두피모반 수술을 시행받는 소아에서 Sevoflurane 마취 시 두피신경 차단술이 수술 후 각성흥분에 미치는 영향
The effect of scalp nerve block on the emergence agitation in children undergoing nevus surgery during sevoflurane anesthesia
- 주제(키워드) emergence agitation , sevoflurane , scalp nevus excision , scalp nerve block
- 발행기관 아주대학교
- 지도교수 김종엽
- 발행년도 2017
- 학위수여년월 2017. 8
- 학위명 석사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000025546
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
BACKGROUND: Emergence agitation (EA) is a common problem in children after recovery from sevoflurane anesthesia. Pain is considered as being one cause of postoperative EA and the compounding factor for agitation assessment in children. The purpose of this study was to investigate the pure effect of postoperative pain on EA after sevoflurane anesthesia in preschool children undergoing excision of scalp nevi. METHODS: Forty-four children, 1-7 years old, undergoing scalp nevus excision were enrolled. Patients were randomly assigned to two groups: the remifentanil group received single intravenous injection of short-acting synthetic opioid, remifentanil 1 μg/kg just before the scalp incision, and the block group received scalp nerve block with 0.25% ropivacaine after the endotracheal intubation. The end-tidal sevoflurane concentration was maintained around 1.5 vol% unless the mean arterial pressure is out of ± 20% range of preoperative values during surgery in both groups. Watcha behavior scale for EA and face, legs, activity, cry, consolability (FLACC) scale scores for pain were recorded postoperatively. RESULTS: There was no difference in end-tidal sevoflurane concentration between the two groups during surgery and the emergence period. Agitation incidence and scores were not different between the two groups during the recovery period. FLACC scale was significantly lower than in the block group than in the remifentanil group at post-anesthesia care unit (PACU) arrival, at 10 and 20 min after PACU arrival, respectively [median (interquartile range); 2 (2-4) vs.5 (3-7), p = 0.002; 2 (2-3) vs. 3(2-5), p = 0.015; 1 (1-2) vs. 2.5 (1-4), p = 0.015]. The number of patients requiring rescue analgesics was significantly lower in the block group than in the remifentanil group [1/22 (5%) vs. 8/22 (36%), p = 0.009]. CONCLUSION: The pre-incisional scalp nerve block decreased the early postoperative pain after nevus excision, but it did not decrease the incidence of EA, compared with pre-incisional single intravenous injection of remifentanil, in the clinical setting of similar anesthetic concentration of sevoflurane having been administered. This clinical evidence implies that pharmacokinetics and pharmacodynamics of sevoflurane itself rather than postoperative pain may be a major factor for provoking EA.
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