• Title/Summary/Keyword: Intravenous infusion

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Sedative methods used during extraction of wisdom teeth in patients with a high level of dental anxiety

  • Seto, Mika;Furuta, Haruhiko;Sakamoto, Yumiko;Kikuta, Toshihiro
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.37 no.3
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    • pp.241-244
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    • 2011
  • Introduction: Intravenous sedation is performed to ensure smooth and safe surgery. Dental anxiety is a reaction to an unknown danger. The Spielberger's state-trait anxiety inventory (STAI) can be used to simultaneously evaluate the levels of state and trait anxiety. State anxiety is defined as subjective feelings of nervousness. This study assessed the presurgical anxiety using STAI and performed intravenous sedation for patients whose level of state anxiety was > stage IV. Based on our clinical experience, it is believed that higher doses of sedatives are needed to induce the desired levels of sedation in patients with a high level of state anxiety. Objectives: This study examined whether the sedative consumption of the patient with a high anxiety level increased. Patients and Methods: Patients with state anxiety scores of ${\geq}$51 were included in Group V, and those with state anxiety scores ranging from 42 to 50 were placed in Group IV. To induce sedation, intravenous access was established, and a bolus dose of 3.0 mg midazolam was administered intravenously. Sedation was maintained by administering a continuous infusion of propofol, which was aimed at achieving an Observer's Assessment of Alertness/Sedation scale of 10-12/20. In this study, midazolam was initially administered when the body movements appeared to occur or the blood pressure increased. This was followed by the administration of higher doses of propofol if low sedation was observed. Results: There were no significant differences in the patient demographics, duration of sedation, and doses of local anaesthetic agents between Groups IV and V. The midazolam dose and mean propofol dose needed to maintain comparable levels of sedation were significantly higher in Group V than in Group IV. Conclusion: In female patients, whose level of preoperative state anxiety is more than Stage V of STAI, a large quantity of sedatives is needed for intravenous sedation.

Effect of propofol on salivary secretion from the submandibular, sublingual, and labial glands during intravenous sedation

  • Keisuke Masuda;Akira Furuyama;Kenji Ohsuga;Shota Abe;Hiroyoshi Kawaai
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.23 no.3
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    • pp.153-162
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    • 2023
  • Background: Recent animal studies have suggested the role of GABA type A (GABA-A) receptors in salivation, showing that GABA-A receptor agonists inhibit salivary secretion. This study aimed to evaluate the effects of propofol (a GABA-A agonist) on salivary secretions from the submandibular, sublingual, and labial glands during intravenous sedation in healthy volunteers. Methods: Twenty healthy male volunteers participated in the study. They received a loading dose of propofol 6 mg/kg/h for 10 min, followed by 3 mg/kg/h for 15 min. Salivary flow rates in the submandibular, sublingual, and labial glands were measured before, during, and after propofol infusion, and amylase activity was measured in the saliva from the submandibular and sublingual glands. Results: We found that the salivary flow rates in the submandibular, sublingual, and labial glands significantly decreased during intravenous sedation with propofol (P < 0.01). Similarly, amylase activity in the saliva from the submandibular and sublingual glands was significantly decreased (P < 0.01). Conclusion: It can be concluded that intravenous sedation with propofol decreases salivary secretion in the submandibular, sublingual, and labial glands via the GABA-A receptor. These results may be useful for dental treatment when desalivation is necessary.

Development of Target-Controlled Infusion System in Plasma Concentration. PART1 : Establishment of Pharmacokinetic Model and Verification (혈중 목표 농도 자동 조절기(TCI) 개발 PART1 : 약동학적 모델의 수립과 검증)

  • 안재목;길호영
    • Journal of Biomedical Engineering Research
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    • v.23 no.5
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    • pp.341-349
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    • 2002
  • The target controlled infusion(TCI) pump system is a logical approach to the development of improved administration techniques of an intravenous anaesthetic agent. The principle of TCI system is based on an understanding of the pharmacokinetic properties, three or four compartment model. The TCI system is optimal and flexible control of the plasma drug concentration. But the clinical goal is always to achieve a therapeutic drug effect, not a therapeutic concentration. So we developed the algorithm to target the concentration at the site of drug effect rather than the concentration in the plasma. If impulse drug is inputted into body, the decline of plasma concentration with time is shown, resulting in the expression of the differential equation. Therefore, we must reformulate our three-compartment model as four-compartment model with the effect compartment. And we tested plasma targeting and effect targeting algorithm by computer simulation using four-compartment model. So we developed the TCI capable of applying all intravenous drugs by adjusting individual pharmacokinetic parameters independently.

Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery

  • Chung, Kyu-Jin;Cha, Kyu-Ho;Lee, Jun-Ho;Kim, Yong-Ha;Kim, Tae-Gon;Kim, Il-Guk
    • Archives of Plastic Surgery
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    • v.39 no.5
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    • pp.540-545
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    • 2012
  • Background Patients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI) system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anesthesia using the TCI system with propofol and remifentanil would be an effective method of anesthesia in breast augmentation. Methods This study recruited 100 patients who underwent breast augmentation surgery from February to August 2011. Intravenous anesthesia was performed with 10 mg/mL propofol and 50 ${\mu}g/mL$ remifentanil simultaneously administered using two separate modules of a continuous computer-assisted TCI system. The average target concentration was set at 2 ${\mu}g/mL$ and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinical effect and vital signs. Oxygen saturation, electrocardiography, and respiratory status were continuously measured during surgery. Blood pressure was measured at 5-minute intervals. Information collected includes total duration of surgery, dose of drugs administered during surgery, memory about surgery, and side effects. Results Intraoperatively, there was transient hypotension in two cases and hypoxia in three cases. However, there were no serious complications due to anesthesia such as respiratory difficulty, deep vein thrombosis, or malignant hypertension, for which an endotracheal intubation or reversal agent would have been needed. All the patients were discharged on the day of surgery and able to ambulate normally. Conclusions Our results indicate that anesthetic methods, where the TCI of propofol and remifentanil is used, might replace general anesthesia with endotracheal intubation in breast augmentation surgery.

A Study of Intravenous Sedation in Dankook University Dental Hospital (단국대학교 치과대학 부속치과병원에서 시행된 정주진정에 대한 연구)

  • O, Jeong Eun;Kim, Jong-Su;Kim, Seung-Oh
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.13 no.1
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    • pp.1-7
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    • 2013
  • Background: Intravenous sedation is effective for dental patients who are anxious. Recently, target-controlled infusion (TCI) has begun to be used widely to administer and titrate propofol and remifentanil during sedation. To investigate the effect and safety of the pharmacologic agents used in anesthetic department, we performed a retrospective study. Methods: Retrospective study of a series of dental procedure under intravenous sedation performed in department of anesthesiology in Dental Hospital of Dankook University was carried out with propofol or propofol/remifentanil between January and August 2011 and January and April 2012. All patients received oxygen by nasal cannula. The average propofol and remifentanil target was 0.5 ${\mu}g/ml$ and 1.0 ng/ml, respectively using a TCI pump. The average peripheral oxygen saturation ($SpO_2$), heart rate, blood pressure, respiratory rate, nasal end-tidal $CO_2$ were recorded at 5-10 minute intervals. The age, gender, weight, procedure and sedation time, type of procedure were also recorded. Results: We included 22 cases of 19 adults (group A) and 6 cases of children (group B). In group A, 4 patients received propofol (group A-P), and 15 patients received propofol with remifentanil (group A-PR). In group B, 6 patients received propofol only. The mean age of group A was 41.1 years old and that of group B was 9.5 years old. No clinically significant complications were noted. There were no case of de-saturation <90%. The median respiratory rate was 13.1 (range 6 to 36) in group A and 19 (range 13 to 25) in group B. The median end tidal $CO_2$ was 36.7 mmHg(range 8 mmHg to 56 mmHg) in group A and 41.7 mmHg (range 30 mmHg to 53 mmHg) in group B. Conclusions: Based on our results, dental sedation using propofol/remifentanil in adult and propofol in children with TCI pump seems to appear as a safe and effective procedure while performing dental procedure.

Intravenous Orexin Reduces LH Secretion in Castrated Camelus Dromedaries Fed a Sub-maintenance Diet

  • Khazali, Homayoun
    • Asian-Australasian Journal of Animal Sciences
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    • v.23 no.1
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    • pp.41-46
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    • 2010
  • It has been shown that orexin has an inhibitory effect on gonadotropin secretions in non-ruminant animals. The goal of this study was to determine whether orexin affects LH, and FSH secretions in the camel, as a pseudo-ruminant animal, under different dietary energy content. Sixteen castrated camels were randomly divided into 4 groups. Animals in groups 1 and 2 were fed 100% and animals in groups 3 and 4 were fed 50% energy content in their diet for 20 days. After 20 days, animals in groups 1 and 3 received infusions of 1 $\mu{g}$ orexin and groups 2 and 4 received infusions of 2 $\mu{g}$ orexin into their jugular vein. Blood samples were collected from the jugular vein every 20 minutes from 4 h before the first infusion of orexin until 4 h after the last orexin infusion. Lower dietary energy intake and infusions of 2 $\mu{g}$ but not 1 $\mu{g}$ orexin significantly (p<0.01) decreased the mean plasma concentrations and pulse amplitudes of LH of the animals. Infusion of 1 and 2 $\mu{g}$ orexin did not change the secretions of LH of the animals fed NE. Different energy dietary intake and infusion of 1 and 2 $\mu{g}$ orexin did not change the mean plasma concentrations of FSH of the animals in all groups. Infusions of 1 and 2 $\mu{g}$ orexin significantly (p<0.01) decreased the glucose levels of animals fed LE but not in NE fed animals. Additionally, plasma glucose levels of the LE-fed animals in groups 3 and 4 were significantly (p<0.01) lower than those of the animals in groups 1 and 2 fed NE diet. The results of this experiment indicated that orexin may negatively affect LH and FSH in camels with negative energy balance, but not in those with positive energy balance.

Propofol Infusion Associated Metabolic Acidosis in Patients Undergoing Neurosurgical Anesthesia : A Retrospective Study

  • Choi, Yoon Ji;Kim, Min Chul;Lim, Young Jin;Yoon, Seung Zhoo;Yoon, Suk Min;Yoon, Hei Ryeo
    • 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.

Effect of Caerulein on the Pancreatic and Gastric Secretion in Rats Studied by Means of Duodenal and Gastric Perfusion (흰쥐의 위(胃).십이지장(十二指腸) 동시관류표본(同時灌流標本)에 대(對)한 Caerulein의 작용(作用))

  • Cho, T.S.;Shin, C.J.;Lee, B.H.;Hong, S.S.
    • The Korean Journal of Pharmacology
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    • v.9 no.2
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    • pp.17-27
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    • 1973
  • Modifying the technique described by Schmidt, et al. (1972) the duodenum and stomach of female rats were perfused separately and contiunously with saline solution under urethane anesthesia. Secretory response of caerulein (Prof. V. Erspamer, F.I. 6934 Caerulein, Farmitalia, Italia), a gastrin or CCK-PZ like peptide, on acid, pepsin, bicarbonate and amylase were studied with and without simultaneous administration of secretin, CCK-PZ or other agents known secretory suppressives. A significant increase of acid, pepsin and amylase output was induced by intravenous infusion of caerulein. The response of acid secretion by caerulein in doses of 140 ng/100g/hr was equivalent to the response of histamine in the doses of $280\;{\mu}g/100g/hr$ and on a weight basis the potency of caerulein was approximately 2,000 times greater than histamine in rats. Acid secretory response of caerulein in the doses of 140 ng/100 g/hr was inhibited by simultaneous infusion of secretin in the doses of 0.2 u/ 100 g/hr, and the acid response was partly inhibited by concomitant infusion of histamine in the doses of $280\;{\mu}g/100g/hr$, but the response was enhanced by infusion of CCK-PZ in the doses of 0.2 u/100 g/hr. The secretory response of both aicd and enzymes were inhibited following administration of atropine in doses of 0.2 mg/100 g, but the response were not affected by hexamethonium in doses of 0.5 mg/100 g. In summary, it is concluded that caerolein is every effective in an increase of acid, pepsin and amylase secretion in rats through, possibly in part, the muscarinic and/or histaminic mechanism(s).

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Comparison of Blood Glucose Levels from the Fingertips of Both Patients with and without Diabetes Who are Receiving Dextrose Fluid Therapy (포도당 수액요법을 받는 당뇨병 환자와 비당뇨병 환자의 양쪽 손가락 끝 혈당치 비교)

  • Park, Suk Hyun;Lee, Chang Kwan;Kim, Yeon Woo;Kwon, Chi Hye
    • Korean Journal of Adult Nursing
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    • v.28 no.2
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    • pp.127-135
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    • 2016
  • Purpose: The aim of this study was to identify the effect of dextrose intravenous fluid (IVF) on the blood glucose levels taken from both fingertips of patients with diabetes mellitus (DM) and those without DM. Methods: From October 2012 to February 2013, 21 DM and 25 non-DM patients were recruited. Blood glucose levels taken from the both fingertips of patients at 7AM while IVF was not infusing and at 11AM, 5PM, and 9PM while IVF was infusing. Results: The differences between the mean values of blood glucose from the fingertips at four different times was not statistically significant in DM patients as well as non-DM patients. Also intra-class correlation for blood glucose levels from the fingertips with and without IVF infusion in both groups was shown over about 0.95 at each time (p<.001). Conclusion: Blood glucose levels measured in the same fingertips of both arms were the same regardless of dextrose IVF infusion. The results indicated that IVF with dextrose may not have any significant effect on the fingertip results of blood glucose level. This study may suggest that patients' both arms and any fingertips can be used for blood glucose monitoring even when the patients are on dextrose IVF infusion.