• Journal of Dental Anesthesia and Pain Medicine
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• 제16권3호
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• pp.217-222
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• 2016

Dental treatment is often performed under general anesthesia or sedation when an intellectually disabled patient has a heightened fear of treatment or has difficulty cooperating. When it is impossible to control the patient due to the severity of intellectual disability, conscious sedation is not a viable option, and only deep sedation should be performed. Deep sedation is usually achieved by propofol infusion using the target controlled infusion (TCI) system, with deep sedation being achieved at a slightly lower concentration of propofol in disabled patients. In such cases, anesthesia depth monitoring using EEG, as with a Bispectral Index (BIS) monitor, can enable dental treatment under appropriate sedation depth. In the present case, we performed deep sedation for dental treatment on a 27-year-old female patient with mental retardation and severe dental phobia. During sedation, we used BIS and a newly developed Anesthetic Depth Monitor for Sedation (ADMS$^{TM}$), in addition to electrocardiography, pulse oximetry, blood pressure monitoring, and capnometry for patient safety. Oxygen was administered via nasal prong to prevent hypoxemia during sedation. The BIS and ADMS$^{TM}$ values were maintained at approximately 70, and dental treatment was successfully performed in approximately 30 min.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권4호
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• pp.235-244
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• 2018

Background: Patients with intellectual disability (ID) often require general anesthesia during oral procedures. Anesthetic depth monitoring in these patients can be difficult due to their already altered mental state prior to anesthesia. In this study, the utility of electroencephalographic indexes to reflect anesthetic depth was evaluated in pediatric patients with ID. Methods: Seventeen patients (mean age, $9.6{\pm}2.9years$) scheduled for dental procedures were enrolled in this study. After anesthesia induction with propofol or sevoflurane, a bilateral sensor was placed on the patient's forehead and the bispectral index (BIS) was recorded. Anesthesia was maintained with sevoflurane, which was adjusted according to the clinical signs by an anesthesiologist blinded to the BIS value. The index performance was accessed by correlation (with the end-tidal sevoflurane [EtSevo] concentration) and prediction probability (with a clinical scale of anesthesia). The asymmetry of the electroencephalogram between the left and right sides was also analyzed. Results: The BIS had good correlation and prediction probabilities (above 0.5) in the majority of patients; however, BIS was not correlated with EtSevo or the clinical scale of anesthesia in patients with Lennox-Gastaut, West syndrome, cerebral palsy, and epilepsy. BIS showed better correlations than SEF95 and TP. No significant differences were observed between the left- and right-side indexes. Conclusion: BIS may be able to reflect sevoflurane anesthetic depth in patients with some types of ID; however, more research is required to better define the neurological conditions and/or degrees of disability that may allow anesthesiologists to use the BIS.

• 대한전기학회논문지:시스템및제어부문D
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• 제55권1호
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• pp.35-41
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• 2006

Although reachers have studied for a long time, they don't make criteria for anesthesia depth. anesthetists can't make a prediction about patient's reaction. Therefor, patients have potential risk such as poisonous side effect late-awake, early-awake and strain reaction. EEG are received from twenty-five patients who agreed to investigate themselves during operation with Enflurane-anesthesis in progress of anesthesia. EEG are divided pre-anesthesia, before incision of skin, operation 1, operation 2, awaking, post-anesthesia by anesthesia progress step. EEG is applied pre-processing, base line correct, linear detrend to get more reliable data. EEG data are handled by electronic processing and the EEG data are calculated by bicoherence. During pre-anesthesia and post anesthesia, appearance rate of bicoherence value is observed strong appearance rate in high frequency range($15\~30Hz$). During the anesthesia of patient, a strong appearance rate is revealed the low frequency area(0~10Hz). After bicoherence is calculated by percentage of a appearance rate, that is, Bicpara$\#$1, Bicpara$\#$2, Bicpara$\#$3 and Bicpara$\#$4 parameter are extracted. In result of bicoherence analysis, Bicpara$\#$2 and Bicpara#4 are considered that the best parameter showed progress of anesthesia effectively. And each separated bicoherence are calculated by average bicoherence's numerical value, divide by 2 area, appear by each BicHz$\#$1, BicHz$\#$2, and observed BicHz$\#$1/BicHz$\#$2's change. In result of bicoherence analysis, BicHz$\#$1, BicHz$\#$2 and BicHz$\#$1/BicHz$\#$2 are considered that the best parameter showed progress of anesthesia effectively. In conclusion, I confirmed the anesthesia progress phase, concluded to usefulness of parameter on bispectrum and bicoherence analysis and evaluated the depth of anesthesia. In the future, it is going to use for doctor's diagnosis and apply to protect an medical accident owing to anesthesia.

• 대한수의학회지
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• 제46권1호
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• pp.47-55
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• 2006

To evaluate method for monitoring anesthetic depth with quantitative electroencephalography (q-EEG), we recorded processed EEG (raw EEG) and pain score till 100 minutes in beagle dogs anesthetized for 60 minutes with propofol (n = 5, PRO group), isoflurane (n = 5, ISO group) and propofol-ketaminefentanyl (n = 5, PFK group). Raw EEG was converted into 95% spectral edge frequency (SEF) by fast Fourier transformation (FFT) method. We investigated anesthetic depth by comparing relationship (Pearson's correlation) between q-EEG (95% SEF) and pain score. Pearson's correlation coefficients are +0.2372 (p = 0.0494, PRO group), +0.79506 (p < 0.001, ISO group) and +0.49903 (p = 0.0039, PFK group).

• 대한임상검사과학회지
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• 제52권4호
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• pp.317-326
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• 2020

마취는 의식의 차단 역할을 하는 주 마취제와 감각, 운동, 반사의 차단을 하는 부 마취제인 근이완제로 구분된다. 깊은 의식의 차단만으로는 심한 자극에 대한 반응을 막을 수 없고, 다량의 진통제만으로는 무의식을 보장할 수 없다. 그러므로 마취는 동시에 두 가지를 모두 만족시켜야 한다. 근 이완제는 흡입 또는 정맥마취제의 투여 용량을 감소시키면서 기관지내 삽입관, 수술 시야 및 수술적 환경(operating conditions)을 향상시킬 수 있으며, 수술 중 기계적 조절 환기(controlled mechanical ventilation) 시 호흡 관리를 위하여 매우 중요하다. 이러한 근이완제는 투여 용량이 과다하면 수술 중 신경 검사가 안 되는 영향을 줄 수 있고, 투여 용량이 부족하게 되면 환자가 수술 중 움직일 수 있어서 근 이완 마취 심도와 수술 중 감시 검사는 밀접한 관계가 있다. 근 이완제를 많이 사용하면, 수술 중 신경생리학적 검사가 원활하게 되지 않는 단점과 수술 이후에 완전히 근 이완효과를 제거하기 어렵다는 단점도 갖고 있다. 수술 중 감시 검사를 하는 수술에서 마취과에서는 어떠한 기준으로 근 이완제를 투여하며 유지하는지에 대하여 국내뿐만 아니라 전 세계적인 동향을 살펴 봄으로써 보다 원활한 수술 중 신경 검사가 되길 바란다.

• 한국임상수의학회지
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• 제39권5호
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• pp.226-234
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• 2022

To evaluate butorphanol and tramadol as adjuvants to lidocaine in dogs undergoing mandibular nerve block. Fifteen beagles were allocated to groups based on the following treatments: lidocaine alone (L group), lidocaine + butorphanol (LB group), or lidocaine + tramadol (LT group). After mandibular nerve block with opioids as an adjunct to local anesthetics, the onset time, duration of action, and depth of anesthesia were evaluated using a quantitative method through neuromuscular blockades (NMBs) monitoring. The onset time of nerve block was 4.60 ± 2.06 min, 2.00 ± 0.00 min, and 2.60 ± 1.62 min in the L, LB, and LT groups, respectively; however, there was no statistically significant difference. The duration of nerve block was 111.88 ± 34.78 min, 302.00 ± 76.72 min, and 260.40 ± 49.88 min in the L, LB, and LT groups, respectively, with a significant difference between L and LB groups. The LB group demonstrated a more profound depth of anesthesia compared to the L and LT groups. In this study, using a quantitative method through NMBs monitoring, it was demonstrated that lidocaine and butorphanol in combination can increase the duration of nerve block and more profound the depth of anesthesia rather than lidocaine alone. Additionally, the combined use of lidocaine and opioids presented an objective indicator that could provide a more clinically stable nerve block.

• Clinical Endoscopy
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• 제55권4호
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• pp.558-563
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• 2022

Background/Aims: Bispectral index (BIS) monitors process and display electroencephalographic data are used to assess the depth of anesthesia. This study retrospectively evaluated the usefulness of BIS monitoring during endoscopic ultrasonography (EUS). Methods: This study included 725 consecutive patients who underwent EUS under sedation with propofol. BIS monitoring was used in 364 patients and was not used in 361. The following parameters were evaluated: (1) median dose of propofol; (2) respiratory and circulatory depression; (3) occurrence of body movements; (4) awakening score >8 at the time; and (5) awakening score 2 hours after leaving the endoscopy room. Results: The BIS group received a significantly lower median dose of propofol than the non-BIS group (159.2 mg vs. 167.5 mg; p=0.015) in all age groups. For patients aged ≥75 years, the reduction in heart rate was significantly lower in the BIS group than in the non-BIS group (1.2% vs. 9.1%; p=0.023). Moreover, the occurrence of body movements was markedly lower in the BIS group than in the non-BIS group (8.5% vs. 39.4%; p<0.001). Conclusions: During EUS examination, BIS monitoring is useful for maintaining a constant depth of anesthesia, especially in patients 75 years of age or older.

• 한국전기전자재료학회논문지
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• 제23권1호
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• pp.76-85
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• 2010

In general, anesthetic depth is evaluated by experience of anesthesiologist based on the changes of blood pressure and pulse rate. So it is difficult to guarantee the accuracy in evaluation of anesthetic depth. The efforts to develop the objective index for evaluation of anesthetic depth were continued but there was few progression in this area. Heart rate variability provides much information of autonomic activity of cardiovascular system and almost all anesthetics depress the autonomic activity. Novel monitoring system which can simply and exactly analyze the autonomic activity of cardiovascular system will provide important information for evaluation of anesthetic depth. We investigated the anesthetic depth as following 7 stages. These are pre-anesthesia, induction, skin incision, before extubation, after extubation, Post-anesthesia. In this study, temporal, frequency and chaos analysis method were used to analyze the HRV time series from electrocardiogram signal. There were NN10-NN50, mean, SDNN and RMS parameter in the temporal method. In the frequency method, there are LF and HF and LF/HF ratio, 1/f noise, alphal and alpha2 of DFA analysis parameter. In the chaos analysis, there are CD, entropy and LPE. Chaos analysis method was valuable to estimate the anesthetic depth compared with temporal and frequency method. Because human body was involved the choastic character.

• 대한전자공학회:학술대회논문집
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• 대한전자공학회 2002년도 하계종합학술대회 논문집(5)
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• pp.289-292
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• 2002

In this study, we measure and analyzed variation of EEG signal by anesthesiologist progress step. In an experiment, the EEG signal was acquired and analyzed as 5 steps(prior surgical operation, during induction, surgical operation, awakening, posterior surgical operation). As a result, we confirm the anesthesiologist progress phase, concluded the possibility of anesthesia depth because using SEF and MF, and Delta ratio confirmed that can presume operating patient's consciousness state.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권4호
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• pp.241-251
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• 2017

Devices that monitor the depth of hypnosis based on the electroencephalogram (EEG) have long been commercialized, and clinicians use these to titrate the dosage of hypnotic agents. However, these have not yet been accepted as standard monitoring devices for anesthesiology. The primary reason is that the use of these monitoring devices does not completely prevent awareness during surgery, and the development of these devices has not taken into account the neurophysiological mechanisms of hypnotic agents, thus making it possible to show different levels of unconsciousness in the same brain status. An alternative is to monitor EEGs that are not signal processed with numerical values presented by these monitoring devices. Several studies have reported that power spectral analysis alone can distinguish the effects of different hypnotic agents on consciousness changes. This paper introduces the basic concept of power spectral analysis and introduces the EEG characteristics of various hypnotic agents that are used in sedation.