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수술 전 불안과 무통 시술시 거치된 경막외 카테터를 이용한 제왕 절개를 위한 경막외 마취 실패와의 관계
윤희조,박승인 대한마취통증의학회 2015 Anesthesia and pain medicine Vol.10 No.4
Background: Patients anesthetized by extension of epidural analgesia during labor frequently experience intraoperative visceral pain during cesarean section. Visceral pain is known to be related to anxiety. We evaluated pain and preoperative anxiety using the numeric rating scale (NRS-11), and examined the relationship of anxiety with failure of extension of epidural analgesia due to intraoperative pain. Methods: Patients received continuous epidural infusion at a rate of 10 ml/h for labor pain. Two percent lidocaine mixed with 100 g fentanyl, 1:200,000 epinephrine, and 2 mEq bicarbonate was injected through the epidural catheter for cesarean section. Failure of epidural anesthesia was defined as the need for conversion to general anesthesia or supplementation with opioids, sedatives, or inhalants after epidural anesthesia for cesarean section. We investigated the relationship of preoperative factors including preoperative anxiety with failure of epidural anesthesia. Results: Heavier weight of parturients, more cervical dilatation at the time of epidural analgesia administration, higher pain NRS score after epidural analgesia, higher pain NRS score before epidural analgesia for cesarean section, and lower rate of iv pethidine due to shivering were associated with a higher failure rate of epidural anesthesia. The failure rate of epidural anesthesia was comparable between the high anxiety group (NRS > 4) and the low anxiety group (NRS ≤ 4). Conclusions: Preoperative anxiety evaluated by NRS may not be associated with failure of extension of epidural analgesia due to visceral pain during intrapartum cesarean section.
Anesthesia for cesarean section in a patient with respiratory failure -A case report-
이해진,이지영,전진영,고현정,박노수 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.64 No.5
We present successful epidural anesthesia and assisted mechanical ventilation in a parturient woman with respiratory failure. A 41-year-old woman at 35 weeks’ of gestation was entering labor. She was pneumonectomized on the left, had bronchiectasis on the remnant lung, and was under assisted mechanical ventilation by continuous positive airway pressure (CPAP) because of severely restricted lung function and superimposed pneumonia. We administered continuous epidural analgesia for vaginal delivery, and extended it for cesarean section after failure of vaginal delivery. During the procedure, her ventilation was continuously assisted by CPAP. The maternal and fetal outcomes were successful.
만성 신부전 환자의 상완 동-정맥루 형성술식을 위한 경추 경막외마취
유승화(Seung Hwa Ryoo),김태준(Tae Joon Kim),옥시영(Si Young Ok),김상호(Sang Ho Kim),박욱(Wook Park),송단(Dan Song),문철(Chul Moon) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6
Purpose: Cervical epidural analgesia is used for pain control in head and neck or upper arm. But it is not commonly used for the purpose of pure regional anesthesia for upper arm surgery. Therefore, we investigated the usefulness of cervical epidural anesthesia (CEA) as a method of regional anesthesia for arteriovenous bridge graft (AVBG) for hemodialysis at upper arm and evaluated the effects of CEA on hemodynamics and respiration. Methods: One hundred-fifty chronic renal failure patients scheduled for AVBG were randomly assigned. In the sitting position, an epidural catheter was inserted at C6-7 or C7-T1 and 15 ml of 0.375% ropivacaine with fentanyl 20㎍ was injected. Analgesic level, blood pressure and heart rate were measured at 5-minute intervals after injection of the drug. Arterial blood sampling was taken for aBGA before and twenty minutes after CEA. Results: Average anesthetic dermatomalsensory levels were C3.4±1.2∼T5.7±2.8. During surgery, hypotension was noted in 49% of patients. It was treated with ephedrine or phenylephrine i.v. Baseline PaCO₂ changed from 42.4±2.9 ㎜Hg to 44.6±3.6 ㎜Hg. Conclusion: The above results suggest that CEA is suitable for AVBG at upper arm as a regional anesthesia.