• 대한수의학회지
• /
• 제38권2호
• /
• pp.401-412
• /
• 1998

This study was conducted to compare the anesthetic effects of intravenous tiletamine-zolazepam(TZ, 7mg/kg TZ), tiletamine-zolazepam-xylazine(TZX, 7mg/kg TZ and 1.1mg/kg X) and ketamine-xylazine(KX, 10mg/kg K and 1.1mg/kg X). Fifteen mixed-breed healthy dogs($3.5{\pm}1.0kg$) were randomly assigned to the three treatment groups(TZ, TZX, KX) with 5 dogs in each group. The mean surgical anesthesia time was $25.6{\pm}4.2$, $62.6{\pm}6.2$ and $21.0{\pm}3.7$ min in TZ-, TZX- and KX-anesthetized dogs, respectively. The duration of the loss of response to toe-web needle prick and to visceral pain was significantly increased in the TZX group with $40.0{\pm}15.8$ min and $44.0{\pm}5.5$ min, respectively(p<0.01). Heart rate decreased significantly below baseline in TZX and KX groups(p<0.05, p<0.01) whereas it increased above baseline in TZ group. Respiratory rate remained unchanged or increased above baseline in TZ group, but decreased significantly from 10 to 30 min in TZX(p<0.01, p<0.05) and at 10 min in KX group(p<0.05). Body temperature decreased significantly below baseline in all three groups(p<0.01, p<0.05). Hematologic(PCV, RBC, WBC) and serum chemistry values(GOT, GPT, BUN, creatinine, total protein, glucose) were monitored before anesthesia, after recovery from anesthesia and 1, 3 and 7 days postanesthesia. All hematologic values remained generally within normal ranges, and GOT, GPT, BUN, creatinine and total protein values were within normal ranges during the period. Glucose values for TZX and KX groups increased greatly after recovery from anesthesia. We conclude that tiletamine-zolazepam-xylazine provides effective surgical anesthesia in dogs and in many cases may be preferable to conventional ketamine-xylazine regimen.

• Journal of Trauma and Injury
• /
• 제27권4호
• /
• pp.178-185
• /
• 2014

Purpose: The aim of this study was to assess the clinical efficacy of combined treatment with local anesthesia and ketamine procedural sedation for pediatric facial laceration repair in the Emergency Department (ED). Methods: Patients aged 1 to 5 years receiving ketamine for facial laceration repair were prospectively enrolled in a double-blind, randomized, and controlled study at an ED. All patients were to receive intravenous ketamine (2 mg/kg). The local anesthesia group (LA group) received a local anesthetic along with ketamine, whereas the no local anesthesia group (NLA group) received only ketamine. The total time of sedation, the patients' movements and groans, adverse events, and the satisfaction ratings of physicians, nurses, and parents were recorded. Results: A total of 186 patients were randomized (NLA group: 90, LA group: 96). The total time of sedation (30.5 minutes for the NLA group, 32.6 minutes for the LA group; p=0.660), patients' groans (26 (28.9%) versus 23 (24.0%); 0.446) and movements (27 (30%) versus 35 (36.5%); p=0.350) was not affected by the addition of local anesthesia. Other adverse events were similar between the two groups. Also, the satisfaction ratings of physicians (median 4 for the NLA group versus 4 for the LA group (p=0.796)), nurses (2 versus 2.5 (p=0.400)), and parents (4 versus 4 (p=0.199)) were equivalent between the two groups. Conclusion: In this study, we found that local anesthesia was not required along with ketamine sedation for pediatric facial laceration repair.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제17권3호
• /
• pp.205-213
• /
• 2017

Background: This study retrospectively investigated outcomes following dental implantation in patients with special needs who required general anesthesia to enable treatment. Method: Patients underwent implant treatment under general anesthesia at the Clinic for the Disabled in Seoul National University Dental Hospital between January 2004 and June 2017. The study analyzed medical records and radiographs. Implant survival rates were calculated by applying criteria for success or failure. Results: Of 19 patients in the study, 8 were males and 11 were females, with a mean age of 32.9 years. The patients included 11 with mental retardation, 3 with autism, 2 with cerebral palsy, 2 with schizophrenia, and 1 with a brain disorder; 2 patients also had seizure disorders. All were incapable of oral self-care due to serious cognitive impairment and could not cooperate with normal dental treatment. A total of 27 rounds of general anesthesia and 1 round of intravenous sedation were performed for implant surgery. Implant placement was performed in 3 patients whose prosthesis records could not be found, while 3 other patients had less than 1 year of follow-up after prosthetic treatment. When the criteria for implant success or failure were applied in 13 remaining patients, 3 implant failures occurred in 59 total treatments. The cumulative survival rate of implants over an average of 43.3 months (15-116 months) was 94.9%. Conclusion: For patients with severe cognitive impairment who are incapable of oral self-care, implant treatment under general anesthesia showed a favorable prognosis.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제18권6호
• /
• pp.349-359
• /
• 2018

Background: Propofol is an intravenous anesthetic which has antioxidant effects due to its similarity in molecular structure to ${\alpha}$-tocopherol. It has been reported that ${\alpha}$-tocopherol increases osteoclast fusion and bone resorption. Here, we investigated the effects of propofol on signaling pathways of osteoclastogenic gene expression, as well as osteoclastogenesis and bone resorption using bone marrow-derived macrophages (BMMs). Methods: BMMs were cultured with macrophage colony-stimulating factor (M-CSF) alone or M-CSF plus receptor activator of nuclear factor kappa B ligand (RANKL) in the presence of propofol ($0-50{\mu}M$) for 4 days. Mature osteoclasts were stained for tartrate-resistant acid phosphatase (TRAP) and the numbers of TRAP-positive multinucleated osteoclasts were counted. To examine the resorption activities of osteoclasts, a bone resorption assay was performed. To identify the mechanism of action of propofol on the formation of multinucleated osteoclasts, we focused on dendritic cell-specific transmembrane protein (DC-STAMP), a protein essential for pre-osteoclastic cell fusion. Results: Propofol increased the formation of TRAP-positive multinucleated osteoclasts. In addition, the bone resorption assay revealed that propofol increased the bone resorption area on dentin discs. The mRNA expression of DC-STAMP was upregulated most strongly in the presence of both RANKL and propofol. However, SB203580, a p38 inhibitor, significantly suppressed the propofol/RANKL-induced increase in mRNA expression of DC-STAMP. Conclusion: We have demonstrated that propofol enhances osteoclast differentiation and maturation, and subsequently increases bone resorption. Additionally, we identified the regulatory pathway underlying osteoclast cell-cell fusion, which was enhanced by propofol through p38-mediated DC-STAMP expression.

• The Korean Journal of Pain
• /
• 제29권1호
• /
• pp.40-47
• /
• 2016

Background: Neuropathic pain, including paresthesia/dysesthesia in the lower extremities, always develops and remains for at least one month, to variable degrees, after percutaneous endoscopic lumbar discectomy (PELD). The recently discovered dual analgesic mechanisms of action, similar to those of antidepressants and anticonvulsants, enable nefopam (NFP) to treat neuropathic pain. This study was performed to determine whether NFP might reduce the neuropathic pain component of postoperative pain. Methods: Eighty patients, who underwent PELD due to herniated nucleus pulposus (HNP) at L4-L5, were randomly divided into two equal groups, one receiving NFP (with a mixture of morphine and ketorolac) and the other normal saline (NS) with the same mixture. The number of bolus infusions and the infused volume for 3 days were compared in both groups. The adverse reactions (ADRs) in both groups were recorded and compared. The neuropathic pain symptom inventory (NPSI) score was compared in both groups on postoperative days 1, 3, 7, 30, 60, and 90. Results: The mean attempted number of bolus infusions, and effective infused bolus volume for 3 days was lower in the NFP group for 3 days. The most commonly reported ADRs were nausea, dizziness, and somnolence, in order of frequency in the NFP group. The median NPSI score, and all 5 median sub-scores in the NFP group, were significantly lower than that of the NS group until postoperative day 30. Conclusions: NFP significantly reduced the neuropathic pain component, including paresthesia/dysesthesia until 1 month after PELD. The common ADRs were nausea, dizziness, somnolence, and ataxia.

• 대한치과마취과학회지
• /
• 제12권3호
• /
• pp.177-181
• /
• 2012

Amyotrophic lateral sclerosis (ALS) is one of the major neurodegenerative diseases that involves degeneration at all levels of the motor system- from the cortex to the anterior horn of the spinal cord. Patients with ALS often have difficulty of ambulation for dental treatment though they have poor oral hygiene state. General anesthesia may cause respiratory problem due to its high sensitivity to muscle relaxant and weakened upper airway. In this case report, 38-year-old female patient with ALS required many dental treatments. Conscious sedation with intravenous target controlled infusion method was successfully employed and patient was discharged without any complications.

• 의료법학
• /
• 제18권1호
• /
• pp.61-99
• /
• 2017

마취는 수술 등 의료행위 시 많은 경우 필요불가결하게 동반될 수밖에 없고 마취 자체가 가진 특성 때문에 그로 인한 의료사고가 빈번하게 발생하고 있다. 마취와 관련된 의료사고가 의사의 과실로 인한 것인지를 판단하기 위해서는 마취의 전 단계를 통하여 의사 등 의료진에게 어떠한 주의의무가 요구되는지를 알아야 한다. 이 글에서는 이러한 주의의무의 기준 등을 알아보기 위하여 마취 관련된 의료사고로 판결이 선고된 1990년대부터 현재까지의 대법원 판결들과 최근의 하급심 판결사례들, 프로포폴이 사용된 사례들을 분석해보았다. 분석 결과 과거 흡입마취로 문제가 된 사례가 많았던 반면 최근에는 주로 정맥마취제나 국소마취제의 사용으로 문제가 된 사례가 많은 것을 알 수 있었고, 특히 마취제 중 프로포폴이 관련된 사고가 2007년경 이후부터 상당히 많이 발생하여 법적 분쟁이 이루어졌음을 알 수 있었다. 그런데 대법원 판례들은 대부분 과거 흡입마취로 마취한 사례여서, 흡입마취의 경우 마취 시 의료진의 주의의무의 정도와 내용에 관해 어느 정도 기준이 제시되고 있었으나, 그 외의 경우에는 그러한 기준이 제시되었다고 보기에는 미흡해 보였다. 프로포폴의 사용과 관련한 마취사고가 끊이지 않고 있는 현실 등에 비추어 볼 때 우선 의료현장에서 각각의 마취제의 사용에 관한 임상지침 등을 세우고 이를 지켜나가는 것이 중요하겠지만, 의료현실이나 의료 관행에 하나의 나침반 역할을 할 수 있도록 법원에서도 우리의 현실에 맞는 적절한 주의의무의 기준을 제시하는 것이 필요하다고 하겠다.

• 한국멀티미디어학회논문지
• /
• 제20권3호
• /
• pp.482-490
• /
• 2017

Early detection of infiltration is one of the most important tasks of nurses to minimize skin damage due to infiltration. For subjects receiving invasive intravenous treatment, the bioelectrical impedance (impedance) were measured in the frequency range of 5 to 500 kHz using bioelectrical impedance spectroscopy (BIS). After attaching electrodes at both ends of a transparent dressing mounted on the skin in which IV solution was infused into the vein, the change in impedance was measured as a function of time and frequency before and after infiltration. The experimental results are described as follows. When IV solution was properly infused into the vein, the impedance was nearly constant over time and decreased with increasing frequency. However, when infiltration occurred, the impedance decreased significantly and thereafter gradually decreased with time. In addition, impedance decreased with time for all applied frequencies. In this study, when IV solution penetrated into the surrounding skin and subcutaneous tissue by infiltration, impedance was quantitatively analyzed for as a function of time and frequency. This suggests a method for early detection of infiltration using BIS.

• 대한기관식도과학회지
• /
• 제4권2호
• /
• pp.171-176
• /
• 1998

Postoperative pain following tonsillectomy remains a significant obstacle to speedy recovery and smooth convalescence. Inadequate analgesia causes poor oral intake and influences the length of hospital stay and ability to return to normal activity. Patient Controlled Analgesia (PCA) is a method of analgesia adminstration that consists of a computer driven pump with a button that the patient may press to adminster a small dose of analgesic drug. The aim of this study was to examine whether Intravenous Patient Controlled Analgesia (IV-PCA) can reduce postoperative pain after tonsillectomy. The 100 patients undergoing tonsillectomy with general anesthesia were divided into two groups. The PCA group patients (n=80) received a mixture of nalbuphine and ketorolac by Walkmed PCA infusor during first 48 postoperative hours. In control group (n=20), the patients received oral acetoaminophen (Tyrenol) regularly and tiaprofenic acid (Surgam) intramuscularly on a p.r.n basis. Analgesic efficacy was evaluated with visual linear analogue scale (VAS) and the adverse effects were evaluated with 4 point scale. The patients of PCA group had less pain than those of control group. The adverse effects in the PCA group were nausea and vomiting. This study suggests that IV-PCA may be safe and effective method of pain control after adult tonsillectomy and is better accepted than oral or intramuscular pain medications.

• 대한소아치과학회지
• /
• 제43권1호
• /
• pp.27-35
• /
• 2016

본 연구는 전신마취 또는 정주진정 하 치과치료가 주 양육자가 인식하는 환아의 구강 건강과 관련된 삶의 질과 환아 가족의 일상생활에 미치는 영향을 확인하기 위해 시행되었다. 10세 이하의 건강한 환아와 그 환아의 주 양육자를 대상으로 연구가 진행되었다. 환아가 전신마취 또는 정주진정 하 치과치료를 위해 내원한 당일, 치료 시작 전에 환아의 주 양육자가 설문지를 작성하고, 치료 후 6개월 이내에 동일한 주 양육자가 동일한 설문지를 다시 작성하였다. 총 43명의 환아가 연구 대상에 포함되었으며, Child Oral Health Impact Profile(COHIP)과 Family Impact Scale(FIS)의 대한민국 버전이 설문에 사용되었다. COHIP과 FIS 점수 모두 술 전에 비하여 술 후에 개선되었다. 성별은 COHIP 및 FIS 점수의 개선에 별다른 영향을 주지 않았으며, 연령은 COHIP 점수의 개선에 영향을 주지 않았다. 그러나 어린 환아의 경우 술 전 FIS 점수가 더 양호한 것으로 나타났다. 치수치료를 한 경우에는 COHIP 점수가 더 크게 개선되었으며, 구치부 기성금속관 수복을 한 경우에는 FIS 점수의 개선 정도가 적었다. 전치부 심미수복 여부와 전치부 조기 발거 여부는 COHIP 및 FIS 점수의 개선 정도에 영향을 주지 않았다. 결론적으로, 전신마취 또는 정주진정 하 치과치료는 주 양육자가 인식하는 환아의 구강 건강과 관련된 삶의 질을 개선시킨다.