• The Korean Journal of Pain
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• 제20권1호
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• pp.40-45
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• 2007

Background: Caudal block is useful when anesthesia for surgery or treatment for chronic pain is needed, but this procedure has a failure rate of up to 25% even when it performed byan experienced physician. This high failure rate is usually due to improper needle placement. Methods: After gaining approval of the ethics committee, 46 patients received caudal blocks under ultrasound guidance; these were performed after the anatomical structures in the sacral hiatus had been measured with ultrasound. All these procedures were performed by the same anesthesiologist. The position and direction of the needle were identified using fluoroscopy by injecting a radio-opaque contrast through the needle. The time taken from thelidocaine injection to verification of the needle was measured and the planned nerve block was then carried out. Results: All cases of needle insertion into the sacral canal under ultrasound guidance were successful. The average duration of the procedure and the trial count were $134.1{\pm}10.1seconds$ and $1.2{\pm}0.1$, respectively. In 12 of the 46 cases (26%), the needle deviated either left or right in the sacral canal, so the direction of the needle had to be adjusted. The distance between two cornua, the depth of the sacral hiatus and the thickness and length of the sacrococcygeal ligament were $17.1{\pm}0.4$, $3.9{\pm}0.3$, $2.3{\pm}0.1$ and $24.9{\pm}0.9mm$, respectively. Conclusions: Ultrasound guidance can increase the success rate of inserting a needle into the sacral canal. However, even when ultrasound is used, the needle can deviate either left or right in the sacral canal.

• 대한한의진단학회지
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• 제22권1호
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• pp.45-56
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• 2018

The authors are using Qi-diagnosis (integrated diagnosis by bio-energy) that is a method of diagnosis and treatment. We applied Qi-diagnosis to the main study to lay the foundation and framework for research and education about the Korean Medicine. The authors try to describe systemically and specifically the Qi-diagnosis that the authors are using in clinical diagnosis ane treatment so that anyone can use it. The authors have been able to grasp the flow of human bio-energy through years of training. It has had many effects by applying the Qi-diagnosis to patients. The steps of the bio-energy flow have become objective. And the authors have been applied to acupuncture, herbal medicine, moxibustion, bruising treatment and anthrax anesthesia in clinical through the Qi-diagnosis. Also, it is applied to the life management of patients. It is applied to arts such as music therapy and art therapy. The deeper the depth of the Qi-diagnosis, the greater the opportunity to utilize the Qi-diagnosis. The Qi-diagnosis is the origin of the korean medicine. It was able to make diagnosis and treatment correct and to establish clues that the medical problems would be solved through the Qi-diagnosis. In order to do so, the diagnostician must be able to feel the auricular flow of the body accurately and objectively. In addition, he must have a comprehensive understanding of the overall framework of medicine. As a result, diagnosis and treatment of the patient as well as general problems of the patient can be identified and advised, so comprehensive treatment is possible. And it is not only a specific person can do it, but it is a diagnostic method that anyone can take if they take the basic steps step by step.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권3호
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• pp.185-191
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• 2016

Background: Failure to maintain a patent airway can result in brain damage or death. In patients with mandibular prognathism or retrognathism, intubation is generally thought to be difficult. We determined the degree of difficulty of airway management in patients with mandibular deformity using anatomic criteria to define and grade difficulty of endotracheal intubation with direct laryngoscopy. Methods: Measurements were performed on 133 patients with prognathism and 33 with retrognathism scheduled for corrective esthetic surgery. A case study was performed on 89 patients with a normal mandible as the control group. In all patients, mouth opening distance (MOD), mandibular depth (MD), mandibular length (ML), mouth opening angle (MOA), neck extension angle (EXT), neck flexion angle (FLX), thyromental distance (TMD), inter-notch distance (IND), thyromental area (TMA), Mallampati grade, and Cormack and Lehane grade were measured. Results: Cormack and Lehane grade I was observed in 84.2%, grade II in 15.0%, and grade III in 0.8% of mandibular prognathism cases; among retrognathism cases, 45.4% were grade I, 27.3% grade II, and 27.3% grade III; among controls, 65.2% were grade I, 26.9% were grade II, and 7.9% were grade III. MOD, MOA, ML, TMD, and TMA were greater in the prognathism group than in the control and retrognathism groups (P < 0.05). The measurements of ML were shorter in retrognathism than in the control and prognathism groups (P < 0.05). Conclusions: Laryngoscopic intubation was easier in patients with prognathism than in those with normal mandibles. However, in retrognathism, the laryngeal view grade was poor and the ML was an important factor.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제16권3호
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• pp.477-497
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• 1994

The purpose of this study was to investigate the effect of timing of implant insertion on osseointegration after tooth extraction. Fifteen mongrel dogs, weighing 15kg or more, were used. The lower right 1st, 2nd, 3rd, 4th premolars and 1st molar were extracted under general anesthesia. Implants were inserted at 2, 4, and 8 weeks after extraction of the teeth, being designated as 2-, 4-, and 8-week groups, respectively. Results obtained were as follows. 1. Macroscopically there was neither an infection at the implant site nor an exposure of the implant. 2. Histologically the surrounding bone of the implant was less mature in the 2-week group than in the 4- and 8-week groups. 3. The implant-bone contact ranged from 75 to 82%, with no significant differences among the groups. No increase in the implant-bone contact was found with increasing healing periods from 4 to 12 weeks after implant insertions. 4. The average depth (0.64mm) of the fibrous connective tissue ingrowth in the 2-week group was slightly deeper than those in the 4- (0.51mm) and 8-week (0.53mm) groups at 12 weeks after implant insertion. 5. the implant-bone interfacial bond strengths were 73.05 kgf in the 2-week group, 69.71 kgf in the 4-week group and 73.76 kgf in the 8-week group. No significant difference was noted in pullout force among the groups. The degree of confidence of interfacial bone strength was highest in the 8-week group, followed by the 4- and 2-week groups. These results indicate that at least 4 weeks of healing period will be required before implant is to be inserted following tooth extraction.

• 한국임상수의학회지
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• 제22권3호
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• pp.194-197
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• 2005

그린 이구아나에서 medetomidine과 tiletamine/zolazepam의 병용마취효과를 알아보기 위하여 본 실험을 실시하였다. Medetomidine은 MZ50, MZ100 및 MZ150 군에서 각각 50, 100 및 150 ${\mu}g/kg$를 사용하였다. Tiletamine/zolazepam ($Zoletil^{(R)}$)은 모든 군에서 10 mg/kg을 적용하였다. 10마리의 건강한 이구아나 (420-490 g)를 2주 간격으로 3회 실험 하였다. 심박동수, 호습수 그리고 체온을 측정하였으며 righting reflex를 통해 마취 심도를 평가하였다. 모든 군에서 심박동수와 호흡수는 마취주사 5분 후에 유의성 있는 감소를 보였으며 (P<0.05) 30분 후에는 지속적으로 증가하는 양상을 보였다. 본 연구결과 medetomidine 100 ${\mu}g/kg$과 tiletamine/zolazepam 10 mg/kg의 병용이 그린이구아나에서 빠르고 안정적이며 효과적인 마취를 제공한다고 생각된다.

• 대한임상검사과학회지
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• 제54권2호
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• pp.157-162
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• 2022

본 술기의 목적은 운동피질 주변에 발생한 뇌종양 환자의 수술에서 TceMEP로 인해 발생하는 위양성을 방지하고 수술 중 운동영역의 정확한 매핑과 피질척수로 보존하기 위함이다. 또한 검사과정에서 발생하는 시행착오를 줄이고 검사시간을 최소화하여 검사결과에 대한 빠른 피드백으로 수술하는 의사에게 정확한 정보를 전달함에 있다. 본 술기의 가장 중요한 요소는 첫번째로 일정 세기의 자극역치로 검사해야 하는 것과 두번째로는 일정 수준의 마취농도를 적정 수준으로 유지하는 것이 수술 중 발생하는 위양성을 막는 기본적이 요소이다. 세번째로는 수술하는 반대쪽 부위에 다중 채널을 이용한 기록전극의 설치로 최대한 많은 근육에서 TceMEP파형과 집접피질자극 및 직접피질하 자극에 대한 반응을 측정하는 것이다. 이런 조건들이 수술이 진행되는 동안 원활하게 유지된다면 검사에서 오는 위양성이 아닌 그 밖의 요인들에서 발생할 수 있는 원인들을 예측할 수 있다.

• 한국임상수의학회지
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• 제32권6호
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• pp.491-498
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• 2015

개에서 remifentanil과 propofol을 사용한 완전 정맥내 마취에서 doxapram의 점적투여가 심폐기능에 미치는 영향에 대해 평가해 보았다. 수컷 비글견 15마리를 사용하였으며 무작위로 5마리씩 3군으로 나누었다. 모든 군에서 전 마취제로 medetomidine을 $20{\mu}g/kg$ 정맥주사 하였고 remifentanil과 propofol의 점적 투여로 1시간 30분 동안 마취하였다. 마취 시작 시, 각 그룹 별로 지정된 용량의 doxapram을 병용 투여하였다. D1 군은 doxapram 0.25 mg/kg을 투여한 후 $8.33{\mu}g/kg/min$의 속도로 점적 투여했다. D2 군은 doxapram 2 mg/kg을 투여한 후 $66.66{\mu}g/kg/min$의 속도로 점적 투여했다. 대조군은 생리 식염수를 투여하였다. 외과적 마취기를 평가하고, 혈액 가스 분석, 호흡수, 심박수, 동맥혈압을 측정하였으며 마취회복기 동안의 행동변화를 관찰 기록하였다. 외과적 마취기는 마취기 전반에 걸쳐 모든 군에서 잘 유지되었다. 대조군에 비해 D2 군에서 호흡수의 유의적인 상승이 있었으며 (p < 0.05), 동맥혈 산소 분압과 산소 포화도에서는 doxapram 처치군 모두에서 대조군에 비해 유의적인 상승을 보였다(p < 0.05). 동맥혈 이산화탄소 분압은 고농도 처치 군인 D2군에서 유의적인 감소를보였다(p < 0.05). 수축기 동맥혈압, 이완기 동맥혈압, 평균 동맥혈압은 D2군에서 유의적인 증가를 보였다. 심박수와 pH는 유의적인 변화가 관찰되지 않았다. 따라서 본 실험을 통해 개에서 remifentanil과 propofol을 사용한 완전 정맥내 마취에서 일어날 수 있는 저산소증이나 저혈압과 같은 심폐 기능 저하를 doxapram의 점적 투여가 진통 작용에 경감 없이 완화 시키는 것을 알 수 있었다.

• 수면정신생리
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• 제2권2호
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• pp.171-179
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• 1995

Objectives : This study was carried out to determine whether the state anxiety may affect sleep on the night before surgery. Methods : The researcher examined the clinical charts of patients who were scheduled to receive surgery by general anesthesia the following day and then had semistructural interview with patients. In addition Spielberger's State Anxiety Inventory(1972), presleep questionnaire and postsleep questionnaire were administered to the patients. One hundred patients who responded to the questions were divided into three groups based on the state anxiety scores; low(n=35), middle(n=27) and high(n=38). Demographic and clinical characteristics of patients, some possible factors affecting sleep, daytime status and nighttime sleep before surgery were compared among three groups. Results : 1) There was no significant difference in demographic characteristics and some possible factors affecting sleep on the night before surgery among three groups. 2) In terms of clinical characteristics, the expectancy of surgical result was significantly different among three groups. More patients in low anxiety group than in middle and high anxiety groups, predicted surgical results as good, while more patients in middle and high anxiety groups than in low anxiety group could not predict their surgical results. 3) For daytime status, high anxiety group felt more tired compared to low anxiety group, but there was no significant difference in daytime nap among three groups. 4) For nighttime sleep before surgery, high anxiety group expected poor sleep and in fact, waked more frequently during sleep than low anxiety group. However there was no difference in bed time, sleep latency, rise time, total sleep time, sleep depth and sleep quality among three groups. 5) The need for hypnotics was higher before bedtime and also after rise in high anxiety group compared to low anxiety group. Conclusions : These results indicate that the individuals with high state anxiety before surgery have poor sleep and furthermore suggest that anxiolytics and/or hypnotics may be required to decrease anxiety and improve sleep for those with high state anxiety.

• Journal of Periodontal and Implant Science
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• 제24권2호
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• pp.340-356
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• 1994

The purpose of this study was to assess the clinical and microbiological effect of chlorhexidine rinse and supragingival plaque control following scaling and root planing on adult periodontal disease. 14 patients with adult periodontitis were selected for the study . They had not taken antibiotics for 6 months and history of dental treatment for 6 months before the study. Patients received a supragingival scaling and root planing under local anesthesia, plaque control group was subjected to professional plaque control 2 times for a period 2 week, chlorhexidine rinse group were subjected to twice daily 0.2% chlorhexidine rinse for a period 2 week. Clinical examination (plaque index, gingival index, probing pocket depth) and distribution of the bacteria morphology of subgingival plaque were monitored on baseline (0 week), 1 week, 2 week, 4 week and 6 week. The results were as follows : 1. Plaque index in chlorhexidine rinse group , plaque control group and control group was significantly reduced during all weeks (P<0.05). 2. Probing pocket depth was significantly reduced at 2, 4, 6 week (P<0.05) in chlorhexidine rinse group and control group, plaque control group was significantly reduced during all weeks (P<0.05). 3. Gingival index was significantly improved at 2, 4, 6 weeks(P<0.05) in chlorhexidine group and plaque control group, control group was significantly improved at 1, 2, 4 weeks (P<0.05). 4. Percentage of cocci was significantly increased at 1, 2, 4 and 6 weeks in chlorhexidine rinse group and control group, plaque control group was significantly increased at 2, 4 and 6 weeks(P<0.05). 5. Percentage of non-motile rods in all group were not significantly changed when compared with those of baseline (0 week) (P<0.05). 6. Percentage of motile rods was significantly reduced during all weeks (P<0.05) in chlorhexidine rinse group, plaque control group was significantly reduced at 2, 4, 6 weeks and 1, 2 and 4 weeks in control group. 7. Percentage of spirochetes was significantly reduced during all weeks (P<0.05), plaque control group was significantly reduced at 2, 4, 6 weeks and 1, 2, 4 weeks in control group. This results were suggested that clinical and microbiological effect of chlorhexidine rinse and supragingival plaque control following scaling and root planing on periodontal disease

• Journal of Periodontal and Implant Science
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• 제26권1호
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• pp.1-26
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• 1996

This study was performed to estimate the effects of cultured bone cell inoculated on porous type hydroxyaptite for the regeneration of the artificial alveolar bone defect. In this experiment 3 beagle dogs were used, and each of them were divided into right and left mandible. Every surgical intervention were performed under the general anesthesia by using with intravenous injection of Pentobarbital sodium(30mg/Kg). To reduce the gingival bleeding during surgery, operative site was injected with Lidocaine hydrochloride(l:80,000 Epinephrine) as local anesthesia. After surgery experimental animal were feeded with soft dietl Mighty dog, Frisies Co., U.S.A.) for 1 weeks to avoid irritaion to soft tissue by food. 2 months before surgery both side of mandibular 1st premolar were extracted and bone chips from mandibular body were obtained from all animals. Bone cells were cultured from bone chips obtained from mandible with Dulbecco's Modified Essential Medium contained with 10% Fetal Bovine Serum under the conventional conditions. Porous type hydroxyapatite were immerse into the high concentrated cell suspension solution, and put 4 hours for attachin the cells on the surface of hydroxyapatite. Graft material were inserted on the artificial bone defect after 3 days of culture. Before insertion of cellinoculated graft material, scanning electronic microscopic observation were performed to confirm the attachment and spreading of cell on the hydroxyapatite surface. 3 artificial bone defects were made with bone trephine drill on the both side of mandible of the experimental animal. First defect was designed without insertion of graft material as negative control, second was filled with porous replamineform hydroxyapatite inoculated with cultured bone marrow cells as expermiental site, and third was filled with graft materials only as positive control. The size of every artificial bone defect was 3mm in diameter and 3mm in depth. After the every surgical intervention of animals, oral hygiene program were performed with 1.0% chlorhexidine digluconate. All of the animals were sacrificed at 2, 4, 6 weeks after surgery. For obtaining histological section, tissus were fixed in 10% Buffered formalin and decalcified with Planko - Rycho Solution for 72hr. Tissue embeding was performed in paraffin and cut parallel to the surface of mandibular body. Section in 8um thickness of tissue was done and stained with Hematoxylin - Eosin. All the specimens were observed under the light microscopy. The following results were obtained : 1. In the case of control site which has no graft material, less inflammatory cell infiltration and rapid new bone forming tendency were revealed compared with experimental groups. But bone surface were observed depression pattern on defect area because of soft tissue invasion into the artificial bone defect during the experimental period. 2. In the porous hydroxyapatite only group, inflammatory cell infiltration was prominet and dense connective tissue were encapsulated around grafted materials. osteoblastic activity in the early stage after surgery was low to compared with grafted with bone cells. 3. In the case of porous hydroxyapatite inoculated with bone cell, less inflammatory cell infiltration and rapid new bone formation activity was revealed than hydroxyapatite only group. Active new bone formation were observed in the early stage of control group. 4. The origin of new bone forming was revealed not from the center of defected area but from the surface of preexisting bony wall on every specimen. 5. In this experiment, osteoclastic cell was not found around grafted materials, and fibrovascular invasion into regions with no noticeable foreign body reaction. Conclusively, the cultured bone cell inoculated onto the porous hydroxyapatite may have an important role of regeneration of artificial bone defects of alveolar bone.