전신마취하 유양골삭개술시의 혈중 ADH (antidiuretic hormone)의 변화

김효은,박윤곤,진홍용,조민수,길혜금 대한마취통증의학회 2006 Korean Journal of Anesthesiology Vol.50 No.3

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.

소아환자의 마취와 연관된 문제점들에 대한 마취통증의학과 전문의들의 의식조사

황태후 대한마취통증의학회 2008 Anesthesia and pain medicine Vol.3 No.3

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.

모니터 파형 해석과 생체 정보

심지연,안원식 대한마취통증의학회 2007 Korean Journal of Anesthesiology Vol.52 No.5

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: aws@snu.ac.kr

제왕절개술을 위한 전신마취 중 각성

최성욱 대한마취통증의학회 2012 Anesthesia and pain medicine Vol.7 No.1

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.

Effect of an epinephrine mixture for interscalene block on hemodynamic changes after the beach chair position under general anesthesia: a retrospective study

김범준,임채성,홍부휘,이지용,이선열,이정은,김윤희,이원형,윤석화 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.2

Background: The beach chair position (BCP) can cause significant hypotension. Epinephrine is used to prolong the duration of local anesthetics; it is also absorbed into blood and can exert systemic effects. This study determined the effects of epinephrine mixed with ropivacaine for an interscalene block (ISB) on hemodynamic changes related to BCP. Methods: Patient data collected from March 2013 to August 2014 were used retrospectively. We divided the patients into three groups: 1) ISB only, 2) I+G (general anesthesia after ISB without epinephrine), and 3) I+E+G (general anesthesia after ISB with epinephrine). Mean blood pressure (MBP) and heart rate (HR) were measured for 30 minutes at 5-minute intervals. Results: The study analyzed data from 431 patients. MBP tended to decrease gradually in the groups I+G and I+E+G. There were significant differences in MBP between the groups I+G and I, and between the groups I+G and I+E+G. Group I+E+G showed a significant increase in HR compared with the other two groups. Conclusions: ISB with an epinephrine mixture did not prevent hypotension caused by the BCP after general anesthesia. HR increased only in response to the epinephrine mixture. A well-planned prospective study is required to compare hemodynamic changes in that context.

Effect of hydroxyethyl starch on blood glucose levels

안태훈,정기태,심수빈,최우영 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.4

Background: Hydroxyethyl starch (HES), a commonly used resuscitation fluid, has the property to induce hyperglycemia as it contains large ethyl starch, which can be metabolized to produce glucose. We evaluated the effect of 6% HES- 130 on the blood glucose levels in non-diabetic patients undergoing surgery under spinal anesthesia. Methods: Patients scheduled to undergo elective lower limb surgery were enrolled. Fifty-eight patients were divided into two groups according to the type of the main intravascular fluid used before spinal anesthesia (Group LR: lactated Ringer’s solution, n = 30 vs. Group HES: 6% hydroxyethyl starch 130/0.4, n = 28). Blood glucose levels were measured at the following time points: 0 (baseline), 20 min (T1), 1 h (T2), 2 h (T3), 4 h (T4), and 6 h (T6). Results: Mean blood glucose levels at T5 in the LR group and T4, T5 in the HES group, increased significantly compared to baseline. There were no significant changes in the serial differences of mean blood glucose levels from baseline between the two groups. Conclusions: Administration of 6% HES-130 increased blood glucose levels within the physiologic limits, but the degree of glucose increase was not greater than that caused by administration of lactated Ringer’s solution. In conclusion, we did not find evidence that 6% HES-130 induces hyperglycemia in non-diabetic patients.

Comparison of the clinical performance of the modified Marsh model for propofol between underweight and normal-weight patients with Crohn’s disease

박수경,최병문,박지현,강현욱,노규정 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.6

Background: The aim of this retrospective study was to compare the clinical performance of the modified Marsh model for propofol between underweight and normal-weight patients with Crohn’s disease. Methods: The medical records of 50 patients who underwent elective surgery for Crohn’s disease were reviewed retrospectively. Propofol and remifentanil were administered using target effect-site concentration (Ce)-controlled infusion with the modified Marsh and Minto models. Target Ce values of propofol were adjusted within a range of 2.5–3 μg/ml to maintain a bispectral index (BIS) value of less than 60 during anesthesia maintenance. Dosages of anesthetic agents administered during surgery were compared between underweight and normal-weight patients. The infusion profiles of patients were applied as inputs to calculate the Ce values in the Schnider model. Results: The total midazolam and remifentanil dosages required for underweight patients were higher than those required for normal-weight patients to maintain BIS values at less than 60 within a target propofol Ce range of 2.5–3 μg/ ml. Simulation results suggested that the Schnider model may be an appropriate pharmacokinetic model for target-controlled infusion in underweight patients, as the clearance was consistently higher in the Schnider model than the modified Marsh model, particularly in underweight patients. Conclusions: The modified Marsh model might cause inadvertent propofol underdosing in underweight patients. Future studies are necessary to compare the predictive performance of the modified Marsh and Schnider pharmacokinetic models in underweight patients.

Comparison of the impact of applications of Targeted Transfusion Protocol and Massive Transfusion Protocol in trauma patients

Shahram Paydar,Behnam Dalfardi,Hosseinali Khalili,Golnar Sabetian,Shahram Bolandparvaz,Mohammad Hadi Niakan,Hamidreza Abbasi,Donat R. Spahn 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.6

Background: The current study assessed a recently developed resuscitation protocol for bleeding trauma patients called the Targeted Transfusion Protocol (TTP) and compared its results with those of the standard Massive Transfusion Protocol (MTP). Methods: Per capita utilization of blood products such as packed red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrates was compared along with mortality rates during two 6-month periods, one in 2011 (when the standard MTP was followed) and another in 2014 (when the TTP was used). In the TTP, patients were categorized into three groups based on the presence of head injuries, long bone fractures, or penetrating injuries involving the trunk, extremities, or neck who were resuscitated according to separate algorithms. All cases had experienced motor vehicle accidents and had injury severity scores over 16. Results: No statistically significant differences were observed between the study groups at hospital admission. Per capita utilization of RBC (4.76 ± 0.92 vs. 3.37 ± 0.55; P = 0.037), FFP (3.71 ± 1.00 vs. 2.40 ± 0.52; P = 0.025), and platelet concentrate (1.18 ± 0.30 vs. 0.55 ± 0.18; P = 0.006) blood products were significantly lower in the TTP epoch. Mortality rates were similar between the two study periods (P = 0.74). Conclusions: Introduction of the TTP reduced the requirements for RBCs, FFP, and platelet concentrates in severely injured trauma patients.

Synergism between rocuronium and cisatracurium: comparison of the Minto and Greco interaction models

김태균,전소은,권재영,김해규 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.4

Background: This study was conducted to investigate the pharmacodynamic interaction between rocuronium and cisatracurium using the response surface model, which is not subject to the limitations of traditional isobolographic analysis. Methods: One hundred and twenty patients were randomly allocated to receive one of the fifteen predefined combinations of rocuronium and cisatracurium. To study single drugs, cisatracurium 0.2, 0.15, or 0.1 mg/kg or rocuronium 0.8, 0.6 or 0.4 mg/kg doses were administered alone. To study the pharmacodynamic interaction, drugs were applied in three types of combination ratio, i.e., half dose of each drug alone, 75% of each single dose of rocuronium and 25% of each single dose of cisatracurium, and vice versa. Train-of-four (TOF) ratio and T1% (first twitch of the TOF presented as percentage compared to the initial T1) were used as pharmacodynamic endpoints, and the Greco and Minto models were used as surface interaction models. Results: The interaction term α of the Greco model for TOF ratio and T1% measurements showed synergism with values of 0.977 and 1.12, respectively. Application of the Minto model resulted in U50 (θ) values (normalized unit of concentration that produces 50% of the maximal effect in the 0 < θ < 1 region) less than 1 for both TOF ratio and T1% measurements, indicating that rocuronium and cisatracurium exhibit synergism. Conclusions: Response surface modeling of the interaction between rocuronium and cisatracurium, based on considerations of their effects on muscle relaxation as measured by TOF ratio and T1%, indicated that the two drugs show considerable synergism.

A comparison between ketorolac and nefopam as adjuvant analgesics for postoperative patient-controlled analgesia: a randomized, double-blind, prospective study

손지선,고성훈,두아람,권영준,한영진 대한마취통증의학회 2017 Korean Journal of Anesthesiology Vol.70 No.6

Background: We compared the analgesic efficacy and side effects of ketorolac and nefopam that were co-administered with fentanyl via intravenous patient-controlled analgesia. Methods: One hundred and sixty patients scheduled for laparoscopic cholecystectomy were randomly assigned to ketorolac (Group K) or nefopam (Group N) groups. The anesthetic regimen was standardized for all patients. The analgesic solution contained fentanyl 600 μg and ketorolac 180 mg in Group K, and fentanyl 600 μg and nefopam 120 mg in Group N. The total volume of analgesic solution was 120 ml. Postoperative analgesic consumption, recovery of pulmonary function, and pain intensities at rest and during the forced expiration were evaluated at postoperative 2, 6, 24, and 48 h. The postoperative side effects of analgesics were recorded. Results: Cumulative postoperative analgesic consumptions at postoperative 48 h were comparable (Group K: 93.4 ± 24.0 ml vs. Group N: 92.9 ± 26.1 ml, P = 0.906) between the groups. Pain scores at rest and during deep breathing were similar at the time of each examination. The recovery of pulmonary function showed no significant differences between the groups. Overall, postoperative nausea and vomiting incidence was higher in Group N compared with Group K (59% vs. 34%, P = 0.015). The other side effects were comparable between both groups. Conclusions: Analgesic efficacies of ketorolac and nefopam that were co-administered with fentanyl for postoperative pain management as adjuvant analgesics were similar. However, postoperative nausea and vomiting incidence was higher in the nefopam-fentanyl combination compared with the ketorolac-fentanyl combination.