소아환자의 마취와 연관된 문제점들에 대한 마취통증의학과 전문의들의 의식조사

황태후 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.3

Background: Anesthesiologist must be aware of the common problems that occur in pediatric anesthesia. The purpose of this survey was to collect information to help improve the quality of pediatric anesthesia by comparing the opinions of anesthesiologists that treat children and those that do not treat children. Methods: A questionnaire surveying the attitudes of 103 anesthesiologists with regard to pediatric problems was analyzed. The questionnaire inquired about the number of years worked in field, the form of work and the responsibilities with regard to the pediatric anesthesia. Each question was rated from 1 (very infrequent) to 5 (very common) for the frequency of problems and from 1 (not importance) to 5 (very important) for the importance of the problem. Then we calculated the average of each item and combined the scores to obtain an average frequency and an average importance. Results: The list of problems had high combined scores for preoperative anxiety (10.62), incision pain (9.59), postoperative agitation (9.53), hypothermia (9.40), and vomiting (9.30) for the pediatric anesthesiologist group. In addition, the problem list had high combined scores for propofol injection pain (11.25), preoperative anxiety (10.92), vomiting (10.17), hypothermia (9.44), and postoperative agitation (9.42) for the non-pediatric anesthesiologist group. Conclusions: The results of this study showed a difference in the pediatric and non pediatric anesthesiologist groups for propofol injection pain. Differences were noted for the average importance (2.34 : 2.80) compared to the average frequency (3.93 : 4.01). The pediatric anesthesiologists regarded propofol injection pain to be less of a problem than did the anesthesiologists who did not care for pediatric patients.

모니터 파형 해석과 생체 정보

심지연,안원식 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.5

심전도나 이산화탄소 파형은 상대적으로 많은 정보를 임상가에게 주고 있다. 반면, 시간에 따른 변화를 압축하여 단순히 상수값을 사용하는 동맥압이나 맥박산소포화도는 상대적으로 적은 정보를 임상가들에게 제공한다. 그러므로, 이러한 파형에 대한 연구를 활성화하여 이들을 임상에 이용한다면 보다 정확하게 환자의 상태를 파악할 수 있어 양질의 진료를 수행하는 데 도움을 줄 수 있을 것으로 생각된다.저자: 심지연·안원식*울산대학교 의과대학 서울아산병원 마취통증의학교실,*서울대학교 의과대학 서울대학교병원 마취통증의학과서울시 종로구 연건동 28, 우편번호: 110-744E-mail: aws@snu.ac.kr

전신마취하 유양골삭개술시의 혈중 ADH (antidiuretic hormone)의 변화

김효은,박윤곤,진홍용,조민수,길혜금 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.3

Background: Markedly reduced urine have been commonly observed during mastoidectomy under general anesthesia. The aim of study was to evaluate the surgery-related mechanism of reduced urine during mastoidectomy. Methods: 11 patients undergoing mastoidectomy were studied. Blood samples were drawn from CVP line inserted through right internal jugular vein just before drilling (Pre-D); at 15 min after drilling (D-15); at the time closest to the inner ear (CHP-1); at 15 min (CHP-2) and 30 min (CHP-3) after CHP-1 and just before emergence (End). MAP, HR, temperature, CVP, and urine output (UO) were recorded at each period. 0.9% normal saline with room temperature was used to irrigate surgical field. Serum ADH, and the osmolalities (serum and urine) were measured. In 6 patients, serum TSH and FSH were measured, simultaneously. Results: There were no significant hemodynamic changes during procedure. UO was decreased in 50% during and after the drilling. No differences showed in UO between before and after the drilling of CHP. Plasma ADH level after the CHP was increased 2-3 fold than before. Serum osmolality was unchanged throughout the periods, while the urine osmolality was significantly increased after the period of CHP. FSH was not changed during the periods and TSH was decreased slightly than in Pre-D. Conclusions: The reduced urine output during mastoidectomy may be influenced by the drilling-related vibration, which may affect the supraoptico-hypophyseal tract, resulting in ADH release. The irrigated isotonic saline with higher osmolality (308 mOsm/kgH2O) than plasma osmolality may partly contributed to the increased ADH. (Korean J Anesthesiol 2006; 50: 296~301) 전신 마취로 수술을 받는 유양골 삭개술 환자에서는 수술적 조작인 드릴의 진동 자체의 영향과 관주액에 의한 국소적 삼투질 농도의 변화가 후뇌하수체로부터의 ADH 분비증가에 영향을 줌으로써 소변량이 더욱 저하될 가능성이 있는 것으로 여겨진다. 그러므로 유양골 삭개술의 마취동안 적절한 약제 선택과 적정마취깊이, 충분한 수액 투여를 유지함으로써 체내 신경 내분비계 호르몬의 급격한 변화를 예방해야 하며 이에 대한 추 후 연구가 필요한 것으로 생각된다.

제왕절개술을 위한 전신마취 중 각성

최성욱 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.1

Awareness during general anesthesia or intraoperative awareness is defined as the unexpected recall of events that occur during anesthesia by patients who receive general anesthesia. The objectives of general anesthesia for cesarean delivery are to keep mother and fetus adequately oxygenated, while limiting drug transmission across the placenta and maintaining maternal comfort. Therefore, the obstetric population is considered at high risk of awareness and recall when undergoing general anesthesia for cesarean delivery. Today, the incidence of awareness during cesarean delivery was reduced to approximately 0.26%, but it remains an undesirable complication with potential for the development of posttraumatic stress disorder. This review examines the recent knowledge of definition, causes, and prevention of awareness during general anesthesia for cesarean delivery. 제왕절개술을 위한 전신마취의 경우 마취 중 각성의 고위험군에 속하지만 적절한 평가와 면담을 통해 환자에게충분히 설명하고, 마취 기계나 약물의 내용물과 용량을 수시로 점검하며 수술 중 주의 깊게 환자를 감시하는 등 마취의 기본적인 원칙을 잘 지키는 것만으로도 그 빈도를 감소시킬 수 있다. 흡입마취제 0.8−1.0 MAC 이하에서는 oxytocin에대한 자궁의 수축력은 잘 유지되므로 적절한 마취를 위해서 충분한 범위의 흡입마취제를 투여하는 것이 바람직하다. 하지만 불가피하게 마취 중 각성이 발생했다면이후 환자의 장기간의 후유증을 줄이기 위해 설명과 상담등을 통해 적절히 대처하는 것이 중요하다.

Initial experience with the unrestricted introduction of sugammadex at a large academic medical center: a retrospective observational study examining postoperative mechanical ventilation and efficiency outcomes

Vikas N. O’Reilly-Shah,Grant C. Lynde,Matthew L. Mitchell,Carla L. Maffeo,Craig S. Jabaley,Francis A. Wolf 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.5

Background: Sugammadex rapidly reverses deep neuromuscular blockade, but owing to cost, questions remain about its optimal utilization. After the unrestricted introduction of sugammadex at Emory University Hospital, we hypothesized that reductions would be demonstrated in the primary outcome of post-anesthesia care unit (PACU) mechanical ventilation (MV) and secondary outcomes of PACU length of stay (LOS) and emergence time (surgery end to anesthesia end time in the PACU). Methods: This retrospective observational study included patients undergoing general anesthesia over a 12-month period. Using multiple variable penalized logistic regression in a one-group before-and-after design, we compared the categorized rates of PACU MV to examine the effect of sugammadex introduction following a post-hoc chart review to ascertain the reason for postoperative MV. Additionally, multiple variable linear regression was used to assess for differences in PACU LOS and emergence time within a propensity-matched set of patients receiving neostigmine or sugammadex. Results: In total, 7,217 surgical cases met the inclusion criteria: 3,798 before and 3,419 after sugammadex introduction. The incidence of PACU MV was 2.3% before and 1.8% after (P = 0.118) sugammadex introduction. PACU MV due to residual neuromuscular blockade (rNMB) decreased from 0.63% to 0.20% (P = 0.005). Ventilation because of other causes was unchanged. PACU LOS and emergence time were unchanged in the propensity-matched set of 1,444 patients. Conclusions: rNMB was an important contributor to PACU MV utilization and its incidence significantly decreased after sugammadex introduction. The selected efficiency measures may not have been sufficiently granular to identify improvements following introduction.

Preoperative ultrasonographic findings of internal jugular veins and carotid arteries in kidney transplant recipients

김갑수,최지원,이승원,박정보,이정진,고저스틴상욱 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.4

Background: Hemodialysis via the internal jugular vein (IJV) has been widely used for patients with end stage renal disease (ESRD) patients, as they have a higher risk of arterial diseases. We investigated the ultrasonographic findings of the IJV and carotid artery (CA) in recipients of kidney transplantation (KT) and identified factors influencing IJV/CA abnormalities. Methods: We enrolled 120 adult KT recipients. Patients in group A (n = 57) had a history of IJV hemodialysis, while those in group B (n = 63) were not yet on dialysis or undergoing dialysis methods not involving the IJV. The day before surgery, we evaluated the state of the IJV and CA using ultrasonography. We followed patients with IJV stenosis for six months after KT. Results: Ultrasonography revealed that four patients (7%) in group A had IJV abnormalities, while no patients in group B had abnormalities (P = 0.118). Of the four patients with abnormalities, one with 57.4% stenosis normalized during follow- up. However, another patient with 90.1% stenosis progressed to occlusion, while the two patients with total occlusion remained the same. Twenty patients in group A (n = 11) and B (n = 9) had several CA abnormalities (P = 0.462). Upon multivariate analysis with stepwise selection, height and age were significantly correlated with IJV stenosis (P = 0.043, odds ratio = 0.9) and CA abnormality (P = 0.012, odds ratio = 1.1), respectively. Conclusions: IJV abnormalities (especially with a history of IJV hemodialysis) and CA abnormalities may be present in ESRD patients. Therefore, we recommend ultrasonographic evaluation before catheterization.

Hypercapnia does not shorten emergence time from propofol anesthesia: a pilot randomized clinical study

권기혁,배한수,강현구,인준용 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.3

Background: The elimination of anesthetic agents is a decisive factor in the emergence from general anesthesia. In this pilot study, we hypothesized that hypercapnia would decrease the emergence time from propofol anesthesia by increasing cardiac output and cerebral blood flow. Methods: A total of 32 patients were randomly divided into two groups based on the end-tidal carbon dioxide values: 30 mmHg (the hypocapnia group) and 50 mmHg (the hypercapnia group). Propofol and remifentanil were infused to maintain a bispectral index of 40–50. Remifentanil infusion was stopped 10 min before the discontinuation of propofol. After cessation of propofol infusion, ventilation settings in the hypocapnia group were maintained constant; a rebreathing tube was connected to the respiratory circuit in the hypercapnia group. The time to spontaneous respiration, eye opening (primary endpoint), mouth opening, and tracheal extubation was recorded and analyzed. Results: Time to eye opening was 9.7 (1.3) min in the hypocapnia group and 9.0 (1.0) min in the hypercapnia group. The difference in the mean times to eye opening between groups was −0.7 min (95% CI, −4.0 to 2.7, P = 0.688). On multiple regression analysis, there was a significant difference in the mean time to eye opening between males and females. Females recovered about 3.6 min faster than males (95% CI, −6.1 to −1.1, P = 0.009). Conclusions: We could not detect a beneficial effect of hypercapnia on propofol emergence time. Irrespective of hypercapnia, females seemed to recover faster than males.

Effects of nefopam on catheter-related bladder discomfort in patients undergoing ureteroscopic litholapaxy

전용우,김선환,백진협,김진아,이용경,민진혜,조형래 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.3

Background: Patients who undergo urinary catheterization may experience postoperative catheter-related bladder discomfort (CRBD). Previous studies have indicated that drugs with antimuscarinic effects could reduce the incidence and severity of CRBD. Accordingly, this study was carried out to investigate whether nefopam, a centrally acting analgesic with concomitant antimuscarinic effect, reduces the incidence and severity of CRBD. Methods: Sixty patients with American Society of Anesthesiologists physical status I and II and aged 18–70 years who were scheduled to undergo elective ureteroscopic litholapaxy participated in this double-blinded study. Patients were divided into control and nefopam groups, comprising 30 patients each. In the nefopam group, 40 mg nefopam in 100 ml of 0.9% saline was administered intravenously. In the control group, only 100 ml of 0.9% saline was administered. All patients had a urethral catheter and ureter stent inserted during surgery. The incidence and severity of CRBD, numerical rating scale (NRS) score of postoperative pain, rescue pethidine dose, and side effects were recorded in the post-anesthesia care unit after surgery. Results: The incidence (P = 0.020) and severity (P < 0.001) of CRBD were significantly different between the control group and the nefopam group. The NRS score of postoperative pain (P = 0.006) and rescue dose of pethidine (P < 0.001) were significantly higher in the control group than in the nefopam group. Conclusions: Intravenous administration of nefopam in patients scheduled to undergo ureteroscopic litholapaxy reduced the incidence and severity of CRBD, NRS score of postoperative pain and analgesic requirements.

Successful airway management with combined use of McGrath® MAC video laryngoscope and fiberoptic bronchoscope in a severe obese patient with huge goiter -a case report-

정미영,박병훈,서재호,김창재 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.3

Huge goitor can lead to tracheal compression and hence difficulty in intubation. This is compounded by severe obesity. Failed tracheal intubation in difficult intubation is a serious event that may lead to increased patient morbidity and mortality. Current intubation rescue techniques and combination of different rescue techniques may increase the success rate of difficult intubation. In a 47-year-old female patient, with severe obesity and a huge goiter, our attempts at intubation using direct laryngoscope, video laryngoscope, and awake fiberoptic bronchoscope had failed. We succeeded by applying video laryngoscope to improve visualization of the airway and fiberoptic bronchoscope as a stylet for endotracheal tube.

Postoperative infusion of a low dose of dexmedetomidine reduces intravenous consumption of sufentanil in patient-controlled analgesia

권대은,구영빈,이선이,정금희,안소운,박정현 대한마취통증의학회 2018 Korean Journal of Anesthesiology Vol.71 No.3

Background: Combining adjunctive medications with patient-controlled analgesia (PCA) has been used to minimize opioid related side-effects. The aim of this study was to evaluate whether postoperative infusion of a sub-sedative dose of dexmedetomidine can reduce opioid consumption and opioid related side-effects. Methods: We selected 60 patients from 18 to 60 years old with an American Society of Anesthesiologists physical status of 1–2 who were scheduled for elective surgery. The types of surgery were limited to thoracoscopic wedge resection of the lung and pulmonary wedge resection under a mini-thoracotomy. Patients received PCA with sufentanil upon arrival in the recovery room, along with a separate continuous infusion of dexmedetomidine that was not mixed in the PCA but started at the same time. Patients were randomly allocated to two groups: dexmedetomidine 0.15 μg/kg/h was administered to patients in group D and normal saline was administered to patients in group C. The visual analogue scale (VAS) pain score, blood pressure, pulse rate, and respiratory rate were measured at each assessment. PCA related side-effects were evaluated. Results: The VAS pain score was significantly lower in the dexmedetomidine group. Patients in the dexmedetomidine group required significantly less PCA at postoperative 1–4, 4–8, and 8–24 h time intervals. The incidence of nausea was significantly less in the dexmedetomidine group, and levels of sedation and hemodynamic variables except for blood pressure at postoperative 8 h were similar between the groups. Conclusions: In conclusion, a postoperatively administered sub-sedative dose of dexmedetomidine reduces PCA sufentanil consumption and decreases nausea.