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Background: Markedly reduced urine have been commonly observed during mastoidectomy under general anesthesia. The aim of study was to evaluate the surgery-related mechanism of reduced urine during mastoidectomy. Methods: 11 patients undergoing mastoidectomy were studied. Blood samples were drawn from CVP line inserted through right internal jugular vein just before drilling (Pre-D); at 15 min after drilling (D-15); at the time closest to the inner ear (CHP-1); at 15 min (CHP-2) and 30 min (CHP-3) after CHP-1 and just before emergence (End). MAP, HR, temperature, CVP, and urine output (UO) were recorded at each period. 0.9% normal saline with room temperature was used to irrigate surgical field. Serum ADH, and the osmolalities (serum and urine) were measured. In 6 patients, serum TSH and FSH were measured, simultaneously. Results: There were no significant hemodynamic changes during procedure. UO was decreased in 50% during and after the drilling. No differences showed in UO between before and after the drilling of CHP. Plasma ADH level after the CHP was increased 2-3 fold than before. Serum osmolality was unchanged throughout the periods, while the urine osmolality was significantly increased after the period of CHP. FSH was not changed during the periods and TSH was decreased slightly than in Pre-D. Conclusions: The reduced urine output during mastoidectomy may be influenced by the drilling-related vibration, which may affect the supraoptico-hypophyseal tract, resulting in ADH release. The irrigated isotonic saline with higher osmolality (308 mOsm/kgH2O) than plasma osmolality may partly contributed to the increased ADH. (Korean J Anesthesiol 2006; 50: 296~301) 전신 마취로 수술을 받는 유양골 삭개술 환자에서는 수술적 조작인 드릴의 진동 자체의 영향과 관주액에 의한 국소적 삼투질 농도의 변화가 후뇌하수체로부터의 ADH 분비증가에 영향을 줌으로써 소변량이 더욱 저하될 가능성이 있는 것으로 여겨진다. 그러므로 유양골 삭개술의 마취동안 적절한 약제 선택과 적정마취깊이, 충분한 수액 투여를 유지함으로써 체내 신경 내분비계 호르몬의 급격한 변화를 예방해야 하며 이에 대한 추 후 연구가 필요한 것으로 생각된다.
심전도나 이산화탄소 파형은 상대적으로 많은 정보를 임상가에게 주고 있다. 반면, 시간에 따른 변화를 압축하여 단순히 상수값을 사용하는 동맥압이나 맥박산소포화도는 상대적으로 적은 정보를 임상가들에게 제공한다. 그러므로, 이러한 파형에 대한 연구를 활성화하여 이들을 임상에 이용한다면 보다 정확하게 환자의 상태를 파악할 수 있어 양질의 진료를 수행하는 데 도움을 줄 수 있을 것으로 생각된다.저자: 심지연·안원식*울산대학교 의과대학 서울아산병원 마취통증의학교실,*서울대학교 의과대학 서울대학교병원 마취통증의학과서울시 종로구 연건동 28, 우편번호: 110-744E-mail: email@example.com
Background: Anesthesiologist must be aware of the common problems that occur in pediatric anesthesia. The purpose of this survey was to collect information to help improve the quality of pediatric anesthesia by comparing the opinions of anesthesiologists that treat children and those that do not treat children. Methods: A questionnaire surveying the attitudes of 103 anesthesiologists with regard to pediatric problems was analyzed. The questionnaire inquired about the number of years worked in field, the form of work and the responsibilities with regard to the pediatric anesthesia. Each question was rated from 1 (very infrequent) to 5 (very common) for the frequency of problems and from 1 (not importance) to 5 (very important) for the importance of the problem. Then we calculated the average of each item and combined the scores to obtain an average frequency and an average importance. Results: The list of problems had high combined scores for preoperative anxiety (10.62), incision pain (9.59), postoperative agitation (9.53), hypothermia (9.40), and vomiting (9.30) for the pediatric anesthesiologist group. In addition, the problem list had high combined scores for propofol injection pain (11.25), preoperative anxiety (10.92), vomiting (10.17), hypothermia (9.44), and postoperative agitation (9.42) for the non-pediatric anesthesiologist group. Conclusions: The results of this study showed a difference in the pediatric and non pediatric anesthesiologist groups for propofol injection pain. Differences were noted for the average importance (2.34 : 2.80) compared to the average frequency (3.93 : 4.01). The pediatric anesthesiologists regarded propofol injection pain to be less of a problem than did the anesthesiologists who did not care for pediatric patients.
Awareness during general anesthesia or intraoperative awareness is defined as the unexpected recall of events that occur during anesthesia by patients who receive general anesthesia. The objectives of general anesthesia for cesarean delivery are to keep mother and fetus adequately oxygenated, while limiting drug transmission across the placenta and maintaining maternal comfort. Therefore, the obstetric population is considered at high risk of awareness and recall when undergoing general anesthesia for cesarean delivery. Today, the incidence of awareness during cesarean delivery was reduced to approximately 0.26%, but it remains an undesirable complication with potential for the development of posttraumatic stress disorder. This review examines the recent knowledge of definition, causes, and prevention of awareness during general anesthesia for cesarean delivery. 제왕절개술을 위한 전신마취의 경우 마취 중 각성의 고위험군에 속하지만 적절한 평가와 면담을 통해 환자에게충분히 설명하고, 마취 기계나 약물의 내용물과 용량을 수시로 점검하며 수술 중 주의 깊게 환자를 감시하는 등 마취의 기본적인 원칙을 잘 지키는 것만으로도 그 빈도를 감소시킬 수 있다. 흡입마취제 0.8−1.0 MAC 이하에서는 oxytocin에대한 자궁의 수축력은 잘 유지되므로 적절한 마취를 위해서 충분한 범위의 흡입마취제를 투여하는 것이 바람직하다. 하지만 불가피하게 마취 중 각성이 발생했다면이후 환자의 장기간의 후유증을 줄이기 위해 설명과 상담등을 통해 적절히 대처하는 것이 중요하다.
It is challenging to predict fluid responsiveness, that is, whether the cardiac index or stroke volume index would be increased by fluid administration, in the pediatric population. Previous studies on fluid responsiveness have assessed several variables derived from pressure wave measurements, plethysmography (pulse oximeter plethysmograph amplitude variation), ultrasonography, bioreactance data, and various combined methods. However, only the respiratory variation of aortic blood flow peak velocity has consistently shown a predictive ability in pediatric patients. For the prediction of fluid responsiveness in children, flow- or volume-dependent, noninvasive variables are more promising than pressure-dependent, invasive variables. This article reviews various potential variables for the prediction of fluid responsiveness in the pediatric population. Differences in anatomic and physiologic characteristics between the pediatric and adult populations are covered. In addition, some important considerations are discussed for future studies on fluid responsiveness in the pediatric population.
Kellie M. Jaremko,Eric S. Schwenk,Amy C.S. Pearson,Jonathan Hagedorn,Ankeet D. Udani,Gary Schwartz,Nabil M. Elkassabany,Anne Snively,Edward R. Mariano 대한마취통증의학회 2019 Korean Journal of Anesthesiology Vol.72 No.5