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척수 손상 환자에서의 자율 신경 이상항진증의 마취 관리 - 증례 보고 -
류승아 ( Seung-ah Ryu ),이찬희 ( Chan-hee Lee ),강창화 ( Chang-hwa Kang ) 경희대학교 경희의료원 2018 慶熙醫學 Vol.33 No.1
Autonomic hyperreflexia (AHR) is one of the clinical symptoms that may occur in patients with spinal cord injury in the fourth to sixth thoracic vertebrae. Sudden hypertension, bradycardia, headache and other symptoms may occur. If not properly treated, AHR can lead to arrhythmia, myocardial infarction, cerebral hemorrhage, etc., which can be life-threatening. In this case, the patient was a 57-year-old man with tetraplegia due to fracture of the cervical vertebrae 3-4, and underwent an abdominoperineal resection of rectum to remove rectal cancer. Regarding concerns of prolonged surgery and intermittently occurring high intensity stimuli that might induce AHR, we expected that the control of depth of general anesthesia will not be enough to prevent the occurrence of AHR. Therefore we performed epidural drug injection under general anesthesia and successfully inhibited the development of AHR during surgery. Additiionally, norepinephrine was injected from the beginning of surgery because of the concern of hypotension that might be caused by the interruption of efferent sympathetic nerves and the decrease of systemic vascular resistance due to vagus hyperactivity. As a result, blood pressure remained normal until the end of the operation, thus we submit a case repot.