• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.5
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• pp.357-367
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• 2022

Background: Low-dose dexmedetomidine may be a suitable alternative to opioids for pediatric ambulatory procedures under general anesthesia (GA). However, the recovery profile remains unclear. Herein, we aimed to evaluate the effects of low-dose dexmedetomidine on the recovery profile of children. Methods: Seventy-two children undergoing ambulatory oral rehabilitation under GA were randomly and equally distributed into two groups (D and F). Group D received an infusion of dexmedetomidine 0.25 ㎍/kg for 4 min for induction, followed by maintenance of 0.4 ㎍/kg/h. Group F received an infusion of fentanyl 1 ㎍/kg over 4 min for induction, followed by maintenance at 1 ㎍/kg/h. The primary outcome was the extubation time. The secondary outcomes were awakening time, end-tidal sevoflurane (ET-Sevo) requirement, change in hemodynamic parameters, Richmond Agitation-Sedation Scale (RASS), Children's Hospital of Eastern Ontario pain scale (CHEOPS) score, length of PACU stay, and incidence of adverse events. Results: Statistically significant differences were observed in the recovery profile between the groups: the median time for extubation was 3.65 (3.44-6.2) vs. 6.25 (4.21-7) minutes in groups D vs. F (P=0.001), respectively, while the corresponding awakening times were 19 (18.75-21) and 22.5 (22-24) minutes, respectively (P < 0.001). The mean ET-Sevo was low in group D (1.1 vs. 1.2; P < 0.001). The heart rate was significantly low across all time points in group D, without resulting in bradycardia. The median RASS and CHEOPS scores were also significantly lower in group D. No significant differences were observed in the mean arterial pressure, incidence of adverse events, or length of PACU stay. Conclusion: Low-dose dexmedetomidine was more effective than fentanyl as an opioid substitute at providing a better recovery profile in pediatric ambulatory oral rehabilitation under GA. Dexmedetomidine also significantly reduced sevoflurane consumption without causing adverse events or prolonging hospital stay.

• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.421-427
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• 2013

There are many intramuscularly injectable drugs commonly used for anesthesia in dogs and combination of drugs were used for decrease the side effects. The objective of this study was to evaluate the anesthetic and cardiopulmonary effects of butorphanol-tiletamine-zolazepam-medetomidine and tramadol-tiletamine-zolazepam-medetomidine in dogs. Ten healthy beagle dogs (intact male; mean body weight : $9.5{\pm}1.60$ kg) were used in the study. Experimental animals were divided into two groups (n=5, each) and received 0.2 mg/kg of butorphanol (BZM) and 2 mg/kg of tramadol (TZM) according to the group after injection of $Zoletil^{(R)}$ (5 mg/kg) and medetomidine (10 ug/kg). All drugs were administered intramuscularly. Anesthesia and recovery, sedation and analgesia score, cardiovascular and respiratory parameters were measured. Induction and recovery time were not significantly different between the groups. Anesthesia time was $117.4{\pm}25.64$ minute and $81.2{\pm}12.50$ minute in BZM and TZM groups, respectively. Sedation and analgesia were satisfied in both groups. In both groups, common side effects related to the medetomidine, significant bradycardia and hypertension were not observed. There were no significant changes in respiratory data. In conclusion, tiletamine-zolazepam-medetomidine in combination with either butorphanol or tramadol can be suitable anesthetic protocol for minor procedures in dogs. They produced adequate anesthesia characterized by rapid induction, adequate analgesia and muscle relaxation without remarkable side effects.

• The Korean Journal of Physiology
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• v.19 no.2
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• pp.139-153
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• 1985

The passive tilt has been performed to study the orthostasis on the cardiovascular system. The orthostasis due to upright tilt was demonstrated as follows: the venous return, cardiac output and systemic arteiral blood pressure were decreased, whereas there was concomitant increase of heart rate, through the negative feedback mediated by such as the baroreceptor . Previous investigators have suggested that the tolerance to the orthostasis could he increased by blocking the cholinergic fiber with atropine which prevented vasodilation and bradycardia through the vasovagal reflex during the orthostasis. However, this hypothesis has not been clearly understood. This study was attempted to clarify the effect of atropine on the tolerance of the cardiovascular system to the upright and head-down tilt, and to investigate the change of the blood flow through head and lower leg with Electromagnetic flowmeter in both tilts before and after atropine state. Fourteen anesthetized dogs of $10{\sim}14kg$ were examined by tilting from supine position to $+77^{\circ}$ upright position (orthostasis), and then to $-90^{\circ}$ head-down position (antiorthostasis) for 10 minutes on each test. And the same course was taken 20 minutes after intravenous administration of 0.5mg atropine. The measurements were made of the blood flow(ml/min.) on the carotid artery, external jugular vein, femoral artery and femoral vein. At the same time pH, $PCO_2$, $PO_2$ and hematocrit (Hct) of the arterial and venous blood, and heart rate(HR) and respiratory rate (RR) were measured. The measurements obtained from upright and head-down tilt were compared with those from supine position. The results obtained are as follows: In upright tilt, the blood flow both on the artery and the vein through head and lower leg were decreased, however the decrement of blood flow through the head was greater than the lower leg And the atropine attenuated the decrement of the blood flow on the carotid artery, but not on the vessels of the lower leg. HR was moderately increased in upright tilt, but slightly in head-down tilt. The percent change of HR after the atropine administration was smaller than that before the atropine state in both upright and head-down tilts. Before the atropine state, RR was decreased in upright tilt, whereas increased in head-down tilt. However after the atropine state, the percent change of RR was smaller than that of before the atropine state in both upright and head-down tilts. In upright tilt, venous $PCO_2$ was increased, but arterial $PO_2$ and venous $PO_2$ were slightly decreased. Hct was increased in both upright and head-down tilts. The findings of blood $PCO_2$, $PO_2$ and Hct were not interferred by the atropine. In conclusion, 1;he administration of atropine is somewhat effective on improving the cardiovascular tolerance to postural changes. Thus, atropine attenuates the severe diminution of the blood flow to the head during orthostasis, and also reduces the changes of HR and RR in both orthostasis and antiorthostasis.

• Journal of Chest Surgery
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• v.42 no.2
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• pp.233-237
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• 2009

Background: Bupivacaine with fentanyl might be suitable as the spinal anesthesia for performing ambulatory surgery to treat varicose vein. Material and Method: Thirty patients who underwent spinal anesthesia for a varicose vein operation were enrolled in this study. They were classified into 2 groups of either fentanyl 25ug mixed with bupivacaine 4mg (group FB4) or bupivacaine 8mg (group B8). We compared the groups for the success of the analgesia, the recovery time from sensory and motor block, the side effects and the postoperative complications. Result: The groups did not differ significantly regarding the success of analgesia (13 of 15 [group FB4], 15 of 15 [group B8]). None of the patients were converted to general anesthesia due to surgical pain. None of the patients required medication for hypotension and/or bradycardia. The operative and nonoperative side effects of motor block (tested for by using a modified Bromage scale) was significantly lower in group FB4 than that in group B8, as checked at 2 hours after spinal anesthesia (p<0.05). Recovery from spinal block was significantly quicker in group FB4 than that in group B8 (p<0.05). The first voluntary micturition time did not differ significantly (6.5 hours v 4.5 hours [p=0.143]) between the groups, but a nelatone catheter was inserted into 2 of the group B8 patients due to dysuria. Conclusion: Adequate intraoperative analgesia and hemodynamic stability and faster mobilization were achieved using bupivacaine 4mg with fentanyl 25ug. Low dose spinal anesthesia with fentanyl is suitable for performing ambulatory surgery to treat varicose vein.

• The Korean Journal of Pharmacology
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• v.28 no.2
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• pp.171-179
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• 1992

Effects of a $M_1$ receptor antagonist, pirenzepine, a $M_2$ receptor antagonist, AF-DX116, and a nicotinic receptor antagonist, mecamylamine on the pressor responses to preganglionic sympathetic nerve stimulation (PNS) and McN-A-343 and DMPP in spinal (pithed) rabbits were investigated, in order to elucidate a functional role of $M_1$, $M_2$ and nicotinic receptors in ganglionic transmission. Pirenzepine and AF-DX116 selectively inhibited the McN-A-343-induced pressor response in chlorisondamine-treated rabbit and the BCh-induced bradycardia, respectively. Electrical stimulations of preganglionic sympathetic outflow at T8 level produced increases in blood pressure. Pirenzepine $(3\;{\mu}g/kg)$ significantly inhibited the PNS-induced pressor response and the degree of inhibition was not changed by increasing the doses to $100\;{\mu}g/kg$. AF-DX116 $(100\;{\mu}g/kg)$ had no effect on the PNS-induced pressor response. Mecamylamine inhibited the PNS-induced pressor response in a dose-dependent manner. The inhibitory action of mecamylamine was significantly augmented by combined-treatment with pirenzepine $(30\;{\mu}g/kg)$ but AF-DX116 $(100\;{\mu}g/kg)$ did not affect the inhibitory action of mecamylamine. McN-A-343 and DMPP elicited pressor response in the spinal rabbit. Pirenzepine and AF-DX116 dose-dependently inhibited the McN-A-343-induced pressor response but they did not affect DMPP-induced pressor response. Mecamylamine inhibited both pressor responses induced by McN-A-343 and DMPP. These results suggest that not only nicotinic receptors but also $M_1$ receptors play a facilitatory role in ganglionic transmission but $M_2$ receptors do not contribute the transmission in spinal (pithed) rabbits.

• The Korean Journal of Physiology
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• v.18 no.1
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• pp.67-79
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• 1984

In an effort to elucidate the physiological characteristics in cardiopulmonary function, electromyogram(EMG), and blood chemistry in athletic high school students, an analysis of electrocardiogram(ECG) and EMG, pulmonary function test, venous blood gas analysis($Pvo_2$ and$Pvco_2$), and measurement of heart rate, blood pressure, respiratory rate, blood glucose and blood lactate were made for 16 to 19 year-old high school students who were divided into athletic (n=19) and non-athletic (n=20) group. The results obtained are summarized as follows. 1) ECG intervals in athletes were longer than in non-athletes, and the difference was significant in R-R, Q-T and T-P intervals. Resting heart rate in athletes was 56.3/min showing a bradycardia compared with 79.8/min in non-athletes. Amplitudes of R and T waves in lead $V_5$ were significantly higher than in non-athletes. 2) Pulmonary function parameters in athletes showed higher values than in non-athletes. Parameters which showed significant differences were FEV 0.5, PEF, FEF 25%, PIF and FEF $200{\sim}1.200\;ml. 3) Heart rate, blood pressure, and respiratory rate after exercise were significantly elevated from resting values. Heart rate and respiratory rate showed greater increase in non-athletes, while blood pressure showed greater increase in athletes. 4) $Pvo_2$ was lowered ana $Pvco_2$ was elevated after exercise, and there was no significant difference between two groups. 5) Blood glucose and lactate levels were elevated after exercise. The difference was significant in blood lactate, and was greater in non-athletes. 6) EMG amplitude was steadily increased with increasing load of exercise, and the increase was greater in athletes than in non-athletes.

• Advances in pediatric surgery
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• v.12 no.2
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• pp.155-166
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• 2006

Inguinal hernia is the most common disease treated by the pediatric surgeon. There are several controversial aspects of management 1)the optimal timing of surgical repair, especially for preterm babies, 2)contralateral groin exploration during repair of a clinically unilateral hernia, 3)use of laparoscope in contralateral groin exploration, 4)timing of surgical repair of cord hydrocele, 5)perioperative pain control, 6)perioperative management of anemia. In this survey, we attempted to determine the approach of members of KAPS to these aspects of hernia treatment. A questionnaire by e-mail or FAX was sent to all members. The content of the questionnaire were adapted from the "American Academy of Pediatrics (AAP) Section on Surgery hernia survey revisited (J Pediatr Surg 40, 1009-1014, 2005)". For full-term male baby, most surgeons (85.7 %) perform an elective operation as soon as diagnosis was made. For reducible hernia found in ex-preterm infants already discharged from the neonatal intensive care unit (NICU), 76.2 % of surgeons performed an elective repair under general anesthesia (85.8 %). 42.9 % of the surgeons performed the repair just before discharge. For same-day surgery for the ex-premature baby, the opinion was evenly divided. For an inguinal hernia with a contralateral undescended testis in a preterm baby, 61.9 % of surgeons choose to 'wait and see' until 12 month of age. The most important consideration in deciding the timing of surgery of inguinal hernia in preterm baby was the existence of bronchopulmonary dysplasia (82.4 %), episode of apnea/bradycardia on home monitoring (70.6 %). Most surgeons do not explore the contralateral groin during unilateral hernia repair. Laparoscope has not been tried. Most surgeons do not give perioperative analgesics or blood transfusion.

• Clinical and Experimental Pediatrics
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• v.52 no.3
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• pp.303-309
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• 2009

Purpose : To identify the short-term clinical outcomes of late preterm infants and to test the hypothesis that late preterm infants have more clinical problems during the early postnatal period than term infants. Methods : One hundred late preterm infants [gestational age (GA) $34^{+0}$-$36^{+6}$ weeks] and the same number of term infants (GA $37^{+0}$-$41^{+6}$ weeks) were randomly selected from 289 late preterm infants and 825 term infants born in the Seoul National University Bundang Hospital between January 2007 and December 2007, and their electronic medical records were reviewed and analyzed. Results : Compared to term infants, late preterm infants had significantly more medical problems such as temperature instability (odds ratio [OR] 8.7), hypoglycemia (OR 17.5), intravenous fluid infusion (OR 10.2), evaluation for sepsis (OR 9.4), respiratory problems (OR 7.5), apnea and bradycardia (OR 8.6), phototherapy for jaundice (OR 3.6), and feeding intolerance (OR 10.0). Hospital stay was also significantly longer in late preterm infants. Conclusion : Late preterm infants had significantly more medical problems and increased length of hospital stay compared to term infants. More attention should be given to caring for these late preterm infants in newborn nursery during the early postnatal period.

• Pediatric Infection and Vaccine
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• v.11 no.1
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• pp.112-120
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• 2004

Purpose : Methicillin Resistant-Coagulase Negative Staphylococcus(MR-CNS) infection has become an increasingly important cause of morbidity in NICU infants. We investigated the c linical characteristics of MR-CNS sepsis. Methods : This study included 40 neonates with MR-CNS sepsis who were admitted to the neonatal intensive care unit of Kangnam Sacred Heart Hospital, Hallym University from January 1998 to July 2002. MR-CNS sepsis was defined as MR-CNS recovery from blood with clinical symptoms and signs of infection. Retrospective analyses of the medical records of patients with MR-CNS sepsis were performed. The analyses included demographic findings, clinical features, hospital courses, risk factors for infection including invasive procedures and mortality. Results : From 1998 to 2002, there were 40 cases of MR-CNS sepsis, comprising 17.7% of late onset infections in NICU of Kangnam Sacred Heart Hospital. The male/female ratio was 1.5 : 1. The mean gestational age of infected babies was $32.4{\pm}4.3$ weeks at birth. And the first positive MR-CNS culture was done in the day $10.6{\pm}9.3$ after birth. Clinical symptoms such as fever, dyspnea, cyanosis, grunting, bradycardia, vomiting and diarrhea were frequent in MR-CNS. Mechanical ventilation was applied in 12 cases and catheter was inserted in 11 cases. The mortality(12.5%) directly attributable to MR-CNS sepsis was similar to other late onset infections. Conclusion : MR-CNS is a pathogen responsible for most late onset and nosocomial infections. And it will be life-threatening in high-risk neonate. Awareness of increasing infections due to MR-CNS in NICU is important not only for infection control but also placing a great limit in use of antibiotics and invasive procedures, especially in premature infants.

• The Korean Journal of Pharmacology
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• v.22 no.2
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• pp.115-122
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• 1986

To delineate the relationship between subtypes of central alpha-adrenoceptor and central calcium channel, influences of intracerebroventricular (icv) diltiazem and nifedipine on the changes of blood pressure and heart rate by icv methoxamine and clonidine were investigated in urethane-anesthetized rabbits. 1) Methoxamine (1mg, icv) produced pressor and bradycardiac effect and clonidine $(30\;{\mu}g,\;icv)$ produced hypotension and bradycardia. 2) Icv diltiazem and nifedipine elicited dose-dependent deprcssor and bradycardiac responses. The depressor response to nifedipine was more prominent than that to diltiazem but the bradycardiac effect of nifedipine was smaller than that of diltiazem. The depressor responses to icy nifedipine $(35{\mu}g)$ and icv diltiazem $(400{\mu}g)$ were persistent but those to intravenous (iv) nifedipine $(35{\mu}g/kg)$ and diltiazem $(200{\mu}g/kg)$ were transient. 3) The pressor response to methoxamine was little affected by pretreatment with in diltiazem $(400{\mu}g)$ or icv nifedipine $(35,\;350{\mu}g)$ but the bradycardiac response to methoxamine was significantly attenuated by the same pretreatment. 4) The depressor response to clonidine was markedly attenuated by pretreatment with icv diltiazem $(400{\mu}g)$ or icv nifedipine $(35,\;350{\mu}g)$ but not affected by pretreatment with iv diltiazem $(200{\mu}g/kg)$ or iv nifedipine $(20{\mu}g/kg)$. Pretreatment with icv and iv diltiazem or nifedipine reduced the bradycardiac effect of clonidine. 5) Pretreatment with icv clonidine had no effect on the depressor and bradycardiac responses to in diltiazcm or icv nifedipine. These results indicate that diltiazem and nifedipine have no effect on icv methoxamine-induced pressor response elicited by the activation of central alpha-l adrenoceptors whereas the icv clonidine-induccd depressor and bradycardiac effects which result from the activation of central alpha-2 adrenoceptors are inhibited by the calcium antagonists.