재왕절개술을 위한 부위마취 중 시행한 Propofol 자가 조절 진정법

Background: During regional anesthesia for a cesarean section, adverse effects such as nausea and/or vomiting (N&V), visceral pain and shivering are common complications. A subhypnotic dose of propofol has been known to have an antiemetic effect perioperatively. Patient controlled sedation (PCS) using propofol might be a solution for emesis and other adverse effects occurring during regional anesthesia in cesarean deliveries. Methods: One hundred ten parturients scheduled for elective cesarean section were randomly divided into two groups: PCS-spinal (n = 55) and PCS-epidural (n = 55). Spinal anesthesia was performed with 0.5% bupivacaine 10 mg and 10 ㎍ of fentanyl. Epidural anesthesia was perfortned with 2% lidocaine 25 ml + 100 ㎍ of fentanyl + 0.1 mg of epinephrine + 1.5 ml of 8.4% sodium bicarbonate in the PCS-epidural group. After delivery, PCS with propofol was applied to the patients in both groups (bolus dose: 30 mg, lock-out time: 3 min, no background infusion). We investigated incidences of adverse effects such as N&V, hypotension, intraoperative visceral pain, and shivering during the operation. We also assessed sedation scores (Grade 1 - 5) in the patients of both groups. Results: There was no difference in sensory levels between the groups. Although more patients in the PCS-epidural group complained of NScV (3.6%: 20%, P 0.018) and shivering (0%: 14.5%, P 0.036) in the PACU, there were no differences intraoperative adverse effects between both groups. The sedation score did not differ between the groups. Conclusions: With PCS using propofol, adverse effects during cesarean section under both regional anesthesias are negligible.