• Journal of Dental Anesthesia and Pain Medicine
• /
• v.18 no.1
• /
• pp.47-56
• /
• 2018

Background: The purpose of this study is to investigate the effects of administration order when a sedative drug (midazolam) and an opioid analgesic drug (fentanyl) is applied for moderate intravenous (IV) sedation in dentistry. Methods: A retrospective chart review was conducted in one dental clinic during its transition from a midazolam-first to a fentanyl-first protocol for dental procedures requiring moderate IV sedation. Physiological parameters, drug administration times, patient recovery times, drug dosages, and patient recall and satisfaction were investigated for differences. Results: A total of 76 charts (40 midazolam-first and 36 fentanyl-first administrations), were used in the analysis. Administering midazolam first resulted in an average 4.38 min (52%) decrease in administration times (P < 0.001), and a decrease in procedural recollection immediately following the procedure (P = 0.03), and 24 to 48 hours later (P = 0.009). Administering fentanyl first required an average of 2.43 mg (29%) less midazolam (P < 0.001). No significant differences were found for change in vital signs, minimum oxygen saturation levels, recovery times, and patient satisfaction (P > 0.05). Oxygen saturation levels did not drop below 90% for either group; however, 5 cases in the fentanyl-first group fell to between 90% and 92%, compared with 0 cases in the midazolam-first group. Conclusions: The administration order of fentanyl and midazolam may have different effects on patients and the sedation procedure. Findings from this study should be used to facilitate discussion among dental practitioners and to guide additional research investigating this topic.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.22 no.3
• /
• pp.217-224
• /
• 2019

Purpose: Various publications on the use of sedation and anesthesia for diagnostic procedures in children have demonstrated that no ideal agent is available. Although propofol has been widely used for sedation during esophagogastroduodenoscopy in children, adverse events including hypoxia and hypotension, are concerns in propofol-based sedation. Propofol is used in combination with other sedatives in order to reduce potential complications. We aimed to analyze whether the administration of midazolam would improve the safety and efficacy of propofol-based sedation in diagnostic esophagogastroduodenoscopies in children. Methods: We retrospectively reviewed the hospital records of children who underwent diagnostic esophagogastroduodenoscopies during a 30-month period. Demographic characteristics, vital signs, medication dosages, induction times, sedation times, recovery times, and any complications observed, were examined. Results: Baseline characteristics did not differ between the midazolam-propofol and propofol alone groups. No differences were observed between the two groups in terms of induction times, sedation times, recovery times, or the proportion of satisfactory endoscopist responses. No major procedural complications, such as cardiac arrest, apnea, or laryngospasm, occurred in any case. However, minor complications developed in 22 patients (10.7%), 17 (16.2%) in the midazolam-propofol group and five (5.0%) in the propofol alone group (p=0.010). Conclusion: The sedation protocol with propofol was safe and efficient. The administration of midazolam provided no additional benefit in propofol-based sedation.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.8 no.2
• /
• pp.113-117
• /
• 2008

Background: The purpose of this study was to compare the use of midazolam only with midazolam with fentanyl or propofol in IV sedation. Methods: 24 cases were divided to midazolam group (M group), midazolam + fentanyl group (MF group), midazolam + propofol group (MP group) and midazolam + fentanyl + propofol group (MFP group). In M group, 2 ml midazolam was injected at first, than at 2 minutes interval 1-2 ml injected continuously depending on the level of sedation. In MP, MFP groups, propofol was injected at the speed of 15-20 ml/hr by infusion pump. In this study, the sedation level was evaluated by using OAA/S scale. In each groups, the recovery time was measured until OAA/S scale score level was 5, and pre and postoperative blood pressure change was measured. Each group's data was statistically analyzed using one-way ANOVA. If significant statistical difference were observed, Dunnet test was performed, and control group was M group. Results: Pre and postoperative blood pressure change were not represent significant statistical difference in 4 groups (P value = 0.679 [systolic], P value = 0.206 [diastolic]). But recovery time were represent significant statistical difference (M group: 35.6, MF group: 32.5, MP group: 17.9, MFP group: 19.6 [P value = 0.002]). The result of Dunnet test on recovery time showed significant statistical difference on MF, MFP group when M group was control group. In MFP group, sedation was increased by using supplemental fentanyl, and postoperative pain control was dominant. Conclusion: To achieve the effect of anxiolysis, analgesia, amnesia effectively, and short recovery time, MFP group is mostly recommended.

• The Journal of Korean Physical Therapy
• /
• v.27 no.2
• /
• pp.112-117
• /
• 2015

Purpose: The purpose of this study was to examine the effects of a task-specific obstacle crossing rehabilitation program on functional gait ability in patients with cerebellar ataxia. Overall, we sought to provide ataxia-specific locomotor rehabilitation guidelines for use in clinical practice based on quantitative evidence using relevant analysis of gait kinematics including valid clinical tests. Methods: Patients with cerebellar disease (n=13) participated in obstacle crossing training focusing on maintenance of dynamic balance and posture, stable transferring of body weight, and production of coordinated limb movements for 8 weeks, 2 times per week, 90 minutes per session. Throughout the training of body weight transfer, the instructions emphasized conscious perception and control of the center of body stability, trunk and limb alignment, and stepping kinematics during the practice of each walking phase. Results: According to the results, compared with pre-training data, foot clearance, pre-&post-obstacle distance, delay time, and total obstacle crossing time were increased after intervention. In addition, body COM measures indicated that body sway and movement variability, therefore posture stability during obstacle crossing, showed improvement after training. Based on these results, body sway was reduced and stepping pattern became more consistent during obstacle crossing gait after participation in patients with cerebellar ataxia. Conclusion: Findings of this study suggest that task-relevant obstacle crossing training may have a beneficial effect on recovery of functional gait ability in patients with cerebellar disease.

• Journal of Korean Neurosurgical Society
• /
• v.39 no.4
• /
• pp.277-280
• /
• 2006

Objective : The aim of this study is to determine which patients with progressively deteriorating acute cerebellar infarction would benefit from surgical treatment and which surgical procedure would best benefit them. Methods : Seventy six patients were treated at our hospital for cerebellar infarction over the past 3 years. Sixty nine patients received conservative management in the neurological department of our hospital. Among them, 7 patients [5 males and 2 females; average age, 49 yrs] were referred to neurosurgical department because of mental deterioration and underwent emergency surgery. Five patients underwent external ventricular drainage with suboccipital craniectomy and two patients underwent suboccipital craniectomy alone. Results : Of the 7 surgically treated patients, 4 patients experienced good recovery and 2 patients experienced moderate disability [disabled but independent] and 1 patient experienced severe disability [conscious but disabled]. There was no death. Conclusion : In patients conservatively treated for cerebellar infarction and showing mental deterioration and radiologically evident brainstem compression and ventricular enlargement, we strongly recommend suboccipital craniectomy [plus optional external ventricular drainage in case of showing hydrocephalus] as a first treatment option.

• Journal of Acupuncture Research
• /
• v.36 no.4
• /
• pp.197-203
• /
• 2019

The purpose of this study was to investigate useful manual therapy techniques for peripheral facial nerve palsy and to propose guidelines to be applied for current manual therapy techniques. Several databases were searched to find manual therapies for facial palsy. These therapies included cervical, and temporomandibular joint chuna manual therapy, proprioceptive neuromuscular facilitation, neuromuscular re-education, facial exercise, and mime therapy. Both cervical, and temporomandibular joint chuna manual therapy release nerve compression, helping blood circulation and nerve conduction. Proprioceptive neuromuscular facilitation uses irradiation, bilateral activation, and eccentric facilitation to improve muscle power and symmetry. Neuromuscular re-education, as a retraining tool for facial movement patterns, enhances neuromuscular feedback. Facial exercise helps the patient continuously move and massage facial muscle themselves. Mime therapy aims to develop a conscious connection between the use of certain muscles and facial expressions. The use of facial chuna manual therapy for peripheral facial nerve palsy can stimulate the proprioceptive neuromuscular receptors in the face. Peripheral facial nerve palsy has 4 phases; progress phase, plateau phase, recovery phase, and sequelae phase. Each phase needs different treatments which include relaxation, assistance, resistance, origin-insertion extension, and nerve pathway expansion.

• The Korean Journal of Physiology
• /
• v.27 no.1
• /
• pp.67-77
• /
• 1993

Acute and chronic effects of ethanol (EOH) administration on the cardiovascular and hormonal responses to repeated hemorrhage were investigated in conscious normotensive Wistar rats and spontaneously hypertensive rats (SHR). The chronic EOH treated group received 5% EOH (vol/vol) ad libitum in the drinking water far the first week,10% for the last 2 weeks, and 20% for the last 5 weeks from the age of 6 weeks. The EOH free group received tap water. Chronic EOH and EOH free groups were randomly subdivided into acute EOH infusion and control groups. Under ether anesthesia, catheters were inserted into the femoral vein and both femoral arteries. After rats regained consciousness and their blood pressure was stabilized, responses to quick hemorrhage (5 ml/kg BW) were tested. In the acute EOH infusion group, hemorrhage was induced 20 min after EOH infusion (1.0 g/kg BW), Baroreceptor reflex sensitivity was assessed by the ratio of changes in hen.1 rate and mean arterial pressure (${\Delta}HR/{\Delta}MAP$) immediately after the hemorrhage. Chronic EOH administration elevated MAP in Wistar rats. During acute EOH infusion, MAP do- creased and HR increased in all groups. In comparison to EOH free control rats, acute or chronic EOH treated rats showed a greater reduction in MAP and a smaller elevation in heart rate in response to a hemorrhage. The degree of MAP reduction was significantly greater in SHR than in Wistar rats. Both the acute and chronic EOH administration attenuated the baroreceptor reflex and retarded MAP recovery, again the trend being much more prominent in SHR. The increase in plasma vasopressin and lenin concentrations after hemorrhage were intensified by the chronic EOH administration. SHR showed a greater vasopressin response but a smaller lenin response than Wistar rats. These results indicate that the EOH treated rats, particularly SHB, are prone to shock by a hemorrhage, which may be partly attributed to an impaired baroreceptor reflex function.

• Korean Journal of Rural Living Science
• /
• v.10 no.1
• /
• pp.21-32
• /
• 1999

To investigate the status of farmers health management for health promotion, and for checking the effect of village health care center during 1 year, 746 subjects were selected with cluster method in 8 provinces of Korea. The most frequent group was 40th of age (39%) : elementary school graduates (32%) The self-conscious of health status tested with CMI (Cornell Medical Index) questionnaire, the subjects in the village of health care center had lower health status than those of conventional village. The farmers living in the village with health care center had longer agricultural work (p＜0.05) and more frequency of spraying pesticides in the fields. The subjects of living the village of health care center were frequently exercise (34%) with health appliance use methods (30%), but the duration time of exercise was similar, Dietary habits and agricultural work condition were similar between two groups. For the fatigue recovery, steeping and bathing were most favorite methods, but exercise was lowest. It was significantly different between 2 groups the fatigue recovering methods, the subjects of village with health care center were more doing exercise (p＜0.01), less sleeping (p＜0.01) than those of conventional village. The working condition of self-estimated of farmers was not good, only 8.7% was thought pleasant condition. Of the various health factors, exercise, nutrition, and working situation would be more important. Considering on farmers exercise, it was very weak point for health management. The foundation and leading of the Farmers health care center was encouraged to farmers. For more effective operations, the experts education, easy and funny exercise program, and health promotion committee for administrators would be needed. The better systemic and continuous exercise programs should develop for associating livelihood. Funding for this project provided by the ministry of health and welfare of Korea.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.29 no.3
• /
• pp.169-172
• /
• 2003

Purpose : We examined the relationship between BIS, sedation score and plasma midazolam concentration to verify the usefulness of BIS to assess the patient's consciousness during sedation. Patients and Methods : Twenty-five young, healthy adult volunteers participated in this clinical study. Midazolam was administered intravenously up to 0.08 mg/kg to induce unconsciousness and we monitored the patient's physiological and conscious status until complete recovery from sedation. BIS and sedation score were measured before sedation, 10, 20, 30 minutes after midazolam administration. Plasma midazolam concentration was measured 10 minutes after midazolam administration. BIS was measured using A-2000 BISTM monitor (Aspect Medical Systems, USA) and the degree of sedation was evaluated with the sedation score. Results : The BIS score correlated with the sedation score (r = 0.676; P < 0.05). With the decreased plasma midazolam concentration, the correlation was better with sedation score (r = -0.656). Although BIS values did not correlate with calculated plasma concentration of midazolam (r = 0.467) at 10 minutes after midazolam administration, values after sedation were well distinguished from those before sedation. Conclusions : BIS is known for an effective predictor of patient's hypnotic state, and it is correlated with the sedation score. But, it doesn't always coincide with the clinical parameters of depth of sedation. So more attention is needed using BIS only during sedation, and it is advisable that the patient's consciousness is monitored with variable sedation score systems every several minutes.

• Journal of the Korean Society of Child Welfare
• /
• no.32
• /
• pp.33-68
• /
• 2010

The aim of the present study is to understand the lived experiences of sexual violence in childhood and adolescence. Qualitative methodology, which allows us to directly meet individuals who experienced sexual violence, see their experience, and qualitatively analyze their experience was employed. More specifically, I conducted in-depth interviews with 6 woman who experienced sex abuse in their childhood and adolescence, and analyzed their experience using categorization and theme analysis methods. The key themes that were derived from the qualitative data include, 'On the day out of the ordinary; Unspeakable terror', 'Why did this kind of thing happen to me', 'Trying not to loss my senses; Unspeakable suffering, unable to speak', 'I hate myself', 'Forgetting wasn't the end; Would it be okay if I speak out' 'Becoming conscious creates more confusion', 'I know that it is not my fault', 'Internalized social norms', 'Denial of feminity', 'Confusion and recovery'. Based on these findings, I propose a practice guideline to help woman who experienced sexual abuse during childhood and adolescence, and implications for future studies.