surgery. Visual analogue scale (VAS) scores at rest and on coughing, sitting and movement, the degree of ambulation, additional analgesic requirements and side effects were assessed. Results: In the levobupivacaine group, VAS scores at rest and on coughing, sitting and movement were lower than in the ropivacaine group (P < 0.05). In the ropivacaine group more patients were able to walk unaided (P < 0.05). There were no differences in local anesthetic consumption, additional analgesic requirements and side effects between the groups. Conclusions: Both 0.1% ropivacaine with sufentanil and 0.1% levobupivacaine with sufentanil provided effective postoperative epidural analgesia, but ropivacaine produced lesser motor block. (Korean J Anesthesiol 2007; 53: 746~52)
빗장 아래 팔신경얼기 차단 환자에서의 0.75% 또는 0.5% Ropivacaine의 비교
박정민 ( Jeong Min Park ),정성미 ( Sung Mee Jung ),조춘규 ( Choon Kyu Cho ),임영수 ( Young Su Lim ),구자현 ( Ja Hyun Ku ),허윤무 ( Youn Moo Heo ),송장호 ( Jang Ho Song ),양춘우 ( Chun Woo Yang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.57 No.5
Background: We performed a prospective, double blind study to compare the clinical effect of vertical infraclavicular brachial plexus block produced by 0.75% vs 0.5% ropivacaine for upper limb surgery. Methods: We included 80 patients receiving upper limb surgery under infraclavicular brachial plexus block. The infraclavicular brachial plexus block was performed via the vertical technique with 30 ml of 0.75% or 0.5% ropivacaine. By observation, we determined nerve type was stimulated and scored the level of sensory block and motor block. The quality of blocks was assessed intra-operatively. The duration of sensory block and motor block and their complications were assessed. Results: There were no significant differences in the frequency of stimulated nerve type, evolution of sensory and motor block quality, or success of block. There were no significant differences in the duration of sensory block and motor block. Vascular puncture was noted in 1 patient in the 0.75% ropivacaine. Conclusions: Both the 0.75% and 0.5% ropivacaine had similar effects in the vertical infraclavicular brachial plexus block. (Korean J Anesthesiol 2009;57:572∼8)
슬관절 전치환술 후 슬관절 주위주입과 병용한 지속적 정맥 진통과 지속적 경막외 진통의 비교
박정민 ( Jeong Min Park ),임영수 ( Young Su Lim ),이우석 ( Woo Suk Lee ),구자현 ( Ja Hyun Ku ),강포순 ( Po Soon Kang ),권희욱 ( Hee Uk Kwon ),조춘규 ( Choon Kyu Cho ),정성미 ( Sung Mee Jung ),양춘우 ( Chun Woo Yang ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.1
Background: Postoperative continuous intravenous analgesia may not provide effective postoperative analgesia following total knee arthroplasty. This study was conducted to determine if combined continuous intravenous analgesia and peri-articular infiltration provided a better quality of analgesia following total knee arthroplasty than epidural analgesia. Methods: A prospective, double-blind study involving 50 patients who had undergone total knee arthroplasty was conducted. Patients were divided into control group and an experimental group. Patients in the control group (n=25) received peri-articular infiltration with 47 mL normal saline prior to closure of the wound and postoperative epidural analgesia for 48 hours. Patients in the experimental group (n=25) received a mixture of peri-articular infiltration of 16 mL of 0.75% ropivacaine, 6 mg morphine, 0.2 mg of epinephrine and 25 mL normal saline prior to closure of the wound and postoperative continuous intravenous analgesia for 48 hours. The analgesic efficacy was then evaluated using the verbal numeric rating scale at 1, 2, 6, 12, 24, and 48 hours postoperatively. The side effects and the dosage of rescue analgesics were then recorded. Results: The experimental group showed a significantly higher pain score than the control group 2 and, 6 hours postoperatively at rest and 2 hours postoperatively following passive knee movement (P<0.05). In addition, the rescue analgesic requirement was higher for the experimental group during the first 24 hours following surgery than for the control group (P<0.05). Conclusions: We found that combined continuous intravenous analgesia and peri-articular infiltration of a mixture of ropivacaine and, morphine injected into the peri-articular tissue provided minimal benefits for pain control during the early postoperative period when compared to epidural analgesia after total knee arthroplasty. (Korean J Anesthesiol 2009;56:47~53)
허리뼈 가시돌기 세로크기 차이를 이용한 4-5 허리뼈 가시사이 공간 확인법
김현우 ( Hyun Woo Kim ),진경욱 ( Gyong Uk Jin ),임영수 ( Young Su Lim ),권희욱 ( Hee Uk Kwon ),강포순 ( Po Soon Kang ),조춘규 ( Choon Kyu Cho ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6
Background: The appropriate landmark of spinal puncture is important for preventing spinal cord injury. L4 spinous process (SP) is the largest in size and L5 is the smallest. In this study `height of SP` is the longitudinal length of SP on lumbar AP view. The purpose of this study was to identify the L4-5 interspinous space (ISS) using difference between L4, 5 SP heights. Methods: Sixty-six patients scheduled for spine surgery were enrolled. After induction of general anesthesia, patients were changed to a prone position. The lumbar vertebrae were palpated from the lowest point of the lumbar spine and cranially. We palpated the difference in spinous process heights and marked the point of step-off from L4 SP to L5 SP. The level was radio-logically confirmed. Direction of estimation error and the effects of spondylolisthesis, sex, and obesity were also analyzed. Results: The number of accurate identification of the L4-5 ISS in males was 36 (85.7%), in females was 17 (70.8%), and in total 53 (80.3%). The difference between L4 and L5 SP heights (DL4-5SPHs) and sex affect the results. DL4-5SPHs were larger in concordant patients than in discordant patients (7.2±4.9 mm: 5.0±1.6 mm, P<0.05). Among errors, there were more cephalad identified cases compared to caudad identified ones (12.1%: 7.6%). Conclusions: The identification of L4-5 ISS using SP height difference was considerably accurate. So, we considered this might be a useful method for spinal anesthesia. (Korean J Anesthesiol 2009; 56: 652~7)
소아에서 Laryngeal Mask Airway 의 적용
양홍석,조춘규,정기운 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.4
Endotracheal intubation is the most useful and safe method to keep airway in general anesthesia. But there are many problems such as severe cardiovascular changes, difficult intubation, larygospasm and tracheal stenosis in using laryngoscope and tracheal intubation. Laryngeal mask airway(LMA) is new method to keep airway and has many advantages such as easy insertion, decreasing cardiovascular changes, insertion without muscle relaxant, decreasing damage of pharynx and laynx and useful in difficult intubation. Cinical study of LMA No. 2 was done in 30 children weighted between 8.9-26 kg, about cardiovascular changes, volume and pressure changes of inflaton cuff, problems and complications during insertion and maintaining of LMA. The result, were follows 1) The average time taken to insert the LMA was 7.4±3.3 second and 12 case were correct placement at the second attempt to use laryngoscope. 2) The volume of inflation cuff without air leak during positive pressure ventilation with 15cmH₂O of peak airway preure was 7.9±0.5ml and inflation cuff pressure at insertion was 40.1±15.9 mmHg and increased(p$lt;0.05) continously. 3) Mean arterial pressure was increased(p$lt;0.05) compared with preinduction value and normalize within a minute. Heart rate was incresed(p$lt;0.05) compared with preinduction value and increase was sustained. 4) There were no complications except 1 case of gastric disteesion.
Propofol 과 Fentanyl 을 이용한 완전정맥마취
진홍용,조춘규 대한마취과학회 1993 Korean Journal of Anesthesiology Vol.26 No.3
Total intravenous anesthesia(TIVA) with ketamine and fentanyl has many advantages such as no air pollution, no hepatic or renal toxicity and good postoperative pain relief compared with inhalational anesthesia, but this anesthetic method also has several disadvantages such as hypertension, delayed recovery and emergence delirium. For improvement of this problems, the authors tried new TIVA method with propofol and fentanyl to the 20 patients in ASA class I or II and compared this method with 20 patients in ASA class I or II who had been anesthetized with enflurane-N₂O from March to May 1992. The results were as follows; 1) Systolic blood pressure decreased after induction from 127±12mmHg to 105±17mmHg in propofol-fentanyl group(p$lt;0.05) and mean arterial pressure decreased after induction from 93 9 mmHg to 799 mmHg in propofol-fentanyl group and from 98±10 mmHg to 83±11 mmHg in enflurane-N₂O group(p$lt;0.05), but they became preoperative values during operation in both groups. RPP(rate-pressure product) and rate decreased about 28-39% after induction and during operation in propofol-fentanyl group(p$lt;0.05) but there was no change in enflurane- N₂ group. 2) The data of arterial blood gas had no clinically significant changes in both groups. 3) The blood sugar level increased during operation(p$lt;0.05) but it became preoperative value from postoperative 30 min in both groups. 4) There were no clinically significant changes in hepatic or renal function test of postoperative 3rd day compared with preoperative one. 5) There were no postoperative complications except 2 cases of nausea in propofol-fentanyl group. 6) Emergence time and recovery time had no difference in both groups but the duration from arrival on recovery room to postanesthetic recovery score of 10 was shorter in propofol- fentanyl group(7.5±7.3 min) than in enflurane-N₂O group(16.7±l0.3 min)(p$lt;0.05). Therefore TIVA with propofol and fentanyl is considered to have good controllability nearly equal to enflurane-N₂O anesthesia and it can be applied asof general anesthetic methods in the case of contraindication to N₂O and volatile anesthetics, but futher study will be required to quantify the appropriate dosage of propofol or fentanyl to minimize perioperative hemodynamic changes and respiratory depression.