Clinical Research Article : Factors in Patient dissatisfaction and refusal regarding spinal anesthesia

( Won Ji Rhee ),( Chan Jong Chung ),( Youn Hee Lim ),( Kyu Han Lee ),( Seung Cheol Lee ) 대한마취과학회 2010 Korean Journal of Anesthesiology Vol.59 No.4

Background: Spinal anesthesia is the most common regional anesthesia conducted for many surgical procedures. Multiple factors can affect the success, the side effects, and patient satisfaction with the procedure. This study was undertaken prospectively to discover factors affecting dissatisfaction and refusal of spinal anesthesia. Methods: Starting in December 2007, patients who underwent spinal anesthesia in the operating rooms of our hospital were surveyed over a period of a year. Before attempting the procedure, patient characteristics and previous history of anesthesia were recorded. Spinal anesthesia was administered with 0.5% heavy bupivacaine combined with fentanyl 0-20 μg. Intraoperative data and postoperative data on the day after surgery were collected. The patients were also asked about their general satisfaction with spinal anesthesia, causes of dissatisfaction with the procedure, and causes of their refusal to have spinal anesthesia again. Results: Six patients among 1,197 cases were excluded from the study because of spinal anesthesia failure. The dissatisfaction rate of spinal anesthesia was 3.7%, and its risk factors were more than three puncture attempts, paresthesia at puncture, postoperative nausea and vomiting, and postoperative backache. The refusal rate to have spinal anesthesia again was 3.2%, and its risk factors were postoperative backache and dissatisfaction. Conclusions: Although spinal anesthesia was conducted safely during the study and revealed a high rate of patient satisfaction (96.3%), side effects still occurred. Therefore, attending anesthesiologists must perform the procedure carefully and always pay attention to patients under spinal anesthesia.(Korean J Anesthesiol 2010;59:260-264)

Clinical Research Article : Effect of ramosetron on shivering during spinal anesthesia

( Min Soo Kim ),( Dong Won Kim ),( Seung Hoon Woo ),( Jun Heum Yon ),( Sang Seok Lee ) 대한마취과학회 2010 Korean Journal of Anesthesiology Vol.58 No.3

Background: Shivering associated with spinal anesthesia is uncomfortable and may interfere with monitoring. The aim of this study is to evaluate the effect of ramosetron, a serotonin-3 receptor antagonist, on the prevention of shivering during spinal anesthesia. Methods: We enrolled 52 patients who were ASA I or II and who had undergone knee arthroscopy under spinal anesthesia. Warmed (37˚) lactated Ringer`s solution was infused over 15 minutes before spinal anesthesia. Patients were randomly allocated to a control group (group S, N=26) or study group (group R, N=26). Spinal anesthesia was performed with a 25-G Quincke-type spinal needle between the lumbar 3-4 interspace with 2.2 ml 0.5% hyperbaric bupivacaine. For patients allocated in groups S and R, 2 ml 0.9% saline and 0.3 mg ramosetron, respectively, was intravenously injected immediately before intrathecal injection at identical times. Shivering and spinal block levels were assessed immediately after the completion of subarachnoid injection, as well as 5, 10, 15, 20, 25, 30, 60, and 120 minutes after spinal anesthesia. Systolic and diastolic blood pressures, heart rate, and peripheral oxygen saturation were also recorded. Core temperatures were measured by tympanic thermometer and recorded before and during spinal anesthesia at 30-minute intervals. Results: Shivering was observed in 2 patients in group R and 9 patients in group S (P=0.038, odds ratio=6.14, 95% C.I.=1.08-65.5). The difference in core temperature between the groups was not significant. Conclusions: Compared to control, ramosetron is an effective way to prevent shivering during spinal anesthesia. (Korean J Anesthesiol 2010; 58: 256-259)

요추마취 후 앉히는 자세가 두통 발생에 미치는 영향 : 안장차단마취와 요추마취의 비교 Saddle Block versus Low Spinal Anesthesia

임석원,유동원 대한대장항문학회 2004 Annals of Coloproctolgy Vol.20 No.1

Evaluation of changes in anesthetic methods for cesarean delivery: an analysis for 5 years using the big data of the Korean Health Insurance Review and Assessment Service

박지인,박상희,Kang Min Seok,강길원,김상태 대한마취통증의학회 2020 Anesthesia and pain medicine Vol.15 No.3

Background: As an anesthesia induced during cesarean section, spinal anesthesia is preferred over general and epidural anesthesia. This study aimed to review the trend of anesthetic methods for cesarean section based on data obtained from the Korean Health Insurance Review and Assessment Service from 2013 to 2018.Methods: The anesthetic methods were analyzed in 753,285 parturients who underwent a cesarean section in Korea from 2013 to 2018. We determined the association between each anesthetic method and hospital type and maternal and fetal factors. We also evaluated whether the anesthetic method was associated with the parturients’ length of hospital stay.Results: General anesthesia, spinal anesthesia, and epidural anesthesia were induced in 28.8%, 47.7%, and 23.6% of parturients from 2013 to 2018, respectively. Trend analyses showed that spinal anesthesia increased from 40.0% in 2013 to 53.7% in 2018. The opposite trend applied to general anesthesia, decreasing from 37.1% in 2013 to 22.2% in 2018. The factors that were significantly associated with the anesthetic method were parturient’s parity, emergency condition, gestational age, and fetal weight. The type of hospital, parturient’s age, and multiple birth were also associated with the anesthetic methods. There was a strong association between general anesthesia and hospital stay longer than 7 days.Conclusions: Spinal anesthesia is currently the main anesthetic method used for cesarean delivery, and the rate of spinal anesthesia is gradually increasing in Korea.

척추 및 경막외마취 전 도포형 국소마취제의 진통효과

김연재,정미화,최영룡,박휴정,원임수,이진영,정진경 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.54 No.4

We evaluated the analgesic efficacy of a 5% eutectic mixture of lidocaine and prilocaine (EMLAⓇ) topically applied before performing skin puncture for spinal or epidural anesthesia. Methods: The patient population consisted of 75 ASA physical status 1 and 2 adults scheduled for operations of the lower abdominal region, the perineal region or the lower extremities. The patients were randomly allocated to one of five groups of equal size: group A - topical application of EMLAⓇ cream 120 min before spinal block; group B - subcutaneous infiltrationof 2 ml of 2% lidocaine immediately before spinal block; group C - no pretreatment before spinal block; group D - topical application of EMLAⓇ cream 120 min before epidural block; and group E - subcutaneous infiltration of 2 ml of 2% lidocaine immediatelybefore epidural block. Pain experienced during the whole procedure was rated using a 10 cm visual analogue scale. Results: Patients in group A experienced less pain compared with those in groups B and C (2.0 ± 1.9 cm vs 4.1 ± 1.9 cm and 3.9 ± 2.2 cm, respectively; P < 0.05). However there was no significant difference between group D and group E (3.6 ± 2.4 cm vs 4.1 ± 2.5 cm). The patients in group A and group D were highly satisfied with the method of analgesia (P < 0.05). Conclusions: EMLAⓇ cream is an effective alternative to subcutaneous infiltration of local anesthetic for analgesia during skin puncture using a 25 G spinal needle. It provides insufficient analgesia however for epidural anesthesia. We evaluated the analgesic efficacy of a 5% eutectic mixture of lidocaine and prilocaine (EMLAⓇ) topically applied before performing skin puncture for spinal or epidural anesthesia. Methods: The patient population consisted of 75 ASA physical status 1 and 2 adults scheduled for operations of the lower abdominal region, the perineal region or the lower extremities. The patients were randomly allocated to one of five groups of equal size: group A - topical application of EMLAⓇ cream 120 min before spinal block; group B - subcutaneous infiltrationof 2 ml of 2% lidocaine immediately before spinal block; group C - no pretreatment before spinal block; group D - topical application of EMLAⓇ cream 120 min before epidural block; and group E - subcutaneous infiltration of 2 ml of 2% lidocaine immediatelybefore epidural block. Pain experienced during the whole procedure was rated using a 10 cm visual analogue scale. Results: Patients in group A experienced less pain compared with those in groups B and C (2.0 ± 1.9 cm vs 4.1 ± 1.9 cm and 3.9 ± 2.2 cm, respectively; P < 0.05). However there was no significant difference between group D and group E (3.6 ± 2.4 cm vs 4.1 ± 2.5 cm). The patients in group A and group D were highly satisfied with the method of analgesia (P < 0.05). Conclusions: EMLAⓇ cream is an effective alternative to subcutaneous infiltration of local anesthetic for analgesia during skin puncture using a 25 G spinal needle. It provides insufficient analgesia however for epidural anesthesia.

척추 마취 시 손가락의 맥파전달시간과 혈압 변화의 비교분석

송봉재,김태균 부산대학교 병원 암연구소 2008 부산대병원학술지 Vol.- No.23

Purpose: During spinal anesthesia, the blood pressure used to decrease abruptly without any notice of physician. Blood pressure and other vital signs should be monitored very carefully to protect the sudden changes of such vital signs. This study was focused on the changes of pulse transit time (PTT) which was known as the surrogate of blood pressure changes. Subject and methods: The study included 10 consecutive urological surgical patients who undergone the spinal anesthesia. Before anesthesia, 500 ml of Hartman's solution was infused intravenously to reduce the vital changes and heavy bupivacaine 12 mg was introduced intrathecally in lateral squatting decubitus position. And then, patients was tum toward the supine position and check the block level of the spinal anesthesia. PTT was recorded and investigated at before and after spinal anesthesia with the investigation of blood pressure changes. Results: Blood pressure was decreased after the spinal anesthesia compared to the preanesthetic values. PTT was decreased soon after the position change from lateral squatting decubitus for spinal anesthesia to supine. PTT of finger was increased as the blood pressure was decreased 6, 8, 10 minutes after spinal anesthesia. Conclusions: Application of PTT monitoring in spinal anesthesia was convenient and beneficial for close monitoring of blood pressure changes as its surrogate marker.

Effect of preoperative warming during cesarean section under spinal anesthesia

정성희,이병상,양현정,권경석,김현혜,송지은,신동욱 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.5

Background: Postoperative hypothermia and shivering is a frequent event in patients during cesarean section under spinal anesthesia. We assessed the effect of preoperative warming during cesarean delivery under spinal anesthesia for prevention of hypothermia and shivering. Methods: Forty five patients undergoing elective cesarean section were randomly assigned to three groups. Group F received warmed intravenous fluid (40oC). Group A patients were actively warmed by forced air-warming. Group C was the control group. Forced air-warming and warmed fluid was maintained for the 15 min preceding spinal anesthesia. Core temperature (tympanic membrane) and the skin temperature of arm and thigh were measured and shivering was graded simultaneously. Results: The core temperature at 45 min decreased less in Groups F and A than Group C (-0.5oC ± 0.3oC vs -0.6oC ± 0.4oC vs -0.9oC ± 0.4oC, respectively; P = 0.004). The arm temperature at 15 min and 30 min exhibited a greater increase in Group A than Group F and Group C (P = 0.001 and P = 0.012, respectively). Leg temperature increased similarly among the three groups. The incidence of shivering was significantly less in Group A and Group F than Group C (20%, 13.3%, and 53.3%, respectively; P = 0.035). Conclusions: Preoperative forced air-warming and warmed fluid prevents hypothermia and shivering in patients undergoing elective cesarean delivery with spinal anesthesia. Background: Postoperative hypothermia and shivering is a frequent event in patients during cesarean section under spinal anesthesia. We assessed the effect of preoperative warming during cesarean delivery under spinal anesthesia for prevention of hypothermia and shivering. Methods: Forty five patients undergoing elective cesarean section were randomly assigned to three groups. Group F received warmed intravenous fluid (40oC). Group A patients were actively warmed by forced air-warming. Group C was the control group. Forced air-warming and warmed fluid was maintained for the 15 min preceding spinal anesthesia. Core temperature (tympanic membrane) and the skin temperature of arm and thigh were measured and shivering was graded simultaneously. Results: The core temperature at 45 min decreased less in Groups F and A than Group C (-0.5oC ± 0.3oC vs -0.6oC ± 0.4oC vs -0.9oC ± 0.4oC, respectively; P = 0.004). The arm temperature at 15 min and 30 min exhibited a greater increase in Group A than Group F and Group C (P = 0.001 and P = 0.012, respectively). Leg temperature increased similarly among the three groups. The incidence of shivering was significantly less in Group A and Group F than Group C (20%, 13.3%, and 53.3%, respectively; P = 0.035). Conclusions: Preoperative forced air-warming and warmed fluid prevents hypothermia and shivering in patients undergoing elective cesarean delivery with spinal anesthesia.

The correlation of cerebrospinal fluid pressure according to the degree of flexion and spinal block level in spinal anesthesia for Cesarean section

한진희,김동옥,이봉재,이재우,권무일,성준경,서대영 대한마취통증의학회 2013 Anesthesia and pain medicine Vol.8 No.2

Background: The use of neuraxial anesthesia for Cesarean section has dramatically increased. There was little information about the relationship of cerebrospinal fluid (CSF) pressure according to the position and spinal block level in pregnant women. The aims of this study are to investigate the cerebrospinal fluid pressure according to the degree of flexion in the lateral position and block height after spinal anesthesia in pregnant women undergoing Cesarean section. Methods: We enrolled 40 patients, American Society of Anesthesiologists physical status I–II, aged 22−40 years, undergoing Caesarean section under spinal anesthesia. Patients were randomly divided into two groups. In group I, patients were placed in a full flexed position, and 10 mg of 0.5% hyperbaric bupivacaine was injected. In group II, the same dose of bupivacaine was injected when the hip and neck was straightened slowly. Following injection,the patients were immediately placed in supine position. The level of spinal anesthesia was checked by pinprick at 5, 10, 15, and 30min after the subarachnoid injection. Results: There was significant difference in the cerebrospinal fluid pressure between full-flexed position and non-full-flexed position. The spinal block height level was T3−T5 in both groups, and there was no significant difference in the spinal block height level in both groups. Conclusions: CSF pressures according to the degree of flexion in the lateral position during the subarachnoid injection have no significant correlation with the block level in spinal anesthesia for Cesarean section.

척추마취 하 제왕절개술시 저혈압 예방을 위한 하지압박붕대법의 효과

이재우,강효석,백승권,최주연 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.2

Background: Hypotension is the most frequent complication associated with spinal anesthesia during cesarean section. Prehydration and/or vasopressor therapy is commonly used for prevention of hypotension in cesarean deliveries. Wrapping of the legs is simple to perform before surgery and was reported be effective for the prevention of post spinal hypotension in a few obstetric units. So we investigated whether wrapping of the legs prevents post spinal hypotension during cesarean section. Methods: 45 patients were randomly allocated to one of 3 groups (15 in each group): prehydration with 10 ml/kg (group I), prehydration with 10 ml/kg and wrapping of the legs (group II), prehydration with 5 ml/kg and wrapping of the legs (group III). Hypotension was defined as a 20% decrease from initial systolic arterial pressure (SAP) or SAP lower than 90 mmHg and was treated with intravenous ephedrine (4 mg, repeated). Blood pressure was recorded before spinal anesthesia and every min for 10 min and then every 2 min for another 10 min after spinal anesthesia. Results: Group I showed a significant decrease in SAP compared to group II and group III 1min after spinal anesthesia, but after that,there was no significant difference between the three groups. Group II showed a significant difference in incidence of severe hypotension after spinal anesthesia compared with group I, but there was no difference of the incidence of hypotension between the three groups. Conclusions: Wrapping of the legs for prevention of post spinal hypotension during elective cesarean section reduces the severity of hypotension. (Anesth Pain Med 2011; 6: 173∼177)

제왕절개술에서 수술 전 심박수 증가와 척추 마취 후 혈압 저하의 연관성

이해광,황정원,김준식,민경범,송인애,유정희,전영태,도상환 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.1

Background: Hypotension is a very common side effect of spinal anesthesia for cesarean delivery. If we can predict the degree of blood pressure decrease after spinal anesthesia, hypotension will be treated better. Tachycardia may reflect the effective circulatory volume deficit. We studied if preoperative heart rate can predict the degree of hypotension after spinal anesthesia. Methods: Fifty-two parturients for elective cesarean delivery were enrolled and the gestation periods of all parturient were over 37weeks. In the supine position, noninvasive blood pressure (BP)and heart rate (HR) were measured as baseline values. After change to the right decubitus position, spinal anesthesia was done. Hyperbaric bupivacaine 8 mg and fentanyl 15 μg were injected intrathecally through 26G spinal needle. After return to the wedged supine position, BP and HR were measured every minute until anesthetic level was fixed. If mean BP decreased below 70% value of baseline, ephedrine 5 mg was injected intravenously. The lowest mean BP, hypotension (<80% of baseline) and total ephedrine requirement were recorded. Retrospective analysis was done after grouping by baseline heart rate (below 80 vs. over 80 beats/min). Results: The patients who had more rapid heart rate before anesthesia, tended to have more decrease of mean BP during spinal anesthesia (P < 0.001, R = 0.45). In retrospective group analysis, the incidence of hypotension was lower in low HR group (46% vs. 83%, P = 0.014). Conclusions: If preoperative heart rate is over 80 beats/min, careful management is required to prevent hypotension during spinal anesthesia for cesarean delivery.