전신마취와 병행한 상박신경총 사각근간 차단 후 발생한 호흡곤란 환자의 술 후 통증조절 증례 보고
Postoperative Analgesia in Dyspneic Patient after Interscalene Brachial Plexus Block with General Anesthesia A case report
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Abstract
A 46 year old, ASA physical status I, 50 kg and 160 cm woman, with left shoulder calcific tendonitis, presented for surgical excision of calcium deposits. Preoperative examinations were within normal limits, with the exception of the 1st degree AV block on ECG. Interscalene brachial plexus block, with 20 ml of 0.75% ropivacaine, was carried out prior to general anesthesia. The intra-operative course was uneventful. She complained of dyspnea and chest discomfort in the recovery room, and her SpO2 dropped to 89%. A chest X-ray showed an upward displacement of the left hemidiaphragm and she could not maintain a head lift for 5 seconds. She was diagnosed with left ipsilateral hemidiaphragmatic paresis and residual neuromuscular blockade. She was treated with oxygen inhalation under deep breathing. The dyspnea recovered 3 hours after brachial plexus block and a continuous infusion of 0.2% ropivacaine, which were started for pain control. Three days later, she was discharged without any complications. It was concluded that the respiratory movement should be carefully observed following interscalene brachial plexus block with general anesthesia, especially during recovery of anesthesia.
참고문헌 (14)
- "Interscalene brachial plexus analgesia after open shoulder surgery:continuous versus patient-controlled infusion", 89, pp.1216~1220 (1999)
- "The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine plus fentanyl on diaphragmatic motility and ventilatory function", 18, pp.93~7 (1993)
- "Patient-controlled analgesia after major shoulder surgery:patient- controlled interscalene analgesia versus patient-controlled analgesia", 87, pp.1343~1347 (1997)
- "One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography", 72, pp.498~503 (1991)
- "Total spinal anesthesia after interscalene blockade of the brachial plexus", 80, pp.939~41 (1994)
- "Pulmonary function changes during interscalene brachial plexus block:effects of decreasing local anesthetic injection volume", 18, pp.244~9 (1993)
- "Respiratory effects of low-dose bupivacaine interscalene block", 82, pp.217~220 (1999)
- "Diaphragmatic motion during continuous interscalene brachial plexus block", 20, pp.543~544 (1995)
- "Effect of continuous interscalene brachial plexus block on diaphragm motion and on ventilatory function", 36, pp.53~7 (1992)
- "Residual paralysis induced by either vecuronium or rocuronium after reversal with pyridostigmine", 95, pp.1656~1660 (2002)
- "An attempt to prevent spread of local anaesthetic to the phrenic nerve by compression above the injection site during the interscalene brachial plexus block", 15, pp.453~456 (1998)
- "Factors influencing distribution of local anesthetic injected into the brachial plexus sheath", 58, pp.225~34 (1979)
- "Phrenic nerve block caused by interscalene brachial plexus block:effects of digital pressure and a low volume of local anesthetic", 24, pp.231~235 (1999)
- "Digital pressure during interscalene block is clinically ineffective in preventing anesthetic spread to the cervical plexus", 83, pp.366~370 (1996)