본문 바로가기
KERD
논문KCI 등재

수술 중 신경계 추적 감시 검사와 근 이완 마취 심도의 측정

Intraoperative Neurophysiological Monitoring and Neuromuscular Anesthesia Depth Monitoring

Sang-Ku Park|Sang-Hun Kim|Soon-Bu Park|Hyo-Chan Kang
대한임상검사과학회 (Korean Society for Clinical Laboratory Science)|2020.12|대한임상검사과학회지 (Korean Journal of Clinical Laboratory Science)|제52권 제4호|pp. 317-326|DOI 10.15324/kjcls.2020.52.4.317

1

조회

0

다운로드

2

인용

0

참고문헌

키워드

AnesthesiaMuscle relaxationNeurophysiological monitoring
주제분류기타자연과학

초록

마취는 의식의 차단 역할을 하는 주 마취제와 감각, 운동, 반사의 차단을 하는 부 마취제인 근이완제로 구분된다. 깊은 의식의 차단만으로는 심한 자극에 대한 반응을 막을 수 없고, 다량의진통제만으로는 무의식을 보장할 수 없다. 그러므로 마취는 동시에 두 가지를 모두 만족시켜야 한다. 근 이완제는 흡입 또는 정맥마취제의 투여 용량을 감소시키면서 기관지내 삽입관, 수술시야 및 수술적 환경(operating conditions)을 향상시킬 수 있으며, 수술 중 기계적 조절 환기(controlled mechanical ventilation) 시 호흡 관리를 위하여 매우 중요하다. 이러한 근이완제는 투여 용량이 과다하면 수술 중 신경 검사가 안 되는 영향을 줄 수 있고, 투여 용량이 부족하게 되면 환자가 수술 중 움직일 수 있어서 근 이완 마취 심도와 수술 중 감시 검사는 밀접한관계가 있다. 근 이완제를 많이 사용하면, 수술 중 신경생리학적검사가 원활하게 되지 않는 단점과 수술 이후에 완전히 근 이완효과를 제거하기 어렵다는 단점도 갖고 있다. 수술 중 감시 검사를 하는 수술에서 마취과에서는 어떠한 기준으로 근 이완제를투여하며 유지하는지에 대하여 국내뿐만 아니라 전 세계적인 동향을 살펴 봄으로써 보다 원활한 수술 중 신경 검사가 되길 바란다.

Abstract

Deep blocking of consciousness alone does not prevent a reaction to severe stimuli, and copious amounts of pain medication do not guarantee unconsciousness. Therefore, anesthesia must satisfy both: the loss of consciousness as well as muscle relaxation. Muscle relaxants improve the intra-bronchial intubation, surgical field of vision, and operating conditions, while simultaneously reducing the dose of inhalation or intravenous anesthesia. Muscle relaxants are also very important for breathing management during controlled mechanical ventilation during surgery. Excessive dosage of such muscle relaxants may therefore affect neurological examinations during surgery, but an insufficient dosage will result in movement of the patient during the procedure. Hence, muscle relaxation anesthesia depth and neurophysiological monitoring during surgery are closely related. Using excessive muscle relaxants is disadvantageous, since neurophysiological examinations during surgery could be hindered, and eliminating the effects of complete muscle relaxation after surgery is challenging. In the operation of neurophysiological monitoring during the operation, the anesthesiologist administers muscle relaxant based on what standard, it is hoped that the examination will be performed more smoothly by examining the trends in the world as well as domestic and global trends in maintaining muscle relaxant.

참고문헌 (45)

  1. Griffith HR, "The use of curare in general anesthesia", Anesthesiology, 3, pp.418~420 (1942)
  2. Henry K. Beecher, "A STUDY OF THE DEATHS ASSOCIATED WITH ANESTHESIA AND SURGERY", Annals of Surgery, 140(1), pp.2~33 (1954), Ovid Technologies (Wolters Kluwer Health)[DOI]
  3. M. V. Madsen, "Is deep neuromuscular blockade beneficial in laparoscopic surgery? Yes, probably", Acta Anaesthesiologica Scandinavica, 60(6), pp.710~716 (2016), Wiley[DOI]
  4. George H Meakin, "Role of muscle relaxants in pediatric anesthesia", Current Opinion in Anaesthesiology, 20(3), pp.227~231 (2007), Ovid Technologies (Wolters Kluwer Health)[DOI]
  5. Ali HH, "Quantitative assessment of residual antidepolarizing block", I. Br J Anaesth, 43, pp.473~477 (1971)[DOI]
  6. 서혜정, "잔류 근이완과 신경근 감시에 대한 설문 조사", Anesthesia and Pain Medicine, 5(1), pp.70~74 (2010), 대한마취통증의학회
  7. K. Fruergaard, "Tactile evaluation of the response to double burst stimulation decreases, but does not eliminate, the problem of postoperative residual paralysis", Acta Anaesthesiologica Scandinavica, 42(10), pp.1168~1174 (1998), Wiley[DOI]
  8. C. R. Mortensen, "Perioperative monitoring of neuromuscular transmission using acceleromyography prevents residual neuromuscular block following pancuronium", Acta Anaesthesiologica Scandinavica, 39(6), pp.797~801 (1995), Wiley[DOI]
  9. George D. Shorten, "Perioperative train-of-four monitoring and residual curarization", Canadian Journal of Anaesthesia, 42(8), pp.711~715 (1995), Springer Science and Business Media LLC[DOI]
  10. Bevan DR, "Monitoring and reversal of neuromuscular block", Am J Health Syst Pharm, 56(11 Suppl 1), pp.10~13 (1999)[DOI]
  11. Glenn S. Murphy, "Residual Neuromuscular Block", Anesthesia & Analgesia, 111(1), pp.120~128 (2010), Ovid Technologies (Wolters Kluwer Health)[DOI]
  12. H. BERG, "Residual neuromuscular block is a risk factor for postoperative pulmonary complications A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium", Acta Anaesthesiologica Scandinavica, 41(9), pp.1095~1103 (1997), Wiley[DOI]
  13. Bertrand Debaene, "Residual Paralysis in the PACU after a Single Intubating Dose of Nondepolarizing Muscle Relaxant with an Intermediate Duration of Action", Anesthesiology, 98(5), pp.1042~1048 (2003), Ovid Technologies (Wolters Kluwer Health)[DOI]
  14. C Baillard, "Residual curarization in the recovery room after vecuronium", British Journal of Anaesthesia, 84(3), pp.394~395 (2000), Elsevier BV[DOI]
  15. Lee JS, "Postoperative residual curarization in the recovery room after vecuronium or rocuronium use", Anesth Pain Med, 1, pp.101~105 (2006)
  16. C. R. Mortensen, "Perioperative monitoring of neuromuscular transmission using acceleromyography prevents residual neuromuscular block following pancuronium", Acta Anaesthesiologica Scandinavica, 39(6), pp.797~801 (1995), Wiley[DOI]
  17. M. J. Scott, "Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations", Acta Anaesthesiologica Scandinavica, 59(10), pp.1212~1231 (2015), Wiley[DOI]
  18. Baillard C, "Postoperative residual neuromuscular block : a survey of management", Br J Anaesth, 95, pp.622~626 (2005)[DOI]
  19. Sangseok Lee, "What anesthesiologists ask to know and should know about the neuromuscular monitoring: an updated review", Anesthesia and Pain Medicine, 12(1), pp.1~8 (2017), The Editorial Office of Anesthesia and Pain Medicine[DOI]
  20. T.H. Christie, "THE ST. THOMAS'S HOSPITAL NERVE STIMULATOR IN THE DIAGNOSIS OF PROLONGED APNŒA", The Lancet, 271(7024), pp.776~ (1958), Elsevier BV[DOI]
  21. Ali HH, "Quantitative assessment of residual antidepolarizing block", I. Br J Anaesth, 43, pp.473~477 (1971)[DOI]
  22. 박상구, "수술 중 신경학적인 모니터링과 마취", 대한임상검사과학회지, 44(4), pp.184~198 (2012), 대한임상검사과학회
  23. T. Fuchs-Buder, "Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision", Acta Anaesthesiologica Scandinavica, 51(7), pp.789~808 (2007), Wiley[DOI]
  24. Guillaume Michaud, "Dominance of the Hand Does Not Change the Phonomyographic Measurement of Neuromuscular Block at the Adductor Pollicis Muscle", Anesthesia & Analgesia, 100(3), pp.718~721 (2005), Ovid Technologies (Wolters Kluwer Health)[DOI]
  25. Claudius C, "Arm-to-arm variation when evaluating neuromuscular block : an analysis of the precision and the bias and agreement between arms when using mechanomyography or acceleromyography", Br J Anaesth, 105, pp.310~317 (2010)[DOI]
  26. Sangseok Lee, "Immobilization with Atrophy Induces De Novo Expression of Neuronal Nicotinic α7 Acetylcholine Receptors in Muscle Contributing to Neurotransmission", Anesthesiology, 120(1), pp.76~85 (2014), Ovid Technologies (Wolters Kluwer Health)[DOI]
  27. Kyo S. Kim, "The Duration of Immobilization Causes the Changing Pharmacodynamics of Mivacurium and Rocuronium in Rabbits", Anesthesia & Analgesia, 96(2), pp.438~442 (2003), Ovid Technologies (Wolters Kluwer Health)[DOI]
  28. Kyo S. Kim, "Rabbits Treated with Chronic Isepamicin Are Resistant to Mivacurium and Rocuronium", Anesthesia & Analgesia, 88(3), pp.654~658 (1999), Ovid Technologies (Wolters Kluwer Health)[DOI]
  29. Dae Woo Kim, "Interactions Between Mivacurium, Rocuronium, and Vecuronium During General Anesthesia", Anesthesia & Analgesia, 83(4), pp.818~822 (1996), Ovid Technologies (Wolters Kluwer Health)[DOI]
  30. R.G Rohling, "Risk of recurarization during retransfusion of autologous blood withdrawn after injection of muscle relaxants: a comparison of rocuronium and mivacurium", Journal of Clinical Anesthesia, 15(2), pp.85~90 (2003), Elsevier BV[DOI]
  31. A. Bräuer, "Preoperative prewarming as a routine measure", Der Anaesthesist, 59(9), pp.842~850 (2010), Springer Science and Business Media LLC[DOI]
  32. Tom Heier, "Impact of Hypothermia on the Response to Neuromuscular Blocking Drugs", Anesthesiology, 104(5), pp.1070~1080 (2006), Ovid Technologies (Wolters Kluwer Health)[DOI]
  33. 김용범, "신경근 감시장치를 부착한 손목의 보온이 강직후 연축수 측정을 이용한 깊은 신경근 차단의 회복예측에 미치는 영향", Anesthesia and Pain Medicine, 6(2), pp.164~168 (2011), 대한마취통증의학회
  34. Mohamed Naguib, "A Survey of Current Management of Neuromuscular Block in the United States and Europe", Anesthesia & Analgesia, 111(1), pp.110~119 (2010), Ovid Technologies (Wolters Kluwer Health)[DOI]
  35. CyrilJacob Chacko, "Survey on neuromuscular management", Journal of Anaesthesiology Clinical Pharmacology, 32(1), pp.122~ (2016), Medknow[DOI]
  36. M. Grayling, "Recovery from neuromuscular blockade: a survey of practice", Anaesthesia, 62(8), pp.806~809 (2007), Wiley[DOI]
  37. M. R. Checketts, "Recommendations for standards of monitoring during anaesthesia and recovery 2015 : Association of Anaesthetists of Great Britain and Ireland", Anaesthesia, 71(1), pp.85~93 (2016), Wiley[DOI]
  38. Kyo S. Kim, "Residual Paralysis Induced by Either Vecuronium or Rocuronium After Reversal with Pyridostigmine", Anesthesia & Analgesia, 95(6), pp.1656~1660 (2002), Ovid Technologies (Wolters Kluwer Health)[DOI]
  39. R. Martin, "Neuromuscular monitoring: does it make a difference?", Canadian Journal of Anaesthesia, 43(6), pp.585~588 (1996), Springer Science and Business Media LLC[DOI]
  40. A. Feldheiser, "Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice", Acta Anaesthesiologica Scandinavica, 60(3), pp.289~334 (2016), Wiley[DOI]
  41. J. Urriza, "Integrative action of axonal membrane explored by trains of subthreshold stimuli applied to the peripheral nerve", Clinical Neurophysiology, 127(2), pp.1707~1709 (2016), Elsevier BV[DOI]
  42. 박상구, "수술 중 신경 생리학적인 모니터링의 기본 기술", 대한임상검사과학회지, 45(2), pp.77~85 (2013), 대한임상검사과학회
  43. 차재관, "체성감각 유발 전위에서 Montage에 대한 개념", Annals of Clinical Neurophysiology, 1(2), pp.160~167 (1999), 대한임상신경생리학회
  44. "Guideline 11C:Recommended standards for intraoperative monitoring of auditory evoked potentials" (2019)[URL]
  45. 임성혁, "수술 중 신경계감시검사에서 검사에 따른 전극의 삽입 및 제거방법", 대한임상검사과학회지, 51(4), pp.453~461 (2019), 대한임상검사과학회[DOI]

관련 논문AI추천

수술 중 신경학적인 모니터링과 마취강지혁, 김기봉, 김동준, 박상구, 박진우, 박찬우, 임성혁, 지효근대한임상검사과학회 · 대한임상검사과학회지2012 · 제44권 제4호수술 중 신경계감시검사에서 검사에 따른 전극의 삽입 및 제거방법김종식, 문대영, 박상구, 박순부, 임성혁, 최영두대한임상검사과학회 · 대한임상검사과학회지2019 · 제51권 제4호수술 중 신경생리 추적감시박윤길대한근전도전기진단의학회 · 대한근전도 전기진단의학회지2013 · 제15권 제1호중증근무력증 환자의 마취 2례 보고박대팔, 이경철영남대학교 의과대학 · Journal of Yeungnam Medical Science1985 · 제2권 제1호Clinical practice guidelines for intraoperative neurophysiological monitoring: 2020 updateKorean Academy of Rehabilitation Medicine, Korean Association of EMG Electrodiagnostic Medicine, Korean Neurological Association, Korean Society of Clinical Neurophysiology, Korean Society of Intraoperative Neurophysiological Monitoring대한임상신경생리학회 · Annals of Clinical Neurophysiology2021 · 제23권 제1호수술증 신경계 감시서대원대한임상신경생리학회 · Annals of Clinical Neurophysiology2008 · 제10권 제1호

이 간행물의 다른 논문 (15건)

코로나바이러스: 사스, 메르스 그리고 코비드-19Eun-Joong Kim, 이동섭pp. 297-309Medical Implementation of Microarray TechnologyJi Un Kangpp. 310-316Relationship between Metabolic Syndrome, Metabolic Syndrome Score, Insulin Resistance and Beta Cell Function in Korean Adults with Obesity윤현pp. 327-334폐결핵 진단을 위한 실시간중합효소연쇄반응과 AFB 염색진단검사의정량적 연관성 비교Sunghyun Kim, 최재선, Sang-Ha Kim, Young-Kwon Kim, Taewon Jungpp. 335-341대전지역의 요로감염 환자로부터 분리된 요로병인성 대장균ST131과 Non-ST131의 비교 분석조혜현pp. 342-348
원문 보기