척추마취 환자의 의식진정시 척수강내 첨가된 Fentanyl이 Propofol 적정용량에 미치는 영향 = The Effect of Intrathecal Fentanyl on Hypnotic Requirement of Propofol during Spinal Anesthesia

다국어 초록 (Multilingual Abstract)

Background: Intrathecal opioid, a useful adjunct to prolong analgesic effects, potentiates spinal anesthesia. The present study was designed to evaluate the effect of intrathecal fentanyl on the hypnotic requirements of propofol during spinal anesthesia. Methods: Sixty patients scheduled for elective urologic surgery under spinal anesthesia were randomly assigned to one of four groups. In Group 1 (n =15), spinal anesthesia was performed with hyperbaric bupivacaine 10 mg, in Group 2 (n = 15) with hyperbaric bupivacaine 10 mg plus fentanyl 10μg, in Group 3 (n = 15) with hyperbaric bupivacaine 10 mg plus fentanyl 20μg, and in Group 4 (n = 15) with hyperbaric bupivacaine 10 mg plus fentanyl 30μg. After performing spinal anesthesia, the target plasma concentration of propofol was set at 2.0μg/ml. Effect site concentration (Ce) was measured when the BIS's reached 80 or 70. Ce was titrated to maintain a BIS of 70-80. Observer's sedation scoring (OAA/S), systolic and diastolic pressures, SpO2 and total infusion dose were measured every 10 minutes for 1 hour.
Results: Ce's at a BIS of 80 were 1.2 ± 0.3μg/ml (Group 1), 1.0 ± 0.3μg/ml (Group 2), 0.9 ± 0.2μg/ml (Group 3), and 0.8 ± 0.2μg/ml (Group 4), respectively. Ce's at a BIS of 70 were 1.6 ± 0.2μg/ml (Group 1), 1.5 ± 0.4μg/ml (Group 2), 1.2 ± 0.3μg/ml (Group 3), and 1.2 ± 0.3μg/ml (Group 4), respectively. Ce's of Group 3 and Group 4 at BISs of 70 and 80 were significantly lower than those of Group 1 (P ＜ 0.05), and the propofol requirements of Groups 3 and 4 to maintain a BIS of 70-80 were significantly less than those of Group 1 (P ＜ 0.05).
Conclusions: These results indicate that adding more than 20μg of fentanyl to hyperbaric bupivacaine for spinal anesthesia reduces the hypnotic requirement of propofol.

국문 초록 (Abstract)

척수강내로 bupivacaine에 20 30μg의 fentanyl을 첨가할 경우 BIS 80 70 정도의 진정을 위해서는 propofol의 목표혈중농도를 0.8 1.2μg/ml에서 조절하는 것이 적절할 것으로 생각되며 척수강내로 fentanyl을 20μg 이상 첨가한 척추마취하의 propofol 진정 시에는 척수강내로 fentanyl을 첨가하지 않았을 때보다 일정한 진정정도에 이르는 propofol의 효과처 농도 및 총 투여량이 감소한다.

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