• 대한정형외과학회지
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• 제56권4호
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• pp.310-316
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• 2021

목적: 화농성 슬관절염은 조기 진단과 신속한 수술적 치료가 필요한 정형외과적 응급 질환이다. 본 연구는 국소 마취하에 배액관 삽입 및 세척을 통한 화농성 슬관절염 치료의 효용성에 대해서 알아보고자 하였다. 대상 및 방법: 2017년 9월부터 2020년 2월까지 화농성 슬관절염을 진단받고 국소 마취하에 배액관 삽입과 세척을 통해 치료를 시행 받은 총 9예(8명)의 환자를 대상으로 후향적 연구를 하였다. 상외측 삽입구에서 상내측으로 관통하는 방식으로 배액관을 넣은 후 약 3 L의 생리식염수를 이용하여 매일 세척하였다. 나이, 성별, 기저질환, 화농성 슬관절염의 원인, 골관절염의 정도, 진단 후 수술까지 소요된 시간, 재원기간, C-반응성 단백이 정상화되는 기간, 배양 균주 등을 확인하였다. 결과: 진단 당시 혈액검사에서 혈청 백혈구 수치는 평균 9,211±2,912개/mm³ (6,100-16,300개/mm³), C-반응성 단백은 평균 12.1±11.2 mg/dl (3.9-35.4 mg/dl)였으며, 초기 관절 천자액 검사상 평균 백혈구 수치는 71,472±51,667개/mm³ (32,400-203,904개/mm³), 평균 다형 백혈구 분율은 평균 91.1%±2.6% (86%-95%)였다. 진단 후 수술까지 소요된 시간은 평균 8.3±1.3 시간(6-10시간)이었고, 평균 세척 기간은 8.2±3.2일(4-15일), 평균 재원 기간은 20.8±8.7일(9-37일)였다. 도말 및 배양 검사로 원인균은 동정되지 않았다. 결론: 화농성 슬관절염의 치료에서 국소 마취를 통한 삽입관 삽입과 세척술은 비교적 빠르고 간단한 방법으로 조기에 관절 내 삼출물을 제거하여 통증을 줄이고 반복적으로 세척할 수 있어 전신 또는 척수 마취의 위험성이 높은 환자에게 치료의 대안으로 활용될 수 있다.

• Journal of Chest Surgery
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• 제24권12호
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• pp.1214-1219
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• 1991

From July 1988 to January 1991 six patients, aged 29 to 70 years underwent transfemoral thrombectomy for the treatment of deep vein thrombosis. Preoperative venograms showed thrombi in the following locations: calf veins[five], superficial femoral or popliteal veins [four], common femoral veins[three], and iliac veins[three], Durations of symptoms before admission were from 1 day to 20days. Operations were performed under local anesthesia and all the patients were requested for doing Valsalva maneuver during thrombectomies. All patients were received heparin pre-and postoperatively, which was switched to Coumadin for preventing of rethrombosis. One patient was transferred to other hospital 4 months after operation due to regional reason, and the remained five patients were evaluated with a mean follow-up time of 20 months. There was no evidence of postoperative pulmonary embolism. Three of five patients were clinically asymptomatic. One complained of the heaviness of involved leg in the evening, and the other had discomfort on walking Even though our cases were a few in number, we concluded that thrombectomy is a valuable treatment modality of deep vein thrombosis.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.7-14
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• 2011

Purpose: Many patients have fear for surgery owing to the injection of lidocaine and the possible pain in the course of the operation. To resolve such a problem the cases to do plastic surgery with monitored anesthetic care are increasing, in which something like sedatives is injected into vein without endotracheal intubation and under voluntary respiration, but the usage is now under the controversy. Methods: There were 25 patients who had surgery with local anesthesia, and another 25 patients who had surgery with monitored anesthetic care which belongs to ASA class 1 and 2 from January to April, 2009. Their anesthesia records were collected and surveys were given before and after the surgery and the surgery staff recorded OAA/S during the surgery. The postoperative surveys included the awakening during the surgery, pain, anxiety, and the degree of patient's satisfaction through visual analogue scale to identify the difference between the two methods. Results: The OAA/S results according to time lapse show that it is possible to lead a fast effective sedation and recovery with monitored anesthetic care, and monitored anesthetic care enhances both surgeon's convenience level and patient's satisfaction level, and reduces awakening, pain, and anxiety, compared to local anesthesia. Conclusion: The current paper shows about the plastic surgery, particularly the outpatient surgery, when monitored anesthetic care method is applied, it could gain a fast sedation and recovery or an effective sedation of patients. The method also has some affirmative effects in regard with surgeon's convenience and the patients' satisfaction degree and the reduction of their awakening, pain, and anxiety. With careful and adequate watch on the measures about vital signs like electrocardiogram, the degree of oxygen saturation, and blood pressure, it could clinically be very useful.

• 대한장애인치과학회지
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• 제14권2호
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• pp.102-105
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• 2018

중등도의 혈우병 A 환아와 중증의 혈우병 B 환아가 응고인자 투여 후 전신마취 하에 각각 매복 과잉치 발거술 및 다수 유치의 우식치료를 받았다. 이와 같이 혈우병 환자의 치과치료 시에는 부족한 응고인자를 보충해주는 등의 응고인자 수준의 관리와 복잡한 의과적 처치 및 술 후 관리가 요구된다. 또한 치과치료 시 출혈을 유발되지 않도록 주의해야 하며 응급 상황 등에 대비하여 국소적 지혈 방법 등을 숙지하고 있는 것이 필요하다.

• 대한후두음성언어의학회지
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• 제29권2호
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• pp.76-78
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• 2018

With recent developments in medical technology and the introduction of various types of lasers, the role of fiberoptic laryngeal laser surgery (FLS) in laryngology has been significantly expanded. FLS are typically performed under local anesthesia, and patients may return to normal activities immediately after the procedure. This corresponds to the current trend of minimally invasive surgery and may limit unnecessary general anesthesia, reduce medical costs, and increase patient compliances. Main indications of FLS procedure were vocal polyp, recurrent respiratory papillomatosis, vocal fold granuloma and vocal fold dysplasia. In this review, we discuss practical tips and unique value of FLS.

• 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.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제26권1호
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• pp.97-104
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• 2000

The temporomandibular joint arthrocentesis is indicated the 'closed lock' due to anterior disc displacement without reduction. It can be easily carried out under local anesthesia with little complications. We performed arthrocentesis to the 24 patients, 9 patients who suffered from acute or chronic closed lock with anterior disc displacement, 2 patients from temporomandibular joint dysfunction related to systemic disease and 13 patients from joint dysfunction with pain. We present the common clinical aspect of arthrocentesis that operator can be easily faced with and possible modifications of this method.

• 대한치과의사협회지
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• 제56권1호
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• pp.42-48
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• 2018

INTRODUCTION The most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars. METHODS Sixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in two separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analogue scale pain scores obtained immediately after surgical extraction were primarily evaluated for the two groups receiving different epinephrine concentrations. Visual analogue scale pain scores obtained 2, 4, and 6 h after administering an anesthetic, onset and duration of analgesia, onset of pain, intraoperative bleeding, operator's and participant's overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the two groups. RESULTS There were no statistically significant differences between the two groups in any measurements except hemodynamic factors (P > .05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine ($P{\leq}01$). CONCLUSION The difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted mandibular third molars in hemodynamically unstable patients.

• 대한장애인치과학회지
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• 제4권1호
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• pp.7-11
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• 2008

치과의사는 혈우병 환자의 치료 시 주의사항에 대해 잘 알고 있어야 한다. 혈우병 환자의 내원 시 소아과 의사 및 혈우재단 등 전문가에게 의뢰하여 환자의 상태에 대한 자문을 얻어야 하고, 치과 치료 시 적절한 계획 하에 최소의 침습적인 치료가 행해지도록 노력해야 하며, 응급 상황을 대비하여 지혈방법을 습득해야 한다. 또 환자와 보호자에게 평소 구강 관리의 중요성을 일깨워 침습적 치과 치료의 빈도를 줄일 수 있도록 해야 한다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제49권3호
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• pp.142-147
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• 2023

Objectives: As medical history before surgery is often based on patient reporting, there is the possibility that patients intentionally hide underlying diseases or that dentists cannot recognize abnormal health states. Therefore, more professional and reliable treatment processes are needed under the Korean dental specialist system. The purpose of this study was to elucidate the necessity of a preoperative blood testing routine prior to office-based surgery under local anesthesia. Patients and Methods: Preoperative blood lab data for 5,022 patients from January 2018 to December 2019 were assembled. Study participants were those who underwent extraction or implant surgery under local anesthesia at Seoul National University Dental Hospital. Preoperative blood tests included complete blood count (CBC), blood chemistry, serum electrolyte, serology, and blood coagulation data. Values outside of the normal range were considered an "abnormality," and the percentage of abnormalities among the total number of patients was calculated. Patients were divided into two groups based on the presence of underlying disease. The rates of abnormalities in the blood tests were compared between groups. Chi-square tests were performed to compare data from the two groups, and P<0.05 was considered statistically significant. Results: The percentages of males and females in the study were 48.0% and 52.0%, respectively. Of all patients, 17.0% (Group B) reported known systemic disease, while 83.0% (Group A) reported no specific medical history. There were significant differences between Groups A and B in CBC, coagulation panel, electrolytes, and chemistry panel (P<0.05). In Group A, the results of blood tests that required a change in procedure were identified even though the proportion was very small. Conclusion: Preoperative blood tests for office-based surgery can detect underlying medical conditions that are difficult to identify from patient history alone and can prevent unexpected sequelae. In addition, such tests can result in a more professional treatment process and build patient confidence in the dentist.