• 제목/요약/키워드: phrenic nerve

검색결과 57건 처리시간 0.029초

경막외차단 유도중 발생한 전척추마취 -증례보고- (A Total Spinal Anesthesia Developed during an Induction of an Epidural Block -A case report-)

  • 박정구;전재규
    • The Korean Journal of Pain
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    • 제8권1호
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    • pp.156-158
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    • 1995
  • Total spinal anesthesia is a well documented serious life threatening complication which results from an attempted spinal or epidural analgesia. We had an accidental total spinal anesthesia associated with a cranial nerve paralysis and an eventual unconsciousness during epidural analgesia. A 45-year-old female with an uterine myoma was scheduled for a total abdominal hysterectomy under the epidural analgesia. A lumbar tapping for the epidural analgesia was performed in a sitting position at a level between $L_{3-4}$, using a 18 gauge Tuohy needle. Using the "Loss of Resistance" technique to identify the epidural space, the first attempt failed; however, the second attempt with the same level and the technique was successful. The epidural space was identified erroneously. However, fluid was dripping very slowly through the needle, which we thought was the fluid from the normal saline which was injected from the outside to identify the space. Then 20 ml of 2% lidocaine was administered into the epidural space. Shortly after the spinal injection of lidocaine, many signs of total spinal anesthesia could be clearly observed, accompanied by the following progressing signs of intracrainal nerve paralysis: phrenic nerve, vagus nerve, glossopharyngeal nerve and trigeminal nerve in that order. Then female was intubated and her respiration was controlled without delay. The scheduled operation was carried out uneventfully for 2 hours and 20 minutes. The patient recovered gradually in th4e reverse order four hours from that time.

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견관절 수술 시 국소신경 차단술을 이용한 통증 관리 - 초음파 유도하 중재술 - (Perioperative Pain Management Using Regional Nerve Blockades in Shoulder Surgery: Ultrasound-Guided Intervention)

  • 오주한;이예현;박해봉
    • 대한정형외과 초음파학회지
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    • 제7권1호
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    • pp.67-75
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    • 2014
  • 견관절 수술을 위한 마취와 수술 후 통증 조절을 위해 적용될 수 있는 국소 신경 차단술에는 사각근간 신경 차단술, 상견갑 신경 차단술, 5번 경추 신경근 차단술 및 액와 신경 차단술 등이 있을 수 있다. 국소 신경 차단술은 통증 조절 효과는 뛰어난 것으로 보고되고 있으나 횡격 신경 마비, 기흉, 신경 손상 등의 부작용이 다수 보고되며 그 실패율도 상당하여, 부작용을 최소화하고 성공률을 높이기 위한 노력으로 초음파 유도하 중재술이 사용되고 있다. 저자들은 이와 관련된 해부학적 기초와 초음파를 이용한 국소 신경 차단 술기 등에 대하여 기술하고자 한다.

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종격동 부신경절종;1례 보고 (Nonfunctioning Paraganglioma of the Anterior Mediastinum - A case eport -)

  • 이정상;김주현
    • Journal of Chest Surgery
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    • 제24권1호
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    • pp.93-97
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    • 1991
  • A case of nonfunctioning paraganglioma of the anterior mediastinum in a 64-year-old woman is presented. The tumor was adherent to the pericardium and parietal pleura but not to the phrenic nerve. Complete excision of the tumor is the treatment of choice, but partial excision may provide long-term survival. A new classification and terminology suggested by Glenner and Grimley is emphasized. This aorticopulmonary paraganglioma is the first case in the Korea.

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Treatment of Idiopathic Persistent Hiccups with Positive Pressure Ventilation - A Case Report -

  • Byun, Sung-Hye;Jeon, Young-Hoon
    • The Korean Journal of Pain
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    • 제25권2호
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    • pp.105-107
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    • 2012
  • A 41-year-old male patient presented with idiopathic persistent hiccups. The hiccups did not respond to pharmacologic treatments including cisapride, omeprazole, and baclofen. Phrenic nerve block was also ineffective. However, the persistent hiccups were successfully treated with short-term positive pressure ventilation using a short-acting muscle relaxant.

Risk of Encountering Dorsal Scapular and Long Thoracic Nerves during Ultrasound-guided Interscalene Brachial Plexus Block with Nerve Stimulator

  • Kim, Yeon Dong;Yu, Jae Yong;Shim, Junho;Heo, Hyun Joo;Kim, Hyungtae
    • The Korean Journal of Pain
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    • 제29권3호
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    • pp.179-184
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    • 2016
  • Background: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. Methods: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. Results: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%). Neither was encountered in 21 cases (30.4%). The average current measured immediately before the disappearance of muscle twitches was 0.44 mA and 0.50 mA at DSN and LTN, respectively. Conclusions: Physicians should be cautious on the risk of injury related to the anatomical structures of nerves, including DSN and LTN, during ultrasound-guided IBPB by posterior approach. Nerve stimulator could be another option for a safer intervention. Moreover, if there is a motor response, it is recommended to select another way to secure better safety.

급성 심근경색에 의해 발생한 좌측 이통 1예 (Left Side Otalgia Caused by Acute Myocardial Infarction)

  • 정주용;박지수;최진웅
    • Korean Journal of Otorhinolaryngology-Head and Neck Surgery
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    • 제60권6호
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    • pp.322-325
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    • 2017
  • Otalgia consists of primary otalgia associated with disorders of the ear itself and referred otalgia due to disorders of organs that share the same innervation with the ear. Disorders of the oral cavity and laryngopharynx served by the glossopharyngeal and vagus nerves are common causes of referred otalgia. Chest pain from myocardial infarction spreads through the afferent pain pathway, especially through the sympathetic nerves in the cardiac plexus and the phrenic nerve, resulting in a typical chest pain or referred pain in the left upper extremity. However, pain spreading through the vagus nerve can theoretically cause referred otalgia. This association between the heart and ear has not been widely acknowledged, even though a referred otalgia can occasionally be the only symptom of the tragic disease, myocardial infarction, and should be taken seriously. We report a patient who complained of left otalgia as the only symptom of myocardial infarction.

수양명경근(手陽明經筋)의 해부학적(解剖學的) 고찰(考察) (Anatomy of Large Intestine Meridian Muscle in human)

  • 심영;박경식;이준무
    • Korean Journal of Acupuncture
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    • 제19권1호
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    • pp.15-23
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    • 2002
  • This study was carried to identify the component of Large Intestine Meridian Muscle in human, dividing into outer, middle, and inner part. Brachium and antebrachium were opened widely to demonstrate muscles, nerve, blood vessels and the others, displaying the inner structure of Large Intestine Meridian Muscle. We obtained the results as follows; 1. Meridian Muscle is composed of the muscle, nerve and blood vessels. 2. In human anatomy, it is present the difference between a term of nerve or blood vessels which control the muscle of Meridian Muscle and those which pass near by Meridian Muscle. 3. The inner composition of meridian muscle in human arm is as follows. 1) Muscle; extensor digitorum tendon(LI-1), lumbrical tendon(LI-2), 1st dosal interosseous muscle(LI-3), 1st dosal interosseous muscle and adductor pollicis muscle(LI-4), extensor pollicis longus tendon and extensor pollicis brevis tendon(LI-5), adductor pollicis longus muscle and extensor carpi radialis brevis tendon(LI-6), extensor digitorum muscle and extensor carpi radialis brevis mucsle and abductor pollicis longus muscle(LI-7), extensor carpi radialis brevis muscle and pronator teres muscle(LI-8), extensor carpi radialis brevis muscle and supinator muscle(LI-9), extensor carpi radialis longus muscle and extensor carpi radialis brevis muscle and supinator muscle(LI-10), brachioradialis muscle(LI-11), triceps brachii muscle and brachioradialis muscle(LI-12), brachioradialis muscle and brachialis muscle(LI-13), deltoid muscle(LI-14, LI-15), trapezius muscle and supraspinous muscle(LI-16), platysma muscle and sternocleidomastoid muscle and scalenous muscle(LI-17, LI-18), orbicularis oris superior muscle(LI-19, LI-20) 2) Nerve; superficial branch of radial nerve and branch of median nerve(LI-1, LI-2, LI-3), superficial branch of radial nerve and branch of median nerve and branch of ulna nerve(LI-4), superficial branch of radial nerve(LI-5), branch of radial nerve(LI-6), posterior antebrachial cutaneous nerve and branch of radial nerve(LI-7), posterior antebrachial cutaneous nerve(LI-8), posterior antebrachial cutaneous nerve and radial nerve(LI-9, LI-12), lateral antebrachial cutaneous nerve and deep branch of radial nerve(LI-10), radial nerve(LI-11), lateral antebrachial cutaneous nerve and branch of radial nerve(LI-13), superior lateral cutaneous nerve and axillary nerve(LI-14), 1st thoracic nerve and suprascapular nerve and axillary nerve(LI-15), dosal rami of C4 and 1st thoracic nerve and suprascapular nerve(LI-16), transverse cervical nerve and supraclavicular nerve and phrenic nerve(LI-17), transverse cervical nerve and 2nd, 3rd cervical nerve and accessory nerve(LI-18), infraorbital nerve(LI-19), facial nerve and infraorbital nerve(LI-20). 3) Blood vessels; proper palmar digital artery(LI-1, LI-2), dorsal metacarpal artery and common palmar digital artery(LI-3), dorsal metacarpal artery and common palmar digital artery and branch of deep palmar aterial arch(LI-4), radial artery(LI-5), branch of posterior interosseous artery(LI-6, LI-7), radial recurrent artery(LI-11), cephalic vein and radial collateral artery(LI-13), cephalic vein and posterior circumflex humeral artery(LI-14), thoracoacromial artery and suprascapular artery and posterior circumflex humeral artery and anterior circumflex humeral artery(LI-15), transverse cervical artery and suprascapular artery(LI-16), transverse cervical artery(LI-17), SCM branch of external carotid artery(LI-18), facial artery(LI-19, LI-20)

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만성 교약성 심낭염의 외과적 치료 -4례 보고- (Surgical Treatment of Chronic Constrictive Pericarditis -Report of 4 ases-)

  • 전희재
    • Journal of Chest Surgery
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    • 제27권9호
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    • pp.793-797
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    • 1994
  • Constrictive pericarditis is often accompanied with ~brothorax and deterioration of cardiac, hemodynamic functions. Surgical relief of fibrous peel causes remarkable improvement in pulmonary, cardiac, hemodynamic function, and subjective symptoms. We experienced 4 cases of constrictive pericarditis combined with bilateral ~brothorax after bilateral pleural effusion caused by tuberculosis and non-specific inflammation. Pleural decortication and pericardiectomy were done at the same time through anterolateral thoracotomy with sternal transection[3 patients] and median sternotomy incision[l patient]. Low cardiac output was the most common complication. With left anterolateral thoracotomy, we could prevent the hypotension from massive retraction for dissecting by median sternotomy, which was good for dissecting from anterior wall of left ventricle to posterior wall of left ventricle and surrounding phrenic nerve. It was enough to dissect the portion being through hard to dissect, right atrium, SVC and IVC.

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원발성 종격동 내배엽동종 [난황난종]: 1 치험례 보 (Primary mediastinal endodermal sinus tumor [yolk sac tumor]: report of a case)

  • 장병철
    • Journal of Chest Surgery
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    • 제17권3호
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    • pp.497-504
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    • 1984
  • The malignant germ cell tumor found in the gonad can originate in the anterior mediastinum. Endodermal sinus tumor[Yolk sac tumor] is a kind of malignant germ cell tumor and is derived from extra-embryonic mesoderm. We experienced a case of primary mediastinal endodermal sinus tumor occurred in 22 year old male patient. His chief complaint was anterior chest pain for 2 days. The tumor located in the anterior mediastinum and invaded upper lobe of the deft lung and pericardium. A left upper lobe resection including phrenic nerve and pericardium was performed and the tumor in the anterior mediastinum was excised. The patient has been treated with combination chemotherapy[Cis-platinum, Vincristine, Actinomycin-D, & Cyclophosphamide} and followed up for 4 months with partial remission.

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원발성 폐암에서 종격동 림프절 평가에 대한 종격동경 검사의 가치 (The Value of Mediastinoscopy for Evaluation of Mediastinal Lymph Nodes in Bronchogenic Carcinoma : Accuracy of Mediastinoscopy)

  • 오상준;김창호
    • Journal of Chest Surgery
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    • 제24권8호
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    • pp.751-756
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    • 1991
  • For the period from June 1988 to July 1991 we studied 29 patients who were judged to have operable disease before mediastinoscopy on clinical criteria[absence of distant metastases, phrenic or laryngeal nerve paralysis, positive scalene node biopsy, and malignant pleural effusion]. All patients had computed tomography and mediastinoscopy prior to operation. In the present study, the sensitivity, specificity, and accuracy of CT were 92%, 56%, and 72%, respectively. And the sensitivity, specificity, and accuracy of mediastinoscopy were 92%, 100%, and 97%, respectively. We concluded that because of the low accuracy of CT, CT cannot replace mediastinoscopy, and routine mediastinoscopy should be performed in preoperative staging of bronchogenic carcinoma.

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