척추마취 거부 사유에 대한 분석

최준권,인준용,신홍일 대한마취통증의학회 2009 Korean Journal of Anesthesiology Vol.56 No.2

Background: Spinal anesthesia is a anesthetic technique that can be easily used and practically applied according to patient's preference and physiologic status, surgical procedures and so forth. The purpose of the present study is to analyze factors related to patient refusal of spinal anesthesia, arising from the previous spinal anesthesia experience associated with side effects or unsatisfactory senses after spinal anesthesia. Methods: One hundred ninety four patients undergoing various surgical procedures under spinal anesthesia were enrolled. We made a questionnaire that consisted of examination items and question items, and checked it during spinal anesthesia and about 24 hours after spinal anesthesia. Factors related to patient refusal of spinal anesthesia were analyzed with multiple logistic regression. Results: Thirty one out of 194 patients (16%) rejected to receive spinal anesthesia if they would have chance to have it again. Significant factors associated with refusal of spinal anesthesia were low back pain (P = 0.005), needle type (Quincke) (P = 0.025) and tingling sensation in the lower extremities immediately after spinal anesthesia induction (P=0.003). Low back pain was significantly associated with the number of attempts of spinal block (P = 0.023). Conclusions: Factors related to patient refusal of spinal anesthesia are low back pain, needle type and tingling sensation. Low back pain is related to the number of attempts of spinal block. Practitioners should give patients appropriate information about spinal anesthesia preoperatively and consider using Whitacre needle and avoid multiple attempts of spinal block so as to increase patient's compliance with spinal anesthesia. Background: Spinal anesthesia is a anesthetic technique that can be easily used and practically applied according to patient's preference and physiologic status, surgical procedures and so forth. The purpose of the present study is to analyze factors related to patient refusal of spinal anesthesia, arising from the previous spinal anesthesia experience associated with side effects or unsatisfactory senses after spinal anesthesia. Methods: One hundred ninety four patients undergoing various surgical procedures under spinal anesthesia were enrolled. We made a questionnaire that consisted of examination items and question items, and checked it during spinal anesthesia and about 24 hours after spinal anesthesia. Factors related to patient refusal of spinal anesthesia were analyzed with multiple logistic regression. Results: Thirty one out of 194 patients (16%) rejected to receive spinal anesthesia if they would have chance to have it again. Significant factors associated with refusal of spinal anesthesia were low back pain (P = 0.005), needle type (Quincke) (P = 0.025) and tingling sensation in the lower extremities immediately after spinal anesthesia induction (P=0.003). Low back pain was significantly associated with the number of attempts of spinal block (P = 0.023). Conclusions: Factors related to patient refusal of spinal anesthesia are low back pain, needle type and tingling sensation. Low back pain is related to the number of attempts of spinal block. Practitioners should give patients appropriate information about spinal anesthesia preoperatively and consider using Whitacre needle and avoid multiple attempts of spinal block so as to increase patient's compliance with spinal anesthesia.

Factors in patient dissatisfaction and refusal regarding spinal anesthesia

이원지,정찬종,임윤희,이규한,이승철 대한마취통증의학회 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.

양측 슬관절 전치환술시 척추경막외병용마취가 스트레스 반응에 미치는 영향

천은희,김종학,백희정,김윤진 대한마취통증의학회 2009 Korean Journal of Anesthesiology Vol.57 No.3

Background: Intraoperative stress may evoke various changes in hormonal secretion and autonomic nervous system activity. We designed this study to investigate the effect of combined spinal-epidural anesthesia on stress hormone responses. Methods: Thirty women more than 60 years of age, undergoing bilateral total knee replacement surgery were studied. Patients were randomized to receive either general anesthesia (group I), or combined spinal-epidural anesthesia (group Ⅱ). Blood samples were obtained immediately before anesthesia induction, immediately after skin incision, after first knee prosthesis insertion, and end of operation, immediately for measurement of cortisol, epinephrine, and norepinephrine. Results: The plasma concentration of cortisol, epinephrine and norepinephrine were significantly lower in group Ⅱ after the prosthesis insertion and at the end of operation, immediately. The plasma concentration of cortisol was significantly higher than basal values in both of two groups through the surgery. Conclusions: Combined spinal-epidural anesthesia has the blocking effect of releasing catecholamine during total knee replacement surgery and immediately after the surgery. The effect of combined spinal-epidural anesthesia on stress responses during total knee replacement is better than that of general anesthesia. Background: Intraoperative stress may evoke various changes in hormonal secretion and autonomic nervous system activity. We designed this study to investigate the effect of combined spinal-epidural anesthesia on stress hormone responses. Methods: Thirty women more than 60 years of age, undergoing bilateral total knee replacement surgery were studied. Patients were randomized to receive either general anesthesia (group I), or combined spinal-epidural anesthesia (group Ⅱ). Blood samples were obtained immediately before anesthesia induction, immediately after skin incision, after first knee prosthesis insertion, and end of operation, immediately for measurement of cortisol, epinephrine, and norepinephrine. Results: The plasma concentration of cortisol, epinephrine and norepinephrine were significantly lower in group Ⅱ after the prosthesis insertion and at the end of operation, immediately. The plasma concentration of cortisol was significantly higher than basal values in both of two groups through the surgery. Conclusions: Combined spinal-epidural anesthesia has the blocking effect of releasing catecholamine during total knee replacement surgery and immediately after the surgery. The effect of combined spinal-epidural anesthesia on stress responses during total knee replacement is better than that of general anesthesia.

혈전색전억제 스타킹의 척추마취 후 저혈압에 미치는 효과

김운성,백승완,김혜진,윤지영,이현정,김태균 대한마취통증의학회 2009 Korean Journal of Anesthesiology Vol.56 No.6

Background: Hypotension during spinal anesthesia is mainly result of sympathetic blockade, which causes pooling of blood into the lower extremities. Mechanical compression of lower limbs prevents venous pooling of blood. Thromboembolic deterrent (TED) stockings are in general surgical use for prophylaxis against lower limb deep vein thrombosis and TED stockings also supply pressure to lower limb. So we investigated the effect of TED stockings to prevent hypotension during spinal anesthesia. Methods: Sixty patients were randomized to receive fluid loading (crystalloid, 10 ml/kg) or TED stockings. After spinal anesthesia (heavy bupivacaine 14 mg), patients were placed in supine position for 12 minutes and in lithotomy position for 18 minutes. Blood pressure, pulse rates, shivering, and nausea were checked every 3 minutes for 30 minutes. If the systolic blood pressure was less than 90 mmHg or mean blood pressure was less than 80% of baseline mean blood pressure then i.v. ephedrine 5 mg was administered. Results: There was no statistically significant difference in baseline characteristics and blocked sensory level between the two groups. There was no statistically significant difference in the incidence of hypotension and mean arterial blood pressure at each time. Conclusions: We conclude that, under the conditions of this study, TED stockings decrease the pooling of blood into the lower limbs and prevent hypotension after spinal anesthesia. Although TED stockings prevent hypotension after spinal anesthesia, it does not reduce the incidence of hypotension. Background: Hypotension during spinal anesthesia is mainly result of sympathetic blockade, which causes pooling of blood into the lower extremities. Mechanical compression of lower limbs prevents venous pooling of blood. Thromboembolic deterrent (TED) stockings are in general surgical use for prophylaxis against lower limb deep vein thrombosis and TED stockings also supply pressure to lower limb. So we investigated the effect of TED stockings to prevent hypotension during spinal anesthesia. Methods: Sixty patients were randomized to receive fluid loading (crystalloid, 10 ml/kg) or TED stockings. After spinal anesthesia (heavy bupivacaine 14 mg), patients were placed in supine position for 12 minutes and in lithotomy position for 18 minutes. Blood pressure, pulse rates, shivering, and nausea were checked every 3 minutes for 30 minutes. If the systolic blood pressure was less than 90 mmHg or mean blood pressure was less than 80% of baseline mean blood pressure then i.v. ephedrine 5 mg was administered. Results: There was no statistically significant difference in baseline characteristics and blocked sensory level between the two groups. There was no statistically significant difference in the incidence of hypotension and mean arterial blood pressure at each time. Conclusions: We conclude that, under the conditions of this study, TED stockings decrease the pooling of blood into the lower limbs and prevent hypotension after spinal anesthesia. Although TED stockings prevent hypotension after spinal anesthesia, it does not reduce the incidence of hypotension.

척추마취 시 맥박 산소포화도의 변화

양경아,정락경,김동연,배민증 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.55 No.6

Background: Pulse oximetry provides valuable data on the arterial oxygen saturation. Significant impairment in the arterial oxygen saturation can occur under vasoconstriction, hypothermia, and hypotension. This study compared the percutaneous oxygen saturation (SpO2) at the hand and the foot with the arterial oxygen saturation (SaO2) during spinal anesthesia. Methods: Twenty eight, ASA physical status 1 or 2, patients received a spinal block with 0.5% hyperbaric bupivacaine. Two pulse oximeter probes were applied to the index finger and second toe of the patients, and the SpO2 values were recorded before, 10, 20, and 30 minutes after the intrathecal injection. The SaO2 was measured before and 30 minutes after the intrathecal injection. Results: During spinal anesthesia, there were similar changes in the SpO2 value from the hand. However, there was a progressive decrease in SpO2 of the foot of 97.6 ± 2.8%, 97.3 ± 2.8%, and 97.2 ± 3.3% at 10, 20, and 30 minutes, respectively (P < 0.05 compared with the baseline). There were significant differences between the hand and foot SpO2 in 20 and 30 minutes (0.79 ± 1.55%, 0.93 ± 1.86%) after the intrathecal injection. The SaO2 value was similar before and 30 minutes after the intrathecal injection. Before spinal anesthesia, there were significant differences between the SaO2 (96.4 ± 2.6%) and SpO2 values of the hand (98.1 ± 2.6%) and the foot (98.3 ± 2.6%). Conclusions: During spinal anesthesia, it is appropriate to measure the SpO2 from the hand because it dose not change significantly. Background: Pulse oximetry provides valuable data on the arterial oxygen saturation. Significant impairment in the arterial oxygen saturation can occur under vasoconstriction, hypothermia, and hypotension. This study compared the percutaneous oxygen saturation (SpO2) at the hand and the foot with the arterial oxygen saturation (SaO2) during spinal anesthesia. Methods: Twenty eight, ASA physical status 1 or 2, patients received a spinal block with 0.5% hyperbaric bupivacaine. Two pulse oximeter probes were applied to the index finger and second toe of the patients, and the SpO2 values were recorded before, 10, 20, and 30 minutes after the intrathecal injection. The SaO2 was measured before and 30 minutes after the intrathecal injection. Results: During spinal anesthesia, there were similar changes in the SpO2 value from the hand. However, there was a progressive decrease in SpO2 of the foot of 97.6 ± 2.8%, 97.3 ± 2.8%, and 97.2 ± 3.3% at 10, 20, and 30 minutes, respectively (P < 0.05 compared with the baseline). There were significant differences between the hand and foot SpO2 in 20 and 30 minutes (0.79 ± 1.55%, 0.93 ± 1.86%) after the intrathecal injection. The SaO2 value was similar before and 30 minutes after the intrathecal injection. Before spinal anesthesia, there were significant differences between the SaO2 (96.4 ± 2.6%) and SpO2 values of the hand (98.1 ± 2.6%) and the foot (98.3 ± 2.6%). Conclusions: During spinal anesthesia, it is appropriate to measure the SpO2 from the hand because it dose not change significantly.

Effect of ramosetron on shivering during spinal anesthesia

김민수,김동원,우승훈,연준흠,이상석 대한마취통증의학회 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 (37o) 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 120minutes 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.

척추마취 중 진정을 위한 Propofol 주입 시 진정점수와 EEG-entropy의 상관관계

이원상,송현철,변종순 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.55 No.4

Background: For the patients undergoing propofol sedation under regional anesthesia, continuous monitoring of the hypnotic level is required for adequate sedation and rapid recovery. We evaluated the correlation between the observer’s assessment of alertness/sedation (OAA/S) and the EEG-entropy. Methods: We studied 40 patients who were scheduled for spinal anesthesia. Premedication with intramuscular midazolam 0.04 mg/kg was carried out 30 minutes before spinal anesthesia. When the anesthesia level was adequate for surgery but lower than T6, an infusion of propofol 10 mg/kg/h was started and this was decreased to 5 mg/kg/h after 1 minute. We measured the response entropy (RE), the state entropy (SE) and the OAA/S score. When the OAA/S score fell to 1, the infusion dose was decreased to half. After this, the infusion dose was decreased or increased to half or twice, respectively, to keep the OAA/S score at 2 or 3. Results: The OAA/S was well correlated with the RE (Spearman’s rho = 0.913) and also the SE (Spearman’s rho = 0.915). With the increasing depth of sedation, there was a progressive decrease in the RE and SE (the OAA/S score/the mean of the RE/the mean of the SE = 5/98/89, 4/92/85, 3/85/78, 2/78/70, 1/66/59). Conclusions: EEG-entropy provided good information for monitoring the hypnotic level for the patients undergoing propofol sedation under spinal anesthesia. Background: For the patients undergoing propofol sedation under regional anesthesia, continuous monitoring of the hypnotic level is required for adequate sedation and rapid recovery. We evaluated the correlation between the observer’s assessment of alertness/sedation (OAA/S) and the EEG-entropy. Methods: We studied 40 patients who were scheduled for spinal anesthesia. Premedication with intramuscular midazolam 0.04 mg/kg was carried out 30 minutes before spinal anesthesia. When the anesthesia level was adequate for surgery but lower than T6, an infusion of propofol 10 mg/kg/h was started and this was decreased to 5 mg/kg/h after 1 minute. We measured the response entropy (RE), the state entropy (SE) and the OAA/S score. When the OAA/S score fell to 1, the infusion dose was decreased to half. After this, the infusion dose was decreased or increased to half or twice, respectively, to keep the OAA/S score at 2 or 3. Results: The OAA/S was well correlated with the RE (Spearman’s rho = 0.913) and also the SE (Spearman’s rho = 0.915). With the increasing depth of sedation, there was a progressive decrease in the RE and SE (the OAA/S score/the mean of the RE/the mean of the SE = 5/98/89, 4/92/85, 3/85/78, 2/78/70, 1/66/59). Conclusions: EEG-entropy provided good information for monitoring the hypnotic level for the patients undergoing propofol sedation under spinal anesthesia.

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.

비뇨기과 수술을 받는 노인 환자의 척추마취 시 첨가된 Fentanyl의 용량에 따른 임상효과의 비교

김정은,문영은,홍상현,전준표,장혜원,김수진,고현정,유건희 대한마취통증의학회 2008 Korean Journal of Anesthesiology Vol.55 No.5

Background: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10μg and 20μg when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. Methods: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10μg; and group 3, bupivacanie 5 mg + fentanyl 20μg. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3−4 or L4−5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. Results: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). Conclusions: The addition of fentanyl 10μg and 20μg to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10μg is recommended as outpatient anesthesia. Background: Spinal anesthesia for urologic surgery in elderly patients is preferred. The addition of opioids to local anesthetics reduces the side effects of spinal anesthesia. This study examined the effects of intrathecal fentanyl 10μg and 20μg when administered with hyperbaric 0.5% bupivacaine to elderly patients undergoing urologic surgery. Methods: Forty-five elderly patients undergoing urologic surgery were randomized into the following three groups: group 1, bupivacaine 7.5 mg; group 2, bupivacaine 5 mg + fentanyl 10μg; and group 3, bupivacanie 5 mg + fentanyl 20μg. The total volume of intrathecally injected was adjusted to 1.5 ml with sterile normal saline. Spinal anesthesia was administered with a 25 G Quincke needle at the L3−4 or L4−5 interspace in the lateral position. The neural block was assessed using a pinprick test and the Bromage scale. Results: There were no significant differences in the onset time of the T10 sensory block, peak level of the sensory block, and onset time of the peak level. The duration of the sensory block was significantly shorter in group 2 than in group 1 (P = 0.017). The duration of the motor block was longer in group 1 than in groups 2 and 3 (P = 0.016, P = 0.04). Pruritus was observed more often in group 3 (37.5%) and shivering was more common in group 1 (P = 0.005). Conclusions: The addition of fentanyl 10μg and 20μg to bupivacaine 5 mg provides adequate anesthesia for elderly patients undergoing urologic surgery with fewer side effects, and fentanyl 10μg is recommended as outpatient anesthesia.