• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.1
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• pp.1-14
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• 2021

This study aimed to evaluate and compare the pre-emptive analgesic efficacy of injected ketorolac to that of other agents for impacted third molar surgical removal in a healthy population. PubMed, Ovid SP, Cochrane databases were filtered from 1980 to July 2020 for potential papers using relevant MeSH terms and pre-specified inclusion and exclusion criteria independently by reviewers. Studies that compared pre-emptive intramuscular or intravenous administration of ketorolac to other agents were evaluated. The outcomes sought were self-reported postoperative pain (patient-perceived pain), median duration for rescue analgesic medication, total number of analgesics consumed in the recovery period, and global assessment (overall patient satisfaction) after the recovery period. Six studies were included in the final evaluation. The outcome of pain perception and the number of analgesics taken were significantly lower in the ketorolac group (intramuscular or intravenous) in most of the studies (n=5) than in the group of other drugs. The mean time for rescue analgesia intake was higher for the ketorolac group, and global assessment scores were also better in the ketorolac group. Although the included studies show significantly better outcomes such as postoperative pain, median time taken for rescue medication, total number of analgesics taken, and overall patient satisfaction with injected ketorolac group in comparison to injected diclofenac, dexamethasone, and tramadol, definitive conclusions cannot be made regarding the superiority of injected Ketorolac as a pre-emptive agent. A greater number of randomized control trials with a proper protocol are needed to make definitive conclusions.

• The Korean Journal of Pain
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• v.35 no.3
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• pp.311-318
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• 2022

Background: Ketamine is widely used in infants and young children for procedural sedation and anesthesia. The aim of this study was to evaluate the efficacy and safety of low dose oral ketamine to control pain and distress in children during intravenous (IV) cannulation. Methods: This is a prospective, randomized, double-blind study, including children aged between 3 and 6 years requiring a non-emergent IV-line placement. Children were randomly assigned to two groups, treated either with oral ketamine or a placebo. All patients were monitored for vital signs. Pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Wong-Baker Faces Pain Rating Scale (WBFS) scales and sedation using a 5-point sedation score. The facility of IV-line placement was measured by a 3-point scale. Adverse effects were recorded after 1 and 24 hours. Results: A total of 79 and 81 children were entered in the ketamine and placebo groups, respectively. The heart and respiratory rates increased significantly in the placebo group. The median CHEOPS 4 (95% confidence interval [CI]: 3, 4, P < 0.001) and WBFS 6 (95% CI: 4, 6, P < 0.001) scores decreased statistically in the ketamine group. IV-line placement was 50% easier in the ketamine group (95% CI: 37%, 63%, P < 0.001). No serious adverse effects were observed in all cases. Conclusions: Low dose oral ketamine effectively decreased the pain and distress during IV cannulation in children without any significant adverse reactions.

• The Korean Journal of Physiology
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• v.19 no.1
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• pp.35-48
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• 1985

One of most frequently used anesthetic agents is barbiturate derivatives. Pentobarbital or thiopental sodium have been used most frequently in the laboratory or clinical practice. There have been reports on the renal effects of barbiturate anesthesia in human and laboartory animals. Renal effects of thiopental sodium anesthesia, however, are still controversial. One of the discrepancies may be derived from the doses used. It has been reported that subanesthetic small dose of thiopental sodium influences the renal function directly. To clarify possible central effects of very small amounts of thiopental sodium on the renal function, experiments have been done in conscious rabbits. Thiopental sodium was infused into the lateral cerebroventricle for 10 minutes. Intracerebroventricular thiopental sodium induced increased urinary volume, glomerular filtration rate and renal plasma flow by doses of $0.1{\sim}1.0\;mg/10 min/rabbit$. Filtration fractions were not changed. Sodium, chloride and potassium excretions were increased by 0.065 mg/10 min/rabbit of thiopental sodium without significant changes of renal hemodynamics. Higher doses of thiopental sodium $(0.1{\sim}1.0\;mg/10 min/rabbit)$ induced greater increases of electrolytes excretion and renal hemodynamics. Free water clearance was not changed by thiopental sodium, but the fractional excretion of free water showed a tendency of decrease. Fractional excretion of sodium was increased by doses of 0.065 to 1.0 mg of thiopental sodium . Highly significant correlation between the changes of glomerular filtration rate and the changes of sodium excretion were found in the higher doses. Plasma renin concentration (activity) was not changed by the centrally administered thiopental sodium. Intravenous thiopental sodium, 1.0 mg/rabbit, induced no changes of renal function in conscious rabbit. These data suggest that intracerebroyentricular thiopental sodium can increase urinary sodium excretion directly by inhibition of sodium reabsorption in the renal tubules and/or indirectly by increasing the renal hemodynamics.

• Journal of Korean Academy of Nursing
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• v.36 no.1
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• pp.114-126
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• 2006

Purpose: This study was performed to evaluate the pre-emptive analgesic effects of a small dose of intravenous ketamine on postoperative pain in patients undergoing a hysterectomy. Method: Sixty patients undergoing a hystrectomy under general anesthesia were randomly allocated to 2 groups. The experimental group(30 patients) received 0.3mg/kg of ketamine after induction of anesthesia, approximately 5 min prior to surgery, but the control group(30 patients)did not receive ketamine. Data was collected in a double-blind manner from April 1st, to October 30th, 2004. Postoperatively, the patients used a patient-controlled analgesia(PCA) pump. Blood pressure, pulse rate, pain, anxiety, count of times pressing the PCA button, administeration of additional analgesics and side effects of ketamine were measured at 1 hour, 3 hours, 6 hours and 24 hours after the operation. Result: There were no statistical differences in blood pressure, pulse rate, pain and anxiety between the experimental and control groups. There were statistical differences in blood pressure, pulse rate, pain and anxiety during the 24 hours postoperatively. In the experimental group, the number of times pressing the PCA button and administering additional analgesic drugs were significantly lower than those of the control group. Conclusion: A 0.3 mg/kg dose of ketamine given at approximately 5 min before surgery resulted in decreasing the number of times pressing the PCA and the administration of additional analgesics.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.76-82
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• 2001

Background: Postoperative nausea and vomiting (PONV) are common after general anesthesia and patient controlled analgesia (PCA) using opioids. This study was designed to compare the effectiveness of ondansetron plus dexamethasone versus ondansetron alone in the prevention of PONV in a patient undergoing a PCA. Methods: We studied 166 ASA I, and II in-patients undergoing general anaesthesia for major gynecological surgery. After induction of anesthesia, Group 1 (n = 64) received intravenous (IV) dexamethasone 10 mg and Group 2 (n = 102) received IV saline 2 ml before the surgical incision. Each patient received IV meperidine 50 mg as a loading dose. Meperidine 5 mg/kg, ketorolac 3.6 mg/kg and ondansetron 8 mg diluted in 40 ml solutions were connected to PCA pump for postoperative pain control. Mean arterial blood pressure, heart rate, pain score and symptom-therapy score were checked at 1, 4, 8, 16, 24, and 36 hours after the PCA connection. Results: For Group 1 and Group 2, respectively, the overall incidence of PONV was 12.5% and 23.5%. The pain scores were lower in patients receiving a combination of ondansetron and dexamethasone than those on ondansetron alone at 4 hr (P < 0.05), 8 hr (P < 0.05) and 16 hr (P < 0.05). Conclusions: This study suggests that the combination of ondansetron and dexamethasone is not more effective than ondansetron alone in the prevention of postoperative nausea and vomiting in women having PCA following major gynecological surgery but is more effective for pain control.

• The Korean Journal of Pain
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• v.31 no.4
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• pp.261-267
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• 2018

Background: To compare the effects of adding two different doses of dexamethasone on the duration and quality of the fascia iliaca block in patients undergoing proximal femoral fracture surgery. Methods: A total of 60 patients (age 18-70 years) undergoing proximal femoral nailing surgery under spinal anesthesia were given fascia iliaca block after random assignment to one of the two groups: Group H received an injection of levobupivacaine (0.5%) 28 ml with 2 ml (8 mg) dexamethasone, and Group L received an injection of levobupivacaine (0.5%) 28 ml with dexamethasone 1 ml (4 mg) with 1 ml normal saline. Assessment of the duration of analgesia and the total tramadol requirement over 48 hours were noted after a successful block. Results: The duration of analgesia was found to be significantly longer in Group H ($17.02{\pm}0.45h$) than in the Group L patients ($14.29{\pm}0.45h$) with a p-value of 0.000. Postoperative analgesic requirement (amount of tramadol in mg) was significantly higher in Group L (Q2: 200.0; IQR: 100.0, 200.0) as compared to Group H (Q2: 100.0; IQR: 100.0, 200.0) with a p-value of 0.034. No patient showed any sign of neurotoxicity. Conclusions: Dexamethasone, in a dose of 8 mg, is superior to 4 mg when used as an adjuvant with levobupivacaine in the FIB. Though both prolonged analgesia and were effective in reducing oral/intravenous analgesics, 8 mg dexamethasone can be recommended as a more efficacious adjuvant to local anesthetics in the FIB.

• International Journal of Oral Biology
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• v.33 no.3
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• pp.97-103
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• 2008

The present study investigated the role of peripheral group I, II, and III metabotropic glutamate receptors (mGluRs) in mustard oil (MO)-induced nociceptive response in the masseter muscles of lightly anesthetized rats. Experiments were carried out on male Sprague-Dawley rats weighing 300-350 gm. After initial anesthesia with sodium pentobarbital (40 mg/kg, i.p.), one femoral vein was cannulated and connected to an infusion pump for intravenous infusion of sodium pentobarbital. The rate of infusion was adjusted to provide a constant level of anesthesia. MO (30 ${\mu}L$) was injected into the mid-region of the left masseter muscle via a 30-gauge needle over 10 seconds. After 30 mL injection of 5, 10, 15, or 20% MO into the masseter muscle, total number of hindpaw-shaking behavior was monitored. Intramuscular administration of MO significantly produced hindpawshaking behavior in a dose-dependent manner, as compared with the vehicle (mineral oil)-treated group. Intramuscular pretreatment with 10 or 100 ng DHPG, a group I mGluRs agonist, enhanced MO-induced hindpaw-shaking behavior, while APDC (20 or 200 ${\mu}g$), a group II mGluRs agonist, or L-AP4 (2 ${\mu}g$), a group III mGluRs agonist, significantly reduced MO-induced nociceptive behavior. The antinociception, produced by group II or III mGluRs agonists, was abolished by pretreatment with LY341495, a group II mGluRs antagonist, or CPPG, a group III mGluRs antagonist, res-pectively. Based on these observations, peripheral mGluRs differentially modulated MO-induced nociceptive behavior response in the craniofacial muscle pain and peripheral group II and III mGluRs agonists could be used in treatment of craniofacial muscle nociception.

• Journal of Veterinary Science
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• v.23 no.6
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• pp.68.1-68.8
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• 2022

Background: Studies on anesthetized dogs regarding pulse pressure variation (PPV) are increasing. The influence of respiratory rate (RR) on PPV, in mechanically ventilated dogs, has not been clearly identified. Objectives: This study evaluated the influence of RR on PPV in mechanically ventilated healthy dogs after hemorrhage. Methods: Five healthy adult Beagle dogs were premedicated with intravenous (IV) acepromazine (0.01 mg/kg). Anesthesia was induced with alfaxalone (3 mg/kg IV) and maintained with isoflurane in 100% oxygen. The right dorsal pedal artery was cannulated with a 22-gauge catheter for blood removal, and the left dorsal pedal artery was cannulated and connected to a transducer system for arterial blood pressure monitoring. The PPV was automatically calculated using a multi-parameter monitor and recorded. Hemorrhage was induced by withdrawing 30% of blood (24 mL/kg) over 30 min. Mechanical ventilation was provided with a tidal volume of 10 mL/kg and a 1:2 inspiration-to-expiration ratio at an initial RR of 15 breaths/min (baseline). Thereafter, RR was changed to 20, 30, and 40 breaths/min according to the casting lots, and the PPV was recorded at each RR. After data collection, the blood was transfused at a rate of 10 mL/kg/h, and the PPV was recorded at the baseline ventilator setting. Results: The data of PPV were analyzed using the Friedman test followed by the Wilcoxon signed-rank test (p < 0.05). Hemorrhage significantly increased PPV from 11% to 25% at 15 breaths/min. An increase in RR significantly decreased PPV from 25 (baseline) to 17%, 10%, and 10% at 20, 30, and 40 breaths/min, respectively (all p < 0.05). Conclusions: The PPV is a dynamic parameter that can predict a dog's hemorrhagic condition, but PPV can be decreased in dogs under high RR. Therefore, careful interpretation may be required when using the PPV parameter particularly in the dogs with hyperventilation.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.1
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• pp.45-50
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• 2012

The Fontan operation is a heart operation used to treat complex congenital heart defects like tricuspid atresia, hypoplastic left heart syndrome, pulmonary atresia and single ventricle. A single ventricle is dedicated to pumping oxygenated blood to the systemic circulation and the entire systemic venous return reaches the pulmonary arterial system without the direct influence of a pumping chamber. In the patient with Fontan operation, it is important to achieve adequate pulmonary blood flow and cardiac output in anesthetic management. In this case, a 10-year-old boy (19.6 kg, 114 cm) with cleft palate, cerebral palsy and severe mental retardation, who underwent a Fontan operation when he was 4 years old, was presented for deep sedation. Because he was suffering from eating disorder with cleft palate, the orthodontist and the plastic surgeon planned to insert intraoral orthodontic device before cleft palate repair. But it was impossible to open his mouth for alginate impression procedure. After careful pre-anesthesia evaluation we planned to administer deep sedation with propofol infusion. After Intravenous catheter insertion, we started propofol intravenous infusion with the formula of a loading dose of 1.0 mg/kg followed by an infusion rate of 6.0 mg/kg/hr with syringe pump. His blood pressure was remained around 80/40 mmHg after loss of consciousness, but he could not maintain his airway patent. So we lowered the infusion rate to 3.0 mg/kg/hr, immediately. The oxygen saturation was maintained above 95% with nasal oxygen supply, and blood pressure was maintained around 100-80/60-40 mmHg. After the sedation of 110 minutes with propofol (the infusion rate to 3.0-5.0 mg/kg/hr), he fully regained consciousness, and was discharged without complication after 1 hour observation. In case of post-Fontan patient, intravenous deep sedation with propofol was safe and effective method of behavioral management during dental treatment.

• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.4
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• pp.508-513
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• 2018

Tidal volume by sevoflurane in small amounts is stable due to the increase in the breathing rate. But alveolus ventilation decreases due to sevoflurane as the degree of sedation increases; this ultimately causes $PaCO_2$ to rise. The occurrence of suppression of breath increases the risk of severe hypoxia and hypercapnia in deeply sedated patients with disabilities. Sevoflurane inhalation anesthesia has a number of risks and may have unexpected problems with hemodynamic changes depending on the underlying state of the body. This study was conducted to examine the stability of internal acid-base system caused by respiratory depression occurring when patients with disabilities are induced by sevoflurane. Anesthetic induction was carried out by placing a mask on top of the patient's face and through voluntary breathing with 4 vol% of sevoflurane, 4 L/min of nitrous oxide, and 4 L/min of oxygen. After the patient's loss of consciousness and muscle relaxation, IV line was inserted by an expert and intravenous blood gas was analyzed by extracting blood from vein. In a deeply sedated state, the average amount of pH of the entire patients was measured as $7.36{\pm}0.06$. The average amount of $PvCO_2$ of the entire patients was measured as $48.8{\pm}8.50mmHg$. The average amount of $HCO_3{^-}$ of the entire patients was measured as $27.2{\pm}3.0mmol/L$. In conclusion, in dental treatment of patients with disabilities, the internal acid base response to inhalation sedation using sevoflurane is relatively stable.