• 대한간호학회지
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• 제36권1호
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• pp.114-126
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• 2006

Purpose: This study was performed to evaluate the pre-emptive analgesic effects of a small dose of intravenous ketamine on postoperative pain in patients undergoing a hysterectomy. Method: Sixty patients undergoing a hystrectomy under general anesthesia were randomly allocated to 2 groups. The experimental group(30 patients) received 0.3mg/kg of ketamine after induction of anesthesia, approximately 5 min prior to surgery, but the control group(30 patients)did not receive ketamine. Data was collected in a double-blind manner from April 1st, to October 30th, 2004. Postoperatively, the patients used a patient-controlled analgesia(PCA) pump. Blood pressure, pulse rate, pain, anxiety, count of times pressing the PCA button, administeration of additional analgesics and side effects of ketamine were measured at 1 hour, 3 hours, 6 hours and 24 hours after the operation. Result: There were no statistical differences in blood pressure, pulse rate, pain and anxiety between the experimental and control groups. There were statistical differences in blood pressure, pulse rate, pain and anxiety during the 24 hours postoperatively. In the experimental group, the number of times pressing the PCA button and administering additional analgesic drugs were significantly lower than those of the control group. Conclusion: A 0.3 mg/kg dose of ketamine given at approximately 5 min before surgery resulted in decreasing the number of times pressing the PCA and the administration of additional analgesics.

• The Korean Journal of Pain
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• 제14권1호
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• pp.76-82
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• 2001

Background: Postoperative nausea and vomiting (PONV) are common after general anesthesia and patient controlled analgesia (PCA) using opioids. This study was designed to compare the effectiveness of ondansetron plus dexamethasone versus ondansetron alone in the prevention of PONV in a patient undergoing a PCA. Methods: We studied 166 ASA I, and II in-patients undergoing general anaesthesia for major gynecological surgery. After induction of anesthesia, Group 1 (n = 64) received intravenous (IV) dexamethasone 10 mg and Group 2 (n = 102) received IV saline 2 ml before the surgical incision. Each patient received IV meperidine 50 mg as a loading dose. Meperidine 5 mg/kg, ketorolac 3.6 mg/kg and ondansetron 8 mg diluted in 40 ml solutions were connected to PCA pump for postoperative pain control. Mean arterial blood pressure, heart rate, pain score and symptom-therapy score were checked at 1, 4, 8, 16, 24, and 36 hours after the PCA connection. Results: For Group 1 and Group 2, respectively, the overall incidence of PONV was 12.5% and 23.5%. The pain scores were lower in patients receiving a combination of ondansetron and dexamethasone than those on ondansetron alone at 4 hr (P < 0.05), 8 hr (P < 0.05) and 16 hr (P < 0.05). Conclusions: This study suggests that the combination of ondansetron and dexamethasone is not more effective than ondansetron alone in the prevention of postoperative nausea and vomiting in women having PCA following major gynecological surgery but is more effective for pain control.

• The Korean Journal of Pain
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• 제31권4호
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• pp.261-267
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• 2018

Background: To compare the effects of adding two different doses of dexamethasone on the duration and quality of the fascia iliaca block in patients undergoing proximal femoral fracture surgery. Methods: A total of 60 patients (age 18-70 years) undergoing proximal femoral nailing surgery under spinal anesthesia were given fascia iliaca block after random assignment to one of the two groups: Group H received an injection of levobupivacaine (0.5%) 28 ml with 2 ml (8 mg) dexamethasone, and Group L received an injection of levobupivacaine (0.5%) 28 ml with dexamethasone 1 ml (4 mg) with 1 ml normal saline. Assessment of the duration of analgesia and the total tramadol requirement over 48 hours were noted after a successful block. Results: The duration of analgesia was found to be significantly longer in Group H ($17.02{\pm}0.45h$) than in the Group L patients ($14.29{\pm}0.45h$) with a p-value of 0.000. Postoperative analgesic requirement (amount of tramadol in mg) was significantly higher in Group L (Q2: 200.0; IQR: 100.0, 200.0) as compared to Group H (Q2: 100.0; IQR: 100.0, 200.0) with a p-value of 0.034. No patient showed any sign of neurotoxicity. Conclusions: Dexamethasone, in a dose of 8 mg, is superior to 4 mg when used as an adjuvant with levobupivacaine in the FIB. Though both prolonged analgesia and were effective in reducing oral/intravenous analgesics, 8 mg dexamethasone can be recommended as a more efficacious adjuvant to local anesthetics in the FIB.

• International Journal of Oral Biology
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• 제33권3호
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• pp.97-103
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• 2008

The present study investigated the role of peripheral group I, II, and III metabotropic glutamate receptors (mGluRs) in mustard oil (MO)-induced nociceptive response in the masseter muscles of lightly anesthetized rats. Experiments were carried out on male Sprague-Dawley rats weighing 300-350 gm. After initial anesthesia with sodium pentobarbital (40 mg/kg, i.p.), one femoral vein was cannulated and connected to an infusion pump for intravenous infusion of sodium pentobarbital. The rate of infusion was adjusted to provide a constant level of anesthesia. MO (30 ${\mu}L$) was injected into the mid-region of the left masseter muscle via a 30-gauge needle over 10 seconds. After 30 mL injection of 5, 10, 15, or 20% MO into the masseter muscle, total number of hindpaw-shaking behavior was monitored. Intramuscular administration of MO significantly produced hindpawshaking behavior in a dose-dependent manner, as compared with the vehicle (mineral oil)-treated group. Intramuscular pretreatment with 10 or 100 ng DHPG, a group I mGluRs agonist, enhanced MO-induced hindpaw-shaking behavior, while APDC (20 or 200 ${\mu}g$), a group II mGluRs agonist, or L-AP4 (2 ${\mu}g$), a group III mGluRs agonist, significantly reduced MO-induced nociceptive behavior. The antinociception, produced by group II or III mGluRs agonists, was abolished by pretreatment with LY341495, a group II mGluRs antagonist, or CPPG, a group III mGluRs antagonist, res-pectively. Based on these observations, peripheral mGluRs differentially modulated MO-induced nociceptive behavior response in the craniofacial muscle pain and peripheral group II and III mGluRs agonists could be used in treatment of craniofacial muscle nociception.

• Journal of Veterinary Science
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• 제23권6호
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• pp.68.1-68.8
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• 2022

Background: Studies on anesthetized dogs regarding pulse pressure variation (PPV) are increasing. The influence of respiratory rate (RR) on PPV, in mechanically ventilated dogs, has not been clearly identified. Objectives: This study evaluated the influence of RR on PPV in mechanically ventilated healthy dogs after hemorrhage. Methods: Five healthy adult Beagle dogs were premedicated with intravenous (IV) acepromazine (0.01 mg/kg). Anesthesia was induced with alfaxalone (3 mg/kg IV) and maintained with isoflurane in 100% oxygen. The right dorsal pedal artery was cannulated with a 22-gauge catheter for blood removal, and the left dorsal pedal artery was cannulated and connected to a transducer system for arterial blood pressure monitoring. The PPV was automatically calculated using a multi-parameter monitor and recorded. Hemorrhage was induced by withdrawing 30% of blood (24 mL/kg) over 30 min. Mechanical ventilation was provided with a tidal volume of 10 mL/kg and a 1:2 inspiration-to-expiration ratio at an initial RR of 15 breaths/min (baseline). Thereafter, RR was changed to 20, 30, and 40 breaths/min according to the casting lots, and the PPV was recorded at each RR. After data collection, the blood was transfused at a rate of 10 mL/kg/h, and the PPV was recorded at the baseline ventilator setting. Results: The data of PPV were analyzed using the Friedman test followed by the Wilcoxon signed-rank test (p < 0.05). Hemorrhage significantly increased PPV from 11% to 25% at 15 breaths/min. An increase in RR significantly decreased PPV from 25 (baseline) to 17%, 10%, and 10% at 20, 30, and 40 breaths/min, respectively (all p < 0.05). Conclusions: The PPV is a dynamic parameter that can predict a dog's hemorrhagic condition, but PPV can be decreased in dogs under high RR. Therefore, careful interpretation may be required when using the PPV parameter particularly in the dogs with hyperventilation.

• 대한치과마취과학회지
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• 제12권1호
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• pp.45-50
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• 2012

The Fontan operation is a heart operation used to treat complex congenital heart defects like tricuspid atresia, hypoplastic left heart syndrome, pulmonary atresia and single ventricle. A single ventricle is dedicated to pumping oxygenated blood to the systemic circulation and the entire systemic venous return reaches the pulmonary arterial system without the direct influence of a pumping chamber. In the patient with Fontan operation, it is important to achieve adequate pulmonary blood flow and cardiac output in anesthetic management. In this case, a 10-year-old boy (19.6 kg, 114 cm) with cleft palate, cerebral palsy and severe mental retardation, who underwent a Fontan operation when he was 4 years old, was presented for deep sedation. Because he was suffering from eating disorder with cleft palate, the orthodontist and the plastic surgeon planned to insert intraoral orthodontic device before cleft palate repair. But it was impossible to open his mouth for alginate impression procedure. After careful pre-anesthesia evaluation we planned to administer deep sedation with propofol infusion. After Intravenous catheter insertion, we started propofol intravenous infusion with the formula of a loading dose of 1.0 mg/kg followed by an infusion rate of 6.0 mg/kg/hr with syringe pump. His blood pressure was remained around 80/40 mmHg after loss of consciousness, but he could not maintain his airway patent. So we lowered the infusion rate to 3.0 mg/kg/hr, immediately. The oxygen saturation was maintained above 95% with nasal oxygen supply, and blood pressure was maintained around 100-80/60-40 mmHg. After the sedation of 110 minutes with propofol (the infusion rate to 3.0-5.0 mg/kg/hr), he fully regained consciousness, and was discharged without complication after 1 hour observation. In case of post-Fontan patient, intravenous deep sedation with propofol was safe and effective method of behavioral management during dental treatment.

• 대한소아치과학회지
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• 제45권4호
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• pp.508-513
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• 2018

세보플루란에 의한 일회 환기량은 낮은 용량에서는 호흡수의 증가로 안정적이다. 그러나 진정 깊이가 증가하면 폐포 환기는 세보플루란에 의해 감소되어 결과적으로는 $PaCO_2$가 증가한다. 호흡 억제의 발생은 깊이 진정된 장애 환자에서 심한 저산소증과 고탄산혈증의 위험을 증가시킨다. 세보플루란 흡입 마취는 여러 위험성이 내제되어 있으며 체내 산 염기 상태에 따라 혈역학적 변화가 발생하기에 예기치 못한 문제 상황이 발생할 수 있다. 세보플루란으로 장애인의 마취 유도 시 발생하는 호흡 억제로 인한 체내 산 염기 상태가 안정한지 알아보고자 이 연구를 진행하였다. 마취 유도는 4 vol% 세보플루란, 4 L/min 아산화질소, 4 L/min 산소를 자발 호흡 하에서 환자 안면부에 마스크를 거치하여 유도하였다. 그 뒤 환자의 의식소실 및 근육 긴장 완화 후 즉시 전문가에 의해 IV line을 거치한 뒤 정맥 채혈을 하여 정맥 내 혈액가스 분석을 하였다. 깊은 진정 상태에서 전체 환자의 평균 pH는 $7.36{\pm}0.06$으로 측정되었다. $PvCO_2$는 전체 환자에서는 평균 $48.8{\pm}8.50mmHg$로 측정되었다. $HCO_3{^-}$는 전체 환자에서 평균 $27.2{\pm}3.0mmol/L$로 측정되었다. 결론적으로 장애인을 대상으로 한 치과 진료시 세보플루란을 이용한 흡입 진정에 대한 체내 산 염기 반응은 비교적 안정적이었다.

• 한국임상수의학회지
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• 제28권5호
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• pp.473-478
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• 2011

이 연구는 개에서 isoflurane을 이용한 전신마취 하에 개복술시 아스코르빈산 (AA)의 항산화 효과를 평가하였다. 12마리의 개를 아스코르빈산 그룹 (AAG) 또는 sham 그룹 (SG)으로 무작위 배정하였다. AAG는 마취 10분 전 에 표준 아스코르빈산의 100 mg/animal 복용량을 정맥주사하였다. 혈장에 있는 코티졸, 포도당, total oxidant status (TOS), total antioxidant status (TAS)와 oxidative stress index (OSI)를 측정하였다. 코티졸 수치는 두 그룹에서 시간이 지남에 따라 유의성있게 증가하였다 (p < 0.05). 포도당 수치의 변화는 두 그룹 사이에 유의성이 없었다. TOS와 OSI는 SG에서 시간이 지남에 따라 유의성 있게 증가하였다 (p < 0.05). 그런데 AAG에서는 유의성있는 변화가 없었다. 그리고, AAG의 TOS와 OSI는 SG에서 보다 더 유의성 있게 낮았다 (p < 0.05). 그러나 TAS는 두 그룹 사이에 유 의성이 있는 변화가 없었다. 이런 결과는 AAG에서 TOS 감소가 항산화제에서 산화제로의 변환과 관련 있음을 예측 해 볼 수 있게 한다. OSI 감소는 손상부위에 발생한 활성산소 (ROS, 즉 산화 스트레스)의 감소가 혈액순환 이상, 기관 부전 및 염증의 수술 부작용을 줄일 수 있다는 것을 의미한다. 그러므로, AA는 개의 개복술에서 산화 스트레스로부터 수술환자를 보호하기 위하여 사용될 수 있다.

• 한국산학기술학회논문지
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• 제20권10호
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• pp.303-308
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• 2019

65세 남자환자에서 전신마취하 관절경 어깨 수술후 갑자기 발생한 사지 마비 증례를 보고하고자 한다. 환자는 술 후 급격한 사지 마비 증상을 보였으며 마취 관리상 특별한 문제는 없었다. 환자의 수술시 자세와 관련하여 마취 유도시에 기관삽관을 위한 과도한 경추 신전은 시행되지 않았으며 수술중 자세에서도 경추부의 과도한 회전이나 신전 또한 진행되지 않았다. 그러나 수술이 종료된 후 근이완의 완전한 회복과 의식 및 자발호흡은 확인되었으나 사지 마비 증상 및 배뇨장애 증상을 보였다. 신속히 시행한 경추부 자기공명 영상에서 경추간판에 의한 척수 신경 압박 소견 보이는 척추성 경추증 증상을 보였다. 환자는 21일간의 고농도 스테로이드 정주 요법을 포함한 보존적 치료 후에 감각 및 운동신경의 완전한 회복을 보이고 다른 신경학적 이상 소견은 보이지 않은 채로 퇴원하였다. 외상과 관련 없이 사지 마비로 나타나는 수술후 척추성 경추증의 발생은 흔하지 않다. 본 증례를 통해 수술후 발생한 비외상성 척추성 경추증 발생에 대해 타 증례 보고와 비교 분석하여 고찰해 보고자 한다. 임상 의사는 60세 이상의 노년층에서의 수술후 사지 마비에 대해 척추성 경추증의 원인 기여에 대해서도 고려하기를 권고한다.

• Journal of Korean Dental Science
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• 제5권2호
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• pp.88-92
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• 2012

Also called necrobacillosis or postanginal sepsis, Lemierre's syndrome (LS) is an uncommon but potentially lethal complication of odontogenic infection. A 27-year-old male diagnosed with Ludwig's angina was transferred from a local hospital due to continuous fever and chills after incision and drainage under general anesthesia. The swelling of both submental and submandibular area subsided, but the fever and chills persisted. While generalized malaise improved, sepsis developed together with the deterioration of liver function. The chest computed tomography scan revealed multiple cavitations throughout both lungs, which were diagnosed as septic pulmonary embolism. After consulting the department of infectious diseases, the patient was treated with intravenous antibiotics focusing on vancomycin and additional antibiotics. After 3 weeks of treatment, the patient recovered completely. Despite its decreased mortality, dentists are not familiar with LS, and it is difficult to diagnose correctly. In this paper, we report a case and present a review of literature.