• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.415-420
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• 2013

This study was performed to examine the anesthetic and cardiopulmonary effects of medetomidine, midazolam and ketamine (MMK) combination in ten beagle dogs. Dogs were randomly allocated to two groups. Treatment group MMK-L received 0.015 mg/kg medetomidine followed by 0.3 mg/kg midazolam and 5 mg/kg ketamine by intramuscular injection. Treatment group MMK-H received 0.02 mg/kg medetomidine followed by 0.3 mg/kg midazolam and 5 mg/kg ketamine by intramuscular injection. Induction, anesthesia, sternal recumbency, standing, walking time, heart rate, arterial blood pressure, rectal temperature, respiratory rate and arterial blood gases were measured. Mean anesthesia time was significantly different between MMK-L group ($52.4{\pm}11.08$ minutes) and MMK-H group ($78.2{\pm}20.72$ minutes). Sedative scores and noxious stimuli were raised to the maximum value at 5 minutes after administration of the test dose and maintained until 40 minutes in both groups. In both groups, the heart rate significantly decreased after MMK administration. The blood pressures (MAP, SAP and DAP) increased after MMK administration but there were no significant differences in blood pressures between two groups. In conclusion, intramuscular administration of medetomidine followed by intramuscular injection of midazolam and ketamine in beagle dogs, leads immediate and sufficient anesthesia and proper doses of medetomidine for minimal adverse effects in intramuscular MMK combination will be 0.015 mg/kg in dogs.

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.1
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• pp.22-28
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• 2008

Background: Cerebral palsy (CP) is non-progressive disorder of motion and posture. In CP patient, there are difficulties in dental treatment because of uncontrolled movement of limb and head, and conjoined disabilities such as cognitive impairment, sensory loss, seizures, communication and behavioral disturbances. It is reported that CP patients have high incidence in caries and a higher prevalence of periodontal disease. But, despite the need for oro-dental care, these patients often are unlikely to receive adequate treatment without sedation or general anesthesia because of uncontrolled movements of the trunk or head. Methods: We reviewed the 58 cases of 56 patients with CP who underwent outpatient general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 19 (2-54) years. The number of male patient was 40 and that of female was 18. They all had severe spastic cerebral palsy and 22 had sever mental retardation, 15 epilepsy, 8 organic brain disorder, 1 blindness, 2 deafness and cleft palate. For anesthesia induction, 14 cases was needed physical restriction who had sever mental retardation and cooperation difficulty, but 44 cases showed good or moderate cooperation. Drugs used for anesthesia induction were thiopental (37 cases), sevoflurane (14 cases), ketamine (3 cases ) and propofol (4 cases). All patients except one were done nasotracheal intubation for airway management and 4 cases were needed difficult airway management and 1 patient already had tracheostomy tube. Mean total anesthetic time was $174{\pm}56$ min and staying time at PACU was $88{\pm}39$ min. There was no death or long term hospitalization because of severe complications. Conclusion: If general anesthesia is needed, pertinent diagnostic tests and workup about anomaly, and appropriate anesthetic planning are essential for safety.

• Journal of the Korean Institute of Electrical and Electronic Material Engineers
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• v.21 no.8
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• pp.770-775
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• 2008

Autonomic nervous system of the anesthetized patients can be influenced by the many kinds of stimulations such as intubation, surgical incision and so on. The changes of the heart rates and blood pressures are surrogates of responses of the autonomic system to the external stimulations. Recently, the power spectral analysis of the heart rate variability (HRV) made it easy to know the fractions and changes of sympathetic and parasympathetic autonomic systems. In this study, the changes of pulse transit time, one of the response of vessels to stimulations, was investigated in relation to the HRV. Ten patients were examined and average age is 22.5 $\pm$ 11.04, average weight is 63 $\pm$ 14.4 kg. The patients were anesthetized only by sevoflurane inhalation. Pulse transit time is determined by calculating the difference of the time between the R peak of ECG and the characteristic point of the plethysmography. Power spectral density (PSD) of the HRV was achieved in the frequency of 0.04-0.15 (LF) and 0.15-0.4 (HF). Compared to preanesthetic period the values of LF and LF/HF ratio of HRV were decreased (p<0.05). HF and PTT was increased in anesthetic state with sevoflurane. Otherwise, after intubation, the HF was decreased and LF, LF/HF ratio and PTT were increased. PSD of the HRV is well-known for the index of the autonomic nervous activity. Not only HRV but PTT analysis also is a useful index reflecting the autonomic responses to various stimulations. And this analysis is useful in bed side monitoring because the calculating method is simple and it takes shorter processing time compared to the HRV analysis.

• Hip & pelvis
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• v.35 no.3
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• pp.206-215
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• 2023

Purpose: Delay in performance of hip fracture surgery can be caused by medical and/or administrative reasons. Although early surgery is recommended, it is unclear what constitutes a delayed surgery and whether the impact of delayed surgery can differ depending on the reason for the delay. Materials and Methods: A total of 269 consecutive hip fracture patients over 50 years of age who underwent surgery were prospectively enrolled. They were divided into two groups: early and delayed (time from reaching the hospital to surgery less than or more than 48 hours). Patients were also categorized as fit or unfit based on anesthetic fitness. One-year mortality was recorded, and regression analyses were performed to assess the impact of delay on mortality. Results: A total of 153 patients (56.9%) had delayed surgery with a mean time to surgery of 87±70 hours. A total of 115 patients (42.8%) were considered medically fit to undergo surgery. No difference in one-year mortality was observed between patients with early surgery and those with delayed surgery (P=0.854). However, when assessment of the time to surgery was performed in a continuous manner, mortality increased with prolonged time to surgery, particularly in unfit patients, and higher mortality was observed when the delay exceeded six days (fit: P=0.117; unfit: P=0.035). Conclusion: The effect of delay on mortality was predominantly observed in patients who were not considered medically fit, suggesting that surgical delays might have a greater impact on patients with medical reasons for delay.

• Journal of Veterinary Clinics
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• v.16 no.1
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• pp.86-94
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• 1999

To invstigate the available dosage and effects of xylazine as preanesthetics on the propofol anesthesia in the dog, the experimental animals were randomly divided into 3 groups (xylazine 0.55 mg/kg (group 1), 1 mg/kg (group 2) and 2 mg/kg (group 3) were premedicated) and, monitored analgesic and anesthetic effect, body temperature, respiratory rate (breaths/minute), heart rate (beats/minutes). Also, hematological and serum chemical changes were monitored. In all experimental groups, the animals were recumbent just after propofol injection and time difference was not detected. Except vomitting after xylazine injection and insignificant ataxia during recovery, no significant side effects were observed. In group 2, loss of toe-web needle prick response time was slightly longer than group 1 but the response in group 2 and group 3 were similar, In group 2 and 3, the duration of anesthesia was longer than group 1 (2 folds) but there was no difference between group 2 and 3. Recovery time was prolonged in proportion to administration dosage of xylazine. In all experimental groups, the body temperature of animals was decresed gradually according to experimental time but no significant changes were monitored. The heart rate and respiratory rate were significantly (p<0.01, p<0.05) decreased after propofol injection Hematologically, no significant changes were monitored in total leukocye numbers, total erythrocye numbers, MCV, MCH, MCHC, serum GOT and GPT values Significant changes in all groups were not observed except significant increase in BUN, total-protein and abumin values of group 3. On the basis of these result, premedication of xylazine can be helpful in decresing some side effects and the dosage of propofol. 1 mg/kg of xylazine as preanesthetics on the propofol anesthesia in the dog is considered to be available.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.61-66
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• 2006

The purpose of this study is to introduce the method of palate repair that combines minimal hard palate dissection and radical retropositiong of levator musculature, which was presented by Sommerlad. As this method presents, additional use of the operating microscope enables atraumatic and radical dissection, and it might provide more improved speech function to the patients. A total of 17 patients with cleft palate underwent Sommerlad's method from December 2003 to August 2004. The mean follow-up period was 4.5 months. The use of a microscope provided high quality variable magnification and good illumination at the operating field. Repair was carried out through incisions at the margins of cleft with mucoperiosteal flap elevation. Muscles were rearranged and repaired properly. It was unable to evaluate the improvement of speech because the patients were too young to learn meaningful speech. Average operating time including anesthetic induction time, V-tube insertion and recovery from anesthesia was 2 hours 45 minutes which was not quite different from conventional method's operating time. Oronasal fistula developed in 2 patients of them. One of them was healed spontaneously. As meticulous and radical muscle dissection was possible with Sommerlad's method, we could minimize the trauma to the muscular and neurovascluar structure. In addition, we expect better faculty of speech as a result of this method although longer follow-up time was unavailable.

• Journal of Chest Surgery
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• v.33 no.9
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• pp.738-743
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• 2000

Background: Video-assisted thoracic surgery(VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. Material and Method: Group I (n=18) underwent video-assisted thoracic surgery, and group II(n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. Result: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I(155.6$\pm$77.8cc) than in group II(572.8$\pm$280.1cc)(p<0.05). Conclusion: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.37-43
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• 2022

Background: The surgical strategy for single-stage resection of primary colorectal cancer (CRC) and synchronous pulmonary metastases remains a matter of debate. Methods: Perioperative data of patients who underwent single-stage resection of primary CRC and synchronous pulmonary metastases were compared to those of patients who underwent 2-stage resections. The demographic data, number of metastases, type of pulmonary and colorectal resections, operation time, blood loss, postoperative complications, morbidities, mortality, medical costs, and length of hospital stay were analyzed. Results: Twenty-two patients underwent single-stage resection of primary CRC and pulmonary metastases, while 27 patients underwent 2-stage resection. Tumor size and the number of pulmonary metastases were not significantly different between the 2 groups. The extent of pulmonary metastasectomy and abdominal procedures were similar in both groups, as was the thoracic surgical approach (video-assisted thoracic surgery vs. thoracotomy). However, open laparotomy was performed more frequently in the 2-stage group than in the single-stage group (p=0.045), which also had a longer total anesthetic time (p=0.013). The operation time, medical costs, estimated blood loss, complication rates, and severity were similar in both groups, but the length of hospital stay was shorter in the single-stage group (p<0.001). Conclusion: Single-stage colorectal and pulmonary resection shortened the overall hospital stay, with no significant changes in operation time, medical costs, hospital mortality, and morbidity. Therefore, single-stage resection could be a good surgical strategy in selected patients.

• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.421-427
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• 2013

There are many intramuscularly injectable drugs commonly used for anesthesia in dogs and combination of drugs were used for decrease the side effects. The objective of this study was to evaluate the anesthetic and cardiopulmonary effects of butorphanol-tiletamine-zolazepam-medetomidine and tramadol-tiletamine-zolazepam-medetomidine in dogs. Ten healthy beagle dogs (intact male; mean body weight : $9.5{\pm}1.60$ kg) were used in the study. Experimental animals were divided into two groups (n=5, each) and received 0.2 mg/kg of butorphanol (BZM) and 2 mg/kg of tramadol (TZM) according to the group after injection of $Zoletil^{(R)}$ (5 mg/kg) and medetomidine (10 ug/kg). All drugs were administered intramuscularly. Anesthesia and recovery, sedation and analgesia score, cardiovascular and respiratory parameters were measured. Induction and recovery time were not significantly different between the groups. Anesthesia time was $117.4{\pm}25.64$ minute and $81.2{\pm}12.50$ minute in BZM and TZM groups, respectively. Sedation and analgesia were satisfied in both groups. In both groups, common side effects related to the medetomidine, significant bradycardia and hypertension were not observed. There were no significant changes in respiratory data. In conclusion, tiletamine-zolazepam-medetomidine in combination with either butorphanol or tramadol can be suitable anesthetic protocol for minor procedures in dogs. They produced adequate anesthesia characterized by rapid induction, adequate analgesia and muscle relaxation without remarkable side effects.

• Journal of Veterinary Clinics
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• v.21 no.2
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• pp.168-171
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• 2004

The effects of alterations of dose of xylaznie (X) and Zoltil$\circledR$ (TZ) on canine anesthesia were examined. Experimental groups were divided into three (Group 1: X 1.1 mg/kg and TZ 10 mg/kg, Group 2: X 1.65 mg/kg and TZ 7.5 mg/kg, Group 3: X 2.2 mg/kg and TZ 5 mg/kg), and each had 5 dogs. A femoral artery was catheterized for measurement of blood pressure, and baseline value was measured. The dogs were sedated with xylazine intramuscularly, then after 10 minutes TZ were injected intravenously. Mean arterial blood pressures (MAP), duration of analgesia, mean arousal time (MAT) and mean walking time (MWT) after TZ injection were measured, and the depth of analgesia and the quality of recovery were scored. The values of MAP were recorded from the time of pre-xylazine injection to arousal. Duration of analgesia and was assessed by tail clamping test, and which were done at 10 minutes intervals after TZ injection. The decreases of MAP from 40 minutes after TZ injection were significant (p<0.05). In group 2, MAP at 20 minutes, and from 40 minutes to arousal were significantly decreased (p<0.05). In group 3, MAP were significantly decreased from 40 minutes. MAT were 62.2$\pm$9.2 minutes in group 1, 60.2$\pm$7.5 minutes in group 2, and 71.0$\pm$6.9 minutes in group 3. MAT in group 3 was significantly increased compared with group 2 (p<0.05), and the differences of MWT among each groups were not significant (p>0.05). The scores of quality of recovery were significantly lowered in group 3 compared with group 1 or group 2, which means the side effects of recovery were less occurred. Thus, it was considered that the combination X 2.2 mg/kg IM and TZ 5 mg/kg IV is more effective to surgical procedures and to prevent long and rough recovery of Zoletil anesthesia.