Laparoscopic cholecystectomy 수술 후 sugammadex와 neostigmine 간에 첫 자발호흡과 부작용 발현 정도 및 영향인자 연구

Abstract

The purpose of the study is to investigate into the time from injection of muscle relaxants to the first spontaneous respiration between sugammadex and conventional reversal for patients of laparoscopic cholecystectomy in retrospective investigation. And the adverse effects in the postanesthetic care unit between 2 reversals, and injection rate of antiemetics for 12 hours will be compared. From 10th January 2014 to twenty seventh April 2017, the 186 patients diagnosed with Gallbladder Stone (N802) were composed of 84 patients in the neostigmine group, 102 patients in the sugammadex group. All statistical analysis were performed with a SPSS version 24.0 for Window (Chicago,IL,USA). The time taken on first spontaneous breathing by sugammadex is faster than that by neostigmine (3.6 min vs 4.9 min; p<0.05). After injection intermediate muscle relaxants, comparing sugammadex group of neostigmine group in aspect of heart rate and mean arterial pressure for 10 minutes after injection it each other, heart rate in neostigmine group is higher than sugammadex group at 5minutes (p<0.05). Mean arterial pressure of neostigmine group is higher than sugammadex group for 10 minutes (p<0.05). The significant adverse effects of neostigmine group is tachycardia (p<0.05), and the frequency of rescue antiemetic of sugammadex group is significantly higher than neostigmine group (p<0.05). sugammadex group achieves spontaneous breathing faster than neostigmine group as much as 78 seconds. But, it is little impact on clinically total anesthetic process. Therefore, it is considered that the choice of drug based on decreasing side effects will be reasonable. In this study, the unwanted effect of neostigmine group is tachycardia, so in case of hemodynamically unstable patient, sugammadex is recommended. And in 12 hours after injection sugammadex to patients, because they need more antiemetics than neostigmine group, it is required to research more on the postoperative nausea vomiting after that.;본 연구는 일반외과 수술중 laparoscopic cholecystectomy를 수행한 환자에서 spontaneous breathing이 돌아올 때, 첫 호흡 시점을 확인하여, 근이완 역전제 투약 후 이 시점까지 소요된 시간(minute)을 conventional reversal 약물인 neostigmine과 신약 sugammadex를 사용한 약물군으로 나누어 비교하고자 하였다. 또한 두 약물군 간의 마취종료 후 부작용 비교 및 근이완 역전제 투약 후 12시간 동안의 antiemetics 투약율을 비교하였다. 원내에 sugammadex가 도입된 2014년 1월 10일부터 2017년 4월 27일까지 gallbladder stone으로 진단되어 laparoscopic cholecystectomy를 받은 환자 186명 중 sugammadex를 사용한 환자는 102명, neostigmine를 사용한 환자는 84명이었다. 첫 spontaneous breathing까지 걸린 시간은 sugammadex 투약군이 neostigmine 투약군보다 빠르게 나타났다(3.6분 vs. 4.9분;p<0.05). 근이완 역전제 투약 후 2분, 5분, 10분에서의 heart rate (HR)와 mean arterial pressure (MAP)를 비교한 결과, 2분, 5분, 10분에서의 MAP는 neostigmine 투약군이 높게 나타났으며 HR는 5분시점에서 neostigmine 투약군이 높게 나타났다(p<0.05). 두 그룹중 neostigmine 투약군에서 높게 나타난 부작용은 tachycardia (p<0.05)이며, sugammadex 투약군에서는 근이완 역전제 투약 후 12시간 이내에 antiemetics의 투약(p<0.05)이 높게 나타났다. 본 연구에서 나타난 부작용으로 sugammadex 군보다 neostigmine 군에서 tachycardia가 유의적으로 많이 발생하였으므로, 혈역학적 측면중 HR가 불안정한 환자에서 sugammadex를 사용하는 것이 추천된다. 또한 근이완 역전제 투약 후 12시간이내에 antiemetics를 투약한 환자군이 sugammadex에서 높게 나타나, 향후 추가연구가 요구된다.