• Journal of Dental Anesthesia and Pain Medicine
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• 제24권1호
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• pp.19-35
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• 2024

Background: This study investigated a safe and effective bolus dose and lockout time for patient-controlled sedation (PCS) with dexmedetomidine for dental treatments. The depth of sedation, vital signs, and patient satisfaction were investigated to demonstrate safety. Methods: Thirty patients requiring dental scaling were enrolled and randomly divided into three groups based on bolus doses and lockout times: group 1 (low dose group, bolus dose 0.05 ㎍/kg, 1-minute lockout time), group 2 (middle dose group, 0.1 ㎍/kg, 1-minute), and group 3 (high dose group, 0.2 ㎍/kg, 3-minute) (n = 10 each). ECG, pulse, oxygen saturation, blood pressure, end-tidal CO₂, respiratory rate, and bispectral index scores (BIS) were measured and recorded. The study was conducted in two stages: the first involved sedation without dental treatment and the second included sedation with dental scaling. Patients were instructed to press the drug demand button every 10 s, and the process of falling asleep and waking up was repeated 1-5 times. In the second stage, during dental scaling, patients were instructed to press the drug demand button. Loss of responsiveness (LOR) was defined as failure to respond to auditory stimuli six times, determining sleep onset. Patient and dentist satisfaction were assessed before and after experimentation. Results: Thirty patients (22 males) participated in the study. Scaling was performed in 29 patients after excluding one who experienced dizziness during the first stage. The average number of drug administrations until first LOR was significantly lower in group 3 (2.8 times) than groups 1 and 2 (8.0 and 6.5 times, respectively). The time taken to reach the LOR showed no difference between groups. During the second stage, the average time required to reach the LOR during scaling was 583.4 seconds. The effect site concentrations (Ce) was significantly lower in group 1 than groups 2 and 3. In the participant survey on PCS, 8/10 in group 3 reported partial memory loss, whereas 17/20 in groups 1 and 2 recalled the procedure fully or partially. Conclusion: PCS with dexmedetomidine can provide a rapid onset of sedation, safe vital sign management, and minimal side effects, thus facilitating smooth dental sedation.

• 생물정신의학
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• 제7권1호
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• pp.14-20
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• 2000

Recently atypical antipsychotics have been used as first line agent in the treatment of schizophrenia, and also played a significant role in the treatment of many kinds of psychiatric disorders. The pharmacokinetic and pharmacodynamic properties of these newer antipsychotics are well known through preclinical and early clinical trials. However, it is important to note the limitations of the results due to its relatively short experience. Clozapine is eliminated principally by the hepatic P450 1A2 and 3A4 cytochrome enzymes. 1A2 inducers such as carbamazepine and smoking can reduce its half-life, while 1A2 inhibitors such as SSRIs, especially fluvoxamine can increase its duration of action. Carbamazepine should be avoided in a patient on clozapine because of carbamazepine's potential effects on bone marrow. Benzodiazepines tend to increase the chances of sedation, delirium and respiratory depression. Risperidone is metabolized to 9-hydroxyriperidone by the hepatic P450 2D6 cytochrome enzymes. Fluoxetine and paroxetine, 2D6 inhibitors interfere with metabolism, but 9-hydroxyrisperidone has similar biological activity as parental drug, so it has little affect on the outcome. Olanzapine shows minimal capacity to inhibit cytochrome P450 isoenzymes and shows minimal chance of drug interaction. It is eliminated principally by the hepatic P450 1A2 and 2D6 cytochrome enzymes.

• Advances in pediatric surgery
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• 제4권1호
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• pp.1-15
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• 1998

To evaluate the effectiveness of central venous catheters(CVCs) in children, 320 CVCs placed in 255 neonate and children over a 10-year period were analyzed retrospectively. CVC was placed by one pediatric surgeon for a total of 6, 116 patients days. Catheters were placed preoperatively for TPN or chemo in 223 cases. CVC was solely for TPN in 57 cases and for chemotherapy in 40. Local anesthesia was utilized in 71 cases, and the general anesthesia was administered in the remainder of the patients. The subclavian vein was catheterized(SCV) in 202 cases(82 infants and neonates), tunneled external jugular venotomy(EJV) was utilized in 38, tunneled internal jugular venotomy(UV) in 2, the facial venotomy(FV) was used in 3, and the umbilical vein was catheterized UVC) with vein transposition in 74 infants. In neonates, 72 UVCs were placed during laparotomy. SCV was increased with ages, from 3 kg of minimal body weight. The average catheter-periods over-all were 19.1 days, SCV 17 days, EJV 40, IJV 60 and UVC 14. Technical complications were; arterial puncture(6), puncture failure(5) and abnormal location(12) in SCV; insertion failure(3) in EJV; abnormal location in the portal vein(4) and the liver parenchyma(2) cystic fluid accumulations in UVC. Twelve migrations(3.8 %) out of position occurred; SCV(2), EJV(1) and UVC(9). There were 4 cases(1.2 %) of catheter obstruction and 11(3.4 %) of catheter infection(3 SCV, 2 EJV and 6 UVC). Rescue procedures were utilized with some success. There was one mortality(0.3 %) due to deep sedation in a 1.06 kg baby during placement of an EJV. The surgeon's experience, proper catheter selection and following safety rules are the most important factors for successful CVCs.

• 한국임상수의학회지
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• 제40권1호
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• pp.25-30
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• 2023

The ventral midline approach (VMA) and right flank approach (RFA) are common procedures for the sterilization of bitches. This study compared the different parameters viz. total duration of surgery, recovery time, and length of the incision as well as body temperature, heart rate, respiration rate, and SpO2 in each approach. Twenty (20) bitches were divided randomly for the RFA and VMA. Meloxicam (0.2 mg/kg) was administered subcutaneously half an hour before the induction to provide preemptive analgesia. Diazepam and ketamine were administered intravenously at dose rates of 0.25 mg/kg and 2.5 mg/kg, and 0.17 mg/kg and 3.33 mg/kg, respectively to produce and maintain anesthesia. Each parameter was recorded at the pre-operative, operative and post-operative times. The average duration of surgery and length of incision of RFA (16.1 ± 5.13 min and 2.44 ± 0.83 cm) were significantly lower (p < 0.05) than the VMA (21.3 ± 5.48 min and 3.53 ± 0.7 cm). The operated bitches showed hypothermia (p < 0.05) at 1 hour compared to baseline and 24 hours of surgery. Heart and respiration rates increased significantly (p < 0.05) during traction and severing of ovarian ligaments in bitches within the RFA group, but there was no significant difference within VMA approaches. The sedation score was significantly higher (p < 0.05) at 1 hour after surgery in both approaches. Based on the duration of surgery and length of incision RFA approach was quick and minimal skin wound. Further studies on bitches considering molecular investigations of surgical stress are imperative.

• Tuberculosis and Respiratory Diseases
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• 제45권2호
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• pp.380-387
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• 1998

연구배경: 압력보조환기법은 기계호흡으로부터 이탈시 최근에 많이 이용되는 인공환기법으로 적절한 압력보조 수준이 이탈 과정에 중요하며 특히 최소압력보조 (minimal pressure support) 수준에서 환자의 환기 상태가 적절하면 치료자는 인공 호흡기로 부터 여탈 및 기관내 관을 발관할 수 있다. 그러나 부적절한 최소압력 보조 수준의 적용은 환기 이탈 기간의 장기화나 이탈 실패를 초래할 수 있다. 본 연구는 이탈기 환자들이 최소압력보조 치의 범위를 알아보고 또한 최대 흡기유량과 총환기계 저항의 곱으로 구한 최소압력보조치의 계산값과 환자의 기관내 관 끝에서 실측한 값 사이의 차이를 비교함으로써 유도식으로 계산된 최소압력 보조 값의 임상적 유용성을 예측하고자 하였다. 방 법: 기저 질환이 호전되어 기계호흡으로부터 이탈이 가능한 환자 16명을 대상으로 폐 감시기 (CP-100 pulmonary monitor, Bicore, USA)를 이용하여 부가된 호흡일을 구한 후 최소압력보조의 수준을 직접 측정하였고, 이들 중 9예에서는 또한 유도식 (peak inspiratory flow rate$\times$total ventilatory system resistance=minimal pressure support)을 이용하여 최소합력보조의 수준을 구하였다. 결 과: 대상환자 16명중 14명에서 측정한 최소압력보조의 실측치는 4~12.5 cm$H_2O$로써 환자에 따라 차이가 심하였다. 대상 환자 중 2명에서 각각 15, 21 cm$H_2O$로써 높게 측정되었으나 기관내 관을 발관 후 내강이 기도 분비물로 심한 폐쇄가 발견되었다. 실측치를 측정한 16명중 9명에서 유도식을 이용하여 최소압력 보조의 계산치를 구하였으며 실측치와 계산치의 비는 평균 0.81로 실측치 보다 높게 나타나는 경향을 보였으나 실측치와 계산치의 상관 계수는 0.88(p=0.002)로 통계학적으로 유의한 상관관계를 보였다. 결 론: 압력보조환기법에 의한 이탈 시도시 최소압력보조 수준의 결정은 유도식을 이용하여 계산된 값을 적용하는 것이 치료자가 임의적으로 일정한 값을 적용하는 것보다 더 나을 것으로 사료된다.

• 대한본초학회지
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• 제39권3호
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• pp.107-114
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• 2024

Objective : Cicadae Periostracum (CP), which is the discarded shell of the Cryptotympana atrata (Fabricius, 1775), is a recognized component of oriental medicine for treatment sore throat, itching, shock, sedation, edema. However, the safety and toxicity of CP have not yet been established. It has been reported that symptoms of addiction or side effects may occur in patients who take high doses of CP or who are hypersensitive to it. Therefore, we investigated the acute toxicity of an CP extracts in Sprague-Dawley (SD) rats. Methods : To study acute toxicity, five SD rats of each sex per group were treated with CP extracts at single doses of 0, 500, 1000, or 2000 mg/kg administrated by oral gavage, and body weight, clinical signs, and mortality were observed after dosing. At the end of 14-day observation period, all animals were sacrificed and complete hematological and macroscopic examinations were performed. Results : There were no dead animal and test article-related effects on body weight change or the gross finding. No toxicologically significant results were observed between control and treated groups in hematology. Although salivation related to stress at the highest dose was observed in clinical signs immediately after administration, it is considered to have no toxicological significance. Conclusion : As the results, we did not find any adverse effect at the dose levels of 500, 1000, or 2000 mg/kg in rats. The minimal lethal dose was considered to be over 2000 mg/kg body weight in rats.