• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.2
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• pp.111-114
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• 2012

Attention deficit hyperactivity disorder (ADHD) is characterized by inattention, impulsivity, and hyperactivity. Given high incidence of ADHD, many children with ADHD is likely to present for anesthesia. This case report suggests intramuscular premedication as an alternative method for anesthetic induction. A 9-year-old male patient with ADHD was transferred for dental treatment under general anesthesia. The patient refused to go into dental clinic office. Oral midazolam was given to the patient, however, he was resistant to take midazolam via oral route. Instead, we administer midazolam and ketamine via intramuscular route. After less than 10 miniutes, the patient became drowsy and was transferred to dental chair. Intravenous access and mask inhalation was possible. The patient received dental treatment under general anesthesia and recovered in a non-complicated way. In this case, intramuscular sedation with midazolam and ketamine was used as a premedication in highly uncoopearive patient refused to take oral sedative medication.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.4
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• pp.245-254
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• 2018

Background: When performing dental treatment under general anesthesia in adult patients who have difficulty cooperating due to intellectual disabilities, anesthesia induction may be difficult as well. In particular, patients who refuse to come into the dental office or sit in the dental chair may have to be forced to do so. However, for adult patients with a large physique, physical restraint may be difficult, while oral sedatives as premedication may be helpful. Here, a retrospective analysis was performed to investigate the effect of oral sedatives. Methods: A hospital-based medical information database was searched for patients who were prescribed oral midazolam or triazolam between January 2009 and December 2017. Pre-anesthesia evaluation, anesthesia, and anesthesia recovery records of all patients were analyzed, and information on disability type, reason for prescribing oral sedatives, prescribed medication and dose, cooperation level during anesthesia induction, anesthesia duration, length of recovery room stay, and complications was retrieved. Results: A total of 97 patients were identified, of whom 50 and 47 received midazolam and triazolam, respectively. The major types of disability were intellectual disabilities, autism, Down syndrome, blindness, cerebral palsy, and epilepsy. Analyses of changes in cooperation levels after drug administration showed that anesthesia induction without physical restraint was possible in 56.0% of patients in the midazolam group and in 46.8% of patients in the triazolam group (P = 0.312). Conclusions: With administration of oral midazolam or triazolam, general anesthesia induction without any physical restraint was possible in approximately 50% of patients, with no difference between the drugs.

• Tuberculosis and Respiratory Diseases
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• v.46 no.2
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• pp.251-259
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• 1999

Background: Even though the necessity for premedication has been questioned, some combinations of antisialogogues, sedatives and analgesics are usually employed by most bronchoscopists. The goal of this study was to determine whether fiberoptic bronchoscopy(FOB) could be performed safely and effectively without premedication while using a standardized topical anesthetic. Method: Eighty outpatients were randomized in a double-blind manner into group I(n=20) with 1 ml normal saline, group II(n=20) with 0.5mg of atropine, group III(n=20) with 0.5mg of atropine plus 5mg of midazolam, and group IV(n=20) with 0.5mg of atropine plus 50mg of meperidine, given intramuscularly 30 minutes before FOB as premedication Topical anesthetics administered were same in each group. Each patient was given 5ml(200mg) of 4% nebulized lidocaine and additional intratracheobronchial 2% lidocaine. Oxygen saturation, pulse rate and electrocardiogram were monitored and recorded before, during, just after and 2 minutes after FOB. Immediately after FOB, the bronchoscopists answered four questions such as ease of procedure, extent of coughing, extent of secretion, and overall impression. Before leaving bronchoscopy suite, patients completed similar questions on discomfort during procedure, and willingness to return for a repeat procedure. Results: Age, gender, baseline pulmonary function, dose of 2% lidocaine used for topical anesthesia, and duration of FOB were not significantly different. There was no statistical difference among group I to IV with regard to extent of coughing answered by bronchoscopist. But extent of secretion was significantly different between group I without atropine and group II-IV with atropine. And there was also significant difference in ease of procedure and overall impression among groups. There was no statistical difference in patient's willingness and level of discomfort among the groups. Thirteen patients(16%) showed hypoxemia(arterial oxygen saturation: <90%), and 3 patients(4%) showed significant tachyarrhythmia(heart rate: > l60/min), but the rate of complication was not statistically different among the groups. Conclusion: These results suggest that the value of premedication is questionable for outpatient FOB, although it may be necessary in excessively anxious patient.

• Journal of Veterinary Clinics
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• v.19 no.2
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• pp.199-203
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• 2002

Cardiovascular effects of propofol, were assessed after premedication with xylazine(1.0 mUkg, IM) under oxygen supply(200 ml/kg/min) via a endotracheal tube. Twelve adult mixed-breed dogs were divided into four groups; 0.2(Group 1), 0.4(Group 2), 0.6(Group 3) and 0.8 mg/kg/min(Group 4) of propofol respectively. Arterial blood pressure and electrocardiogram were monitored with a physiograph after an arterial catheter was inserted into the femoral artery. pH, arterial carbon dioxide tension($PaCO_2$and arterial oxygen tension($PaO_2$) were evaluated with arterial blood collected through the inserted catheter. Diastolic arterial pressure, systolic arterial pressure and mean arterial pressure were decreased slightly in Group I IIand III, but decreased significantly in Group IV. They were increased rapidly after stopping propofol infusion in Group IV pH was maintained in normal range in Group I, II and m, but was decreased in proportion to time passing in Group IV. $PaCO_2$ was increased significantly only in Group IV but $PaO_2$ was maintained in normal range in all groups Although heart rate was recorded in normal range for 90 minutes, arythmia was noted after stopping propofol infusion in all groups. It was concluded that propofol depressed the cardiovascular system in proportion to infusion dosage, and 0.8 mg/kg/min of propofol infusion rate was not appropriated in canine anesthesia with xylazine premedication.

• Korean Journal of Veterinary Service
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• v.39 no.2
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• pp.93-99
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• 2016

The anesthetic depth and cardiovascular effect of alfaxalone constant rate infusion in dogs premedicated with xylazine or acepromazine were evaluated. Ten dogs were randomly allocated into 2 groups. In group AA, dogs were premedicated with 0.02 mg/kg of intravenous acepromazine at 15 min before induction. In group XA 1.1 mg/kg of intravenous xylazine was premedicated at 5 min before induction. The anesthesia was maintained with 6 mg/kg/hr of alfaxalone after induction with 2 mg/kg alfaxalone in both groups. In both of groups, the qualities of induction were satisfactory without any adverse event, but adequate analgesia could not be provided, according to the withdrawal test. $PaO_2$ and $SaO_2$ implied a slight hypoxemia state in XA group, while those values of group AA were not significantly changed. The acepromazine and alfaxalone combination induce mild tachycardia. The bispectral index score were significantly decreased in group XA, compared with that in group AA. The premedication of xylazine before alfaxalone constant rate infusion in this study could provide adequate analgesia during 30 min, while the premedication with acepromazine could not.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.9 no.1
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• pp.46-50
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• 2013

Developmental disorders are a group of psychiatric conditions originating in childhood that involve serious impairments in different areas. These disorders comprise language disorders, learning disorders, motor disorders and autism spectrum disorders. Midazolam is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties. The anterograde amnesia property of midazolam is useful for premedication before surgery to inhibit unpleasant memories. This article presents a case report including caries treatment of a 8-year-old male patient with developmental disorders using oral midazolam premedication as an alternative method of behavior management prior to general anesthesia.

• The Korean Journal of Pharmacology
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• v.15 no.1_2 s.25
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• pp.21-27
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• 1979

It is well known that picrotoxin, an amaroid substance of Anamirta cocculus, is a classic stimulant on the central nervous system accompanying convulsive activity, and it liberates catecholameine from the adrenal mdulla through its central action to increase blood sugar level. Schou reported that lithium and alcohol have the similar inhibitory property on the $Na^+,\;K^+$-ATPase activity, and recently, the therapeutic efficacies of lithium on the alcohol withdrawal syndrome and the chronic alcoholics have been studied. Many studies about the hypoglycemic effect of lithium and alcohol were reported but the interaction between those hypoglycemic action is little known. Therefore, in this paper, the hypoglycemic effect of lithium and ethanol on the hyperglycemia induced with picrotoxin, and the interaction of them in those hypoglycemic action were investigated with reference to the anticonvulsive action of them. The results were obtained as follows: 1. The convulsive dose (: $CD__{50}$) of picrotoxin in mice was slightly increased by the pretreatment of lithium or ethanol. 2. The blood sugar level was markedly increased by picrotoxin but the level was sugar level was significantly decreased by lithium, ethanol or both. 3. The hyperglycemic effect of picrotoxin was significantly potentiated by the lithium pretreatment, but the potentiation effect of lithium was markedly suppressed by the additional injection of ethanol after lithium injection and more markedly suppressed by the premedication of ethanol before lithium injection 4. The hyperglycemic effect of picrotoxin was markedly inhibited by the ethanol pretreatment, and the inhibitory effect of ethanol was significantly strenthened by the additional injection of lithium after ethanol injection, but on the contrary, the inhibitory effect was completely disappeared by the premedication of lithium before ethanol injection.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.85-88
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• 2011

Purpose: Takotsubo cardiomyopathy is a relatively uncommon type of stress-induced cardiomyopathy characterized by transient left ventricular regional wall motion abnormalities. Emotional and physical stresses play a key role in this type of cardiomyopathy in postmenopausal women. The current hypothesis is that the syndrome represents a form of catecholamine surge due to stress or epinephrine-mediated acute myocardial stunning. Methods: A 44-year-old woman had suffered premature ventricular contraction following a cardiogenic shock during a breast augmentation surgery under enflurane anesthesia and tumescent solution infiltration. She was treated with cardiopulmonary resuscitation at a local clinic. Then she was brought to the Emergency Department of the authors' hospital. Results: The woman's echocardiogram showed an ejection fraction of 20~25% with associated basal hyperkinesis and left ventricular apical ballooning. The patient was admitted to the ICU and required inotropic support for two weeks. The patient's condition dramatically improved, and her ejection fraction returned to 70%. Conclusion: It is believed that there were multiple triggering factors of the onset of Takotsubo cardiomyopathy in the woman's social and family history, including infiltration of a large volume of the tumescent solution and VPCs induced by enflurane anesthesia without premedication. The importance of careful history-taking, careful pre-operative consultation on psychological suffering especially for breast surgery, premedication before surgery, patient reassurance, and post-operative psychosocial and emotional assistance was again seen in this case.

• The Korean Journal of Pain
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• v.10 no.2
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• pp.166-169
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• 1997

Background: We have noted a high incidence of vasovagal episodes associated with use of interscalene block(ISB) for shoulder arthroscopy in the sitting position. The purpose of this retrospective study is to alert the possibility of potentially dangerous vasovagal events, describe the characteristics of this problem, and propose therapeutic devices. Methods: Results 62 patients who underwent shoulder arthroscopy in the sitting position with ISB were retrospectively analyzed. Group 1, 10 patients experienced vasovagal events characterized by sudden hypotension and bradycardia. Remaining 52 patients, Group 2, did not experience these symptoms. All patient charts were reviewed for age, sex, side of surgery, premedication, preoperative fluid and intraoperative medications. Perioperative hemodynamic changes were also compared between the two groups. Results: Vasovagal events experienced in 16% of patients(10/62) and occurred $39{\pm}18$ min after sitting position and $22{\pm}18$ min after start of operation. Number of patients who receiving anticholinergics for premedication were significantly lower in Group 1 than Group 2(2/10 vs. 28/52, p<0.05). Conclusions: Bezold-parish reflex is a potential mechanism for sudden hypotension and bradycardia which can occur during shoulder arthroscopy in sitting position. Therefore anticholinergic pretreatment and meticulous monitoring during operation are recommended to prevent B-J reflex.

• Phonetics and Speech Sciences
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• v.2 no.2
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• pp.101-108
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• 2010

An inhaled salbutamol and salmeterol for chronic obstructive pulmonary disease(COPD) and asthma have been used worldwidely. But there has been few study about the voice change evoked from the post-medicine effect. To evaluate the voice influenced of short-acting and long-acting ${\beta}_2$-agonists, two experiments were carried out: one was salbutamol experiment 1 with eight patients, the other was salmeterol experiment 2 with six patients. Experiment 1 was made of two stages: premedication & postmedication. Experiment 2 was four stages: stageI was premedication, stageII was postmedication & pregaggling, stageIII was postmedication & postgaggling(100 ml with water), and stageIV was postmedication & 30 minutes later. Measured parameters were F0, F0_SD, Jitter_rap, Shimmer_apq11, HNR, BW(1, 2, 3), Intensity, and H1-H2. The mean data collected from 3 repetitions each was statistically analyzed by Wilcoxon signed rank test for experiment 1 and repeated measures ANOVA for experiment 2. In experiment 1, significant differences were found in the Jitter_rap(Z= -2.10, p=0.036). The findings indicated that the postmedicated voice was worse than premedicated voice. In experiment 2, there wasn't significant difference, but values of parameters related to voice quality(Jitter_rap, Shimmer_apq11, HNR, and H1-H2) showed changes toward stageⅣ, that is, the voice quality was worse under medication.