• Journal of Korean Neurosurgical Society
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• v.51 no.2
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• pp.81-85
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• 2012

Objective : The purpose of this prospective study was to evaluate the effects of body mass index (BMI) on intra-abdominal pressure (IAP) and intraoperative blood loss (IBL) during lumbar spinal surgery. Methods : Thirty patients scheduled for single level posterior lumbar interbody fusion were allocated equally to a normal group (Group 1, BMI;$18.5-22.9kg/m^2$), an overweight group (Group 2, BMI; $23-24.9kg/m^2$), and an obese group (Group 3, BMI; $25.0-29.9kg/m^2$) according to BMI. IAP was measured using a urinary bladder catheter; 1) supine after anesthesia induction, 2) prone at skin incision, 3) prone at the end of surgery. In addition, IBL was also measured in the three groups. Results : IAP in the supine position was not significantly different in groups 1, 2, and 3 (2.7 mm Hg, 3.0 mm Hg, and 4.2 mm Hg, respectively) ($p$=0.258), and IAP in the prone position at incision increased to 7.8 mm Hg, 8.2 mm Hg, and 10.4 mm Hg, respectively, in the three groups, and these intergroup differences were significant, especially for Group 3 ($p$=0.000). IAP at the end of surgery was slightly lower (7.0 mm Hg, 7.7 mm Hg, and 9.2 mm Hg, respectively). IBLs were not significantly different between the three groups. However, IBLs were found to increase with IAP in the prone position ($p$=0.022) and BMI ($p$<0.05). Conclusion : These results show that BMI affects IAP in the prone position more than in the supine position during lumbar spinal surgery. In addition, IBLs were found to increase with IAP in the prone position and with BMI. Thus, IBLs can be expected to be higher in morbidly obese patients due to an increased IAP.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.3
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• pp.481-488
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• 2009

Buckley's formocresol was first introduced as a pulp medicament in 1904, and since 1930, it has been the treatment of choice for primary molar pulpotomies. Formocresol has fixation effect of pulp tissue and high clinical success rate. But side effect such as displacement and loss of permanent successor, amelogenesis imperfecta, cyst formation, mutation by general absorption, possibility of cancer induction have been reported. Of those, dentigerous cyst can form in the periradicular region after formocresol pulpotomy caused by an alteration of the reduced enamel epithelium, which result in fluid accumulation between the epithelium and the tooth crown. The present case describes a 6-year-old girl who had accidentally discovered in the panoramic radiograph a single, well-defined, radioluscent area enclosing the second unerupted mandibular premolar. The second left primary molar had been pulpotomizied 3 year before. Surgical treatment was carried out, the primary molar was extracted and cystectomy was performed under local anesthesia. In the extracted second primary molar, formocresol cotton pellet was left in the pulp chamber. Histologic study confirmed the suspected diagnosis of dentigerous cyst. This report present a case of dentigerous cyst associated with inadequate formocresol pulpotomized deciduous molar.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.8
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• pp.4529-4532
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• 2013

Background: Acute normovolemic hemodilution (ANH) has been widely used to prevent the massive blood loss during hepatic carcinoma. The influences of ANH on coagulation function are still controversy, especially in elderly patients. The study observed ANH effects on coagulation function and fibrinolysis in elderly patients undergoing the disease. Materials and Methods: Thirty elderly patients (aged 60-70 yr) with liver cancer (ASA I or II) taken hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group (n=15) and control group (n=15). After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch (130/0.4) and Ringer's solution, respectively. Blood samples were drawn from patients in both groups at five different time points: before anesthesia induction (T1), 30 min after ANH (T2), 1 h after start of operation (T3), immediately after operation (T4), and 24 h after operation (T5). Then coagulation function, soluble fibrin monomer complex (SFMC), prothrombin fragment (F1+2), and platelet membrane glycoprotein (CD62P and activated GP IIb/GP IIIa) were measured. Results: The perioperative blood loss and allogeneic blood transfusion were recorded during the surgery. The perioperative blood loss was not significantly different between two groups (p>0.05), but the volume of allogeneic blood transfusion in ANH group was significantly less than in control group ($350.0{\pm}70.7$) mL vs. ($457.0{\pm}181.3$) mL (p<0.01). Compared with the data of T1, the prothrombin time (PT) and activated partial thromboplastin time (APTT) measured after T3 were significantly longer (p<0.05) in both groups, but within normal range. There were no significant changes of thrombin time (TT) and D-dimer between two groups at different time points (p>0.05). SFMC and F1+2 increased in both groups, but were not statistically significant. PAC-1-positive cells and CD62P expressions in patients of ANH group were significantly lower than those at T1 (p<0.05) and T2-T5 (p>0.05). Conclusions: ANH has no obvious impact on fibrinolysis and coagulation function in elderly patients undergoing resection of liver cancer. The study suggested that ANH is safe to use in elderly patients and it could reduce allogeneic blood transfusion.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.1
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• pp.109-114
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• 1997

Malignant hyperthermia is a hypermetabolic, fatal syndrome triggered by anesthetic drugs that occurs frequently in genetically susceptible persons. It is characterized by tachycardia, rapidly increasing temperature, skeletal muscle rigidity, respiratory and metabolic acidosis, cyanosis etc. It has been noted that the majority of cases of malignant hyperthermia are fatal unless early diagnosis and treatment are performed. Thus, the accurate prediction of preanesthetic susceptibility and early diagnosis of malignant hyperthermia is necessary to appropriate treatment. Dantrolene sodium has been shown to be effective in the prevention and treatment of malignant hyperthermia. We experienced a case of malignant hyperthermia, which is presented of a 32-year-old healthy male patient in whom a orthognatic surgery was performed under $O_2-N_2O$-enfl-rane anesthesia with induction by pentobarbital and succinylcholine. We discuss this case with reviewing the history, incidence, etiology, pathophysiology, clinical signs & biochemical changes, prevention & treatment.

• Korean Journal of Acupuncture
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• v.34 no.4
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• pp.265-270
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• 2017

Objectives : The present study aimed to examine the analgesic effect of electroacupuncture(EA) applied to the brook point of the Liver meridian in the rat model of inflammatory pain and to investigate involvement of endogenouse opioid in the EA-induced analgesia. Methods : Knee arthritis was induced by injection of $125{\mu}l$ of complete Freund's adjuvant into the knee joint cavity unilaterally. To examine the level of pain, weight bearing forces(WBFs) of affected limb was measured. EA treatment was given at the LR2, LI4 or non-acupoint on the contralateral limb with frequency of 2 Hz and intensity of 2 mA under gaseous anesthesia. Results : After induction of arthritis, rats subsequently showed a reduced stepping force of the affected hindlimb due to a painful knee. EA applied to the LR2 point on the contralateral hind limb produced a significant improvement of stepping force of the hind limb lasting for at least 2 h, and this effect was equivalent to that obtained by 5 mg/kg of oral indomethacin. The effect of EA was specific to the acupoint since it could not be mimicked by EA applied to the LI4 point or the arbitrary non-acupoint. The analgesic effect was blocked by pretreatment with naltrexone(10 mg/kg, i.p.). Conclusions : These results suggest that acupuncture applied to LR2, brook point of Liver meridian suppresses inflammatory pain in a rat model of knee arthritis and this effect seems to be mediated by endogenous opioid systems.

• Journal of Chest Surgery
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• v.33 no.8
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• pp.648-654
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• 2000

Background: Cardiopulmonary bypass during open heart surgery causes systemic inflammatory respose. IL-10 is an anti-inflammatory cytokine that inhibits inflammatory process and protects organ function by down regulation of pro-inflammatory cytokine release and maintenance of blood level balance with pro-inflammatory cytokines. Mateial and Method: Plasma IL-10 levels were measured and analyzed in 22 patients who underwent open heart surgery (11 cases of coronary artery bypass graft, 11 cases of valve replacement) under cardiopulmonary bypass since 1988 January to July at Department of Thoracic and Czardiovascular surgery, Yeungnam University Hospital. 1g of methylprednisolone was administrated to thirteen patients randomly. Blood samp.es were taken and collected at the time of induction of anesthesia, 10 min before cardiopulmonary bypass, 10 min after starting of CPB, 10 min aftr aortic cross clamping, 10 min after ACC release, and 10 min, 2 hours, and `5 hours after CPB respectively. The plasma levels of IL-10 were determined by enzyme-linked immunosorbent assays(ELISA). Wilcoxon-Raule Sum test was used for statistical analysis. Result: In all 22 patients, cardiopulmonary bypass time was used for statistical analysis. Result: In all 22 patients, cardiopulmonary bypass time was 171$\pm$41.4 min and aortic cross clamp time was 118$\pm$36.5 min. Peak IL-10 level was achieved at 10 min after ACC(361.0$\pm$52.81pg/ml) and was decreased sharply at 2 hours after CPB. Peak IL-10 level was correlated positively with aortic cross clamp time(p=0.011); however, it did not correlated with bypass time(p=0.181). In valve replacement group, mean IL-10 level at peak point was 567.89$\pm$107.69 pg/ml and was significantly higher than that of coronary artery bypass group(205.67$\pm$192.70 pg/ml)(p<0.001). ACC time in valve replacement group was significantly longer than that of coronary artery bypass group(p<0.01), however, bypass time was not(p=0.212). Thirteen patients with steroid pretreatment before starting of CPB showed relatively higher plasma IL-10 level than in control group, however, no statistical significance was noted(p=0.19). Conclusion: plasma level of IL-10 was increased in association with cardiopulmonary bypass and revealed peak at 10 min after ACC release. IL-10 level was correlated positively with ACC time. Therefore, systemic inflammatory respeonse in association with cardiopulmonary bypass could be decreased by reducing ACC time during cardiac surgery.

• Applied Microscopy
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• v.27 no.3
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• pp.333-346
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• 1997

The ischemia and reperfusion injury of the skeletal muscles is caused by generation of reactive oxygen during ischemia and reperfusion. It is well known that over 4 hours of ischemia injures the skeletal muscles irreversibly. The author has demonstrated the effects of SOD (superoxide dismutase), DMTU (dimethyl thiourea) and ischemic preconditioning on ultrastructural changes of the muscle fibers in the rectus femoris muscles after 4 hours of ischemia and 1 day and 3 days of reperfusion. A total of 72 healthy Sprague-Dawley rats weighing from 200 gm to 250 gm were used as experimental animals. Under urethane(1.15 g/kg, IP, 2 times) anesthesia, lower abdominal incision was done and the left common iliac artery was occluded by using vascular clamp for 4 hours. The left rectus femoris muscles were obtained at 1 and 3 days after the removal of vascular clamp. The SOD (15,000 unit/kg) or DMTU (500 mg/kg) were administered intraperitoneally at 1 hour before induction of ischemia. The ischemic preconditioned group underwent three episodes of 5 minutes occlusion and 5 minutes reperfusion followed by 4 hours of ischemia and 1 day and 3 days of reperfusion. The specimens were sliced into $1mm^3$ and prepared by routine methods for electron microscopic observation. All specimens were stained with uranyl acetate and lead citrate and then observed with Hitachi-600 transmission electron microscope. The results were as follows: 1. SOD or DMTU alone did not affect the ultrastructure of muscle fibers in the rectus femoris muscles. The electron density of mitochondrial matrix was decreased by ischemic preconditioning. 2. Dilated cisternae of sarcoplasmic reticulum, triad, mitochondria and the loss of myofilament in the sarcomere were observed in the 4 hours ischemia and 1 day reperfused rectus femoris muscles. Markedly changed sarcoplasmic reticulum, triad, disordered or loss of myofilament, indistinct A-band and I-band, and irregular electron lucent M -line and Z-line are seen in the 4 hours ischemia and 3 days reperfused rectus femoris muscles. 3. SOD reduced the changes of organelles in the muscle fibers of the 4 hours ischemia and 1 day reperfused rectus femoris muscles of the rats, but SOD did not affect the changes of muscle fibers in the 4 hours ischemia and 3 days reperfused muscles. On the other hand, DMTU markedly attenuated considerably the ultrastructural change of the 4 hours ischemia and 1 day or 3 days reperfused rectus femoris muscles. 4. By the ischemic preconditioning, the change was attenuated remarkably in the 4 hours ischemia and 1 day reperfused rectus femoris muscles. As the ischemic reperfused changes of muscle fibers were regenerated or recovered by ischemic preconditioning, the ultrastructures of them were similar to those of normal control in the 4 hours ischemia and 3 days reperfused rectus formoris muscles. Consequently, it is suggested that DMTU is stronger inhibitor to ischemic reperfused change than SOD. The ischemia and reperfusion-induced muscular damage is remarkably inhibited by ischemic preconditioning.

• Development and Reproduction
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• v.6 no.1
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• pp.17-23
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• 2002

In oocyte retrieval, a vein anesthetic drug is commonly used for induction and maintenance of general anesthesia. Propofol and Thiopental sodium are frequently used for ultrasound-guided transvaginal oocyte retrieval. The present study aimed to assess the effects of Propofol and Thiopental on in vitro fertilization(IVF). Immature porcine oocytes were exposed to various concentrations ot Propofo1 and Thiopental sodium. The rates of oocyte maturation, fertilization and development were observed. The parthenogenetic effects of the anesthetics were also evaluated. The rate of oocyte maturation after exposure to high concentrations of the anesthetics for long time was significantly higher than that of the control. But the rate of fertilization after long-time exposure to the high concentration of the anesthetic drugs was significantly lower than that of the control. The results support that Propofo1 serves like other anesthetics described, as a parthenogenetic activator. Oocytes exposed to Thiopental sodium showed decreased rates of maturation and fertilization. These results suggest that usage of optimum concentration of anesthetic drug is important in increasing the rates of oocyte maturation, fertilization and development in IVF.

• Korean Journal of Veterinary Research
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• v.39 no.3
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• pp.616-627
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• 1999

This study was performed to evaluate anesthetic and cardiovascular effects of xylazine/fentanyl/azaperone and medetomidine/midazolam as preanesthetics and their combinations with antagonists in halothane-anesthetized dogs. Eight clinically healthy dogs($4.54{\pm}2.16kg$) were used at the interval of more than 14 days between experiments in turn for propionyl promazine(PP 0.3mg/kg, IM), xylazine/fentanyl/azaperone(XFA 2mg/kg, 0.0137mg/kg, 0.11mg/kg, IM), medetomidine/midazolam(MM 0.02mg/kg, 0.3mg/kg, IM), combination of XFA and their antagonists (yohimbine 0.05mg/kg, naloxon 0.0005mg/kg, IV) and combination of MM and their antagonist(atipamezole 0.08mg/kg IM). The sedation induction times in XFA($2.56{\pm}1.01min$) and MM($5.44{\pm}2.07min$) groups were significantly better than that of PP group($10.75{\pm}2.38min$)(p < 0.05). The thiopental sodium dose required for tracheal intubation in XFA($2.38{\pm}3.38mg/kg$) and MM($3.91{\pm}3.47mg/kg$) groups were significantly less than that of PP group($12.57{\pm}2.13mg/kg$)(p < 0.05). All time indices expressing the recovery(pedal reflex recurrence time, extubation time, arousal time, standing time and walking time) were significantly shorter in the combination groups of XFA or MM with their antagonists than in PP, XFA and MM groups(p < 0.05). The suppressions of cardiovascular function of XFA and MM were more than that of PP. Heart rate and cardiac output were recovered by the antagonists of XFA and MM, but mean arterial pressure were not recovered by the antagonists. PP induced apnea in 4 out of 8 dogs, but XFA in none and MM in one. The present study suggested that for rapid sedation, prevention of apnea after intubation and rapid recovery after halothane cessation, combinations of xylazine/fentanyl/azaperone or medetomidine/midazolam with their antagonists are recommendable as preanesthetic method in gas anesthetised dogs with normal cardiovascular function.

• The Korean Journal of Pain
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• v.22 no.2
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• pp.135-140
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• 2009

Background: The chronobiology of postoperative pain is an interesting topic. This study was performed to evaluate the effects of adenosine on inta-operative remifentanil requirements and on postoperative pain in patients undergoing tonsillectomies and how those effects change with changing time of day the surgery is performed. Methods: For this study, 120 patients were randomly allocated into four groups. Patients in groups B and D received adenosine at a dose of $50{\mu}g/kg/min$, and those in group A and C received an equal volume of saline from 10 minutes after the induction of anesthesia until the end of surgery. Group A (saline) and B (adenosine) patients entered the operating room after 08:30 and finished before 11:00, Group C (saline) and D (adenosine) patients entered the operating room after 13:30 and finished before 16:00. We evaluated the intraoperative time-weighted mean remifentanil dose, and postoperative pain scores at 1, 6, 12, and 24 hours, and the analgesic dose required during the following 24 hours. Results: Time-weighted mean remifentanil doses during the intraoperative period and the analgesic requirement during the following 24 hours in group D was significantly lower than in the other groups. The numeric rating scale for pain at 1, and 6 hours in group D was significantly lower (P < 0.01) than that of group A. There were no significant differences in side effects among groups. Conclusions: Use of intraoperative adenosine infusion provides perioperative analgesia. Postoperative pain is affected by the time of day the operation is performed.