• The Korean Journal of Pain
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• 제7권2호
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• pp.199-204
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• 1994

The purpose of this study is to evaluate the feasibility, advantages/disadvantages of patient-controlled sedation (PCS) compared to anesthesiologist-controlled sedation (ACS) during neurolytic pain block and regional anesthesia. Forty patients were divided randomly into two groups of 20 patients each. Group 1(ACS) received 0.01 $mg{\cdot}kg^{-1}$ intravenous midazolam and 0.5 ${\mu}g{\cdot}kg^{-1}$ fentanyl intravenously by anesthesiologist just before, 30, and 60 minutes after the procedure to acheive sedation; Group 2 (PCS) patients self-administered a mixture of midazolam (0.4 mg) and fentanyl ($20{\mu}g$) using a syringe type infusion pump (Terumo, Japan) to acheive sedation. Considering the dermographics of patients, the types and durations of procedure performed, the level of average sedation the comfort level were similar in both groups. But the doses of midazolam and fentanyl administerd in group 2 were smaller than those in group 1 (p<0.01). Patients in PCS group showed their level of sedation more proper than did those in ACS group. However, patients in ACS group rated their level of comfort higher than did those in PCS group. The findings of this study indicate that PCS using a combination of midazolam and fentanyl is a fafe and effective technique. More studies are, however, needed to determinc the best choice of drug(s), doses, lock-out intervals, and possible use of continuous infusion with patient-controlled sedation.

• 대한족부족관절학회지
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• 제15권2호
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• pp.97-101
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• 2011

Intravenous Patient Controlled Analgesia (IV PCA0 after general or spinal anesthesia may be a method of postoperative pain control, but side effects such as nausea, vomiting, and sedation occurs in most patients. The following research is based on the ultrasound guided femorosciatic nerve block held on parts below the knee joint operation. Because this anesthesia is held locally on the sciatic nerve with continuous anesthesia performed through perineural catheterization, the complications of nausea, vomiting, and sedation may be reduced while postoperative pain caused by the sciatic nerve is controlled. The following report is held on this experience.

• 임상간호연구
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• 제16권1호
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• pp.71-82
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• 2010

Purpose: The study was aimed to investigate the effects of warm fluid used during surgery on the patients' hypothermia prophylaxis and recovery after surgery. Methods: This data were collected from Jul. 13 to Nov. 31. 2009 at S hospital in M City. 60 patients who met the selection criteria were recruited in the study and divided into two groups. The warmed fluids were used for 30 patients in the experimental group, and the fluids in room air temperature were used for the others in the control group. Collected data were statistically analyzed using SPSS/win 18.0. Results: The body temperatures of the control group were significantly lower during surgery than those of the experimental group (p<.001). Shivering was significantly less occurred in the experimental group than the control group (p=.018). The experimental group used warmed fluids recovered faster than the control group. Conclusion: Warming fluid for the patients with general anesthesia was revealed to be effective in decreasing hypothermia during surgery, reducing shivering, helping recovery from the anesthesia. Further research is warranted to refine and apply this evidence in nursing practice.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.141-146
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• 2015

Background: An understanding of the features of postoperative pain is essential for optimal analgesic dosing strategies. Using a visual analogue scale (VAS) score and patient controlled analgesia (PCA) infusion pattern analysis, an anesthesiologist can estimate when and how severely patients suffer from pain. Several reports have been published about circadian changes in the pain threshold. Postoperative pain was analyzed retrospectively in 250 patients who underwent orthognathic surgery. Methods: A total of 250 patients were allocated into two groups according to the time of recovery from anesthesia. Patients in the early group (group E) recovered from anesthesia before 06:00 p.m. Patients in the late group (group L) recovered from anesthesia after 06:00 p.m. All patients received intravenous patient controlled analgesia (IV PCA) at the end of the operation. The VAS score of pain intensity was measured. Self-administration of bolus analgesic from the IV PCA device was also analyzed according to actual time and elapsed time. Results: VAS scores showed no difference between the two groups except 36 hours after recovery from anesthesia. On POD1, there were two peaks for self-administration of bolus analgesics in group L and one peak in the morning for group E. Two peaks each in the morning and in the afternoon were shown in both groups on POD2. Conclusions: Diurnal variance in pain should be considered for effective dosing strategies.

• 대한치과마취과학회지
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• 제9권1호
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• pp.9-16
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• 2009

Background: This study aimed to evaluate the cooperative levels of dental patients requiring general anesthesia during dental treatments. Anesthetic induction methods for patients were also recorded and analyzed using descriptive statistics. Methods: Total 566 patients who visited Seoul National University Dental Hospital Clinic for Persons with Disabilities were reviewed on pre-anesthetic review and anesthesia records. The cooperative levels of patients were graded by 4 levels and induction methods used for the patients during general anesthesia application were analyzed. Results: More than half of patients(55.8%) were willing to receive the anesthetic induction(cooperative level 1), 18.6% were minimally cooperative(level 2), 20.8% needed physical restraint prior to induction(level 3), and 4.8% was poorly cooperative and induction procedure was performed under an unconscious condition after ketamine intramuscular injection(level 4). There was no gender difference in cooperative levels(P=0.11). Patients over 30 years revealed better cooperation levels compared to other age groups(P<0.05). For patients of level 1, 53.5% were anesthetized in a way of intravenous induction, while 77.1% out of patients of level 3 were anesthetically induced through inhalation method. Conclusion: Many dental patients with special needs were not cooperative to receive anesthetic induction. Additional behavioral support may be applied to poorly cooperative patients for the safe and successful clinical outcome.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권2호
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• pp.116-124
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• 2020

Objectives: Postoperative nausea and vomiting (PONV) is considered as one of the most incessant and anguishing factors for patients who have surgery under general anesthesia. The occurrence of PONV after orthognathic surgery can lead to dehydration, infection, bleeding at the surgical site, and patient discomfort, all of which leave a patient with a negative impression of anesthesia and surgery. The purpose of this study is to assess the incidence of PONV after orthognathic surgery and to correlate it with factors related to patient, anesthesia, and surgery. Materials and Methods: A 10-year retrospective survey was done for patients who underwent orthognathic surgery between January 2008 and March 2018. The incidence of PONV was evaluated, correlations with factors related to patient, anesthesia, and surgery were studied, and the duration between the end of surgery and the occurrence of the first episode of PONV was tabulated. Results: The medical records of 109 patients were screened, out of which 101 satisfied the inclusion criteria. Amongst these patients, 60 patients (59.4%) suffered from PONV. Patient's sex, induction agent used, intravenous fluids administered intraoperatively, duration and type of surgery, and the presence of a nasogastric tube were seen to have a significant influence on precipitating PONV. It was noted that among the patients who suffered from PONV, 61.7% of them experienced it 48-96 hours after the end of surgery. Conclusion: Despite the improved anesthetic equipments, drugs, and surgical techniques currently used, the incidence of PONV was high in our study. Certain factors that were seen to influence PONV in this study need to be considered in order to develop an efficacious protocol to reduce PONV in orthognathic surgeries.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권5호
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• pp.349-356
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• 2022

Background: Awake fiberoptic intubation (AFOI) is the procedure of choice for securing the airway in patients with a difficult airway when undergoing surgeries under general anesthesia. An ideal drug would not only provide conscious sedation but also maintain spontaneous ventilation, smooth intubation conditions, and stable hemodynamics. We compared the effects of dexmedetomidine alone and dexmedetomidine in combination with fentanyl at a dose lower than the standard dose for achieving conscious sedation during AFOI in difficult airway patients undergoing oral cancer and dental surgeries. Methods: We included 68 adult patients undergoing AFOI. The patients were randomized in two groups, wherein Group D received intravenous dexmedetomidine 1 ㎍/kg and Group DF received dexmedetomidine 0.5 ㎍/kg and fentanyl 1 ㎍/kg. The outcomes measured were airway obstruction score, intubation scores, fiberoptic intubation comfort score, sedation score, and hemodynamic variables. Results: Low-dose dexmedetomidine with fentanyl showed similar results as those with the standard dose of dexmedetomidine in terms of airway obstruction, vocal cord movement, degree of cough, degree of limb movements, and intubation comfort. However, the sedation achieved and incidence of hypotension and bradycardia were higher in Group D than in Group DF. Conclusions: A low dose of dexmedetomidine-fentanyl provides satisfactory intubation conditions as those with a standard dose of dexmedetomidine in AFOI, thereby avoiding bradycardia, hypotension, and sedation.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2006년도 춘계학술대회
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• pp.133-133
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• 2006

• 대한소아치과학회지
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• 제37권2호
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• pp.213-217
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• 2010

Chloral hydrate와 hydroxizine을 이용한 경구진정법은 적용대상의 나이와 체중에 따라 제한을 받는다. 일반적으로 경구 진정법은 36개월 미만, 체중 15 kg 미만의 환아에서 가장 좋은 진정 효과를 보인다. 그러나 36개월 이상 또는 15 kg 이상의 환아에 대해서는 경구진정법이 적절한 진정 효과를 얻는데 한계를 가지며, 얕은진정으로 인해 시술 중 잦은 움직임을 보여 쉽게 진정에 실패하게 된다. 진정 실패 시 고려 할 수 있는 대안은 추가적인 약제 투여로 인한 재진정의 유도나, 좀 더 깊은진정 법으로의 전환이 있다. 그러나 깊은진정법으로의 전환은 환아의 움직임과 동통의 감소를 위해 흡입마취제 및 마취기계가 요구되어 외래 진료실에서는 쉽게 선택되지 못한다. EMLA cream(Eutectic Mixture of Local Anesthesia)은 피부의 도포마취를 위해 널리 사용되고 있는 약제로 본 증례에서는 이를 이용하여 자극 없이 정주진정 경로를 확보하여 경구진정에서 정주진정으로의 전환에 성공하였다. 만 46개월, 체중 15 kg 남아가 다발성 우식을 주소로 단국대학교 치과대학 병원 소아치과에 내원하였다. 일반적인 행동조절 하에 치료 권유하였으나 보호자의 요구에 의해 경구진정 시도하였으며, 경구진정 실패를 고려하여 복용 전 EMLA cream을 사전 도포하였다. 경구 복용 90분 경과 뒤에도 진정효과를 얻지 못하여 보호자의 동의하에 아산화질소를 이용하여 얕은진정 유도 후, EMLA cream 도포 부위에 정맥로를 확보하였다. 총 시술 시간 2시간 30분으로 특별한 부작용 없이 성공적으로 시술을 완료하였다.

• 대한소아치과학회지
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• 제26권4호
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• pp.589-594
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• 1999

소아치과 환자에서 협조가 안 되는 환자의 진료시 여러 가지 방법의 진정요법이나 다른 방법이 이용된다. 이 중에서도 최근의 경향은 약물을 이용하여 진정을 시행하는 방법이 주로 이용된다. 약물 투여방법 중에서도 흡입가스를 이용하여 진정을 유발하는 경우가 장점이 많아 최근 사용이 증가하는 추세이다. 흡입가스를 이용한 경우 폐를 통해 약물이 흡수되므로 적절한 진정수준에 도달하기 위해서는 환자의 호흡양상이 주 영향을 끼친다. 가스를 이용한 흡입진정 시에는 환자가 반드시 비호흡을 하여야 폐를 통해 흡수가 되므로 구호흡을 하는 경우는 정맥로를 이용한 진정이나 기관내삽관을 필요로 한다. 저자는 $N_2O-O_2$를 이용한 진정요법을 시행하는 중에 완전한 구호흡을 하는 환자를 기관내삽관을 하지 않고 끝 부분이 둥글고 유연한 흡인도관을 사용하여 아산화질소를 투여함으로서 만족할 만한 결과를 얻었기에 이에 보고 한다.