• 한국임상수의학회지
• /
• 제30권6호
• /
• pp.428-434
• /
• 2013

본 실험에서는 xylazine 혹은 acepromazine으로 전마취된 비글 견에서 alfaxalone과 remifentanil의 병용 지속주입 마취법을 비교 평가 하였다. 10마리의 비글견을 각 5마리씩 두 군으로 나누었다. AAR군에서는 마취 유도 15분전에 acepromazine 0.02 mg/kg을 정맥 내 투여하였고 XAR 군에서는 마취 유도 5분 전에 xylazine 1.1 mg/kg을 정맥 내 투여하였다. Alfaxalone 2 mg/kg을 정맥 투여하여 마취를 유도하였으며, 6 mg/kg/hr의 alfaxalone과 0.05 ${\mu}g/kg/min$ remifentanil을 각각 정맥 내 지속주입하여 마취를 유지하였다. Bispectral index (BIS)는 마취 후 모든 시점에서 마취전과 비교해 감소하였으며 마취 중 급격한 증가는 관찰되지 않았다. 마취기 동안의 BIS와 근전도 값은 XAR군이 AAR군에 비해 확연히 감소되었다. Xylazine 혹은 acepromazine으로 전처치한 개에서 alfaxalone 과 remifentanil의 병용 지속주입 마취법은 적절한 진통작용을 나타내었다. XAR군에서는 호흡계 기능 저하가 있었고 AAR군에서는 빈맥이 유발되어 마취법 사용에 주의가 필요하나 임상에서 적용이 가능하다고 판단된다.

• Journal of Audiology & Otology
• /
• 제23권2호
• /
• pp.89-95
• /
• 2019

Background and Objectives: Knowing the ototoxic potential of the agents used in medical treatments is important for the protection of hearing. Although we have knowledge regarding some effects of dexmedetomidine, which is an anesthetic-sparing drug, its influence over the hearing system has never been studied and is obscure yet. The aim of this study is to determine the effects of intravenous dexmedetomidine application during sevoflurane anesthesia on otoacoustic emissions (OAEs). Subjects and Methods: This prospective randomized study was performed on 60 patients (34 male, 26 female, mean age: 30.6±9.2 years) who were scheduled for an elective surgery under general anesthesia and the patients were enrolled and randomly divided into 2 groups. They received dexmedetomidine (Group D) or Saline (Group S) infusion during a standardized Sevoflurane anesthesia. Transient and distortion product OAEs were measured preoperatively and postoperatively (24th hour). OAE results were compared within and between groups. Results: In group D postoperative OAEs were lower than preoperative OAEs and postoperative levels of group S, especially at low frequencies (p<0.05). Conclusions: Dexmedetomidine infusion affects the micromechanical function of cochlea especially in the low-frequency region. Dexmedetomidine should be carefully used during general anesthesia to avoid its probable harmful effects on cochlear micromechanics.

• 대한청각학회지
• /
• 제23권2호
• /
• pp.89-95
• /
• 2019

Background and Objectives: Knowing the ototoxic potential of the agents used in medical treatments is important for the protection of hearing. Although we have knowledge regarding some effects of dexmedetomidine, which is an anesthetic-sparing drug, its influence over the hearing system has never been studied and is obscure yet. The aim of this study is to determine the effects of intravenous dexmedetomidine application during sevoflurane anesthesia on otoacoustic emissions (OAEs). Subjects and Methods: This prospective randomized study was performed on 60 patients (34 male, 26 female, mean age: 30.6±9.2 years) who were scheduled for an elective surgery under general anesthesia and the patients were enrolled and randomly divided into 2 groups. They received dexmedetomidine (Group D) or Saline (Group S) infusion during a standardized Sevoflurane anesthesia. Transient and distortion product OAEs were measured preoperatively and postoperatively (24th hour). OAE results were compared within and between groups. Results: In group D postoperative OAEs were lower than preoperative OAEs and postoperative levels of group S, especially at low frequencies (p<0.05). Conclusions: Dexmedetomidine infusion affects the micromechanical function of cochlea especially in the low-frequency region. Dexmedetomidine should be carefully used during general anesthesia to avoid its probable harmful effects on cochlear micromechanics.

• Clinics in Shoulder and Elbow
• /
• 제20권1호
• /
• pp.10-17
• /
• 2017

Background: The purpose is to determine the efficacy of additional intravenous patient-controlled analgesia (IV-PCA) by comparing the analgesic effects between interscalene block (ISB) combined with IV-PCA and single ISB after arthroscopic shoulder surgery. Methods: A total of 213 patients who underwent arthroscopic shoulder surgery were divided into two groups based on the type of perioperative anesthesia. The single ISB group included 100 patients, while the IV-PCA group included 113 patients. The visual analogue scale for pain (VAS pain) scores were assessed at 12, 24, and 48 hours postoperatively in accordance with shoulder pathology. Postoperative narcotics-related complications and consumption of additional non-steroidal anti-inflammatory drugs between the two groups were compared. Results: VAS pain showed no significant difference between the two groups at most points of the postoperative timeline, regardless of shoulder pathology, except in patients with rotator cuff repair at postoperative 24 hours. Although the IV-PCA group showed a statistically lower VAS pain score than the ISB group at postoperative 24 hours (p=0.04), the difference in the VAS pain score was only 9.0 mm in patients with rotator cuff repair. Narcotics-related complications were observed more frequently in the IV-PCA group than in the ISB group for patients with rotator cuff repair. Conclusions: Additional IV-PCA demonstrated no booster effect for immediate pain control in patients undergoing arthroscopic shoulder surgery with preoperative single ISB. Furthermore, patients with IV-PCA experienced greater narcotics-related complications.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제21권2호
• /
• pp.129-137
• /
• 2021

Background: Inappropriate use of intravenous and inhaled anesthetics may be dangerous in infants undergoing facial cleft surgeries. This study primarily aimed to compare the effect of infraorbital nerve block on sevoflurane requirement in infants undergoing cheiloplasty. Intraoperative opioid consumption, hemodynamics, blood glucose levels, extubation time, and delirium were also compared. Methods: This prospective, randomized, double-blinded study was conducted in 34 infants undergoing cheiloplasty under general anesthesia. After induction, group A received bilateral infraorbital nerve block with 0.5 mL of 0.5% bupivacaine and group B 0.5 mL saline. An increase in heart rate or blood pressure > 20% was managed by increasing sevoflurane by 2-2.5%, followed by fentanyl 0.5 ㎍/kg bolus. The chi-square test and independent-sample t-test were used where applicable. Results: Demographics, duration of surgery, and intravenous fluids used were comparable between the groups. Compared to group A, patients in group B had significantly higher consumption of fentanyl (14.2 ± 4.4 ㎍ vs. 22.1 ± 6.2 ㎍) and sevoflurane (14.2 ± 4.8 mL vs. 26.8 ± 15.6 mL). Intraoperative hemodynamic parameters were significantly lower in group A, the number of times increases in hemodynamic parameters occurred, and fentanyl supplemental bolus was required remained significantly lower in group A than in group B. Intraoperative glycemic levels remained higher in group B, and the extubation time was significantly shorter in group A than in group B (4.40 ± 1.60 min vs. 9.2 ± 2.18 min). Group A had a lesser occurrence of postoperative delirium. Conclusion: Supplemental infraorbital block in infants undergoing cheiloplasty under general anesthesia resulted in significantly decreased anesthetic requirements and optimal hemodynamic and glycemic levels with faster extubation and lesser delirium.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제23권1호
• /
• pp.29-37
• /
• 2023

Background: A high incidence (40-73%) of postoperative nausea and vomiting (PONV) has been reported following orthognathic surgery, and various risk factors have been associated with it. Identifying PONV risk factors based on initial onset time will help establish preventive measures. This study aimed to identify factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Methods: This study included 590 patients who underwent orthognathic surgery. Multivariate logistic regression analysis was performed to identify the risk factors that are significantly related to PONV. The objective variables were classified into three categories: no PONV, early PONV (initial onset time: 0-2 h after anesthesia), and late PONV (initial onset time: 2-24 h after anesthesia). The explanatory variables included relevant risk factors for PONV, as considered in previous studies. Results: Total intravenous anesthesia with propofol was a significant depressant factor for early PONV (adjusted odds ratio [aOR] = 0.340, 95% confidence interval [CI] = 0.209-0.555) and late PONV (aOR = 0.535, 95% CI = 0.352-0.814). The administration of a combination of intraoperative antiemetics (vs. no administration) significantly reduced the risk of early PONV (aOR = 0.464, 95% CI = 0.230-0.961). Female sex and young age were significant risk factors for late PONV (aOR = 1.492, 95% CI = 1.170-1.925 and unit aOR = 1.033, 95% CI = 1.010-1.057, respectively). Conclusion: We identified factors that are significantly related to PONV based on the initial onset time after orthognathic surgery. Total intravenous anesthesia with propofol significantly reduced the risk of PONV not only in the early period (0-2 h after anesthesia) but also in the late period (2-24 h after anesthesia).

• 대한장애인치과학회지
• /
• 제2권2호
• /
• pp.142-146
• /
• 2006

환아의 연령, 과다체중, 환아의 약물 거부 등으로 인하여 chloral hydrate를 이용한 수면치료가 불가능한 경우, Midazolam을 이용한 정주진정요법이 전신마취를 대신하는 대안으로 사용될 수 있다. 본 환아의 경우, 0.3mg/kg의 midazolam을 근주하고, 70% 아산화질소 가스를 이용하여 초기 수면상태를 유도하고 정맥천자를 실시한 후, 0.2mg/kg midazolam을 정주하여 50분간 별다른 부작용 없이 성공적으로 치료할 수 있었다.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제16권3호
• /
• pp.165-173
• /
• 2016

Dentists often sedate patients in order to reduce their dental phobia and stress during dental treatment. Sedatives are administered through various routes such as oral, inhalation, and intravenous routes. Intravenous administration has the advantage of rapid onset of action, predictable duration of action, and easy titration. Typically, midazolam, propofol or dexmedetomidine are used as intravenous sedatives. Administration of these sedatives via infusion by using a syringe pump is more effective and successful than infusing them as a bolus. However, during intravenous infusion of sedatives or opioids using a syringe pump, fatal accidents may occur due to the clinician's carelessness. To prevent such risks, smart syringe pumps have been introduced clinically. They allow clinicians to perform effective sedation by using a computer to control the dose of the drug being infused. To ensure patient safety, various alarm features along with a drug library, which provides drug information and prevents excessive infusion by limiting the dose, have been added to smart pumps. In addition, programmed infusion systems and target-controlled infusion systems have also been developed to enable effective administration of sedatives. Patient-controlled infusion, which allows a patient to control his/her level of sedation through self-infusion, has also been developed. Safer and more successful sedation may be achieved by fully utilizing these new features of the smart pump.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제15권3호
• /
• pp.173-179
• /
• 2015

Issues related to the control of seizures and bleeding, as well as behavioral management due to mental retardation, render dental treatment less accessible or impossible for patients with Sturge-Weber syndrome (SWS). A 41-year-old man with SWS visited a dental clinic for rehabilitation of missing dentition. A bilateral port-wine facial nevus and intraoral hemangiomatous swollen lesion of the left maxillary and mandibular gingivae, mucosa, and lips were noted. The patient exhibited extreme anxiety immediately after injection of a local anesthetic and required various dental treatments to be performed over multiple visits. Therefore, full-mouth rehabilitation over two visits with general anesthesia and two visits with target-controlled intravenous infusion of a sedative anesthesia were planned. Despite concerns regarding seizure control, bleeding control, and airway management, no specific complications occurred during the treatments, and the patient was satisfied with the results.

• 한국임상수의학회지
• /
• 제26권5호
• /
• pp.480-482
• /
• 2009

A 2-year-old, castrated male, Scottish fold cat was referred to Veterinary Medical Teaching Hospital of Seoul National University (VMTH-SNU) for evaluation of acute bilateral blindness after general anesthesia. For dental prophylaxis in local animal hospital, general anesthesia had been induced with intravenous acepromazine and ketamine, and maintained with isoflurane after intubation. At VMTH-SNU on next day, complete blood count, electrolytes and serum chemistry values were within normal ranges. On neurologic examination, visual placing and postural reactions like as hopping, hemiwalking and wheelborrowing were reduced on right hindlimb. On ophthalmic examination, menace responses were absent on both eyes and pupillary light reflex (PLR) reduced on right eye, but other reflex and fundus were normal. Prednisolone (2 mg/kg sid for 3 days) was administrated orally and tapered. Visual placing was possible on 2nd day, and postural reactions were recovered on 4th day after dental prophylaxis. Based on the process and recovery, this case was considered as postoperative visual loss (POVL) after general anesthesia.