• 대한소아치과학회지
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• 제28권4호
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• pp.633-637
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• 2001

소아치과에서 국소마취는 공포의 대상이며, 특히 행동조절이 힘든 소아의 경우 더욱 그러하다. 국소마취에 대한 공포는 주사침의 자입시나 주사액의 주입시 느끼는 동통 만큼이나 주사침 자체의 공포도 크게 차지한다. 주사침 자입시의 동통을 완화하기 위하여, 도포마취제 등이 개발되었으나 이들은 국소마취의 동통을 완화시키는 면은 있으나 주사침 자체에 대한 공포를 없애지는 못하였다. Syrijet Mark II$^{(R)}$(Mizzy Inc, USA)는 주사침이 없는 치과용 분사식 주사기 (jet injection device)로서 소아에서 주사침에 대한 공포를 성공적으로 감소시킬 수 있다고 알려져 있다. 저자들은 여러 행동등급의 소아를 대상으로 Syrijet을 사용하여 국소마취를 시행한 후 동통평가의 척도로서 VAS(visual analogue scale)를 소아에게 적합하게 색상화한 CAS(color analogue scale)를 이용하여 국소마취시의 동통수준을 측정한 결과, 기존 주사침에 의한 국소마취시 보다 국소마취의 동통이 감소된 것을 알 수 있었다. Syrijet의 장점으로는 주사침이 없다는 점, 기존의 술식에서 일회용이었던 마취용 카트리지를 재사용할 수 있다는 점, 신경 및 혈관에 안전하다는 점 등이 있었으며, 단점으로 부피가 크며, 가격이 비싸며, 사용시 숙련성을 요구한다는 점 등이 있었다.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제21권3호
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• pp.266-269
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• 1999

This article discusses the vascular change of dorsal surface of tongue following inferior alveolar nerve block of 2% lidocaine HCl with 1:100,000 epinephrine. Twenty-two rats were randomly allocated to three groups: control group; without mandibular nerve block, experimental group 1; 2% lidocaine HCl, experimental group 2; 2% lidocaine HCl plus 1:100,000 epinephrine. The assessments were performed at 1-, 5-, 30-, 60-, 120-minute after inferior alveolar nerve block. Vessel diameters using the micrometer were measured and compared. Results showed that the increase in vascular constriction in group 3 was greater than those in groups 1 and 2. In conclusion, local anesthesia combined with epinephrine assures safer anesthesia for hemostasis.

• 대한치과마취과학회지
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• 제12권3호
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• pp.151-155
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• 2012

A vasovagal reaction is defined as the 'development of hypotension and bradycardia associated with the typical clinical manifestations of pallor, sweating and weakness'. The most profound degree of vasovagal reaction results in fainting or syncope. Incidence of vasovagal reactions in the local anesthetic department of a dental hospital is around 2%. The pathophysiology of the hypotension/bradycardia reflex responsible for vasovagal syncope is not completely understood. Central as well as peripheral mechanisms have been implicated in its pathogenesis: however their relative contribution is not fully elucidated. Recently, trigeminocardiac reflex, previously known as oculocardiac reflex, may serve as syncope. The management of vasovagal syncope is evolving. Non-pharmacological treatment options are a fundamental first step of all treatment pathways. In this article, we would like to review new mechanism of vasovagal syncope and hope to be of help to manage the syncopal patients.

• 대한기관식도과학회지
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• 제2권2호
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• pp.213-221
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• 1996

To evaluate the clinical effectiveness of expandable metallic stents, the stents were implanted under endoscopic guidance with local anesthesia or general anesthesia for maintenance of the constructed subglottic space of trachea. The nine patients with respiration difficulty were subjected for expandable stents. The stenosis of upper airway were due to the framework problem of subglottic trachea and tracheostoma after total laryngectomy. Stents were constructed of 0.4 m stainless steel win in a zigzag configuration of 8 bends. A single stent was 20 m in diameter when fully expanded and 20 mm long. The stents were placed accurately to the stenotic site and followed to the 5 month after stent placement. The stenotic area became narrowed with overgrowing of granuloma in all patients and the metallic stents were removed and the stenotic area reconstructed surgically. As conclusion, this technique for the treatment of the subglottic trachea showed simple and safe, but highly recurred due to overgrowing of granuloma. We suggest that the expandable metallic stent is not encouraging in this study.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권1호
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• pp.65-69
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• 2017

Patients with severe gag reflex (SGR) have difficulty getting the treatment they require in local clinics, and many tend to postpone the start of their treatment. To address this problem, dentists have used behavioral techniques and/or pharmacological techniques for treatment. Among the pharmacological methods available, propofol IV sedation is preferred over general anesthesia because it is a simpler procedure. Propofol in combination with remifentanil is characterized by stable sedative effects and quick recovery, leading to a deep sedation. Remifentanil acts to reduce the pain caused by lipid-soluble propofol on injection. The synergistic effects of propofol-remifentanil include reduction in the total amount of drug required to achieve a desired sedation level and anti-emetic effects. In this case report, we outline how the use of propofol-remifentanil IV sedation enabled us to successfully complete a wide range of dental treatments in a patient with SGR.

• Journal of Chest Surgery
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• 제22권2호
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• pp.330-336
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• 1989

The patient was 47-year-old male who had suffered from aphasia and hemiplegia of the right side, but mental state was alert. On physical examination, BP was 130/80 mmHg in the right arm, but not checked in the left arm. The pulses of the left common carotid, brachial, and radial arteries were not palpable. The pulses of the right femoral, popliteal, and dorsalis pedis arteries were weakly palpable. Brain CT Scan revealed cerebral infarction of the left hemisphere. Aortogram showed occlusion of the left common carotid, and the right internal carotid and common iliac arteries. Subclavian steal phenomena were observed in the delayed aortogram. Double extra-anatomic bypasses; Axillo-Axillar bypass and Femora-Femoral bypass, were performed in the local anesthesia at two stages, because of risk of major operation under general anesthesia. Postoperatively, all pulses except for pulse of the left common carotid artery were equally palpable. On discharge, the hemiplegia of the right side was improved and able to walk with assistance.

• Journal of Chest Surgery
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• 제21권2호
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• pp.389-394
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• 1988

The patient was 22-year old male who had been suffered from labored breathing. Computerized tomography, tracheoscopy, tracheogram disclosed tracheal obstruction by external mass compression on Tl level, which ranged 4.Oem in the length and approximately 4mm in diameter on tracheogram. Under the local anesthesia, tracheostomy was done to prevent intraoperative airway obstruction. And general anesthesia, low collar incision 8z extended median sternotomy was made and nearly total thyroidectomy was performed. After the circumferential resection of the obstructed segment approximately 4cm in length[7 tracheal rings], direct end-to-end anastomosis of trachea was performed. Postoperatively, the patient`s neck was maintained in flexion state to reduce tension of anastomotic site. Postoperatively. medical therapy[Comthyroid k Calcium lactate] and radiotherapy were done. At present, 2-months after operation, he lives well.

• 대한후두음성언어의학회지
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• 제28권1호
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• pp.52-54
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• 2017

Vocal polyps are benign laryngeal lesions which arise from the Reinke's space abd hoarseness is the most common symptom. However, airway compromised is rarely presented in the vocal polyp. A rare case of large subglottic polyp causing dyspnea is reported. Tracheostomy was performed under local anesthesia and then the mass was resected under general anesthesia using a laryngofissure approach. The dyspnea and hoarseness disappeared after surgery immediately. The histopathological findings indicated a diagnosis of vocal cord polyp with chronic inflammatiuon. We consider that tracheostomy is the safest and most useful procedure to guarantee the upper airway in cases of large vocal polyp showing dyspnea. We hereby report a case of huge subglottic polyp in which a tracheostomy and laryngofissure was required for removing the subglottic mass successfully.

• 대한치과마취과학회지
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• 제7권2호
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• pp.126-130
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• 2007

Sedation is often indicated for the relief of anxiety for outpatient oral surgery. In combination with local anesthesia, it is safe and effective method of treatment. However, it is not always effective in allowing the physician to complete the planned oral surgery procedure. On occasion, a procedure is left unfinished due to patient combativeness and discomfort and hypertension in spite of increase in sedative doses. Episodic increases in blood pressure were most commonly caused by light anesthesia or sedation and by the patient's experience of pain during treatment. Female patient was 42 years old. blood pressure is 150/90 mmHg. Extraction and implant surgery was done under IV sedation. During seadtion, her blood pressure was increased (200/100 mmHg). Surgery was stopped. She was done monitoring blood pressure. The blood pressure was decreased to 130/90 mmHg. Sedation was failed due to significant hypertension. Blood pressure is seldom increased during sedation but we should evaluate the patient's medical history and know guideline for hypertension crisis.

• The Korean Journal of Pain
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• 제6권2호
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• pp.270-274
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• 1993

Massive extradural spread, distinguished from subarachnoid injection that sometimes follows the introduction of small amounts of local anesthetics or narcotics during attempted epidural anesthesia or analgesia, has been attributed to subdural injection. A 64-year-old woman was admitted for partial radical hysterectomy under general anesthesia after insertion of lumbar epidural cathter by loss of resistance technique with 5 ml of air. In this case, we experienced severe respiratory depression and loss of consciousness after administration of 4 mg of morphine for postoperative pain control. We confirmed air shadows at right silvian and suprasella cisterna region by CT scanning. Patients was recovered without sequele after 2 days, As this case resembles a "massive epidural", it is suggested that subdural injection rather than epidural injection may explain the phenomenon.