• Journal of Dental Anesthesia and Pain Medicine
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• 제23권1호
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• pp.39-43
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• 2023

Nasotracheal intubation is commonly performed under general anesthesia in oral and maxillofacial surgery. For the convenience of surgery, nasal Ring-Adair-Elwyn (RAE) tubes are mainly used. Because the nasal RAE tubes were bent in an "L" shape, the insertion depth was limited. Particularly, it is necessary to accurately determine the appropriate depth of the RAE tubes in children. Several types of nasal RAE tubes are used in the medical market, which vary in material and length. We performed endotracheal intubation using a nasal RAE tube for double-jaw surgery, but air leakage persisted even when the air pressure in the cuff was increased. When checked with a laryngoscope, it was confirmed that the tube was pushed out, and the cuff was caught on the vocal cords, causing air leakage. Since inserting the tube deeply did not solve the problem, replacing it with a nasal RAE tube (Polar^TM, Preformed Tracheal Tube, Smith Medical, Inc., USA) did not cause air leakage; thus, we reported this case.

• Current Optics and Photonics
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• 제6권5호
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• pp.489-496
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• 2022

Our previous study on monitoring cerebral oxygenation with a variation of isoflurane concentration in a rat model showed that near-infrared spectroscopy (NIRS) signals have potential as a new depth of anesthesia (DOA) index. However, that study obtained results from the brain in a completely invasive way, which is inappropriate for clinical application. Therefore, in this follow-up study, it was investigated whether the NIRS signals measured in a minimally invasive model including the skull and cerebrospinal fluid layer (CSFL) are similar to the previous study used as a gold standard. The experimental method was the same as the previous study, and only the subject model was different. We continuously collected NIRS signals before, during, and after isoflurane anesthesia. The isoflurane concentration started at 2.5% (v/v) and decreased to 1.0% by 0.5% every 5 min. The results showed a positive linear correlation between isoflurane concentration and ratio of reflectance intensity (RRI) increase, which is based on NIRS signals. This indicates that the quality of NIRS signals passed through the skull and CSFL in the minimally invasive model is as good as the signal obtained directly from the brain. Therefore, we believe that the results of this study can be easily applied to clinics as a potential indicator to monitor DOA.

• Journal of Periodontal and Implant Science
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• 제39권sup2호
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• pp.239-251
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• 2009

Purpose: Full-mouth disinfection enables to reduce the probability of cross contamination from untreated pockets to treated ones, for completing the entire SRP under local anesthesia with chlorhexidine as a mouth wash in two visits within 24 hours. This study aimed to compare the clinical effects of modified full-mouth disinfection (Fdis) after 6 months with those of conventional SRP (cSRP). Methods: Thirty non-smoking chronic periodontitis subjects were randomly allocated two groups. The Fdis group underwent the entire SRP under local anesthesia in two visits within 24 hours, a week after receiving supragingival scaling. A chlorhexidine (0.1%) solution was used for rinsing and subgingival irrigation for Fdis. The cSRP group received SRP per quadrant under local anesthesia at one-week intervals, one week after they had received scaling. Clinical parameters were recorded at baseline, after 1, 3 and 6 months. Results: There are significant (P<0.05) decreases in the sulcus bleeding index, and plaque index, and the increases in gingival recession were significantly smaller with Fdis after six months compared with cSRP. There was significant improvement in the probing depth and clinical attachment level for initially medium-deep pockets (4-6mm) after Fdis compared with cSRP. Multi-rooted teeth showed significantly larger attachment gain up to six months after Fdis. Single-rooted teeth showed significantly more attachment gain, 1 and 6 months after Fdis. Conclusions: Fdis has more beneficial effects on reducing gingival inflammation, plaque level, probing depth, gingival recession and improving clinical attachment level over cSRP.

• Journal of Korean Neurosurgical Society
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• 제55권4호
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• pp.185-189
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• 2014

Objective : General anesthesia is often preferred for endovascular coiling of intracranial aneurysm at most centers. But in the authors' hospital, it is performed under monitored anesthesia care (MAC) using dexmedetomidine. To determine the feasibility and safety of this approach, the authors reviewed our initial experience. Methods : Retrospective data was analyzed from July 2012 to November 2012. We performed coil embolization in 28 cases using this method. Among them, for statistical significance, we analyzed 12 cases in which the procedure time exceeded an hour. Vital signs were analyzed every 10 minutes. Depth of sedation was measured according to the Ramsay sedation scale and frequency of the repeated roadmap image(s) caused by movement of the patient's head during the procedure. Results : All procedures were completed without occurrence of procedure related complications. Under MAC using dexmedetomidine, vital signs of the patients were stable, no statistical significance regarding hemodynamic and respiratory parameters was observed between time points (p>0.05). Adequate sedation was achieved. Mean Ramsay sedation scale was $3.67{\pm}1.61$ (2 to 6). Repeated roadmap image(s) due to patient's factor occurred in only one case. The mean dosage of drug for adequate sedation for the procedure was $0.65{\pm}0.12mcg/kg/hr$ without loading doses. Conclusion : To the best of my knowledge, this is the first report published in English using the method of monitored anesthesia with dexmedetomidine for intracranial aneurysm coiling. Monitored anesthesia care using dexmedetomidine without loading dose for embolization of intracranial aneurysms appeared to be a safe and effective alternative to general anesthesia.

• 대한임상검사과학회지
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• 제52권4호
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• pp.317-326
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• 2020

마취는 의식의 차단 역할을 하는 주 마취제와 감각, 운동, 반사의 차단을 하는 부 마취제인 근이완제로 구분된다. 깊은 의식의 차단만으로는 심한 자극에 대한 반응을 막을 수 없고, 다량의 진통제만으로는 무의식을 보장할 수 없다. 그러므로 마취는 동시에 두 가지를 모두 만족시켜야 한다. 근 이완제는 흡입 또는 정맥마취제의 투여 용량을 감소시키면서 기관지내 삽입관, 수술 시야 및 수술적 환경(operating conditions)을 향상시킬 수 있으며, 수술 중 기계적 조절 환기(controlled mechanical ventilation) 시 호흡 관리를 위하여 매우 중요하다. 이러한 근이완제는 투여 용량이 과다하면 수술 중 신경 검사가 안 되는 영향을 줄 수 있고, 투여 용량이 부족하게 되면 환자가 수술 중 움직일 수 있어서 근 이완 마취 심도와 수술 중 감시 검사는 밀접한 관계가 있다. 근 이완제를 많이 사용하면, 수술 중 신경생리학적 검사가 원활하게 되지 않는 단점과 수술 이후에 완전히 근 이완효과를 제거하기 어렵다는 단점도 갖고 있다. 수술 중 감시 검사를 하는 수술에서 마취과에서는 어떠한 기준으로 근 이완제를 투여하며 유지하는지에 대하여 국내뿐만 아니라 전 세계적인 동향을 살펴 봄으로써 보다 원활한 수술 중 신경 검사가 되길 바란다.

• 대한치과의사협회지
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• 제51권7호
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• pp.398-404
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• 2013

Apprehension and phobia regarding dental procedures are represent the most common deterrents in patients seeking dental care and very common. For these individuals, and others who cannot cooperate during care, procedural sedation may permit completion of intraoral procedures. In most cases, the level of sedation may be kept at minimal to moderate levels permitting patient maintenance of their airway patency and ventilation. Unlike many medical procedures, the majority of dental procedures, no matter the depth of sedation, are performed in the presence of complete analgesia provided by local anesthesia. Therefore, the goal of procedural sedation is to primarily suppress patient fear and apprehension and gain cooperation. Any issues regarding actual pain are usually limited to that produced by the local anesthetic injections or, rarely, the extent of the procedure. For the extremely phobic patient, however, allaying apprehension may be very challenging. Intravenous titration of sedative drugs is the most effective route of administration to achieve this goal but requires advanced training beyond that provided in undergraduate training.

• The Korean Journal of Physiology and Pharmacology
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• 제3권5호
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• pp.491-499
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• 1999

This study was designed to evaluate the efficacy of dynamic parameters, such as correlation dimension $D_2,$ by comparing spectral electroencephalographic (EEG) parameters. These parameters are used to estimate the depth of halothane anesthesia as defined by the presence of body movement in response to a tail clamp. Six rats were used and each of them was exposed to halothane sequentially at the concentrations of 0%, 0.5%, 1.0% and 1.5% for 30 min. A tail clamp was applied every five min and the movements were recorded at each concentration level. The spectral parameters and the dynamic parameters were derived from 20-sec and 10-sec segments, respectively, from the last 5-mins of EEG recording at each concentration level. Correlation coefficients between the parameters and the movements were calculated. Standardized values of three parameters, betaL power, median power frequency (MPF), and $D_2$ were derived by calculation based on the number of animals showing the movement in response to a tail clamp. The betaL power had the largest correlation coefficient to spontaneous movement and to the response to a tail clamp than any other band parameter. MPF had a better correlation with the movement than 90% spectral edge frequency. Among the dynamic parameters, $D_2$ on the parietal cortex had a better correlation with the movement. The level of deviation and variation of standardized $D_2,$ MPF, and betaL were significant (p<0.01). The order of deviation and variation was; betaL power > MPF > $D_2.$ The correlation dimension serves as a better index for the depth of halothane anesthesia defined in forms of a response to external stimulation.

• The Korean Journal of Pain
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• 제9권1호
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• pp.130-134
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• 1996

Background: This study was designed to determine the distance from skin to lumbar epidural space in obstetric parturients and whether weight, height, or PI (ponderal index, $kg/m^2$) might influence the epidural depth. Methods: 71 obstetric patients undergoing elective cesarean section during epidural anesthesia in L2-3 level were partitioned into groups according to their prepregnant BMI(body mass index), and in each group weight, height, PI, epidural depth were measured. Results: All patients were classified as underweight(n=18), normal(n=49), overweight(n=4) and no one was partitioned into obese group. the distance from skin to lumbar epidural space was found to be 3.7 cm(underweight), 4.1 cm(normal), 4.7 cm(over weight) and total mean distance was found to be 4.0 cm. The epidural depth had correlation with weight and height in underweight, and weight and PI in normal, but had no correlation with any measurements in overweight group. Conclusion: These results suggest body weight may be a useful parameter for predicting the distance from skin to lumbar epidural space in underweight and normal weight obstetric parturients.

• 한국임상수의학회:학술대회논문집
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• 한국임상수의학회 2006년도 춘계학술대회
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• pp.133-133
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• 2006

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권4호
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• pp.241-251
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• 2017

Devices that monitor the depth of hypnosis based on the electroencephalogram (EEG) have long been commercialized, and clinicians use these to titrate the dosage of hypnotic agents. However, these have not yet been accepted as standard monitoring devices for anesthesiology. The primary reason is that the use of these monitoring devices does not completely prevent awareness during surgery, and the development of these devices has not taken into account the neurophysiological mechanisms of hypnotic agents, thus making it possible to show different levels of unconsciousness in the same brain status. An alternative is to monitor EEGs that are not signal processed with numerical values presented by these monitoring devices. Several studies have reported that power spectral analysis alone can distinguish the effects of different hypnotic agents on consciousness changes. This paper introduces the basic concept of power spectral analysis and introduces the EEG characteristics of various hypnotic agents that are used in sedation.