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.

Bispectral Index 감시장치로 경막외마취의 진정효과를 평가할 수 있는가?

신병철,이혜원,신혜원,조헌,임혜자,윤석민,장성호 대한마취과학회 2002 Korean Journal of Anesthesiology Vol.43 No.6

Background: Epidural anesthesia has been shown to a have direct sedative effect and to markedly reduce the amount of hypnotic agents required for sedation. A Bispectral Index (BIS) is a useful of the level of sedation and loss of consciousness for several anesthetics including propofol. In this study, we investigated whether BIS monitoring could detect the sedative effect of epidural anesthesia during propofol induction. Methods: Twenty patients scheduled for elective lower abdominal surgery were included. A Target controlled infusion (target effect concentration 5㎍/ml, induction time 3 min) of propofol was administered to the patients with or without epidural anesthesia (2% lidocaine 15 ml) at the L_2-3 level. The OAA/S scale and BIS were evaluated 20 min after epidural injection. Hypnotic requirements of propofol were determined using loss of eye opening in response to verbal command as an epidural. At the time of induction of hypnosis, the target concentration, target effect concentration and BIS were recorded. Results: Epidural lidocaine significantly decreased the hypnotic dose of propofol (1.0±0.2㎍/ml vs. 1.3±0.1㎍/ml; p=0.0008), hypnotic calculated concentration (3.3±0.6㎍/ml vs. 4.1±0.3㎍/ml; P=0.0007), and the hypnotic effect concentration (0.7±0.3㎍/ml vs. 1.1±0.1㎍/ml; P=0.0007). In the patients with epidural anesthesia, the OAA/S scale was decreased without a change of the BIS after epidural anesthesia and BIS recorded at the time of induction of hypnosis was much higher in patients with epidural anesthesia than in patients without in epidural anesthesia (92.7±2.2㎍/ml vs. 85.5±6.2㎍/ml; P=0.0029). Conclusions: Epidural anesthesia included a sedative effect without a change of the BIS and then induced the hypnosis with lesser dose of propofol. At the time of hypnosis, a higher BIS was noticed with epidural anesthesia. These results concluded that BIS monitoring could not detect the sedative effect induced with epidural anesthesia. (Korean J Anesthesiol 2002; 43: 698~703)

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.

경막외 Lidocaine이 Bispectral Index로 측정한 적절한 마취깊이에 필요한 Desflurane 농도에 미치는 효과

최영균,신상우,이근무,정순호,김영재,신치만,박주열 白中央醫療院 2004 仁濟醫學 Vol.25 No.1

Background: Epidural anesthesia potentiates sedative drug effects and decreases minimum alveolar concentration (MAC) of inhalation anesthetics. The authors hypothesized that epidural anesthesia also decreases the general anesthetic requirements for adequate depth of anesthesia as measured by Bispectral Index(BIS) Methods: After premedication with 0.02 mg/kg midazolam, 30 patients aged 20-75 yr were randomized in a double-blinded fashion to receive general anesthesia with either intravenous saline placebo or intravenous lidocaine control (1-mg/kg bolus does; 25 ㎕·kg-1·min-1). A matched group was prospectively assigned to receive epidural lidocaine (15 ml; 2%) with intravenous saline placebo. All patients receive 1.5 mg/kg propofol and 1mg/kg rocuronium for tracheal intubation. After 10 min of equilibration period with 3% end-tidal desflurane concentration, BIS was measured at every 30 second. If BIS score was above 50, vaporizer dial was increased by 0.5 vol%. If BIS score was under 45, vaporizer dial was decreased by 0.5 vol%. When BIS score was maintained between 45-50 by 3minutes, we checked the end tidal desflurane concentration and defined as MACBIS50(Minimum alveolar concentration at BIS 50). MACBIS50, BIS score, and mean arterial pressure were recorded. Results: The MACBIS50 of desflurane (2.5 0.49%) was significantly decreased with lidocaine epidural anesthesia compared with general anesthesia alone (3.1 0.59%) or with intravenous lidocaine (3.0 0.51%)(p<0.05). Conclusions: Epidural anesthesia reduced by 19% the desflurane required for adequate depth of anesthesia. This effect was not a result of systemic lidocain absorption, but may have been caused by deafferentation by epidural anesthesia or direct rostral spread of local anesthetic within the cerebrospinal fluid. Lower-than-expected concentrations of volatile agents may be sufficient during combined epidural-general anesthesia.

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

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

Association between anesthetic method and postpartum hemorrhage in Korea based on National Health Insurance Service data

Jee Yongho,Lee Hyun Jung,김윤진,김동연,우재희 대한마취통증의학회 2022 Anesthesia and pain medicine Vol.17 No.2

Background: Postpartum hemorrhage (PPH) is a major cause of maternal mortality. An increasing incidence of PPH has been reported in many countries. The risk factors for PPH differ among studies and it can occur in patients with no known risk factors. In this large-scale study, we investigated whether the anesthetic method used was associated with PPH after cesarean section.Methods: We extracted data on cesarean sections performed between January 2008 and June 2013 from the National Health Insurance Service database. The anesthetic methods were categorized into general, spinal and epidural anesthesia. To compare the likelihood of PPH among deliveries using different anesthetic methods, crude and adjusted odds ratios (ORs) and 95% confidence intervals were calculated using logistic regression analysis.Results: Data from 330,324 cesarean sections were analyzed, and 21,636 cases of PPH were identified. Univariate analysis showed that general and epidural anesthesia increased the risk of PPH compared to spinal anesthesia. The OR for PPH was highest for morbidly adherent placenta, followed by placenta previa, placental abruption, and hypertension. When other clinical covariates were controlled for, general and epidural anesthesia still remained significant risk factors for PPH compared to spinal anesthesia.Conclusions: This study showed that general and epidural anesthesia elevated the risk of PPH compared to spinal anesthesia during cesarean section. Since we could not consider the potential bias of group differences in indications, more in-depth clinical trials are needed to validate our findings. Obstetric factors such as placental abnormalities had high odds ratios and thus are more important than the choice of anesthetic method, which should be based on the patient’s clinical condition and institutional resources.

Epidural Abscess after Combined Spinal and Epidural Anesthesia for Total Knee Replacement Arthroplasty

( Eun Ji Lee ),( Eun Kyung Lee ),( Jeong Jin Min ) 경희대학교 경희의료원 2017 慶熙醫學 Vol.32 No.1

Spinal and epidural anesthesia are widely used for surgical procedure and pain management. As, central neuraxial block (CNB) is increasingly relied upon, the incidence of complications is likely to increase. Although, the frequency of infectious complications following CNB has historically been considered extremely low, it could lead to serious results, such as arachnoiditis, meningitis, cord compression secondary to abscess formation. Early recognition and diagnosis followed by prompt treatment is essential. Here we report a case of epidural abscess after combined spinal and epidural anesthesia. The patient was diagnosed with epidural abscess at 8th day of post anesthesia, and treated by surgical intervention. Fortunately, the patient was fully recovered without any neurologic sequelae. The issue of antiseptic techniques before CNB has gained an intensive attention. Appropriate selection and application of skin antiseptic may play a significant role in preventing infectious complications of CNB.

Clinical Research Article : Laparoscopic cholecystectomy under epidural anesthesia: a clinical feasibility study

( Ji Hyun Lee ),( Jin Huh ),( Duk Kyung Kim ),( Jea Ryoung Gil ),( Sung Won Min ),( Sun Sook Han ) 대한마취과학회 2010 Korean Journal of Anesthesiology Vol.59 No.6

Background: Laparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC. Methods: Twelve American Society of Anesthesiologists class I or II patients received an epidural block for LC. The level of epidural block and the satisfaction score of patients and the surgeon were checked to evaluate the efficacy of epidural block for LC. Results: LC was performed successfully under epidural block, with the exception of 1 patient who required a conversion to general anesthesia owing to severe referred pain. There were no special postoperative complications, with the exception of one case of urinary retention. Conclusions: Epidural anesthesia might be applicable for LC. However, the incidence of intraoperative referred shoulder pain is high, and so careful patient recruitment and management of shoulder pain should be considered.

The Efficacy of Epidural Ketamine on Shivering during Transurethral Resection of the Prostate under Epidural Anesthesia

한동엽,정희종,이철,최덕화 대한배뇨장애요실금학회 2010 International Neurourology Journal Vol.14 No.2

Purpose: Ketamine may decrease core-to-peripheral redistribution of heat through direct central sympathetic stimulation and inhibition of norepinephrine uptake into postganglionic sympathetic nerve endings. The purpose of this study was to evaluate the efficacy of epidural ketamine in preventing shivering during transurethral resection of the prostate (TURP) under epidural anesthesia. Materials and Methods: Ninety-three male patients scheduled for TURP under epidural anesthesia were enrolled in this study. Patients were randomized into one of three groups. Group 1 consisted of 31 patients who received epidural 0.75% ropivacaine, group 2 consisted of 32 patients who received epidural ketamine (0.2 mg/kg) in addition to 0.75% ropivacaine, and group 3 consisted of 30 patients who received epidural ketamine (0.4 mg/kg) in addition to 0.75% ropivacaine. Shivering and side effects such as hypotension, bradycardia, nausea, and hallucination were recorded during the anesthesia and for 2 hours while in the postanesthetic recovery room. Results: Shivering was statistically more frequent in group 1 than in the other groups. The incidence of sedation was significantly higher in group 3 than in the other groups. The incidences of side effects such as hypotension, bradycardia, and nausea were significantly higher in group 1 than in the other groups. Conclusions: In this study, epidural ketamine 0.2 mg/kg and 0.4 mg/kg was shown to have a lower incidence of shivering and other side effects except sedation. In patients who undergo TURP under epidural anesthesia, the prophylactic use of low-dose epidural ketamine would be helpful in preventing any adverse effects, including shivering.

증례보고 : 여러 시험 방법으로 확인되지 않은 경막외 카테터의 혈관내 거치

김영택 ( Young Taek Kim ),김신성 ( Sin Sung Kim ),류지근 ( Ji Keun Ryu ),정욱 ( Wook Jung ) 대한마취과학회 2007 Korean Journal of Anesthesiology Vol.53 No.4

Epidural anesthesia for cesarean section allows the mother to be awake, minimizes or completely avoids the problem of maternal aspiration and neonatal drug depression from general anesthetics. But epidural anesthesia has the potential to produce local anesthetic systemic toxicity or inadvertent high spinal block which is due to unintentional administration of drug into an epidural vessel or subarachnoid space. There are several ways to avoid these complications. These include careful aspiration of epidural catheter, fractionation of the epidural dose, and the use of epinephrine containing epidural test dose before injection of epidural dose. We report a case of a pregnant woman who had developed a seizure after an injection of the epidural anesthetic. This occurred despite using the techniques of aspiration and epinephrine containing epidural test dose injection. So we thought that the seizure occurred probably by the migration of epidural catheter while changing positions and it should be considered in all cases of epidural anesthesia. (Korean J Anesthesiol 2007; 53: 544~6)