Cerebral hemorrhage presenting as alteration of consciousness during the anesthesia recovery period -A case report-

민두재,김운영,이세화,이윤숙,김재환,박영철 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.3

Catastrophic neurological events can occur rarely in anesthetic recovery period and they must be quickly diagnosed. We report here on a spontaneous intracerebral hemorrhage (SICH) that developed during the anesthesia recovery period in a 52-year-old man who had undergone uneventful orthopedic surgery. He had predisposing factors including 25 year history of heavy alcohol consumption and smoking. The risk of spontaneous intracerebral hemorrhage following non-cardiovascular and non-neurovascular surgery is exceedingly small during the anesthesia recovery period,especially for a patient with no history of hypertension and coagulopathy. We also describe the differential diagnosis of an altered mental status that occurs during anesthetic recovery period. (Anesth Pain Med 2011; 6: 266∼269)

Sufentanil infusion before extubation suppresses coughing on emergence without delaying extubation time and reduces postoperative analgesic requirement without increasing nausea and vomiting after desflurane anesthesia

이재연,임병건,박혜윤,김난숙 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.62 No.6

Background: Coughing, hypertension, tachycardia, and even laryngospasm can occur due to airway irritation during emergence from anesthesia. We investigated the effect of maintaining a sufentanil infusion during emergence from anesthesia by evaluating the incidence of cough and recovery profiles at extubation. Methods: In total, eighty-four patients undergoing an elective laparoscopic hysterectomy were randomly divided into two sufentanil groups and a control group. During emergence, sufentanil was administered in the sufentanil groups at a rate of 0.2 μg/kg/hr (Group S1) or 0.3 μg/kg/hr (Group S2), and saline was administered to the control group. Cough score, hemodynamic changes, and recovery profiles, such as duration from skin closure to a bispectral index of 80, to eye opening at verbal command, to tracheal extubation and the total duration of study solution infusion, were recorded. The pain score, the total volume of administered patient-controlled analgesia (PCA), and the postoperative nausea and vomiting (PONV) score were evaluated 1, 6, and 24 hours after surgery. Results: Groups S1 and S2 showed significantly lower cough scores and smaller hemodynamic changes on extubation compared to Group C. Recovery profiles showed no significant differences among the three groups. Pain score, PONV at 1 hour postoperatively, and the total volume of PCA administered at all evaluation times were significantly lower in Groups S1 and S2 than in the control group. However, pain score, and PONV at 6 hours and 24 hours postoperatively showed no significant differences. Conclusions: A sufentanil infusion (0.2-0.3 μg/kg/hr) during emergence from desflurane anesthesia may suppress coughing on extubation in patients with body mass indexes (BMI) of 21-26 without delaying extubation time. It may also reduce the postoperative analgesic requirement without increasing PONV. Background: Coughing, hypertension, tachycardia, and even laryngospasm can occur due to airway irritation during emergence from anesthesia. We investigated the effect of maintaining a sufentanil infusion during emergence from anesthesia by evaluating the incidence of cough and recovery profiles at extubation. Methods: In total, eighty-four patients undergoing an elective laparoscopic hysterectomy were randomly divided into two sufentanil groups and a control group. During emergence, sufentanil was administered in the sufentanil groups at a rate of 0.2 μg/kg/hr (Group S1) or 0.3 μg/kg/hr (Group S2), and saline was administered to the control group. Cough score, hemodynamic changes, and recovery profiles, such as duration from skin closure to a bispectral index of 80, to eye opening at verbal command, to tracheal extubation and the total duration of study solution infusion, were recorded. The pain score, the total volume of administered patient-controlled analgesia (PCA), and the postoperative nausea and vomiting (PONV) score were evaluated 1, 6, and 24 hours after surgery. Results: Groups S1 and S2 showed significantly lower cough scores and smaller hemodynamic changes on extubation compared to Group C. Recovery profiles showed no significant differences among the three groups. Pain score, PONV at 1 hour postoperatively, and the total volume of PCA administered at all evaluation times were significantly lower in Groups S1 and S2 than in the control group. However, pain score, and PONV at 6 hours and 24 hours postoperatively showed no significant differences. Conclusions: A sufentanil infusion (0.2-0.3 μg/kg/hr) during emergence from desflurane anesthesia may suppress coughing on extubation in patients with body mass indexes (BMI) of 21-26 without delaying extubation time. It may also reduce the postoperative analgesic requirement without increasing PONV.

Risk factors of emergence agitation after general anesthesia in adult patients

임종철,김정아,홍정인,박상융,이종환,정찬종 대한마취통증의학회 2016 Anesthesia and pain medicine Vol.11 No.4

Background: Emergence agitation (EA) is one of the most common complications after general anesthesia. The goal of this retrospective study was to determine the risk factors of EA in adult patients who underwent general anesthesia. Methods: We retrospectively investigated the medical records of 5,358 adult patients who stayed in the postanesthesia care unit (PACU) of our hospital after general anesthesia during the 1-year period from January 2014 to December 2014. Psychological and behavioral status in the PACU was determined by the Aono four-point scale. Grade of 3 or 4 were considered as manifestations of EA. Multiple variables assessed EA risk factors. Results: Two-hundred-forty-five patients (4.6%) developed EA. In multivariate analysis, male gender (OR = 1.626, P = 0.001), older age (OR = 1.010, P = 0.035), abdominal surgery (OR = 1.633, P = 0.002), spine surgery (OR = 1.777, P = 0.015), longer duration of anesthesia (OR = 1.002, P < 0.001), postoperative nausea and vomiting (OR = 20.164, P < 0.001) and postoperative pain (OR = 3.614, P < 0.001) were risk factors of EA. Conclusions: Male gender and older patients were risk factors of EA after general anesthesia in adult patients. Careful attention is needed for patients who receive abdominal or spine surgery, and who receive prolonged anesthesia. Adequate postoperative analgesia and antiemetic therapy should be provided to reduce the incidence of EA.

임상연구 : 소아에서 Propofol-Remifentanil과 Sevoflurane-Nitrous Oxide를 사용한 전신 마취 시 회복기의 비교 연구

김종후 ( Jong Hu Kim ),이영철 ( Young Chul Lee ),이종남 ( Jong Nam Lee ),박영철 ( Young Chul Park ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.6

Background: Remifentanil and sevoflurane are characterized by rapid emergence from anesthesia. Therefore, propofol-remifentanil anesthesia (PR) and sevoflurane-nitrous oxide anesthesia (SN) were compared with regard to the recovery characteristics in children. Methods: Sixty children scheduled for tonsillectomy were randomly assigned to receive PR (n = 30) or SN (n = 30). The PR group was induced by remifentanil, propofol and vecuronium, maintained with infusion of remifentanil and propofol. The SN group was induced by sevoflurane, nitrous oxide, vecuronium maintained with sevoflurane in 50% nitrous oxide. At the end of operation, all anesthetics were discontinued and 100% oxygen was inspirated in both groups. The times to spontaneous breathing, extubation, eye opening, PACU discharge were assessed and postoperative nausea/vomiting, agitation were noted. Results: Spontaneous breathing occurred after 9.29 ± 1.02 minutes (PR) versus 6.85 ± 0.60 minutes (SN) (P < 0.05), extubation after 9.19 ± 0.91 minutes versus 8.87 ± 0.67 minutes, eye opening after 9.47 ± 1.01 minutes versus 14.85 ± 0.80 minutes (P < 0.05) and PACU discharge after 21.32 ± 2.01 minutes versus 27.55 ± 1.72 minutes (P < 0.05). The occurrence of postoperative nausea/vomiting was 7% (PR) versus 13% (SN), and the incidence of agitation was 60% (PR) versus 83% (SN). Conclusions: It was observed that the recovery of propofol-remifentanil anesthesia was faster than that of sevoflurane-nitrous oxide anesthesia, except spontaneous breathing. The incidences of postoperative nausea/vomiting were low in both groups, and the incidences of agitation were higher in SN group than in PR group. (Korean J Anesthesiol 2006; 51: 709~14)

Randomized controlled trial of the effect of general anesthetics on postoperative recovery after minimally invasive nephrectomy

Yoon Hyun-Kyu,Joo Somin,Yoon Susie,Seo Jeong-Hwa,Kim Won Ho,Lee Ho-Jin 대한마취통증의학회 2024 Korean Journal of Anesthesiology Vol.77 No.1

Background: General anesthetic techniques can affect postoperative recovery. We compared the effect of propofol-based total intravenous anesthesia (TIVA) and desflurane anesthesia on postoperative recovery.Methods: In this randomized trial, 150 patients undergoing robot-assisted or laparoscopic nephrectomy for renal cancer were randomly allocated to either the TIVA or desflurane anesthesia (DES) group. Postoperative recovery was evaluated using the Korean version of the Quality of Recovery-15 questionnaire (QoR-15K) at 24 h, 48 h, and 72 h postoperatively. A generalized estimating equation (GEE) was performed to analyze longitudinal QoR-15K data. Fentanyl consumption, pain severity, postoperative nausea and vomiting, and quality of life three weeks after discharge were also compared.Results: Data were analyzed for 70 patients in each group. The TIVA group showed significantly higher QoR-15K scores at 24 and 48 h postoperatively (24 h: DES, 96 [77, 109] vs. TIVA, 104 [82, 117], median difference 8 [95% CI: 1, 15], P = 0.029; 48 h: 110 [95, 128] vs. 125 [109, 130], median difference 8 [95% CI: 1, 15], P = 0.022), however not at 72 h (P = 0.400). The GEE revealed significant effects of group (adjusted mean difference 6.2, 95% CI: 0.39, 12.1, P = 0.037) and time (P < 0.001) on postoperative QoR-15K scores without group-time interaction (P = 0.051). However, there were no significant differences in other outcomes, except for fentanyl consumption, within the first 24 h postoperatively.Conclusions: Propofol-based TIVA showed only a transient improvement in postoperative recovery than desflurane anesthesia, without significant differences in other outcomes.

Comparison of Dexmedetomidine and Remifentanil on Airway Reflex and Hemodynamic Changes during Recovery after Craniotomy

최승호,김현주,민경태,이정림,하상희,이우경,서재희 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.4

Purpose: During emergence from anesthesia for a craniotomy, maintenance of hemodynamic stability and prompt evaluation of neurological status is mandatory. The aim of this prospective, randomized, double-blind study was to compare the effects of dexmedetomidineand remifentanil on airway reflex and hemodynamic change in patients undergoing craniotomy. Materials and Methods: Seventy-four patients undergoing clipping of unruptured cerebral aneurysm were recruited. In the dexmedetomidinegroup, patients were administered dexmedetomidine (0.5 μg/kg) for 5 minutes, while the patients of the remifentanilgroup were administered remifentanil with an effect site concentration of 1.5 ng/mL until endotracheal extubation. The incidenceand severity of cough and hemodynamic variables were measured during the recovery period. Hemodynamic variables, respiration rate, and sedation scale were measured after extubation and in the post-anesthetic care unit (PACU). Results: The incidence of grade 2 and 3 cough at the point of extubation was 62.5% in the dexmedetomidine group and 53.1% in the remifentanil group (p=0.39). Mean arterial pressure (p=0.01) at admission to the PACU and heart rate (p=0.04 and 0.01, respectively)at admission and at 10 minutes in the PACU were significantly lower in the dexmedetomidine group. Respiration rate was significantly lower in the remifentanil group at 2 minutes (p<0.01) and 5 minutes (p<0.01) after extubation. Conclusion: We concluded that a single bolus of dexmedetomidine (0.5 μg/kg) and remifentanil infusion have equal effectivenessin attenuating coughing and hemodynamic changes in patients undergoing cerebral aneurysm clipping; however, dexmedetomidineleads to better preservation of respiration.

Comparison of Emergence Time in Children Undergoing Minor Surgery According to Anesthetic: Desflurane and Sevoflurane

김정민,이재훈,이혜진,구본녀 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.3

Purpose: In earlier analyses, desflurane has been shown to reduce average extubation time and the variability of extubation time by 20% to 25% relative to sevoflurane in adult patients. We undertook this study to determine which agents prompt less recovery time in pediatric patients undergoing minor surgery. Materials and Methods: After obtaining Institutional Review Board approval, we retrospectively reviewed the anesthesia records of 499 patients, with an average age of 5 years, who underwent minor surgeries at Severance Eye and Ear, Nose and Throat Hospital between May 2010 and April 2011. Anesthesia was induced with propofol and rocuronium. Anesthesia was maintained with sevoflurane (n=340) or desflurane (n=159) with 50% air/O2. Time from cessation of anesthetics to recovery of self-respiration, eye opening on verbal command and extubation were compared between the two groups. Additionally,the incidences of postoperative respiratory adverse events were also compared. Results: Times to self-respiration recovery, eye opening on verbal command, and extubation were significantly faster in the desflurane group than the sevoflurane group (4.6±2.5 min vs. 6.9±3.8 min, 6.6±3.0 min vs. 9.2±3.6 min, and 6.2±2.7 min vs. 9.3±3.7 min, respectively, p<0.005). There were no statistically significant differences between the two groups with respect to adverse respiratory events during the peri-operative period (38.2% vs. 34.6%, p=0.468). Conclusion: Emergence and recovery from anesthesia were significantly faster in the desflurane group of children undergoing minor surgery. Desflurane did not result in any differences in respiratory adverse events during recovery compared to sevoflurane.

Effects of Dexmedetomidine Infusion on the Recovery Profiles of Patients Undergoing Transurethral Resection

권소영,주진덕,전가영,오현석,인장혁 대한의학회 2016 Journal of Korean medical science Vol.31 No.1

Transurethral resection has been the gold standard in the operative management of benign prostatic hyperplasia and bladder tumor; however, it is associated with several complications that may cause patient discomfort. We evaluated the usefulness of continuous infusion of dexmedetomidine on emergence agitation, hemodynamic status, and recovery profiles in patients undergoing elective surgery by a randomized clinical trial. Sixty patients aged 30 to 80 yr who were scheduled for elective transurethral resection under general anesthesia were included in this study. Participants were randomly assigned to two groups (control group, group C; dexmedetomidine group, group D). A total of 60 male patients were enrolled in this study and randomly assigned to group C (n = 30) or group D (n = 30). The quality of emergence in group D was marked by a significantly lower incidence of emergence agitation than in group C (P = 0.015). Patients in group D therefore felt less discomfort induced by the indwelling Foley catheter than those in group C (P = 0.022). No statistically significant differences were found between the two groups with respect to side effects including bradycardia (P = 0.085), hypotension (P = 0.640), and postoperative nausea and vomiting (P = 0.389). Our study showed that intraoperative dexmedetomidine infusion effectively reduced the incidence and intensity of emergence agitation and catheter-induced bladder discomfort without delaying recovery time and discharge time, thus providing smooth emergence during the recovery period in patients undergoing transurethral resection (Clinical Trial Registry No. KT0001683).

복강경하 담낭절제술 환자에서 bispectral index 감시하의 propofol-remifentanil 마취와 desflurane-remifentanil 마취의 회복양상 비교

김영신,이우경,최영순,채영근,안소운,이애리나,윤종원,이용경 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.4

Background: The aim of this prospective, double-blind randomized study was to compare the recovery characteristics of desflurane-remifentanil and propofol-remifentanil anesthesia in patients undergoing a laparoscopic cholecystectomy under BIS monitoring. Methods: Eight patients (ASA I−II, 20−65 yr) undergoing laparoscopic cholecystectomy were randomly assigned to receive propofol-remifentanil anaesthesia or desflurane-remifentanil. The BIS was monitored and maintained between 45−55. At the end of surgery all anesthetics were discontinued. Time to eye opening and time to extubation was recorded. Subsequently, the patients were transported to the post-anesthetic care unit (PACU) and the modified aldrete score, visual analogue scale (VAS), blood pressure,heart rate, and postoperative nausea and vomiting (PONV) were recorded upon arrival at the PACU, as well as at 15 min, 30 min,1 hr, 2 hr, and 24 hr. Results: There were no significant differences in the incidence of PONV between the two groups. Modified aldrete scores were significantly higher in the propofol group at 15 min postoperative period (P = 0.013, Propofol = 9.87, Desflurane = 9.62). Further,VAS scores were significantly higher in the desflurane group at 30min (P = 0.037, Propofol = 4.26, Desflurane = 5.0), and the number of antiemetic injections were significantly higher in the desflurane group at arrival to the PACU (P = 0.035, Propofol = 0, Desflurane = 0.11 ± 0.052) and at 24 hr (P = 0.03, Propofol = 0.41 ± 0.562,Desfluarane = 0.62 ± 0.157). Conclusions: In patients undergoing laparoscopic cholecystectomy with BIS monitoring, there is no significant differences in the incidence of PONV. The use of propofol is associated with less postoperative pain.

전신마취 후 Transient Global Amnesia (TGA)의 경험 - 증례 보고 -

임수진 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.1

Transient global amnesia is characterized by a sudden memory loss of recent and/or remote events and transient inability to acquire new knowledge. Although mostly followed by complete recovery within a day, this rare and unexpected event in recovery phase after general anesthesia should be embarrassing and confusing, so we must proceed with prompt differential diagnosis for other organic intracranial pathology including transient ischemic attack and go on close observation. We describe a case of transient global amnesia of a 66-year-old woman after general anesthesia for excision and biopsy of left neck mass.