• Journal of Veterinary Science
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• 제21권1호
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• pp.8.1-8.11
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• 2020

This study reports the clinical use of two sevoflurane-based anesthetic techniques in dogs undergoing craniectomy. Twenty-one animals undergoing elective rostrotentorial or transfrontal craniectomy for brain tumor excision, anesthetized with sevoflurane, were enrolled in this retrospective, observational study. Anesthetic records were allocated to two groups: Sevo-Op (sevoflurane and short acting opioid infusion): 8 dogs and Sevo-Dex (sevoflurane and dexmedetomidine infusion): 13 dogs. Average mean arterial pressure (MAP), heart rate, end-tidal carbon dioxide, end-tidal sevoflurane and intraoperative infusion rates during surgery were calculated. Presence of intra-operative and post-operative bradycardia, tachycardia, hypotension, hypertension, hypothermia, hyperthermia was recorded. Time to endotracheal extubation, intraoperative occurrence of atrioventricular block, postoperative presence of agitation, seizures, use of labetalol and dexmedetomidine infusion were also recorded. Data from the two groups were compared with Fisher's exact test and unpaired t tests with Welch's correction. Odds ratio (OR) and 95% confidence interval (CI) were calculated for categorical variables. Intra-operatively, MAP was lower in Sevo-Op [85 (± 6.54) vs. 97.69 (± 7.8) mmHg, p = 0.0009]. Time to extubation was longer in Sevo-Dex [37.69 (10-70) vs. 19.63 (10-25), p = 0.0033]. No differences were found for the other intra-operative and post-operative variables investigated. Post-operative hypertension and agitation were the most common complications (11 and 12 out of 21 animals, respectively). These results suggest that the infusion of dexmedetomidine provides similar intra-operative conditions and post-operative course to a short acting opioid infusion during sevoflurane anesthesia in dogs undergoing elective rostrotentorial or transfrontal intracranial surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권2호
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• pp.69-81
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• 2023

Background: In order to assess the effectiveness of various analgesio-sedative combinations for pain relief and sedation in pediatric dental patients, a thorough evaluation of clinical studies and patient outcomes is necessary. Methods: A total of 128 healthy, uncooperative pediatric dental patients were randomly allocated to receive one of the four combinations of drugs via the intranasal (IN) route: Group I received midazolam-ketamine (MK), Group II received dexmedetomidine-ketamine (DK), Group III received midazolam-fentanyl (MF), and Group IV received dexmedetomidine-fentanyl (DF) in a parallel-arm study design. The efficacy and safety of the combinations were evaluated using different parameters. Results: The onset of sedation was significantly faster in the DF group than in the DK, MF, and MK groups (P < 0.001). The depth of sedation was significantly higher in the DK and DF groups than in the MK and MF groups (P < 0.01). DK and DF produced significant intra- and postoperative analgesia when compared with combinations of MK and MF. No significant adverse events were observed for any of the combinations. Conclusions: The DK and DF groups showed potential as analgesio-sedatives in view of their anxiolytic and analgesic effects.

• 대한치과마취과학회지
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• 제13권1호
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• pp.19-22
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• 2013

Certain oral surgery can be performed safely under monitored anesthesia care (MAC) with local anesthesia. Several drugs, such as propofol, benzodiazepine, and opioids have been used for MAC either alone or in combination. Benzodiazepine may cause excessive sedation and confusion, and propofol can also result in disorientation and excessive sedation. Low dose propofol anesthesia with the concomitant use of dexmedetomidine is an effective technique for MAC in patients who are scheduled for intraoral surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권1호
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• pp.25-29
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• 2016

Background: The most important reason for pre-operative administration of medication is to reduce anxiety. Alleviation of fear and anxiety about surgery enables patients to remain comfortable during treatment. Dexmedetomidine (DEX) is a fast-acting drug that is used as a premedication in different circumstances because it has sedative and anti-anxiolytic effects, and stable hemodynamics. It also has the advantage of intranasal administration. The aim of this study was to investigate the effects and hemodynamic stability of DEX by retrospectively analyzing cases in which DEX was administered nasally as a premedication. Methods: Ten patients treated at Dankook University Dental Hospital, recruited between February and April 2015, received intranasal delivery of $2{\mu}g/kg$ DEX, 30 minutes prior to general anesthesia. Anesthesia records of anxiety, blood pressure, respiration, pulse, estimated arterial oxygen saturation ($SpO_2$), and partial pressure, or maximum concentration, of carbon dioxide ($ETCO_2$) were analyzed. Results: Administration of DEX prior to a general anesthetic effectively relieved anxiety. Respiratory depression, the most severe adverse effect of other sedatives, was not observed. Hemodynamic stability under general anesthesia was maintained during treatment and a reduction in emergence delirium was observed upon completion of treatment. Conclusions: Premedication administration of DEX is safe for pediatric patients undergoing dental treatment under general anesthesia.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권3호
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• pp.152-157
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• 2019

Objectives: The number of elderly patients with systemic basal disease requiring invasive dental treatment has increased. Appropriate prediction of surgical invasiveness and combined use of psychosedation are thought to contribute to safe whole-body management. Dexmedetomidine (DEX) exhibits analgesic and anti-anxiolytic properties and causes mild respiratory depression. Studies regarding DEX use in elderly non-intubated patients are scarce. We aimed to use retrospective data to determine an effective dose of DEX to induce adequate sedation in elderly patients undergoing invasive dental surgery under local anesthesia. Materials and Methods: One hundred two patients aged 70 to 96 years were presumably appropriately controlled with sedation. DEX was administered at an initial loading dose of 2.0 to $3.1{\mu}g/kg/hr$ for 10 minutes. We divided the patients into five groups by age and compared their blood pressures and heart rates. Results: In all five groups, blood pressure decreased suddenly at approximately 15 and 20 minutes after DEX administration. A marked decrease in blood pressure was noted in patients aged 75 to 79 years. Conclusion: For elderly patients aged 75 years and above, the initial loading dose of DEX needs to be reduced to lower than half that required for young and middle-age adults.

• 분석과학
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• 제35권3호
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• pp.136-142
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• 2022

안락사 시킨 유기견의 사체를 고온 및 고압 처리하여 가루로 만들고 사료 원료(육골분)로 사용했다는 언론보도에 따라 안락사에 사용된 마취제 케타민과 덱스메데토미딘의 사료 내 잔류가능성이 제기되었다. 이에 신속한 잔류 조사를 위해 QuEChERS 전처리와 질량분석기를 이용한 동시분석법을 개발하였다. 개발된 동시분석법의 직선성은 0.999 이상을 보였다. 선택성은 무처리 시료와 케타민과 덱스메데토미딘이 정량한계수준으로 처리된 시료의 비교를 통해 평가하였고, MRM 크로마토그램을 확인한 결과 각각의 머무름 시간에서 매질의 간섭은 없었다. 검출한계는 0.6 ㎍/L, 정량한계는 2 ㎍/L로 설정하였으며, 분석법의 최종 정량한계는 10 ㎍/kg로 설정하였다. 육골분, 육분, 애완용 배합사료 중 케타민의 회수율 실험 결과, 80.48-98.63 %, 상대표준편차 5.00 % 이하의 결과를 보였으며, 덱스메데토미딘은 회수율 72.75-93.00 %, 상대표준편차 4.83 % 이하의 결과를 보였다. 개발된 분석법을 활용하여 케타민과 덱스메데토미딘의 잔류실태조사를 실시하였다. 해당 원료가 배포된 시기에 제조된 육골분 등의 사료 6 점을 수거하여 분석한 결과, 육골분 시료 한점에서 케타민이 10.8 ㎍/kg이 검출되었고, 덱스메데토미딘은 정량 한계 미만의 농도로 확인되었다. 이에 해당 원료를 사용한 제품은 전량 회수, 폐기되었다. 이후에도 육골분 사료의 안전성 확보를 위해 육골분 및 배합사료 등의 시료 32점을 추가로 수거하여 케타민과 덱스메데토미딘에 대한 잔류 조사를 실시 하였고, 분석결과 두 성분 모두 검출되지 않았다. 하지만 이번 조사를 통해 마취제 같은 의약품들이 고온 및 고압에도 분해되지 않고 잔류할 수 있다는 사실을 확인하였고, 이에 따라 육골분 사료에서 관리하고 있지 않은 다른 잠재적 유해물질들에 대한 조사의 필요성이 제기되었다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권3호
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• pp.162-165
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• 2016

We report a case of a morbidly obese man with an aortic aneurysm, in whom dental surgery was performed before elective cardiac surgery. His aortic aneurysm required emergency surgery. However, because of his morbid obesity, elective cardiac surgery was planned. Considering the high risk of infective endocarditis, dental surgery was required. Our patient was at a high risk of aortic rupture caused by hypertension and breathing difficulty in the supine position. Dexmedetomidine (DEX) is an anti-anxiety, sedative, and analgesic medicine that can stabilize circulatory dynamics and minimize blood pressure fluctuations. We administered intravenous DEX for sedation of the patient in Fowler's position. In conclusion, our understanding of the risk factors of DEX enabled us to perform safe invasive oral treatment.

• The Korean Journal of Physiology and Pharmacology
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• 제20권5호
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• pp.441-447
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• 2016

Despite the complex vascular effects of dexmedetomidine (DEX), its actions on human pulmonary resistance arteries remain unknown. The present study tested the hypothesis that DEX inhibits vascular tension in human pulmonary arteries through the endothelial nitric oxide synthase (eNOS) mediated production of nitric oxide (NO). Pulmonary artery segments were obtained from 62 patients who underwent lung resection. The direct effects of DEX on human pulmonary artery tension and changes in vascular tension were determined by isometric force measurements recorded on a myograph. Arterial contractions caused by increasing concentrations of serotonin with DEX in the presence or absence of L-NAME (endothelial nitric oxide synthase inhibitor), yohimbine (${\alpha}_2$-adrenoceptor antagonist) and indomethacin (cyclooxygenase inhibitor) as antagonists were also measured. DEX had no effect on endothelium-intact pulmonary arteries, whereas at concentrations of $10^{-8}{\sim}10^{-6}mol/L$, it elicited contractions in endothelium-denuded pulmonary arteries. DEX (0.3, 1, or $3{\times}10^{-9}mmol/L$) inhibited serotonin-induced contraction in arteries with intact endothelium in a dose-dependent manner. L-NAME and yohimbine abolished DEX-induced inhibition, whereas indomethacin had no effect. No inhibitory effect was observed in endothelium-denuded pulmonary arteries. DEX-induced inhibition of vasoconstriction in human pulmonary arteries is mediated by NO production induced by the activation of endothelial ${\alpha}_2$-adrenoceptor and nitric oxide synthase.

• 대한임상검사과학회지
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• 제54권3호
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• pp.201-208
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• 2022

Neuroinflammation is defined as a neurological inflammation within the brain and the spinal cord. In neuroinflammation, microglia are the tissue-resident macrophages of the central nervous system, which act as the first line of defense against harmful pathogens. Dexmedetomidine (Dex) has an anti-inflammatory effect in many neurological conditions. Additionally, the microRNA-30a-5p (miR-30a-5p) mimic has been proven to be effective in macrophages in inflammatory conditions. This study aimed to investigate the synergistic anti-inflammatory effects of both miR-30a-5p and Dex in lipopolysaccharide (LPS)-induced BV2 cells. This study showed that miR-30a-5p and Dex decreased nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) translocation in LPS-induced BV2 cells. MiR-30a-5p and Dex alleviated tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), LPS-induced phosphorylation c-Jun N-terminal kinases (JNK), extracellular signal-regulated kinase (ERK) and p38. Also, the expression of the NOD-like receptor pyrin domain containing 3 inflammasome (NLRP3), cleaved caspase-1, and ASC was inhibited. Furthermore, LPS-stimulated nitric oxide (NO) production, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2) expression were attenuated by Dex and miR-30a-5p. Our results indicate that a combination of Dex and miR-30a-5p, attenuates NF-κB activation, the mitogen-activated protein kinase (MAPK) signaling pathway, and inflammatory mediators involved in LPS-induced inflammation and inhibits the activation of the NLRP3 inflammasome in LPS-activated BV2 cells.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권6호
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• pp.348-355
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• 2022

Objectives: To compare the vital sign stability and cost of two commonly used sedatives, midazolam (MDZ) and dexmedetomidine (DEX). Patients and Methods: This retrospective study targeted patients who underwent mandibular third molar extractions under intravenous sedation using MDZ or DEX. The predictor variable was the type of sedative used. The primary outcome variables were vital signs (heart rate and blood pressure), vital sign outliers, and cost of the sedatives. A vital sign outlier was defined as a 30% or more change in vital signs during sedation; the fewer changes, the higher the vital sign stability. The secondary outcome variables included the observer's assessment of alertness/sedation scale, level of amnesia, patient satisfaction, and bispectral index score. Covariates were sex, age, body mass index, sleeping time, dental anxiety score, and Pederson scale. Descriptive statistics were computed including propensity score matching (PSM). The P-value was set at 0.05. Results: The study enrolled 185 patients, 103 in the MDZ group and 82 in the DEX group. Based on the data after PSM, the two samples had similar baseline covariates. The sedative effect of both agents was satisfactory. Heart rate outliers were more common with MDZ than with DEX (49.3% vs 22.7%, P=0.001). Heart rate was higher with MDZ (P=0.000). The cost was higher for DEX than for MDZ (29.27±0.00 USD vs 0.37±0.04 USD, P=0.000). Conclusion: DEX showed more vital sign stability, while MDZ was more economical. These results could be used as a reference to guide clinicians during sedative selection.