Deep hypothermic total circulatory arrest (DHCA) under total intravenous anesthesia for giant basilar aneurysm clipping -A case report-

김영리,강지영,김경미,청익수,최지원 대한마취통증의학회 2009 Anesthesia and pain medicine Vol.4 No.4

The prevalence of unruptured intracranial aneurysm varies between 3.6% and 6%. Aneurysms in the posterior circulation, inaccessible by normothermic surgical clipping and giant aneurysms require direct surgical clipping under hypothermic circulatory arrest for cerebral protection. The authors describe a case of giant basilar aneurysm clipping requiring deep hypothermic total circulatory arrest under total intravenous anesthesia. The patient was a 43-year-old female with a giant aneurysm at the tip of the basilar artery. Total intravenous anesthesia with propofol (average effect site concentration 4 mcg/ml) and remifentanil (average effect site concentration 3 ng/ml) and deep hypothermic total circulatory arrest were performed. Neurophysiologic function was monitored by electroencephalography, and somatosensory and motor evoked potentials. Cardiac and coagulation profiles showed no significant changes. The aneurysm was successfully clipped but the patient expired. Further collations of clinical experiences should enable the identification of an optimal means of anesthetic management during complex cerebrovascular surgery.

General Anesthesia of a Patient with Charcot-Marie-Tooth Disease

( Junbum Lee ),( Gahee Kim ),( Sangho Lee ),( Jeong-hyun Choi ) 경희대학교 경희의료원 2022 慶熙醫學 Vol.37 No.1

Charcot-Marie-Tooth (CMT) disease is a hereditary motor and sensory neuropathy of the peripheral nervous system. The initial presentation is usually foot drop or muscle wasting of the distal part of the leg. The symptom eventually progresses to atrophy of respiratory muscles, vocal cord and diaphragm. CMT patients require special caution during the general anesthesia. CMT disease can cause malignant hyperthermia, respiratory insufficiency and hyperkalemia during anesthesia. This report presents a 50-year-old man who has been diagnosed CMT disease and scheduled to undergo anterior cervical discectomy and fusion to treat cervical spinal stenosis. Propofol and remifentanil were used for the total intravenous anesthesia, and rocuronium was used for muscle relaxant purpose. Several intraoperative monitoring methods were performed to proceed the anesthesia safely, and the patient was discharged without any complications 5 days after the surgery. This case report with comprehensive literature review investigates possible adverse events and special cautions during the general anesthesia of CMT patients, and discusses adequate intraoperative monitoring to avoid such problems.

악안면골 성형재건수술(Maxillofacial Reconstructive Surgery)에 적용하였던 유도저혈압 마취의 유용성 비교

허철회,정윤진,김종운,김문철,우성,조강희 인제대학교 1996 仁濟醫學 Vol.17 No.3

저자들은 본원에서 1990년 3월부터 1995년 7월까지 198례의 악안면골 성형재건수술에서 선택한 저혈압 약물의 차이에 따라 달리 하였던 유도저혈압 마취방법들을 4군으로 분류하여, 제1군을 흡입마취제(enflurane, halothane)와 sodium nitroprusside(SNP) 사용군, 제2군은 흡입마취제, SNP, 그리고 beta blocker(labetalol) 사용군, 제3군은 흡입마취제와 beta blocker 사용군, 제4군은 propofol과 fentanyl을 사용한 완전정맥마취와 SNP와 beta blocker 사용 군으로 하였다. 마취 및 수술 소요시간, 혈압조절의 용이성, 반사성 빈맥의 유무, 수술중 수혈 여부와 양, 수술후 중환자실 재원일수 및 총 입원일수, 수술후 부작용 등을 비교한 결과 propofol과 fentanyl을 사용한 완전정맥마취군이 다른 군들에 비하여 수술시간의 감소, 반사성 빈맥의 발생 빈도의 감소, 수혈 빈도와 수혈량의 감소를 보였던 바 완전정맥 유도저혈압 마취방법이 유용한 방법으로 평가되었다. The maxillofacial reconstructive surgery is needed close care during operation and anesthesia. The field of operation is limited by the mouth cavity. Airway managements and blood pressure controls are keystone. So, the induced hypotensive anesthesia is essential to the maxillofacial reconstructive surgery for bleeding control and accurate operation. There were 198 cases of maxillofacial reconstructive surgery under induced hypotensive anesthesia in the plastic surgery department of Paik Hospital from 1990 to 1995. Authors had divided them in 4 groups base on anesthetic protocols. Group I(N ;43) was inhalation anew thetics(enflurane, halothane) and sodium nitroprusside(SNP) ; group II(N;99) was inhalation anesthetics(enflurane), SNP, and labetalol ; group IIII(N ; 27) was inhalation anesthetics(enflurane) and labetalol ; group IV (N ;29) was total intravenous anesthesia(propofol, fentanyl, midazolam) with SNP and esmolol(or labetalol). The retrospective study was taken base on the several records of the patients, especially, the duration of operation and anesthesia, degree of fluctuation in the mean arterial blood pressure, amounts of the blood loss and transfusion during operation, complications, and the period of hospitalization, in respectively. Mean operation times of 4 groups decreased periodically, and there were the controlability of blood pressure without reflex tachycardia in beta blocker using groups. Amounts and incidences of transfusion were also decreased in total intravenous anesthesia group. But, there were no significant differencies in total admission days and ICU stay periods between 4 groups.

완전정맥마취에 의한 수술 중 Hydroxyethyl Starch (130/0.4) 용액의 동시투여가 혈소판 기능에 미치는 영향

조호연 ( Ho Yeon Cho ),신용섭 ( Yong Sup Shin ),손수창 ( Soo Chang Son ),이선열 ( Sun Yeul Lee ),조완호 ( Wan Ho Cho ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.6

Background: Colloid solutions are used to treat hypovolemia and expanding plasma, but they may inhibit platelet function and reduce the level of coagulation factors during surgery. This study was conducted to compare the effects of hydroxyethyl starch (HES) on adenosine diphosphate (ADP)- and collagen-induced platelet aggregation in patients undergoing total intravenous anesthesia. Methods: Patients undergoing endoscopic sinus surgery under total intravenous anesthesia with propofol and remifentanil were divided into a group that underwent fluid management with only crystalloid solution (n=15) and a group that was managed with crystalloid solution that included 6% HES (130/0.4) (n=15). ADP-and collagen-induced platelet aggregation were measured 5 minutes before induction, after the first intraoperative hour, and one hour postoperatively. Results: Significantly diminished ADP- and collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the patients that were managed with colloid solution that included HES. In addition, significantly diminished collagen-induced aggregation values were observed intraoperatively when compared with the preoperative value in the group that was managed with the solution that only contained the crystalloid. However, ADP -and collagen-induced platelet aggregation were recovered postoperatively in both groups. Conclusions: The results of this study indicated that fluid therapy with colloid solution that contained 6% HES (130/0.4) may diminish ADP-induced platelet aggregation intraoperatively in patients subjected to total intravenous anesthesia. (Korean Aens-En)

Total intravenous anesthesia in a 10-month-old patient with congenital myotonic dystrophy undergoing endoscopic third ventriculostomy -A case report-

조정화,김지연,백승혜,송준걸,이유미,김정욱 대한마취통증의학회 2012 Korean Journal of Anesthesiology Vol.63 No.2

Myotonic dystrophy is a rare genetic disorder characterized by muscle atrophy and weakness. Surgical treatment of this condition poses various problems for the anesthesiologist. We describe the anesthetic management of a 10-month-old infant with congenital myotonic dystrophy, who was scheduled for endoscopic third ventriculostomy under general anesthesia. Anesthesia was induced with thiopental sodium, fentanyl, and vecuronium, and thereafter maintained via continuous infusion of propofol and remifentanil. The train-of-four ratio was monitored throughout the operation, and muscle relaxation was reversed with pyridostigmine and glycopyrrolate at the end of the procedure. We show that total intravenous anesthesia using propofol and remifentanil is a satisfactory anesthetic technique in very young patients with congenital myotonic dystrophy.

증례보고 : 선천성무통무한증 환아의 전 정맥마취관리

이석진 ( Seuk Jin Lee ),김영기 ( Young Ki Kim ),성규완 ( Kyu Wan Seong ),김성우 ( Seong Woo Kim ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.52 No.3

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare hereditary sensory and autonomic neuropathy. CIPA is characterized by inability to sweat, insensitivity to pain, self-mutilation, recurrent episodes of hyperpyrexia, mental retardation, and autonomic nervous system abnormality. Patients with CIPA may undergo surgery because of susceptibility to trauma, bony fracture and osteomyelitis due to insensitivity to pain. We report a child who had undergone anesthesia with total intravenous anesthesia. The anesthetic management of this condition is discussed. (Korean J Anesthesiol 2007; 52: 367~70)

Dental Management of a Patient with Spinal Muscular Atrophy under Total Intravenous Anesthesia: A Case Report

Hyejin Cho,Hyuntae Kim,Ji-Soo Song,Teo Jeon Shin,Hong-Keun Hyun,Jung-Wook Kim,Ki-Taeg Jang,Young-Jae Kim Asia Association for Disability and Oral Health 2021 대한장애인치과학회지 Vol.17 No.2

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease caused by mutations in the survival of motor neurons (SMN1) gene, located on chromosome 5q13. It affects 1 in 6,000 to 1 in 10,000 live births and is characterized by degeneration of lower motor neurons in the anterior horn in the spinal cord, resulting in muscle weakness and atrophy. Special care must be taken during general anesthesia due to weak respiratory muscles and hypersensitivity to muscle relaxants. This report describes dental treatment of a 6-year-11-months old boy with SMA type II under total intravenous anesthesia using propofol and remifentanil without the use of muscle relaxant. The patient exhibited malocclusions related to weak masticatory muscles and mouth breathing. Dental caries treatment with composite resin restoration and surgical extraction of impacted mesiodens was performed without any postoperative complications. The patient recovered fully from general anesthesia and was discharged on the day without the need of hospitalization.

임상연구 : Propofol-Remifentanil 및 Propofol-Nitrous Oxide를 이용한 전신마취의 비교

서정훈 ( Jeong Hun Suh ),윤정연 ( Jung Yeon Yun ),박금숙 ( Kum Suk Park ),도상환 ( Sang Hwan Do ) 대한마취과학회 2006 Korean Journal of Anesthesiology Vol.51 No.2

Background: Remifentanil is a novel, ultra-short acting opioid. This study was performed to compare the hemodynamic responses of remifentanil and nitrous oxide under propofol-based anesthesia during the intraoperative period. Methods: Forty patients undergoing gynecologic surgery were randomly allocated to either remifentanil (R group) or N2O group (N group). In the R group, remfentanil was continuously infused from the induction of anesthesia (0.5㎍/kg/min) to the end of surgery (0.1-0.5㎍/kg/min). In the N group, fentany1 (2㎍/kg) was injected intravenously and N2O was used thereafter. In both groups, target-concentration infusion of propofol was applied. We compared mean arterial pressure (MAP) and heart rate (HR) before and after tracheal intubation and during the rest of anesthetic time between the two groups. Postoperative parameters such as nausea/vomiting, consciousness level and pain at 2 and 24 hours were also compared. Results: The magnitude of MAP and HR after tracheal intubation were significantly smaller and more stable in the R group than in the N group. Hypertensive (systolic blood pressure> 140 mmHg) episodes were significantly less frequent in the R group (3.0%) than in the N group (12.4%) during the operation. R group showed less MAP (76 ± 12 mmHg) and HR (61 ± 10 bpm) compared with those of N group (86 ± 17 mmHg, 63 ± 8 bpm, P < 0.05 respectively). Other postoperative measures were comparable between the two groups. Conclusions: We conclude that the continuous infusion of remifentanil can provide more stable hemodynamic status than N2O without significant adverse effects, in propofol-based general anesthesia. (Korean J Anesthesiol 2006; 51: 151~6)

Effects of PEEP on the thermoregulatory responses during TIVA in patients undergoing tympanoplasty

안태훈,Jung-Woo Yang 대한마취통증의학회 2011 Korean Journal of Anesthesiology Vol.61 No.4

Background: During general anesthesia, core temperature decreases, largely due to heat loss caused by peripheral vasodilation, resulting in heat redistribution to peripheral tissues. Multiple factors contribute to body temperature regulation during general anesthesia. It was reported that baroreceptor unloading by positive end-expiratory pressure (PEEP) attenuates anesthetically-induced hypothermia. So, we evaluated the effects of PEEP on thermoregulatory responses during total intravenous anesthesia (TIVA). Methods: Forty healthy patients scheduled for tympanoplasty were allocated two groups, Group ZEEP (zero end-expiratory pressure, n = 20) and Group PEEP (PEEP application of 5 cmH_2O, n = 20). Ambient temperature was maintained at 22-24℃, and anesthesia was induced and maintained with propofol-remifentanil. The core temperature and the temperature difference between forearm and fingertip skin were monitored before and after the induction of general anesthesia having a duration of 180 minutes. Results: The core temperature gradient (Ti-Tf ) was higher in patients with ZEEP than with PEEP. The core temperature was maintained at a higher level in patients with PEEP. Additionally, the vasoconstriction threshold was higher in patients with PEEP. Conclusions: It seems that PEEP attenuates anesthetically-induced hypothermia during TIVA.

위암 환자에서 sevoflurane-remifentanil 균형마취와 propofolremifentanil 전정맥 마취가 수술 후 스트레스 반응에 미치는 영향

이수현,남상범,이종석,김혜진 대한마취통증의학회 2014 Anesthesia and pain medicine Vol.9 No.2

Background: The effects of anesthetics on postoperative stressresponse remains not fully understood. We evaluated the effectsof sevoflurane-remifentanil balanced anesthesia and propofolremifentaniltotal intravenous anesthesia (TIVA) on postoperativeinterleukin 6 (IL-6), tumor necrosis factor α (TNF-α), cortisol, andlaboratory test values for patients with stomach cancer. Methods: Forty patients were randomly assigned to sevoflurane-remifentanil group (group S) and propofol-remifentanil group(group P). Anesthesia was maintained with balanced anesthesia(group S) or TIVA (group P). We measured the IL-6, TNF-α, cortisoland performed laboratory tests before (T1) and after surgery (T2). Results: Concentration of IL-6 and cortisol increased (group S:1.89 ± 1.69 pg/ml to 47.11 ± 44.37 pg/ml, 10.68 ± 4.89 pg/ml to14.93 ± 6.79 pg/ml, group P: 1.74 ± 1.60 pg/ml to 61.58 ± 48.65pg/ml, 9.96 ± 4.40 pg/ml to 14.27 ± 7.43 pg/ml, respectively) postoperativelyin both groups, but there were not different betweengroup S and group P. There were no differences of TNF-α betweenT1 and T2 in both groups. Changes of other laboratory values wereindifferent between groups. Conclusions: The effects of sevoflurane-remifentanil balancedanesthesia and propofol-remifentanil TIVA on postoperative stressresponses in patients with stomach cancer were not different. Further investigations are required to assess the effects of anestheticson other stress response profiles and such significances.