• Journal of Korean Neurosurgical Society
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• v.56 no.2
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• pp.135-140
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• 2014

Objective : Propofol and volatile anesthesia have been associated with metabolic acidosis induced by increased lactate. This study was designed to evaluate changes in pH, base excess (BE), and lactate in response to different anesthetic agents and to characterize propofol infusion-associated lactic acidosis. Methods : The medical records of patients undergoing neurosurgical anesthesia between January 2005 and September 2012 were examined. Patients were divided into 2 groups : those who received propofol (total intravenous anesthesia, TIVA) and those who received sevoflurane (balanced inhalation anesthesia, BIA) anesthesia. Propensity analysis was performed (1 : 1 match, n=47), and the characteristics of the patients who developed severe acidosis were recorded. Results : In the matched TIVA and BIA groups, the incidence of metabolic acidosis (11% vs. 13%, p=1) and base excess (p>0.05) were similar. All patients in the TIVA group who developed severe acidosis did so within 4 hours of the initiation of propofol infusion, and these patients improved when propofol was discontinued. Conclusions : The incidence of metabolic acidosis was similar during neurosurgical anesthesia with propofol or sevoflurane. In addition, severe acidosis associated with propofol infusion appears to be reversible when propofol is discontinued.

• Korean Journal of Veterinary Research
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• v.38 no.2
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• pp.401-412
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• 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
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• v.27 no.4
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• pp.178-185
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• 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
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• v.17 no.3
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• pp.205-213
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• 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
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• v.18 no.6
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• pp.349-359
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• 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
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• v.29 no.1
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• pp.40-47
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• 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.

• The Korean Society of Law and Medicine
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• v.18 no.1
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• pp.61-99
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• 2017

Medical practices such as surgery often need to accompany anesthesia, which frequently causes medical accidents. In order to determine whether a medical accident related to anesthesia was caused by a doctor's fault, it is necessary to understand what is the duty of care required for the medical staff such as a doctor through all stages of anesthesia. This paper analyzed Supreme Court decisions since 1990s and recent lower courts' decisions in order to understand standard of care with respect to anesthesia. While numerous medical accidents were related to inhalation anesthesia in the past, it turned out that recent medical accidents were often related to the use of intravenous or local anesthetics. In particular, legal disputes with respect to medical accidents related to propofol have considerably increased since 2007. However, because Supreme Court decisions as to anesthesia accidents are mostly related to inhalation anesthesia, they seem to be insufficient to set standard of care as to other types of anesthesia accidents. In light of the fact that medical accidents related to the use of propofol have been increasing, it is critical to establish and maintain clinical guidelines on the use of each anesthetic in the medical field. However, The Courts can present the standard of care suitable for medical reality to serve as a compass for medical practices.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.3
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• pp.177-181
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• 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.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.1
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• pp.27-35
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• 2016

The present study aimed to assess the perception of a child's primary caregiver on the oral health-related quality of life (OHRQoL) of dental treatment under general anesthesia (GA) or intravenous sedation (IV-SED) in pediatric dental patients. Self-administered questionnaires were completed before dental treatment under GA or IV-SED by 52 primary caregivers of healthy pediatric patients (10 years old or younger), and 43 (84%) of these caregivers completed the same questionnaires within 6 months after treatment. The Korean version of Child Oral Health Impact Profile (COHIP) and the Family Impact Scale (FIS) were used to assess OHRQoL in the questionnaires. The scores of COHIP and FIS improved after dental treatment. Demographic variables such as gender did not affect the improvement of COHIP and FIS, and age did not affect that of COHIP. However, baseline FIS score of younger patients was better than that of older patients before dental treatment. Regardless of the treatment variables, all COHIP and FIS scores were improved after dental treatment. COHIP score improved more in cases with pulp treatments compared to those without the treatments. On the other hand, FIS score improved less in cases with posterior stainless steel crown restorations compared to those without them. Anterior esthetic restorations and anterior teeth extractions did not affect the degree of improvement. Based on the primary caregiver's perceptions, the OHRQoL of healthy pediatric patients was improved by dental treatment under GA or IV-SED.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.21
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• pp.9505-9509
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• 2014

Objective: To investigate the effects of stellate ganglion block (SGB) on the peri-operative vasomotor cytokine content and intrapulmonary shunt in patients with esophagus cancer who underwent thoracotomy. Materials and Methods: Forty patients undergoing elective resection of esophageal cancer patients who had I~II American Society of Anesthesiologist (ASA) were randomly divided into total intravenous anesthesia group (group N, n=20) and total intravenous anesthesia combined with SGB group (group S, n=20, 0.12 mL/kg 1% lidocaine was used for SGB 10 min before induction). Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary arterial pressure (MPAP) and continuous cardiac output (CCO) were continuously monitored. The blood from internal jugular vein was drawn respectively before induction ($T_0$), and 30 min ($T_1$), 60 min ($T_2$) and 120 min ($T_3$) after one-lung ventilation (OLV), and 30 min (T4) after two-lung ventilation. The contents of plasma endothelin (ET), nitric oxide (NO) and calcitonin gene-related peptide (CGRP) were detected with enzyme linked immunosorbent assay (ELISA). Meanwhile, arterial and mixed venous blood samples were collected for determination of blood gas and calculation of intrapulmonary shunt fraction (Qs/Qt). Results: During OLV, ET contents were increased significantly in two groups (P<0.05), and no significant difference was presented (P>0.05). NO content in group S was obviously higher than in group N at T3 (P<0.05), whereas CGRP content in group N was markedly lower than in group S at each time point (P<0.05). Qs/Qt was significantly increased in both groups after OLV, but there was no statistical significant regarding the Qs/Qt at each time point between two groups. Conclusions: Total intravenous anesthesia combined with SGB is conducive to regulation of perioperative vasomotor cytokines in thoracotomy, and has little effect on intrapulmonary shunt at the time of OLV.