Clinical Study of the Patient with Traumatic Head Injury / 대한마취과학회지

Clinical analysis was done of 284 head injured patients admitted to the hospitals in the Chonbuk area from January to December 31, 1984. The results were the following. 1) Head injury occureed mostly in the 3rd and 4th decade and male patients were 3.7 times as friquent as the female patients. 2) The main cause of head injury was traffic accidents(79%) Other causes were blunt traums, falls, and gunshot in that orer. Many of the traffic accidents involved motorcycles. 3) The accidents were prevalent between 6 and 12 P.M. on Wednesday and Thursday, and in spring and autumn. 4) There was close relation between the level of the consciousness and the death rate of the victims. That is, everyone who was clear or in a stuporous mental state at the time of operation survived, while most of the patients who were semi-or fully comatose died. 5) The time lag between the accident and the surgical operation was 1 to 3 hours. 6) 71% of the injuries were epidural and subdural hematomas, and the rest of the injuries were compressed skull fracture, hemorrage inside the brain parenchyme, in that order. 7) The anesthesia was induced mostly with thiopental sodium and maintained with halothane-N2O-O2 sequence(91.5%). NLA was used in the rest ofr anesthesia(9.1%). 8) Total anesthesia time lapsed for the operation was 2~3 hour in 38%, 3~4 hour in 25% and less than 1 hour in 1.7%.

Inadvertent Dural Puncture during Epidural Block / 대한마취과학회지

Evaluation of inadevertent dural puncture occuring among 308 epidural blocks done for the relief of pain from various conditions was performed. Dural puncture was suspected in 5 out of 308 eqidural bloks(1.6%). Aspiration of CSF was negative 3 cases in which dural puncture was suspected only after developing spinal anesthesia. Of the 3 negative CSF aspirations, one case had a history of laminectomy. Adhesions of the adjacent tissues might result in the loss of flexibility and a decreases in potential epidural space which might cause dural tearing during injection and subarachoid injection of the local anesthetic followed by high spinal anesthesia. In another case, the needle tip was obstructed by tissue which led to negative aspiration of CSF and failure to feel loss of resistance. The second injection at the same site many cause subarachonold injection of the local anesthetic through the previously perforated dura mater and in turn, lead to spinal anesthesia. In the last case, there was no reason to suspect dural puncture since the loss of resistance plus air rebound were definite and aspiration of CSF was negative, but dural puncture was suspected after the patient developed spinal anesthesia.

Clinical Study on the Management of Pain / 대한마취과학회지

Several methods for the management of intractable pain for various conditions including malignant disorders, herpes zoster, and low back pain and/or sciatica in 80 patients were described and analyzed. Neurolytric blocks of celiac plexus were given to the patients suffering from intra-abdominal pain from malignant origin or chronic pancreatitis. Herpes zoster was treated mainly by chemical sympathectomy via paravertebral route and occassionaly corticosteroid was administered epidurally with the local anesthetic, bupivacaine. All the patients with low back pain and/or sciatica were given epidural corticosteroid one to three times. Other peripheral were blocks and regional corticosteroid therpy were given to the rest of the patients. Fair to excellent result was obtained in 71% of the patients but the response was poor in the remaining 28% of the patients. It seems that the earlier the patients were referred to the pain clinic, the better the results were.