• Title/Summary/Keyword: Anesthesia, General

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Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study

  • Do, Wangseok;Cho, Ah-Reum;Kim, Eun-Jung;Kim, Hyae-Jin;Kim, Eunsoo;Lee, Heon-Jeong
    • Journal of Yeungnam Medical Science
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    • v.35 no.1
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    • pp.45-53
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    • 2018
  • Background: Carotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA. Methods: Medical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay. Results: There was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p<0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p<0.0001 between 0-6 h, p<0.004 between 6-12 h, and p<0.001 between 12-24 h). The duration of hospital stay was significantly more in the GA group ($13.3{\pm}4.6days$ in the GA group vs. $8.5{\pm}2.4days$ in the RA group, p<0.001). Conclusion: In this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.

Use of Midazolam Intranasal Spray for Dental Treatment of Autism Patients (자폐증 환자의 행동조절을 위한 Midazolam Intranasal Spray 사용사례)

  • Song, Young-Gyun;Lee, Suk Young;Kim, Seung-Oh
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.12 no.4
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    • pp.223-227
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    • 2012
  • Autism patients in general have bad oral hygiene. It is hard for autism patients to get dental treatment as poor communication. Therefore, they may have to be treated by deep sedation or general anesthesia in numerous cases. However, this process requires induction with mask, so it is not easy to do for disobliging autism patient. Midazolam is a water-soluble benzodiazepine, has been used in pediatric dentistry or dentistry for the handicapped because of rapid onset. Midazolam can be administered through oral, rectal, intramuscular,intravenous, and intranasal (IN) routes. IN route of midazolam may be considered as effective way to allay for uncooperative autism patients before general anesthesia. In this case report, two autism patients required dental treatment. Intranasal spray of midazolam before general anesthesia was safe and effective procedure of behavioral management.

Prosthodontic Treatment of Persons with Disabilities Under Dental Sedation and General Anesthesia (치과진정법과 전신마취를 이용한 장애환자의 보철치료)

  • Kim, Yun-Hee;Lee, Jin-Han
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.12 no.3
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    • pp.183-191
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    • 2012
  • In most persons with disabilities had poor oral hygiene because of less attention and ability to perform a dental care. So the increased prevalence and severity of dental disease were common oral state. Although most persons with disabilities need a adequate dental treatment, it is often very difficult to treat because of noncooperativity and involuntary muscle movements. Dental treatments under sedation and general anesthesia were make to provide a high-quality dental service because of decreased anxiety and fear associated dental treatment in persons with disabilities. The dental professionals must be able to select and apply the proper sedation methods in agreement with the characteristics of the disabilities, general conditions, sedation experience and capacity of dentist, type and time of dental treatment, equipments of dental clinic, consent of patient's protector. The proshodontic treatment procedures, such as abutment preparation, dental impression taking process, try-in process of prosthesis and adjustment of occlusion, are difficult even for patients without disabilities. Those procedures are more difficult to patients with disability because it's too hard to control breathing and muscle. In this report, we performed prosthetic dentistry procedures to three patients with disabilities under dental sedation and general anesthesia.

The Effect of Chest Meridian Massage on Post- Anesthetic Recovery of General Anesthesia Patients (흉부경락마사지가 충수돌기 절제술 환자의 마취 후 회복에 미치는 효과)

  • Lee, Byung-Yup;Shon, Kyung-Hee
    • Korean Journal of Adult Nursing
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    • v.17 no.4
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    • pp.612-621
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    • 2005
  • Purpose: This study aims at confirming the effects of the chest meridian massage on the post-anesthetic recovery of general anesthesia appendectomy patients. Method: The research was post-test designed as a nonequivalent control group among quasi-experiments tested. The data was collected from June 20, 2003 to October 14, 2003 at a hospital in P city. In the collected data, using SPSS Win 10.0 program, these general features were analyzed by real numbers and percentages; the homogeneity among variables by $X^2-test$ and t-test and the research hypothesis by the t-test. Result: Hypothesis 1; The experimental group receiving the treatment of the chest meridian massage will have a much higher post-anesthetic recovery score than that of the control group not receiving it was supported(t=2.544, p=.014). Hypothesis 2; The experimental group receiving the treatment of the chest meridian massage will have a much shorter time of stay in the recovery room than that of the control group not receiving it was supported(t=-4.919, p=.000). Conclusion: According to these results, it may be concluded that Chest Meridian Massage is effective in producing a higher level of post-anesthetic recovery score and helps appendectomy patients reduce the time of stay in the recovery room. Therefore the chest meridian massage can be considered as an intervention therapy for directly nursing general anesthesia appendectomy patients.

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Closed Reduction of Nasal Bone Fracture Under the Mask Ventilation Anesthesia Using Oral Airway (기도유지기 마스크 환기마취를 이용한 비관혈적 비골골절 정복술)

  • Park, Byung-Chan;Nam, Hyun-Jae;Lee, Jun-Ho;Kim, Yong-Ha;Heo, Min-Jung;Seo, Il-Sook
    • Archives of Craniofacial Surgery
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    • v.9 no.2
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    • pp.77-80
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    • 2008
  • Purpose: The majority of nasal fractures have been treated by closed reduction. And they were manipulated under local anesthesia or general anesthesia. Under the local anesthesia, patients can feel the pain and fear, so general anesthesia through the endotracheal intubation became popularized recently to treat the nasal fracture. But it has still the drawbacks of postanesthetic complication. Therefore, under the mask ventilation anesthesia using oral airway, we tried to manipulate the nasal fracture. Methods: From July 2007 to November 2007, we worked with fifty patients that were manipulated the nasal fracture. Fifty patients were divided into two groups, general anesthesia with the endotracheal intubation group(n=25) and the mask ventilation using oral airway group(n=25). We checked up the anesthesia time, postanesthetic complication, postoperative aesthetic & functional problem of nose in two groups. Results: In total operation time and sore throat frequency among the postoperative anesthetic complications, there was statistically significant difference between the mask ventilation group and the endotracheal intubation group(p<0.05). But there was no difference statistically in nausea frequency(p>0.05). And no patients complained of postoperative nasal complication such as septal deviation, septal perforation, nasal obstruction and hump nose in two groups. Conclusion: Through the mask ventilation using oral airway, we could reach satisfactory results in the anesthetic time and postanesthetic complication.

Convergent factors affecting length of stay in the postanesthesia care unit among elderly from general anesthesia patients (노인 전신마취 환자의 회복실 체류에 영향을 미치는 융합적 요인)

  • Lee, Su-Jin
    • Journal of Internet of Things and Convergence
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    • v.3 no.2
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    • pp.21-32
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    • 2017
  • This study is a descriptive investigation for understanding factors influencing the length of stay in the postanesthesia care unit of elderly patients. Retrospective investigation was conducted on 300 patients aged 65 or older among those who had received an operation under general anesthesia and treated in postanesthesia care unit of hospital C located in Gyeonggi-do, from January 1 to December 31, 2014. The patients' average postanesthesia care unit stay was found to be 48.4 minutes and the 30-59 minute section accounted for the highest part with 58.0%. The postanesthesia care unit stay time according to intra-operative factors showed significant differences depending upon muscle relaxants, transfusion, ABGA, body temperature and total hours under anesthesia. Concerning the post anesthesia care unit stay length according to post-operative factors, significant differences were observed depending upon complications, PCA device, and circulatory drug use. In order to find out factors influencing the post anesthesia care unit stay length, the multiple regression analysis was conducted. As a result, the circulatory drug use and intra-operative lower body temperature were found to have an effect on the post anesthesia care unit stay length with the total explanatory power of 13%. Based on these findings above, it is deemed helpful to carefully monitor factors related to the post anesthesia care unit stay length and provide swift response accordingly for shorter post anesthesia care unit stay time of elderly general anesthesia patients.

Comparative randomized study of propofol target-controlled infusion versus sevoflurane anesthesia for third molar extraction

  • Chung, Patrick K;Dhanrajani, Parmanand
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.18 no.3
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    • pp.169-175
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    • 2018
  • Background: The objective of this study was to compare hemodynamic and recovery characteristics of total intravenous anesthesia using propofol target-controlled infusion (TCI) versus sevoflurane for extraction of four third molar teeth. Methods: One hundred patients undergoing extraction of four third molar teeth under general anesthesia were randomized to one of two groups. Group 1 received propofol TCI-oxygen for induction and propofol TCI-oxygen-air for maintenance. Group II received a propofol bolus of 2 mg/kg for induction and sevoflurane-oxygen-air for maintenance. Heart rate, mean arterial pressure (MAP), operating time, time to emergence, nausea and vomiting, and sedation and pain scores were measured in each group. Results: Demographic data, including age, gender, weight, and height, were not significantly different between the two groups. The MAP was significantly higher after intubation (P = 0.007) and injection of anesthesia (P = 0.004) in the propofol group than in the sevoflurane group, with significant reflex bradycardia (P = 0.028). The mean time to emergence from anesthesia using propofol was 25 s shorter than that of sevoflurane (P = 0.02). Postoperatively, the propofol group was less sedated than the sevoflurane group at 30 min (0.02 versus 0.12), but this difference was not significant (P = 0.065). Conclusion: Both propofol TCI and sevoflurane are good alternatives for induction and maintenance of anesthesia for short day-case surgery. However, propofol TCI does not blunt the hemodynamic response to sudden, severe stimuli as strongly as sevoflurane, and this limitation may be a cause for concern in patients with cardiac comorbidities.

Awareness during general anesthesia despite simultaneous bispectral index and end-tidal anesthetic gas concentration monitoring

  • Lee, Jungwon;Park, Chorong;Kim, Saeyoung
    • Journal of Yeungnam Medical Science
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    • v.36 no.1
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    • pp.50-53
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    • 2019
  • Awareness during general anesthesia occurs in approximately 0.1-0.2% of cases; nevertheless, particular attention is required because it can lead to critical complications including insomnia, depression, anxiety, and post-traumatic stress disorder. To prevent these complications, bispectral index (BIS) and end-tidal anesthetic gas (ETAG) concentration monitoring are commonly used to examine patient consciousness during surgery. In the present case, an 80-year-old man was scheduled for total gastrectomy. Anesthesia was maintained using desflurane 4.0-5.0% vol, oxygen, and nitrous oxide. The authors simultaneously monitored BIS, which was maintained between 37 and 43, and ETAG, which was maintained between 0.9 and 1.2 minimum alveolar concentration (MAC). After the operation, however, the authors were surprised to learn that the patient complained of awareness during anesthesia. Although BIS and ETAG concentration monitoring are useful in preventing awareness during anesthesia, they cannot be completely trusted. Even though BIS was maintained at approximately 40 and ETAG at 0.7-1.3 MAC, awareness during anesthesia occurred.