S-Space College of Veterinary Medicine (수의과대학) Dept. of Veterinary Medicine (수의학과) Theses (Ph.D. / Sc.D._수의학과)
Evaluation of Factors Influencing Epidural Anesthesia in Dogs
개의 경막외마취에 영향을 미치는 인자의 평가
|dc.description||학위논문 (박사)-- 서울대학교 대학원 : 수의학과(임상수의학전공), 2015. 8. 이인형.||-|
|dc.description.abstract||본 연구는 개의 경막외마취에 영향을 미치는 인자를 평가하여 경막외마취에 대한 실질적인 기준을 제시하기 위해 실시하였으며, 총 4개의 장으로 구성하였다.
제1장에서는 흉와위에서 흉요추 부위의 높이 차이가 경막외마취침을 이용한 경막외마취에 미치는 영향을 검토하였다. 조영제-메틸렌블루 혼합용액을 요천추 경막외공간에 주사하고 경막외강 상행경사로 (주사위치로부터 가장 높은 척추까지)의 수직높이 및 각도에 따른 경막외분포를 평가한 결과, 경막외분포와 수직높이 및 각도와의 유의적인 연관성은 확인되지 않았다. 조영제-메틸렌블루 혼합용액은 경막외용액의 유체역학연구를 용이하게 하였으며, 요천추 부위의 높이 차이가 경막외용액의 분포에 영향을 미치지 않는다는 것을 확인하였다.
제2장에서는 주사속도에 따른 경막외강압력의 증가가 경막외마취침을 이용한 경막외마취에 미치는 영향을 검토하였다. 압력측정장비에 연결된 두 개의 척수침을 각각 제6번 및 제7번 요추사이 및 요천추 경막외공간에 삽입한 후, bupivacaine-iohexol 혼합용액을 요천추 부위 경막외강에 투여하는 동안 각각의 척수침을 통해 경막외강압력과 주사압력을 측정하였다. 1 및 2 ml/minute의 속도로 주사한 후, 경막외분포와 감각차단영역을 평가하였다. 주사속도에 따라 최고 경막외강압력 및 최고 주사압력에서 유의적인 차이가 확인되었으나, 경막외분포와 감각차단영역에서는 유의적인 차이가 확인되지 않았다. 주사부위와 압력측정부위를 분리하여 정확한 경막외강압력의 측정이 가능하였으며, 주사속도의 증가가 경막외강압력을 증가시키나, 경막외분포와 감각차단영역에는 영향을 미치지 않음을 확인하였다.
제3장에서는 '국소마취제의 투여량'이 카테터를 이용한 흉추 경막외마취에 미치는 영향을 검토하였다. 카테터를 통하여 네 가지 용량(0.05, 0.10, 0.15, 0.20 ml/kg)의 lidocaine을 제7번째 흉추 경막외공간에 투여하였다. 감각차단영역의 범위와 균질성이 투여용량에 비례하여 증가함을 확인하였다. 일부 개체에서 일시적인 신경증상(Horner 증후군, 운동실조, 후지마비, 진정, 혼미, 기침)이 관찰되었다. 이와 같은 결과들은 국소마취제의 투여량을 결정할 때, 진통영역의 범위 외에도 균질성과 합병증의 발생이 함께 고려되어야 함을 제시하였다.
제4장에서는 카테터를 이용한 흉추 경막외마취를 개에서 임상적으로 적용하여 그 유효성을 평가하였다. 우측 전지 절단술(n=2)과 폐엽절단술을 위한 개흉술(n=1)에서 bupivacaine 혹은 bupivacaine-morphine 합제를 수술 중ᆞ후 진통을 위해 반복적으로 투여하였다. 효과적인 진통과 최소의 전신 부작용을 확인하였으나, 폐엽절제술을 한 1증례에서 급성 후지마비 증상이 관찰되었으며, 자기공명 영상진단을 통해 급성 추간판탈출증이 진단되었다. 이와 같은 결과들은 경막외마취의 임상적 적용 시 합병증이 없는 안전하고 효과적인 진통관리를 위해 종합적이고 균형적인 접근이 필요함을 제시하였다.
본 연구의 결과들을 통하여, 경막외마취 시 진통발현의 범위는 주로 투여되는 약제의 부피에 의해 영향을 받으며, 흉와위에서 흉요추 부위의 높이차이와 주사속도에 따른 경막외강압력의 변화에는 영향을 받지 않음을 확인하였다. 또한 투여부피의 증가는 진통범위 외에도 진통영역의 균질성을 증가시켰다. 따라서 경막외마취 시 적절하고 고른 진통효과를 위하여 경막외마취침을 이용한 방법뿐만 아니라 카테터를 이용한 방법을 적용할 때에도 상대적으로 많은 부피로 약제를 투여하는 것이 추천된다. 그러나, 경막외마취의 적용 시에는 관련 합병증을 예방하기 위해서 종합적이고 균형적인 접근이 필요하다고 판단된다.
|dc.description.abstract||This study was performed to establish practical guidelines for epidural anesthesia (EA) through evaluation of factors influencing EA in dogs, and consists of four chapters.
In chapter I, the effect of difference in vertebral height at the thoracolumbar region on EA was verified using the needle technique in sternally recumbent dogs. Contrast medium-methylene blue (CM-MB) mixture was injected at the lumbosacral (L7-S1) epidural space for evaluation of cranial spread according to the perpendicular height (PH) and angle of the upward slope (from the injection point to the highest vertebra) along the epidural canal. However, the epidural spread did not show significant correlations with PH and angle. The CM-MB mixture facilitated the hydrodynamic study of epidural solution, and it was verified that the upward slope had no significant inhibitory effect on the cranial spread of epidural solution.
In chapter II, the effect of epidural pressure according to injection speed on EA was verified using the needle technique. Two spinal needles connected to electrical pressure transducers were inserted into the L6-L7 and the L7-S1 epidural spaces to measure epidural and injection pressure (EP and IP, respectively) during injection of a bupivacaine-iohexol mixture via the spinal needle at L7-S1. After injection with two speeds (1 and 2 ml/minute), epidural distribution (ED) and sensory blockade (SB) were evaluated. Significant differences were observed according to injection speed for peak EP and peak IP, but not for ED and SB. Separating the epidural injection and pressure monitoring lines facilitated accurate EP profiling during injection, and it was verified that the increase in epidural injection speed increased the EP, but not the epidural spread or blockade.
In chapter III, the volume effect of local anesthetic solution on thoracic EA was evaluated using the catheter technique. Epidural injection of lidocaine with four different volumes (0.05, 0.10, 0.15, and 0.20 ml/kg) was performed at the seventh thoracic epidural space via an epidural catheter. The extent and homogeneity of dermatomal SB increased according to the volumes administered. Some dogs showed temporary neurologic signs (Horners syndrome, paraplegia, ataxia, depression, and stupor) which had a tendency to increase in their frequency and severity when high volumes were administered. The results suggested that not only the extent of epidural blockade, but also its homogeneity and neurologic complications, should be concurrently considered when choosing an injectate volume of local anesthetics.
In chapter IV, the clinical application of thoracic EA with a catheter was evaluated in dogs. Bupivacaine or a bupivacaine-morphine combination was repeatedly administered at 0.2 ml/kg to provide intra- and postoperative analgesia after amputation of the right thoracic limb (n = 2) and thoracotomy for pulmonary lobectomy (n = 1). Effective analgesia was shown with minimal systemic effects. However, sudden paraplegia was observed in the thoracotomy case, and acute intervertebral disc disease was diagnosed through magnetic resonance imaging. These results suggested that clinical application of EA requires a coordinated multidisciplinary approach for safe and effective pain management without complications.
Through the present studies, it was verified that EA was primarily influenced by injection volume, but not by the difference in vertebral height in sternal recumbency or epidural pressure according to injection speed. In addition, higher injection volume increased not only the extent of SB and ED, but also their homogeneity. Therefore, a relatively high volume of injectate is recommended to provide even and adequate analgesia when performing EA using an epidural catheter as well as a needle. However, the use of EA requires a coordinated multidisciplinary approach to reduce the occurrence of potential complications.
Cranial Epidural Spread of Contrast Medium and Methylene Blue Dye in Sternally Recumbent Anesthetized Dogs
Materials and Methods
4. Epidural injection of solution·········································11
5. Evaluation of epidural spread········································12
6. Statistical analyses·····················································14
The Effect of Epidural Injection Speed on Epidural Pressure and Distribution of Solution in Anesthetized Dogs
Materials and Methods
2. Anesthesia and positioning···········································27
3. Epidural injection and the pressure measuring system············28
4. Computed tomography to evaluate epidural distribution·········30
5. Evaluation of the extent of sensory blockade······················31
6. Statistical analyses·····················································32
1. Epidural and injection pressures·····································34
2. Epidurography and sensory blockade·······························37
The Volume Effect of Lidocaine on Thoracic Epidural Analgesia in Conscious Beagle Dogs
Materials and Methods···················································48
1. Epidural catheterization···············································49
3. Epidural blockade······················································53
4. Statistical analyses·····················································55
1. Epidurography and epidural blockade·······························57
Clinical Application of Thoracic Epidural Analgesia Using a Catheter in 3 Dogs
Materials and Methods
2. Anesthetic techniques·················································77
1. Case 1···································································80
2. Case 2···································································82
3. Case 3···································································84
ABSTRACT IN KOREAN··········································105
|dc.title||Evaluation of Factors Influencing Epidural Anesthesia in Dogs||-|
|dc.title.alternative||개의 경막외마취에 영향을 미치는 인자의 평가||-|
- Appears in Collections:
- College of Veterinary Medicine (수의과대학)Dept. of Veterinary Medicine (수의학과)Theses (Ph.D. / Sc.D._수의학과)