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.

바이코히어런스 분석 기법을 이용한 마취 단계별 뇌파의 특성 분석

朴濬模(Jun-Mo Park),朴鍾德(Jong-Duk Park),田桂錄(Gye-Rok Jeon),許榮(Young Huh) 대한전기학회 2006 전기학회논문지 D Vol.55 No.1

Although reachers have studied for a long time, they don't make criteria for anesthesia depth. anesthetists can't make a prediction about patient's reaction. Therefor, patients have potential risk such as poisonous side effect, late-awake, early-awake and strain reaction. EEG are received from twenty-five patients who agreed to investigate themselves during operation with Enflurane-anesthesis in progress of anesthesia. EEG are divided pre-anesthesia, before incision of skin, operation 1, operation 2, awaking, post-anesthesia by anesthesia progress step. EEG is applied pre-processing, base line correct, linear detrend to get more reliable data. EEG data are handled by electronic processing and the EEG data are calculated by bicoherence. During pre-anesthesia and post anesthesia, appearance rate of bicoherence value is observed strong appearance rate in high frequency range(l5-30㎐). During the anesthesia of patient, a strong appearance rate is revealed the low frequency area(0-10㎐). After bicoherence is calculated by percentage of a appearance rate, that is, Bicpara#1, Bicpara#2, Bicpara#3 and Bicpara#4 parameter are extracted. In result of bicoherence analysis, Bicpara#2 and Bicpara#4 are considered that the best parameter showed progress of anesthesia effectively. And each separated bicoherence are calculated by average bicoherence's numerical value, divide by 2 area, appear by each Bic㎐#1, Bic㎐#2, and observed Bic㎐#1/Bic㎐#2's change. In result of bicoherence analysis, Bic㎐#1, Bic㎐#2 and Bic㎐#1/Bic㎐#2 are considered that the best parameter showed progress of anesthesia effectively. In conclusion, I confirmed the anesthesia progress phase, concluded to usefulness of parameter on bispectrum and bicoherence analysis and evaluated the depth of anesthesia. In the future, it is going to use for doctor's diagnosis and apply to protect an medical accident owing to anesthesia.

The Effects of Epidural Anesthesia in Elderly Patients during Single-Level Lumbar Microdiscectomy

박성배,김문철,하성일 대한척추신경외과학회 2010 Neurospine Vol.7 No.1

Objective: To analyze the effect of epidural anesthesia in elderly patients with single-level lumbar discectomy. Methods: Medical records of 28 patients aged between 60 and 90 years who had undergone single-level lumbar microdiscectomy by two surgeons from January 2004 to December 2008 were retrospectively reviewed. Patients were divided into 2 groups: Group I was comprised of patients with lumbar discectomy under epidural anesthesia and Group II was comprised of patients with lumbar discectomy under general anesthesia. Factors taken into account when comparing the effects of epidural and general anesthesia were surgical time, anesthetic time, starting time of ambulation after surgery, hospital stay, postoperative headache, nausea, vomiting, urinary difficulty, back pain and patient satisfaction. The score on the visual analogue scale(VAS) for back pain was measured after surgery. Results: 15 patients(Group I) underwent discectomy under epidural anesthesia. The mean age of patients in Group I and II were 65±6.1 years and 67±6.7 years, respectively. 19 patients had underlying co-morbidities, such as cardiovascular, pulmonary, cerebrovascular diseases and cancer. Demographically, there was no statistical diffe- rence between the two groups. Surgical time, anesthetic time, starting time of ambulation after surgery and hospital stay were longer in patients in Group II. The incidences of urinary difficulty and VAS score for back pain were significantly lower in Group I. The incidences of headache, nausea and vomiting and patient satisfaction were not different between Group I and II. Conclusion: Epidural anesthesia was as efficacious and as safe as general anesthesia. Elderly patients who need to undergo single-level lumbar discectomy could be offered epidural anesthesia. Objective: To analyze the effect of epidural anesthesia in elderly patients with single-level lumbar discectomy. Methods: Medical records of 28 patients aged between 60 and 90 years who had undergone single-level lumbar microdiscectomy by two surgeons from January 2004 to December 2008 were retrospectively reviewed. Patients were divided into 2 groups: Group I was comprised of patients with lumbar discectomy under epidural anesthesia and Group II was comprised of patients with lumbar discectomy under general anesthesia. Factors taken into account when comparing the effects of epidural and general anesthesia were surgical time, anesthetic time, starting time of ambulation after surgery, hospital stay, postoperative headache, nausea, vomiting, urinary difficulty, back pain and patient satisfaction. The score on the visual analogue scale(VAS) for back pain was measured after surgery. Results: 15 patients(Group I) underwent discectomy under epidural anesthesia. The mean age of patients in Group I and II were 65±6.1 years and 67±6.7 years, respectively. 19 patients had underlying co-morbidities, such as cardiovascular, pulmonary, cerebrovascular diseases and cancer. Demographically, there was no statistical diffe- rence between the two groups. Surgical time, anesthetic time, starting time of ambulation after surgery and hospital stay were longer in patients in Group II. The incidences of urinary difficulty and VAS score for back pain were significantly lower in Group I. The incidences of headache, nausea and vomiting and patient satisfaction were not different between Group I and II. Conclusion: Epidural anesthesia was as efficacious and as safe as general anesthesia. Elderly patients who need to undergo single-level lumbar discectomy could be offered epidural anesthesia.

국소마취와 전신마취로 시행된 비성형술의 환자 만족도과 합병증 비교

허성재,차은주,조현수,박지혜,이진걸,김정수 대한이비인후과학회 2018 대한이비인후과학회지 두경부외과학 Vol.61 No.5

Background and Objectives Since rhinoplasty techniques require meticulous and delicatemanipulation, proper anesthesia is essential. The aim of the current study is to comparepatient satisfaction and complication of rhinoplasty performed under local anesthesia againstgeneral anesthesia. Subjects and Method Patients who underwent rhinoplasty by a single surgeon betweenMarch 2014 and January 2017 were enrolled in this study. Midazolam was utilized to sedatethe patient during local anesthesia. Pain and memory of surgery under local anesthesia, satisfactionof anesthesia, and willingness to undergo the surgery with the same anesthesia methodagain were evaluated. Cardiopulmonary events, nausea, and vomiting were assessed as complications. Aesthetic satisfaction of patients and the doctor was evaluated 6 month after thesurgery. The parameters were compared between local and general anesthesia. Results A total 120 patients were included in this study. The degree of pain was low duringsurgery under local anesthesia. Although most of patients remembered the process of surgeryduring local anesthesia, satisfaction of local anesthesia was high. The satisfaction of anesthesiaand willingness to undergo surgery with same anesthesia were not signifcantly different betweenlocal and general anesthesia. No serious complications developed during local anesthesiaand there were no signifcant differences of aesthetic satisfaction between local and generalanesthesia. Conclusion Patient satisfaction and aesthetic results of rhinoplasty performed under localanesthesia were comparable to general anesthesia, indicating that surgeons do not need to beafraid of applying local anesthesia in rhinoplasty.

Differences of cognition and neuropathology in ApoE4 knock-in mouse following isoflurane anesthesia and surgery

Yeonkyeong Lee,Harry Jung,Jong-Ho Kim,Jong-Hee Sohn 한국실험동물학회 2021 한국실험동물학회 학술발표대회 논문집 Vol.2021 No.7

Introduction: Postoperative cognitive dysfunction (POCD) following anesthesia and surgery is a common and severe complication, especially in elderly patient. Several previous studies have suggested that anesthesia and surgery may increase the Alzheimer’s disease (AD) risk, although it is unknown whether anesthesia or surgery has more effects on cognition. Thus, we investigated the differences of cognition and neuropathology whether anesthesia only or surgery/anesthesia can have different effects in AD mouse model. Methods: The 5-month-old ApoE4 KI male mouse were randomly assigned to anesthesia/surgery group or anesthesia only group. We performed abdominal surgery under isoflurane anesthesia (2.5%) or only anesthesia during two hours. Morris water maze (MWM)and Y maze tests were conducted 2 days before and 2, 4, 7 days after anesthesia and surgery. The mean escape latencies and spontaneous alternation percentage were the major outcome. Neuron apoptosis in hippocampal sections was evaluated using the terminal d-UTP nick-end labeling (TUNEL) assay. Amyloid beta (Ab) level were assessed by quantitative immunohistochemistry (IHC). Results: The anesthesia/surgery group exhibited increased mean escape latencies of MWM at postoperative 2 day, whereas anesthesia only group exhibited such increases at postoperative 4 day. However, performance on a Y-maze test did not differ. More TUNEL-positive neurons were evident in the hippocampal CA3 region of anesthesia only group at postoperative days 2 and 4, but not at day 7 (P < 0.05). Also, IHC revealed significantly elevated Aβ deposition in the hippocampal CA3 and dentate gyrus region of anesthesia only group at postoperative days 2, 4 and 7 (P < 0.05). Conclusions: Isoflurane anesthesia induced pathological hippocampal changes in ApoE4 KI mice, but not in isoflurane anesthesia/surgery group. We suggest that isoflurane anesthesia itself has a more detrimental effect on cognition and neuropathology in AD mouse models than surgery.

Effects of Isoflurane Anesthesia on Post-Anesthetic Sleep-Wake Architectures in Rats

Hwan-Soo Jang,Ji-Young Jung,Kwang-Ho Jang,Maan-Gee Lee 대한생리학회-대한약리학회 2010 The Korean Journal of Physiology & Pharmacology Vol.14 No.5

The sleep homeostatic response significantly affects the state of anesthesia. In addition, sleep recovery may occur during anesthesia, either via a natural sleep-like process to occur or via a direct restorative effect. Little is known about the effects of isoflurane anesthesia on sleep homeostasis. We investigated whether 1) isoflurane anesthesia could provide a sleep-like process, and 2) the depth of anesthesia could differently affect the post-anesthesia sleep response. Nine rats were treated for 2 hours with ad libitum sleep (Control), sleep deprivation (SD), and isoflurane anesthesia with delta- wave-predominant state (ISO-1) or burst suppression pattern-predominant state (ISO-2) with at least a 1-week interval. Electroencephalogram and electromyogram were recorded and sleep-wake architecture was evaluated for 4 hours after each treatment. In the post-treatment period, the duration of transition to slow-wave-sleep decreased but slow wave sleep (SWS) increased in the SD group, but no sleep stages were significantly changed in ISO-1 and ISO-2 groups compared to Control. Different levels of anesthesia did not significantly affect the post-anesthesia sleep responses, but the deep level of anesthesia significantly delayed the latency to sleep compared to Control. The present results indicate that a natural sleep-like process likely occurs during isoflurane anesthesia and that the post-anesthesia sleep response occurs irrespective to the level of anesthesia.

Effects of Isoflurane Anesthesia on Post-Anesthetic Sleep-Wake Architectures in Rats

장환수,정지영,장광호,이만기 대한약리학회 2010 The Korean Journal of Physiology & Pharmacology Vol.14 No.5

The sleep homeostatic response significantly affects the state of anesthesia. In addition, sleep recovery may occur during anesthesia, either via a natural sleep-like process to occur or via a direct restorative effect. Little is known about the effects of isoflurane anesthesia on sleep homeostasis. We investigated whether 1) isoflurane anesthesia could provide a sleep-like process, and 2) the depth of anesthesia could differently affect the post-anesthesia sleep response. Nine rats were treated for 2hours with ad libitum sleep (Control), sleep deprivation (SD), and isoflurane anesthesia with deltawave-predominant state (ISO-1) or burst suppression pattern-predominant state (ISO-2) with at least a 1-week interval. Electroencephalogram and electromyogram were recorded and sleep-wake architecture was evaluated for 4 hours after each treatment. In the post-treatment period, the duration of transition to slow-wave-sleep decreased but slow wave sleep (SWS) increased in the SD group, but no sleep stages were significantly changed in ISO-1 and ISO-2 groups compared to Control. Different levels of anesthesia did not significantly affect the post-anesthesia sleep responses, but the deep level of anesthesia significantly delayed the latency to sleep compared to Control. The present results indicate that a natural sleep-like process likely occurs during isoflurane anesthesia and that the post-anesthesia sleep response occurs irrespective to the level of anesthesia.

Effects of Isoflurane Anesthesia on Post-Anesthetic Sleep-Wake Architectures in Rats

Jang, Hwan-Soo,Jung, Ji-Young,Jang, Kwang-Ho,Lee, Maan-Gee The Korean Society of Pharmacology 2010 The Korean Journal of Physiology & Pharmacology Vol.14 No.5

The sleep homeostatic response significantly affects the state of anesthesia. In addition, sleep recovery may occur during anesthesia, either via a natural sleep-like process to occur or via a direct restorative effect. Little is known about the effects of isoflurane anesthesia on sleep homeostasis. We investigated whether 1) isoflurane anesthesia could provide a sleep-like process, and 2) the depth of anesthesia could differently affect the post-anesthesia sleep response. Nine rats were treated for 2 hours with $ad$ $libitum$ sleep (Control), sleep deprivation (SD), and isoflurane anesthesia with delta-wave- predominant state (ISO-1) or burst suppression pattern-predominant state (ISO-2) with at least a 1-week interval. Electroencephalogram and electromyogram were recorded and sleep-wake architecture was evaluated for 4 hours after each treatment. In the post-treatment period, the duration of transition to slow-wave-sleep decreased but slow wave sleep (SWS) increased in the SD group, but no sleep stages were significantly changed in ISO-1 and ISO-2 groups compared to Control. Different levels of anesthesia did not significantly affect the post-anesthesia sleep responses, but the deep level of anesthesia significantly delayed the latency to sleep compared to Control. The present results indicate that a natural sleep-like process likely occurs during isoflurane anesthesia and that the post-anesthesia sleep response occurs irrespective to the level of anesthesia.

Clinical Research Article : Factors in Patient dissatisfaction and refusal regarding spinal anesthesia

( Won Ji Rhee ),( Chan Jong Chung ),( Youn Hee Lim ),( Kyu Han Lee ),( Seung Cheol Lee ) 대한마취과학회 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.(Korean J Anesthesiol 2010;59:260-264)

Hemodynamic Comparison of Cervical Epidural Anesthesia with General Anesthesia for Lung Operation

Jin, Hong Yong 중앙대부설한국의과학연구소 1989 한국의과학 Vol.21 No.2