• Proceedings of the PSK Conference
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• 2003.10b
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• pp.118.2-118.2
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• 2003

Propofol(2, 6-diisopropylphenol) is rapid, short-acting intravenous anaesthetic agent. It is used for the induction and maintenance of general anaesthesia or sedation. The recommended doses are 2-2.5mg/kg given as a titration infusion over about 30min to achieve anaesthesia. Recently, we encountered 4 fatalities related to propofol. One death is a suicide by self-administered of propofol and the others are therapeutic misadventures during surgical care. The propofol level in the blood and tissues were determined by gas chromatographic analysis with mass spectral detection. (omitted)

• The Korean Journal of Pain
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• v.14 no.1
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• pp.46-50
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• 2001

Background: Ondansetron is both a central and peripheral serotonin (5HT) receptor antagonist and droperidol is a dopaminergic blocking drug which acts centrally at the chemoreceptor trigger zone. We assessed the efficacy and adverse effects of ondansetron, droperidol or both, in the prevention of postoperative emesis during postoperative intravenous patient-controlled analgesia (PCA) using butorphanol and ketorolac medication. Methods: We studied 60 women, aged 25-60 yrs, who underwent total abdominal hysterectomy (TAH), under general anesthesia using $N_2O-O_2$-enflurane. A bolus dose of 1 mg of butorphanol and 4 mg of ondansetron were given to patients and thereafter, PCA was started using 10 mg of butorphanol and 240 mg of ketorolac mixed into the 5% D/W solution (total volume; 100 ml, 1 ml of bolus dose, and 10 min of lockout interval). We also added ondansetron 4 mg (Group O, n = 20), ondansetron 4 mg and droperidol 2.5 mg (Group OD, n = 20), or droperidol 2.5 mg (Group D, n = 20) to the PCA drug. The severity of pain, nausea, vomiting, sedation and other side effects were assessed at 0, 1, 2, 6, 12, 24, 36 and 48 hr after awakening. Results: There was no difference in the incidence of nausea and vomiting between the three group [Group O: 4 (20%) and 3 (15%), respectively; Group OD: 1 (5%) and 1 (5%), respectively; Group D: 3 (15%) and 3 (15%), respectively]. Group O showed a lower sedation score than the other groups (P < 0.05). The pain score and other side effects did not show any difference between the groups. Conclusions: The combination of ondansetron and droperidol showed no clinical benefit compared with ondansetron or droperidol alone for prevention of postoperative nausea and vomiting during postoperative PCA using butorphanol and ketorolac.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.166-171
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• 1996

The purpose of this study is to compare the postoperative analgesic effect of morphine and meperidine, employing intravenous patient controlled analgesia after cesarean section. Among fifty nine parturients undergoing cesarean section with general anesthesia, 32 were administered morphine designated as 'morphine group', and 27 parturient administered meperidine as 'meperidine' group, during 48 hours after commencement of PCA. Doses administered, based on potency for this setting, were equivalent to 1 mg morphine or 10 mg meperidine. Loading dose was administered when parturient first complained of pain after cesarean section. This was followed with bolus dose, 1 mg for morphine group and 10 mg for meperidine group, with a lockout interval of 8 minutes between doses wherever parturient requested additional analgesia. Visual analog scale(VAS) pain scores during rest were significantly lower at only 1 and 2 hour for the meperidine group, than morphine group. Loading dose and cumulative dose at 1, 2 and 3 hours were significantly lower for meperidine group than the morphine group. There were no significant difference in total dose and hourly dose for 48 hours and cumulative dose at 6, 12, 24, and 48 hours between both groups. More than 90% of the parturients from both groups were satisfied with the analgesic effects of pain relief. Morphine group experienced side effects such as: pruritus, sedation and dizziness. Meperidine group had sedation, dizziness, nausea and local irritation. Neither group required any specific treatment for any of the above side effects. We conclude that meperidine had greater analgesic effect at early stage of post-operative period.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.441-446
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• 2001

Flumazenil is a competitive antagonist of benzodiazepines. It is usually administered intravenously. However, if the intravenous route is not available then other routes of drug administration should be considered. This study was designed to evaluate the reversal effects of flumazenil after nasal administration. Twenty-five young, healthy adult volunteers participated in this clinical trial. The dosage of 0.08mg/kg midazolam was administered intravenously to induce deep sedation. Ten minutes after midazolam administration, 0.5mg of flumazenil was dropped nasally, over a period of one minute. Blood samples were taken to measure the concentration of midazolam and flumazenil at 0, 5, 10, and 20min after nasal administration of flumazenil, using High Performance Liquid Chromatography. The degree of sedation was evaluated with sedation score and bispectral index (BIS), Statistical analysis was performed by multivariate ANOVA and correlation analysis (P<0.05). Peak serum flumazenil concentration was reached in 10min. Sedation score decreased after midazolam administration and showed a significant increase after flumazenil administration. However, BIS decreased during the first 10min after midazolam administration and then no significant changes after flumazenil administration. There were two instances representing rapid and complete reversal of midazolam after intranasal administration of flumazenil. In conclusion, intranasal flumazenil administration may be effective in some patients when intravenous route is not available in condition of benzodiazepine overdose.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.4
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• pp.303-307
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• 2016

Background: In dental intravenous sedation, continuous intravenous infusion of a low-dose drug requires an infusion pump such as a syringe pump. To develop a new syringe pump for clinical use, the functions of the pump must meet certain international standards. Various safety and efficacy tests must be performed on the syringe pump, as stipulated by these standards, and an approval must be received from the approving agency based on such test results. Methods: The authors of the present study developed a novel syringe pump and performed efficacy evaluation by testing its infusion speed at 1 and 25 ml/h, and infusion performance testing at 2 and 24 h. Moreover, performance evaluation was conducted by comparing the novel pump to an existing pump with the infusion speed varied from 1 to 5 ml/h. Results: In the efficacy testing on the newly developed syringe pump, infusion with the infusion speed initially set to 1 ml/h resulted in infusion speeds of 1.00 and 0.99 ml/h in the 2- and 24-h assessment, respectively. Changing the infusion speed setting to 25 ml/h resulted in an infusion speed of 25.09 and 23.92 ml/h in the 2- and 24-h assessment, respectively. These results show no significant differences when compared with other commercially available pumps. Conclusions: The efficacy testing of the newly developed syringe pump showed the accuracy to be within tolerance. Based on these findings, we believe that the newly developed syringe pump is suitable for clinical use.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.179-184
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• 1997

Background: Ketorolac($Tarasyn^{(R)}$) is a non-steroidal anti-inflammatory drug(NSAID) which has shown to be an effective postoperative analgesic available parenterally, and when combined with morphine can reduce its requirement. The analgesic efficacy and adverse effects of continuous infusion of ketorolac added to morphine IV PCA was evaluated in 60 women after abdominal hysterectomy. Methods: Patients were assigned to receive either morphine intravenous(IV) bolus followed by morphine IV patient controlled analgesia(PCA), or ketorolac 30mg IV and continuous IV infusion at 4.0mg/hr in combination with the above regimen. The authors evaluated PCA morphine used, pain assessment(verbal pain intensity score and visual analogue scale) and side effects at 2, 4, 6 and 24hrs during pain control. Results: Continuous infusion of ketorolac decreased the PCA morphine usage significantly(30.4 ---> 19.6 mg : p=0.007) at 24hrs postoperatively. Significant differences were seen favoring ketorolac infusion in pain intensity and visual analogue scale both at rest and during movement. There were no differences in incidences of deep sedation, nausea & vomiting. But the ketorolac group they complained of dizziness more than morphine only group. Little pruritus was recorded in either groups. Conclusions: The authors conclude continuous IV infusion of ketorolac in conjunction with morphine PCA provide effective analgesia after low abdominal surgery.

• Journal of Veterinary Clinics
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• v.28 no.3
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• pp.291-296
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• 2011

The aims of the present study were to investigate the anesthetic and hemodynamic effects of medetomidine-ketamine combination and to compare antagonistic effects of atipamezole and yohimbine on the recovery of pig from anesthesia induced by medetomidine-ketamine combination. Landrace and Yorkshire cross-bred pigs were evaluated in the present study. Pigs (n = 8) received three different treatments (one treatment per 14 days in a random order). All pigs were injected intramuscularly with medetomidine, and ketamine in a single syringe. Intravenous injections of atipamezole (MKA), yohimbine (MKY), or a control saline solution (MK) were administered 20 minutes after the medetomidine-ketamine combination injection. The intravenous antagonist injections quickly reversed the medetomidine-ketamine induced sedation in the pigs, resulting in a significantly shorter duration of anesthesia in the MKA and MKY groups compared to the MK group. Mean arterial pressure (MAP) levels were significantly lower in the MKA and MKY groups compared to the MK group. Scores for posture and responses to noxious stimuli after atipamezole and yohimbine administration were significantly lower in the MKA and MKY groups than in the MK. In conclusion, the sedative effects and increases in blood pressure induced by a medetomidine-ketamine combination were quickly and smoothly reversed by atipamezole or yohimbine.

• Journal of Veterinary Clinics
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• v.28 no.2
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• pp.211-218
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• 2011

The aims of this study were to investigate the anesthetic effects of medetomidine-midazolam-ketamine (MMK) combination and to compare antagonistic effects of atipamezole and yohimbine in dogs anesthetized with MMK. Eighteen adult male healthy beagles were used in this study. All dogs were anesthetized with intramuscular (IM) administration of medetomidine (0.04 mg/kg), midazolam (0.2 mg/kg) and ketamine (5 mg/kg) in one syringe. Intravenous (IV) administration of atipamezole (0.24 mg/kg, MMKA), yohimbine (0.2 mg/kg, MMKY) or saline solution (0.1 ml/kg, MMK) was administered 20 minutes after MMK combination anesthesia. Induction and recovery times, scores of sedation and analgesia, heart rate, blood pressure, rectal temperature, respiratory rate and blood gases were determined and recorded for each dog. Mean anesthesia times, sternal recumbency times, standing times and walking times in the MMKA and MMKY groups were significantly shorter than those in the MMK group. But there were not significantly different between MMKA and MMKY groups. In all groups, MMK administration produced a satisfactory sedation and analgesia for all dogs. However, after administration of atipamezole or yohimbine the scores for posture and response to noxious stimuli were significantly lower in the MMKA or MMKY group than those in the MMK group. MMK produced good sedation and anesthesia effects, and atipamezole or yohimbine can be used as a safe and effective agent for antagonizing the MMK anesthesia in dogs.

• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.4
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• pp.508-513
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• 2018

Tidal volume by sevoflurane in small amounts is stable due to the increase in the breathing rate. But alveolus ventilation decreases due to sevoflurane as the degree of sedation increases; this ultimately causes $PaCO_2$ to rise. The occurrence of suppression of breath increases the risk of severe hypoxia and hypercapnia in deeply sedated patients with disabilities. Sevoflurane inhalation anesthesia has a number of risks and may have unexpected problems with hemodynamic changes depending on the underlying state of the body. This study was conducted to examine the stability of internal acid-base system caused by respiratory depression occurring when patients with disabilities are induced by sevoflurane. Anesthetic induction was carried out by placing a mask on top of the patient's face and through voluntary breathing with 4 vol% of sevoflurane, 4 L/min of nitrous oxide, and 4 L/min of oxygen. After the patient's loss of consciousness and muscle relaxation, IV line was inserted by an expert and intravenous blood gas was analyzed by extracting blood from vein. In a deeply sedated state, the average amount of pH of the entire patients was measured as $7.36{\pm}0.06$. The average amount of $PvCO_2$ of the entire patients was measured as $48.8{\pm}8.50mmHg$. The average amount of $HCO_3{^-}$ of the entire patients was measured as $27.2{\pm}3.0mmol/L$. In conclusion, in dental treatment of patients with disabilities, the internal acid base response to inhalation sedation using sevoflurane is relatively stable.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.3
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• pp.173-179
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• 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.