• Title/Summary/Keyword: 전신 마취

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DIFFERENT WAYS OF SURGICAL MANAGEMENT FOR CHILDREN WITH CONFOUND ODONTOMA IN THE MANDIBLE (아동의 하악골에 발생한 복합 치아종의 외과적 처치에 관한 증례보고)

  • Chung, Woo-Sung;Choi, Yeong-Chul;Lee, Keung-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.26 no.3
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    • pp.499-506
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    • 1999
  • The odontoma is relatively a common benign odontogenic tumor and caused by overgrowth of odontogenic tissues. The recent classification by World Health Organization divides odontoma into 2 groups such as compound odontoma and complex odontoma. Compound odontoma comprises dental tissues, resembling the morphology of a tooth and has predilection for the anterior maxilla. In contrast, complex odontoma has unorganized mass, not resembling the normal tooth and has predilection for the posterior mandible. The etiology of odontoma is unknown and almost asymptomatic. So, it usually is found in routine radiographic examination, and most common presenting symptom is impacted or unerupted permanent teeth and retained primary teeth. It can occurs almost anywhere in jaws. It is desirable that odontoma should be removed by surgical enucleation including follicle and surrounding soft tissues. Considering the age and behavioral cooperation of patient, the development of permanent dentition, the location of odontoma in jaw, the need for the concomitant operative dentistry, operation is performed in outpatient department with/without sedation or under general anesthesia with endotracheal intubation. In this case report, 2 patients with compound odontoma were treated by surgical enucleation including follicle and surrounding soft tissues. One patient, about 5 years old, was treated under general anesthesia and concomitant operative dentistry was performed. The other patient, about 11 years old, was treated under local anesthesia in outpatient department. In 2 cases, after 4 months, surgical defects were filled with new bone and normalization of eruption path of impacted permanent teeth was observed.

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Effect of Intravenous Administration of Tramadol on the Minimum Alveolar Concentration of Isoflurane in Dogs (개에서 트라마돌의 정맥투여가 아이소플루란의 최소폐포농도에 미치는 영향)

  • Seok, Seong-Hoon;Park, Se-Jin;Lee, Seung-Yong;Jin, So-Young;Kim, Young-Ki;Hwang, Jae-Min;Lee, Hee-Chun;Yeon, Seong-Chan
    • Journal of Veterinary Clinics
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    • v.32 no.4
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    • pp.308-312
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    • 2015
  • This study was aimed to evaluate the effects of tramadol hydrochloride on the minimum alveolar concentration of isoflurane ($MAC_{ISO}$) in dogs. Six healthy, female German shepherd dogs (aged 1-2 years) were used in this study. Anesthesia was induced by mask induction and maintained with isoflurane in oxygen. Mechanical ventilation maintained the end-tidal $CO_2$ partial pressure ($P_{ET}CO_2$) from 35 to 45 mmHg throughout the study. A baseline $MAC_{ISO}$ ($MAC_{ISO}B$) was determined starting 45 minutes after induction of anesthesia by clamping a pedal digit until gross purposeful movement was detected. After $MAC_{ISO}B$ determination, dogs received a tramadol loading dose of 3 mg/kg followed by a continuous rate infusion (CRI) of 2.6 mg/kg/h. The determination of $MAC_{ISO}$ after administration of tramadol ($MAC_{ISO}T$) began 20 min after the start of the CRI. Arterial blood pressure and heart rate were recorded continuously and arterial blood samples for blood gas analysis were collected at the end of the equilibration period. Mean ${\pm}$ SD values for the $MAC_{ISO}B$ and $MAC_{ISO}T$ were $1.33{\pm}0.04%$ and $1.23{\pm}0.04%$, respectively. The $MAC_{ISO}B$ decreased significantly by $7.5{\pm}0.2%$ (P < 0.05) after administration of tramadol. The mean heart rate and arterial blood pressure of six dogs were not changed significantly after tramadol administration. The blood gas levels remained constant during the study. In conclusion, tramadol could significantly reduce $MAC_{ISO}$ without depression of cardiorespiratory function. Thus, the use of tramadol on inhalation anesthesia with isoflurane in dogs can improve the stability of anesthesia and the quality of recovery.

Changes of Blood Gases, Plasma Catecholamine Concentrations and Hemodynamic Data in Anesthetized Dogs during Graded Hypoxia Induced by Nitrous Oxide (아산화질소에 의한 점진적 저산소가스 흡입이 혈중 가스치와 Catecholamine치 및 혈역학에 미치는 영향)

  • Kim, Sae-Yeon;Song, Sun-Ok;Bae, Jung-In;Cheun, Jae-Kyu;Bae, Jae-Hoon
    • Journal of Yeungnam Medical Science
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    • v.15 no.1
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    • pp.97-113
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    • 1998
  • The sympathoadrenal system plays an important role in homeostasis in widely varing external environments. Conflicting findings, however, have been reported on its response to hypoxia. We investigated the effect of hypoxia on the sympathoadrenal system in dogs under halothane anesthesia by measuring levels of circulating catecholamines in response to graded hypoxia. Ten healthy mongreal dogs were mechanically ventilated with different hypoxic gas mixtures. Graded hypoxia and reoxygenation were induced by progressively decreasing the oxygen fraction in the inhalation gas mixture from 21%(control) to 15%, 10% and 5% at every 5 minutes, and then reoxygenated with 60% oxygen. Mean arterial pressure, central venous pressure and mean pulmonary arterial pressure were measured directly using pressure transducers. Cardiac output was measured by the thermodilutional method. For analysis of blood gas, saturation and content, arterial and mixed venous blood were sampled via the femoral and pulmonary artery at the end of each hypoxic condition. The concentration of plasma catecholamines was determined by radioenzymatic assay. According to the exposure of graded hypoxia, not only did arterial and mixed venous oxygen tension decreased markedly at 10% and 5% oxygen, but also arterial and mixed venous oxygen saturation decreased significantly. An increased trend of the oxygen extraction ratio was seen during graded hypoxia. Cardiac output, mean arterial pressure and systemic vascular resistance were unchanged or increased slightly. Pulmonary arterial pressure(PAP) and pulmonary vascular resistance(PVR) were increased by 55%, 76% in 10% oxygen and by 82%, 95% in 5% oxygen, respectively(p<0.01). The concentrations of plasma norepinephrine, epinephrine and dopamine increased by 75%, 29%, 24% in 15% oxygen and by 382%, 350%, 49% in 5% oxygen. These data suggest that the sympathetic nervous system was activated to maintain homeostasis by modifying blood flow distribution to improve oxygen delivery to tissues by hypoxia, but hemodynamic changes might be blunted by high concentration of nitrous oxide except PAP and PVR. It would be suggested that hemodynamic changes might not be sensitive index during hypoxia induced by high concentration of nitrous oxide exposure.

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Establishment of Featal Heart Surgery with an Improvement of the Placental Blood Flow in Cardiopulmonary Bypass Using Fetal Lamb Model (양태아를 이용한 심폐우회술에서의 태반혈류개선을 통한 태아심장수술의 기반기술 확립)

  • 이정렬;박천수;임홍국;배은정;안규리
    • Journal of Chest Surgery
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    • v.37 no.1
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    • pp.11-18
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    • 2004
  • Background: We tested the effect of indomethacine and total spinal anesthesia on the improvement of placental flow during cardiopulmonary bypass on fetal lamb. Material and Method: Twenty fetuses at 120 to 150 days of gestation were subjected to bypass via trans-sternal approach with a 12 G pulmonary arterial cannula and 14 to 18 F venous cannula for 30 minutes. All ewes received general anesthesia with ketamine. In all the fetuses, no anesthetic agents were used except muscle relaxant. Ten served as a control group in which placenta was worked as an oxygenator during bypass (Control group). The remainder worked as an experimental group in which pretreatment with indomethacine and total spinal anesthesia was performed before bypass with the same extracorporeal circulation technique as control group (Experimental group). Observations were made every 10 minutes during a 30-minute bypass and 30-minute post bypass period. Result: Weights of the fetuses ranged from 2.2 to 5.2 kg. In Control group, means of arterial pressure decreased from 44.7 to 14.4 mmHg and means of Pa$CO_2$ increased from 61.9 to 129.6 mmHg at each time points during bypass. Flow rate was suboptimal (74.3 to 97.0 $m\ell$/kg/min) during bypass. All hearts fibrillated immediately after the discontinuation of bypass. On the contrary, in Experimental group, means of arterial pressure reamined higher (45.8 to 30 mmHg) during bypass (p<0.05). Means of Pa$CO_2$ were less ranging from 59.8 to 79.4 mmHg during bypass (P<0.05). Flow rates were higher (78.8 to 120.2 $m\ell$/kg/min) during bypass (p<0.05). There were slower deterioration of cardiac function after cessation of bypass. Conclusion: In this study, we demonstrated that the placental flow was increased during fetal cardiopulmonary bypass in the group pretreated with indomethacine and total spinal anesthesia. However, further studies with modifications of the bypass including a creation of more concise bypass circuit, and a use of axial pump are mandatory for the clinical application.

Effect of Grid Keratotomy on Indolent Corneal Ulcers in Dogs (개에서 만성 각막 상피 결손증 치료법으로서의 각막 격자 절개법)

  • Ahn, Jae-Sang;Kim, Se-Eun;Park, Young-Woo;Ahn, Jeong-Taek;Lee, Yesran;Lee, Eui-Ri;Seo, Kang-Moon;Jeong, Man-Bok
    • Journal of Veterinary Clinics
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    • v.28 no.6
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    • pp.562-565
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    • 2011
  • A total of 29 eyes (25 dogs: one eye, 2 dogs: both eyes) with indolent corneal ulcer were treated with grid keratotomy from January 2008 to March 2010. The corneal lesions were reevaluated at 7-14 day intervals. The treatments had been repeated until fluorescein dye was not retained on the cornea and the epithelium did not appear to be loosely attached to the stromal layer. The healing rate of the corneal ulcers was 86.2%. The mean healing time ($mean{\pm}SD$) was $15.92{\pm}9.19$ days, ranged from 7 to 39 days. The lesions of remaining 4 eyes had deteriorated or not improved for more than 6 weeks. In those cases, $3^{rd}$ eyelid flap following grid keratotomy was applied. After 2 weeks, all of the eyes healed by the treatment. The results in this study suggest that grid keratotomy could be an excellent choice as an initial treatment for superficial corneal ulcers in dogs. In the cases of recurrence or to promote healing of the lesions, however, $3^{rd}$ eyelid flap following grid keratotomy is recommended.

Oxymetazoline as an ${\alpha}_1-Adrenoceptor$ Agonist -A pressor effect in the rabbit- (${\alpha}_1-Adrenoceptor$ Agonist로서의 Oxymetazoline -가토혈압(家兎血壓) 상승작용(上昇作用)-)

  • Park, Young-Tae;Choi, Soo-Hyung
    • The Korean Journal of Pharmacology
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    • v.18 no.2
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    • pp.59-67
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    • 1982
  • 1) Oxymetazoline, which has been known as an agonist for${\alpha}_1-adrenoceptor$ in various peripheral tissues, caused a pressor response in urethane-anesthetized rabbits when given intra-ventricularly. This pressor response was little affected by pretreatment of rabbits with i.v. guanethidine or chlorisondamine, but it was weakened in rabbits pretreated with either of i.v. phentolamine or guanethidine and chlorisondamine and in guanethidine-pretreated adrenal-ligated rabbits. 2) The pressor to intraventricular oxymetazoline was markedly attenuated by intraventricular pretreatment with prazosin, whereas intraventricular pretreatment with yohimbine or piperoxan did not affect this response. 3) Reserpine-pretreated rabbits also responded with hypertension to intraventricular oxymetazoline, which was markedly diminished by pretreatment with intraventricular prazosin but not affected by yohimbine. 4) Oxymetazoline, given intravenously, produced a pressor response in both whole and spinal rabbits. Intravenous prazosin, phentolamine and yohimbine, in this order, showed greater antagonizing effect to this pressor response. 5) The results indicate that oxymetazoline acts an agonist for ${\alpha}_1-adrenoceptors$ in the rabbit brain participating in the regulation of the blood pressure and in the vasculature of rabbits.

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Subxiphoid Pericardial Drainage of Pericardial Effusions (심낭삼출액에 대한 검상하 심낭배액술)

  • 오삼세;장우익
    • Journal of Chest Surgery
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    • v.30 no.7
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    • pp.693-700
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    • 1997
  • To assess the effectiveness of subxipoid pericardial drainage for the treatment of pericardial effusion, we reviewed 80 cases of subxiphoid pericardial drainage between January 1986 and December 1995. There were 39 males and 41 females with ages ranging from 20 to 80 years. The diagnosis of pericardial effusion was made by echocardiography. The procedure was carried out under general anesthesia in 50(62.5%) and under local anesthesia in 30 patients(37.5%). Among the 33 p tients with malignant pericardial effusion, cytology was positive .in 14 of 31(45%), and pericardial biopsy showed malignancy in 7 of 29 patients(24%). Among the 27 patients with tuberculous pericardial effusion, the diagnosis was confirmed by histology of pericardial biopsy in 12 patient or bacteriologic culture in 1 patient. The operative mortality was 17.5% (14180 patients) and all the mortality occurred in the malignant group. There were no operation-related mortality Sixty six patients were followed from 9 days to 5 years; mean follow-up was 452 days. Recurrent pericardial effusions, necessitating further surgical intervention, occurred in 6 (7.5%) patients. Constrictive pericarditis developed later in 4 patients(5%) and two of them had undergone complete pericardiectomy. In summary, subxiphoid pericardial drainage allowed safe and efficient drainage of pericardial effusions with sampling for cytology and pericardial biopsy, and had an acceptable morbidity and mortality.

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ANTEROGRADE AMNESIC EFFECT OF MIDAZOLAM (Midazolam 투여시 선행성 건망증 발현에 관한 연구)

  • Lee, Jung-Ha;Kim, Mi-Ra;Lee, Nan-Young;Lee, Sang-Ho
    • Journal of the korean academy of Pediatric Dentistry
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    • v.31 no.3
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    • pp.412-420
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    • 2004
  • The purpose of this study was to assess the anterograde amnesic effect of Midazolam administrated by intranasal and oral route. Fifteen healthy volunteers(ASA I) were administrated with placebo, oral Midazolam(15mg), intranasal Midazolam(0.25mg/kg) every 2 weeks. First picture cards were shown to volunteers before medication. At 15, 30, 45 minutes, other picture cards were shown to volunteers. BP, $SpO_2$ and sedation scores were measured. After 24 hours, the volunteers were questioned about their memory of pictures. To assess amnesic effect, recall and recognition test were performed using a series of picture cards designed for this purpose. The obtained results were as follows; 1. Compared to placebo, Midazolam group(oral and intranasal) experienced a significant anterograde amnesic effect(P<0.01) 2. There was no difference between oral and intranasal Midazolam(P>0.01). 3. Anterograde amnesic effect of oral and intranasal Midazolam group began at 15minutes. It became increasingly, oral Midazolam group experienced extremely amnesic effect at 45minutes, intranasal Midazolam group was at 30minutes. 4. After 30minutes of Midazolam administration, anterograde amnesia of oral Midazolam group is more effective than intranasal Midazolam group.

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Respiratory Assist by Use of Electrical Diaphragmatic Pacing (전기자극에 의한 횡격막 조율을 이용한 호흡보조장치)

  • 오중환;김은기;서재정;박일환;김부연;이상헌;이종국;이영희
    • Journal of Chest Surgery
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    • v.34 no.6
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    • pp.441-446
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    • 2001
  • Background: Electrical breathing pacing has many advantages over mechanical ventilation. However, clinically permanent diaphragmatic pacing has been applied to limited patients and few temporary pacing has been reported. Our purpose is to investigate the feasibility of temporary electrical diaphragm pacing in explothoracotomy canine cases. Methods: Five dogs were studied under the general anesthesia. Left 5th intercostal space was opened. Self designed temporary pacing leads were placed around the left phrenic nerve and connected to the myostimulator. Chest wall was closed after tube insertion with underwater drainage. Millar catheter was introduced to the aorta and right atrium. Swan-Ganz catheter was introduced to the pulmonary artery. When the self respiration was shallow with deep anesthesia, hemodynamic and tidal volume were measured with the stimulator on. Results: Tidal volume increased from 143.3$\pm$51.3 ml to 272.3$\pm$87.4 ml(p=0.004). Right atrial diastolic pressure decreased from 0.7$\pm$4.0 mmHg to -10.5$\pm$4.7 mmHg(p=0.005). Pulmonary arterial diastolic pressure decreased from 6.1+2.5 mmHg to 1.2$\pm$4.8 mmHg(p<0.001). The height of water level in chest tube to show intrathoracic pressure change was from 10.3$\pm$6.7cmH$_{2}$O to 20.0$\pm$5.3 cmH$_{2}$O. Conclusion: Temporary electrical diaphragmatic pacing is a simple method to assist respiration in explothoracotomy canine cases. Self designed pacing lead is implantable and removable. Negative pressure ventilation has favorable effects on the circulatory system. Therefore, clinical application of temporary breathing pacing is feasible in thoracotomy patients to assist cardiorespiratory function.

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The Effects of Semi-Fowler's position on Post-Operative Recovery and Pain for Patients with Laparoscopic Abdominal Surgery (복강경 수술 후 반좌위가 수술회복성과 통증에 미치는 영향)

  • Choi, Un Jong;Ha, Tae Uk;Kang, Ji Sook
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.18 no.5
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    • pp.412-419
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    • 2017
  • Purpose:This study was conducted to identify the effects of theSemi-Fowler's position on post-operative recovery and pain for patients with laparoscopic abdominal surgery Methods: This study utilized a non-equivalent control group non-synchronized design to validate the effects of theSemi-Fowler's position. After IRB approval, 56 patients took part in this study, 29 in the experimental group and 27 in the control group. Consent was obtained from the participants. The Semi-Folwer's position was applied to experimental group and the supine position was applied to the control group for 24 hours after surgery. All data were reviewed retrospectively from April to June 2016. Collected data, frequency, percentage, average, standard deviation, chi-squared test, independent t-test and repeated measures ANOVA were conducted using SPSS 20.0. Results: There was no significant difference between the experimental and control group with regard to recovery outcomes; however, there was a significance differencebetween groups and among check times with regard to post operational pain. Conclusion:The results of this study provide information that will be usefulto the development of strategies for improving recovery outcomes and pain for laparoscopic operation patients.