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- 주제어 : Neurosurgical anesthesia (검색결과 4 건)
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뇌수술을 위한 장시간 Propofol-Remifentanil 마취의 후향적 분석
김은미 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.4
Background: A rare, but fatal, propofol infusion syndrome has been reported in critically ill patients after prolonged use of propofol (more than 24−48 hours). But there are few reports on the clinical characteristics of prolonged anesthesia (more than 10 hours) using propofol, especially in the neurosurgical patients. Methods: A retrospective study was conducted to find intra-and post-anesthetic characteristics (up to 7 postoperative days) and long-term outcomes (more than 1 and half years) in the neurosurgical patients who needed prolonged propofol-remifentanil anesthesia. Data were collected via medical records and descriptive analysis was conducted. Results: Thirty one neurosurgical patients underwent 34 operations using propofol-remifentanil anesthesia for more than 10 hours from November 2005 to January 2007. Mean duration of anesthesia and surgery was 936 ± 279 and 805 ± 283 min, respectively. Propofol and remifentanil were administered with a mean infusion rate of 7.2 ± 1.8 mg/kg/h and 8.6 ± 2.4μg/kg/h, respectively. Vasopressors were used in six cases during anesthetic management. Intraoperative hypotension occurred in two patients. Even though hepatic, cardiac, and renal enzymes elevated transiently in some patients during postanesthetic course, any significant lactic acidosis did not occur in them. Two patients died of sepsis and GI bleeding thereafter. Median days of hospital admission and stay at neurosurgical care unit were 36.5 days and 8 days. Conclusions: A retrospective analysis of the prolonged propofol and remifentanil anesthesia for 34 neurosurgical cases did not show any morbidities and mortalities related to intravenous anesthetics.
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뇌신경 마취영역에서 ketamine의 적용에 대한 재평가
류태하,정진용 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.4
Traditionally, Ketamine has been considered to be contraindicatedin neurosurgical patients due to the risk of intracranial hypertension. The evidence for this contraindication originated from early casereports and case-control studies which were inadequately designedand controlled. However, several recent articles indicate thatketamine can be safely used in traumatic brain injured patientstreated with mechanical ventilation and that there is no significantincrease in the intracranial pressure (ICP). Ketamine is an N-methyl-D-aspartate antagonist. It is believed to provide neuroprotectionthrough a reduction in the glutamate excitotoxicity. This evidenceis based on in vitro and animal studies. However, studies aboutits neuroprotective effects in humans are scarce. Data to recommendketamine as first-line anesthetics for neurosurgery are insufficient,but ketamine as an adjuvant anesthetic agent may havebenefits for neurosurgical patients, such as traumatic head injuredpatients with unstable hemodynamics. Therefore, ketamine shouldnot be considered as absolutely contraindicated for neurosurgicalpatients and adequately powered, high-quality randomizedcontrolled studies are needed to provide clinical evidences.
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신경외과 수술 환자의 기관내 튜브 발관을 위한 Isoflurane의 호기말 최소 폐포 농도 측정
김시오 慶北大學校 醫科大學 1996 慶北醫大誌 Vol.37 No.1
목적 : 이 연구는 두부손상 신경외과 수술환자의 기관내 튜브발관에 의한 고혈압과 빈맥으로 뇌압상승을 초래하는 것을 방지할 목적으로, 마취가 깊게 유지된 상태에서의 기관내 튜브 발관시의 호기말 최소 폐포 농도 측정을 하기 위하여 시행하였다. 대상 및 방법 : 의식장애가 심하지 않고 계획수술로 진행된 뇌동맥류 환자 23명을 대상으로 수술이 끝난 후 미리 정해진 농도의 isoflurane을 최소한 15분간 투여후 기관내 튜브를 발관하였을때 환자가 기침, 숨 참기, 기도 폐색, 후두경련등이 있는 경우 불만족(unsatisfactory)하다고 하고 결과를 각각의 정해진 isoflurane농도에 만족과 불만족으로 표시한 후 50% 환자에서 만족하는 호기말 isoflurane의 농도를 구하였다. 결과 : 기관내 튜브 발관시 50%의 환자에서 만족하는 호기말 isoflurane의 농도는 0.90%이었고 이때의 standard error는 ±0.17이었다. 결론 : 호기말 isoflurane의 농도 0.90%에서 50%의 두부손상 신경외과 수술환자에서 기침등의 원치 않는 부작용 없이 기관내 튜브를 발관할 수 있다고 하겠다. Background : Tracheal extubation is also as important as tracheal intubation in anesthetic management. So deeply anesthetized extubation is recommended not to produce hypertension and tachycardia which is harmful in neurosurgical patients. This study was done to determine a minimum alveolar con centration of isoflurane for tracheal extubation in neurosurgical patients. Methods : Twenty-three patients with minimum neurologic deficit were undergone aneurysmal clip ping operation. At the end of surgery a predetermined end-tidal concentration was achieved, a steady state maintained for at least 15min, and the trachea was extubated. In patients who coughed or bucked on the endotracheal tube during suctioning of oropharynx, or who moved or coughed within 1 min of tracheal extubation, or who developed breath-holding or laryngospasm after tracheal extubation, extubation was considered unsatisfactory. Results were plotted as satisfactory or unsatisfactory extubation versus end-tidal isoflurane concentration. End-tidal concentration of isoflurane at which tracheal extubation was accomplished in 50% of pa tients satisfactorily was estimated by probit analysis. Results : The minimum alveolar concentrations of isoflurane at which 50% of patients has satisfactory tracheal extubation was found to be 0.90% (standard error ±0.17). Conclusions : In 50% of anesthetized neurosurgical patients tracheal extubation may be accomplished without coughing or moving at 0.90% end-tidal isoflurane concentration.
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