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Comparison of Efficacy of Propofol When Used with or without Remifentanil during Conscious Sedation with a Target-Controlled Infuser for Impacted Teeth Extraction

  • Sung, Juhan;Kim, Hyun-Jeong;Choi, Yoon Ji;Lee, Soo Eon;Seo, Kwang-Suk
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.14 no.4
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    • pp.213-219
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    • 2014
  • Background: Clinical use of propofol along with remifentanil for intravenous sedation is increasing in these days, but there are not enough researches to evaluate proper target concentration when these drugs are infused by using target controlled infusion (TCI) pump in dental treatment cases. In this study, we compared efficacy of TCI conscious sedation and target concentration of propofol when it used with or without remifentanil during conscious sedation with the help of a TCI for the surgical extraction of impacted teeth. Methods: After IRB approval, all the charts of patients who had undergone surgical extraction of impacted teeth under propofol TCI sedation for 6 months were selected and reviewed for this study. After reviewal of charts, we could divide patients in two groups. In one group (group 1), only propofol was selected for sedation and initial effect site concentration of propofol was $1{\mu}g/ml$ (n = 33), and in another group (group 2), both propofol and remifentanil was infused and initial effect site concentration of each drug was $0.6{\mu}g/ml$ and 1 ng/ml respectively (n = 25). For each group, average propofol target concentration was measured. In addition, we compared heart rate, respiratory rate, and systolic and diastolic blood pressure as well as oxygen saturation. Besides, BIS, sedation scores (OAAS/S), and subjective satisfaction scores were compared. Results: Between group 1 and 2, there were no significant differences in demographics (age, weight and height), and total sedation time. However, total infused dose and the effect site target concentration of propofol was $163.8{\pm}74.5mg$ and $1.13{\pm}0.21{\mu}g/ml$ in group 1, and $104.3{\pm}46.5mg$ and $0.72{\pm}0.26{\mu}g/ml$ in the group 2 with $1.02{\pm}0.21ng/l$ of the effect site target concentration of remifentanil, respectively. During sedation, there were no differences between overall vital sign, BIS and OAAS/S in 2 groups (P > 0.05). However, we figured out patients in group 2 had decreased pain sensation during sedation. Conclusions: Co-administration of propofol along with remifentanil via a TCI for the surgical extraction of impacted teeth may be safe and effective compared to propofol only administration.

Risk factor analysis of additional administration of sedative agent and patient dissatisfaction in intravenous conscious sedation using midazolam for third molar extraction

  • Shin, Dong-Whan;Cho, Jin-Yong;Han, Yoon-Sic;Sim, Hye-Young;Kim, Hee-Sun;Jung, Da-Un;Lee, Ho
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.43 no.4
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    • pp.229-238
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    • 2017
  • Objectives: The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intravenous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction. Materials and Methods: Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer's assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05. Results: Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; however, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction. Conclusion: The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral surgery under IVS. The amnesia about the procedure affects patient satisfaction positively.

An Effects of a New PGE1: Lipo-AS013 on Blood Flow and Survival of Skin Flap (새로운 PGE1인 Lipo-AS013이 피판의 혈류와 생존에 미치는 영향)

  • Seul, Chul Hwan;Choi, Jong Woo;Chi, Yong Hoon;Tark, Kwan Chul
    • Archives of Plastic Surgery
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    • v.32 no.1
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    • pp.5-11
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    • 2005
  • Prostaglandin $E_1$($PGE_1$) is known to have various physiological action such as vasodilatation, decrease of blood pressure, angiogenesis, inhibition of platelet aggregation and so forth. $PGE_1$ has been developed in many different formulations in order to overcome its chemical instability and deactivation in the lungs when administered parenterally. Lipo-AS013 is a potent drug with higher chemical stability and greater vascular wall targeting than others. The study was done on $3{\times}10cm$ model flap of dorsal skin of Sprague-Dawley rats and the flap perfusion survival were observed and documented. The flap treated with Lipo-AS013 beforehand was given intravenously Sodium fluorescein 10 minutes later, and then Percent Dye Fluorescence Index(% DFI) was calculated. The results were compared to a control group and the group administered locally epinephrine.. In the control group, the % DFI and flap survival rate increased from $54.1{\pm}6.7$ to $65.0{\pm}2.6$(p<0.01) while in Lipo-AS013 group from $55.3{\pm}2.2$ to $67.4{\pm}1.9$(p<0.01), respectively. In the epinephrine group, the % DFI(p<0.05) and flap survival rate(p<0.001) decreased. In the both epinephrine and Lipo-AS013 group Percent DFI and flap survival rate are comparable with the control group.The result indicates that the potent Lipo-AS013 enhances the blood flow and flap survival. This highly potent Lipo-AS013 may have targeting ability and accumulate $PGE_1$ onto the vascular walls. A quantitative analysis of fluorescence on the skin surface is a reliable tool to measure the blood perfusion into an ischemic flap and its viability. Further comparative study with conventional $PGE_1$ and Lipo-$PGE_1$ is needed in order to clarify the action and efficiency of Lipo-AS013.

A preliminary study to determine the order of the latent fingerprint deposition on thermal paper - A short term study - (감열지상 잠재지문의 남겨진 순서결정에 대한 예비적 연구 - 단기연구 -)

  • Lim, Dong-A;Ok, Yun-Seok;Heo, Bo-Reum;Choi, Sung-Woon
    • Analytical Science and Technology
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    • v.30 no.5
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    • pp.279-286
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    • 2017
  • Determination of the order of latent fingerprints deposition on the surface of thermal paper, often found in crime scenes, is related to the study of time course and aging of fingerprints and can provide additional information in criminal investigations. A preliminary study was performed to determine the deposition order of fingerprints left with two different conditions of deposition pressure and time (in seconds) after 1 day intervals for 7 days on thermal paper (receipt and fax thermal paper) using an iodine fuming method. The resultant images of the visualized fingerprints were analyzed with densitometric image analysis to measure the changes in the areas of the ridges, which can be correlated to the deposition order. No significant variation was found with the different types of thermal paper. The average areas of the friction ridges increased gradually or were similar to the values from day 1 for 3 days, and then a continual decrease was shown from day 4 through day 7. The area values from day 6 and day 7 were less than half of those from day 1. Furthermore, the test with overlapped fingerprints showed the possibility of differentiation between fingerprints that are 1-3 and 6-7 days old based on the clarity visible to the naked eye. Additional experiments with the deposition conditions can prove that the current method is valuable for the determining the order of fingerprint deposition on thermal paper.

Preparation and Evaluation of $PGE_1$ Transurethral Suppositories (프로스타글란딘 $E_1$ 요도좌제의 제조 및 평가)

  • Kim, Jong-Oh;Quan, Qi-Zhe;Rhee, Jong-Dal;Choi, Han-Gon;Yong, Chul-Soon
    • Journal of Pharmaceutical Investigation
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    • v.30 no.3
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    • pp.173-178
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    • 2000
  • The purpose of this work is to develop a transurethral suppository containing prostaglandin $E_1\;(PGE_1)$, which stabilizes the drug, gives no irritation to physiological body and enhances the erectile response of $PGE_1.\;PGE_1$ transurethral suppositories were prepared with various amounts of compositions such as saturated polyglycolysed glyceride $(Suppocire^{\circledR}\;AP,\;SAP)$, polyoxyethylene hydrogenated castor oil (HCO-50) and ethanol. The melting points, viscosities and $PGE_1$ release of the suppositories were investigated. Ocular irritation test was carried out after application of $PGE_1$ suppository to rabbit's eye. The intracavernous pressure (ICP), penile length and duration of erectile response were determined after transurethral administration of $PGE_1$ suppository and compared with those after intracavernosal injection of $PGE_1$ solution to cats. HCO-50 hardly affected the melting points and viscosities of $PGE_1$ suppositories. Additionally, $PGE_1$ transurethral suppositories, whose melting point ranges was $34-35^{\circ}C$, was speedily melted in physiological body. HCO-50 significantly decreased the dissolution rates of $PGE_1$ from the suppositories. Dissolution mechanism analysis showed the release of $PGE_1$ was proportional to the square root of time, indicating that $PGE_1$ might be released from the suppositories by Fickian diffusion. The release rate of $PGE_1$ from $PGE_1$ suppository [PGE1/SAP/HCO-50/ethanol (1/94.5/2.5/2%)] was about 80% within 2 h. This $PGE_1$ suppository gave no significant irritation to the ocular tissue, expecting that it gave no irritation to the urethral tissue less sensive than ocular tissue. Furthermore, $PGE_1$ in this suppository was stable at $4^{\circ}C$ for 2 years. This suppository increased the ICP and penile erection similar to those of injectable $PGE_1$ solution. However, it gave 2.5-fold increased duration of erectile response than injectable $PGE_1$ solution. Our results suggested that it gave more effective erectile response than injectable $PGE_1$ solution in cats. It is concluded that this $PGE_1$ suppository with good safety, excellent stability and enhanced erectile response, could be a more effective and convenient transurethal delivery system of $PGE_1$.

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Anti-microbial and Anti-thrombosis Activities of Lees of Sweet Potato Soju (고구마 소주 주박의 항균 및 항혈전 활성)

  • Kim, Mi-Sun;Lee, Ye-Seul;Kim, Jong Sik;Shin, Woo-Chang;Sohn, Ho-Yong
    • Microbiology and Biotechnology Letters
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    • v.42 no.3
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    • pp.258-266
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    • 2014
  • Sweet potato soju (SPS), a form of traditional distilled alcoholic liquor in Korea, is manufactured by the distillation of fermented broth under normal pressure, thus providing it for a uniquely smooth taste infused with the flavor of sweet potato. After distillation, the lees of SPS is produced as by-product and discarded. In this study, the ethanol and hot water extracts of lees of SPS, and their subsequent organic solvent fractions using hexane, ethylacetate (EA), butanol, and water residue were prepared in an effort at the efficient re-use of the lees of SPS. The ethanol extraction yield was 1.36-fold higher than that of the hot water extraction, and the EA fraction revealed the highest total polyphenol content among the solvent fractions. The various extracts and solvent fractions did not demonstrate hemolytic activity at up to 0.5 mg/ml concentrations against human red blood cells. In the bioactivity assay, only the EA fraction displayed a broad spectrum of anti-microbial activity against different pathogenic and food spoilage bacteria, and demonstrated significant anti-coagulation activity by inhibitions of thrombin, prothrombin and blood coagulation factors. Furthermore, only the EA fraction from the hot water extract of the lees of SPS showed anti-platelet aggregation activity, which is comparable to aspirin (a commercially available drug). Our results suggest that the EA fraction of the hot water extract prepared from the lees of SPS has a high potential as a novel resource for anti-microbial and anti-thrombosis agents.

Pastor's Expectations from Parish Nurses (목회자의 목회간호에 대한 역할기대)

  • Kim, Chung-Nam;Kwon, Young-Sook
    • Research in Community and Public Health Nursing
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    • v.7 no.1
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    • pp.154-169
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    • 1996
  • Parish nursing is a community health nursing role developed in 1983 by Lutheran chaplain Granger Westberg. An increasing emphasis on holistic care, personal reseponsibility for a healthy lifestyle, and changes in healthcare delivery systems have undoubtedly facilitated the establishment and nurturance of an innovative nursing role in the community. Parish nurses are functioning in a variety of church congregations of various denominations. The parish nurse is a educator, a personal health counselor, a coordinator of volunteers. The parish nurses helps people relate to the complexed medical care system and assists people to integrate faith and health. The autors conducted a study on pastor's expectations from parish nurses. Results of this study will be useful to those instrumental in planning, initiating, supporting, and evaluating a parish nurses program The research was done on 130 pastors in Taegue and Kyong Sang Buck Do, of various ages ranging from their 20's to 60's: and pastoring churches of various sizes, ranging from under 100 to over 300 members. 94.6% agreed that they needed a parish nurse on their staff; and 86.2% said they wanted to start a parish nurse program in their churches if certain basic conditions were met. The pastors responded that some would hire the nurses on a full-time basis(22.3%), a part -time basis (37.7%) or use volunteer nurses (40%). The pastors said they would expect the following from a parish nurse: health counselling (80.0%) regular health check-ups (78.5%) health care for the elderly (78.5%) health information and education (72.3%) hospice care (72.3%) visiting sick church members at home (69.2%) arranging and training volunteers to help the seek (59.2%) health care for expectant mothers (50.0%) introducing and taking people to health care facilities (46.2%) The pastors were surveyed about specific areas of health education they would want the parish nurse to teach(for example, high blood pressure and heart disease prevention and management(76.2%) ; stress management(74.6%); and diabetes prevention and management(73.8%). The pastors were surveyed about specific areas of health counselling they would expect the parish nurse to do (for example, drug abuse, (73.1), alcohol abuse(64.6%), marriage conflict(60.0%), recovery after the loss of a loved one(56.9%), and women's conflict with parents-in-law(53.8%). The pastors were surveyed about types of things they would want included in regular health check-ups, what they would want a parish nurse to do on home visits, and what they would want included in home care for the elderly. They were also surveyed on what kind of spiritual care they would like parish nurses to give. Most (90.7%) wanted their parish, parishioners to be involved in the parish nurses program as volunteers, and in a variety of ways(such as visiting sick in their homes(68.5%) and helping with housework(63.1%) and taking sick people to health facilities(60%). Parish nurses role, activities, and boundaries of practice should be continuously monitored and refined and a 'case manager' should be conceptualized as an additional or all-encompassing role. An initial parish / community needs and readiness assessment should be done prior to establishing a program to detemine if the congregation is ready, willing, and able to support such a position for at least a 2 to 3 year period.

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The Efficacy and Safety of Moclobemide Twice Daily : An Open Trial in Patients with Major Depressive Disorder (1회 2회 분복 투여하는 Moclobemide의 효과와 안전성 : 주요우울장애 환자에서 개방 시험)

  • Yoon, Jin-Sang;Lee, Hyung-Young;Kook, Seung-Hee;Choi, Young
    • Korean Journal of Biological Psychiatry
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    • v.3 no.1
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    • pp.102-108
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    • 1996
  • This was an open trial to evaluate the efficacy and safety of moclobemide twice daily for treatment of Korean patients with major depressive disorder(DSM-III-R). The duration of the trial was 6 weeks with the initial dose of moclobemide being fixed lor the first two weeks at 300mg/day(150mg twice daily, each token after morning and evening meals). Thereafter, when necessary, the dose was allowed to increase to 600mg/day or decrease to 150mg/day according to the seventy of the depression and/or the tolerability of the drug. Hypnotics and/or sedatives from a benzodiazepine group could be concomitantly administered at usual dosage. Patients were assessed at baseline and at days 14, 28 and 42. Efficacy was primarily judged on the Hamilton Rating Scale for Depression(HAM-D) and Beck Depression Inventory(BDI). Patients had to score at least 17 respectively an both scales to enter the trial. Secondary efficacy parameters included Clinical Global Impression(CGI) for severity of illness and improvement. Safety and tolerability were judged on reported adverse events, vital signs and laboratory parameters. In addition, there was a series of questions and assessments for the psychiatrists and patients to complete at the end of the trial Twenty nine patients completing trial were included in the analysis of efficacy : of thirty one patients participating in the safety and tolerability analysis, those who withdraw voluntarily without particular reasons or violated the treatment schedule were not included. The efficacies as determined by HAM-D, BDI or CGI were found to be significant compared to baseline. The number of responders defined as patients with a total score of 10 or less or with a total score of 50% or less of the baseline score on HAM-D and BDI were 17(59%) and 18(62%) respectively. Regarding safety and tolerability, nine patients(29%) reported mild adverse events probably related to moclobemide : of these one patient dropped out because of poor tolerability : however, there were no appreciable changes in blood pressure, pulse rate, body weight or laboratory parameters for all patients over the trial period. Furthermore, the physicians' and patients' opinions at final evaluation showed that moclabemide has a good antidepressant effect as well as a favorable tolerability. In conclusion, a twice-daily dosage schedule with maclobemide is recommendable for the treatment of Korean patients with major depressive disorder since its efficacy and safety were demonstrated in this study.

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Molecular Epidemiology of Metallo-β-lactamase Producing Pseudomonas aeruginosa Clinical Isolates (임상에서 분리된 Metallo-β-lactamase 생성 Pseudomonas aeruginosa의 분자역학)

  • Choi, Myung-Won
    • Journal of Life Science
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    • v.22 no.9
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    • pp.1268-1276
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    • 2012
  • The emergence and dissemination of carbapenem-resistant bacteria have resulted in limitations of antibiotic treatment and potential outbreaks of metallo-${\beta}$-lactamase (MBL) producing Pseudomonas aeruginosa resistant to carbapenems. In this study, we conducted molecular characterization of the MBL genes of the ${\beta}$-lactam drug-resistant P. aeruginosa and prepared basic data for treatment and prevention of proliferation of antimicrobial-resistant bacterial infections. Forty-two P. aeruginosa isolates of 254 were resistant to imipenem or meropenem. Among the 42 isolates, 28 isolates were positive for the Hodge test, and 23 isolates were positive for the EDTA-disk synergy test (EDST). MBLs were detected in 59.5% (25/42) of P. aeruginosa isolates. Eight isolates harbored $bla_{IMP-6}$, whereas 17 isolates harbored $bla_{VIM-2}$. The $bla_{IMP-6}$ gene was in a class 1 integron containing five gene cassettes: $bla_{IMP-6}$, qac, aacA4, $bla_{OXA-1}$, and aadA1. Some strains that produce IMP-6 and VIM-2 showed epidemiological relationships. The $bla_{IMP-6}$ gene in carbapenem-resistant P. aeruginosa showed an identical pattern to a gene cassette that was reported at a hospital in Daegu, Korea. Therefore, MBL-producing P. aeruginosa is already endemic in the community. We are concerned that the existence of carbapenem-resistant bacteria containing the blaMBL gene may increase pressure on antibiotic selection when treating infections. We believe that we should select appropriate antibiotics based on the antibiotic susceptibility test and continue the research to prohibit the emergence and spread of antibiotics resistant bacteria.

Effects of Cyclobuxine D on the Electrocardiogram (ECG) and Heart Rate in Anesthetized Rats and Isolated Frog Heart (Cyclobuxine D의 흰쥐에 있어서 ECG와 심박동수에 패한 작용과 적출 개구리 심장에 대한 작용)

  • Lee, Jong-Hwoa;Park, Young-Hyun;Cho, Byung-Heon;Kim, Yu-Jae;Kim, Jong-Bae;Kim, Chun-Sook;Cha, Young-Dong;Kim, Young-Suk
    • The Korean Journal of Pharmacology
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    • v.22 no.2
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    • pp.105-114
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    • 1986
  • This study was undertaken to search for a new antiarrhythmic agent in natural plants. Extracts of Buxus microphylla var. koreana Nakai have been used as folk remedies of several diseases, including malaria and venereal disease, but any study on the pharmacological actions of this plant has not yet been carried out and its active ingredients have not been identified. In our laboratory, we isolated buxuletin (nonalkaloid) and cyclobuxine D (steroidal alkaloid) from Buxus microphylla var. koreana Nakai and reported their pharmacological actions: diuretic effects of buxuletin in rabbits and hypotensive effect of cyclobuxine D in rats. In the present study, we investigated the effect of cyclobuxine D on isolated frog heart and heart rate in urethane anesthetized rats. In order to clarify the mechanism of bradycardic effect of cyclobuxine D, we examined the changes of the ECG parameters (PR, QRS and R ${\alpha}$ T interval) produced by intravenous injection of cyclobuxine D in anesthetized rats. Cyclobuxine D depressed the contractile force in isolated frog heart and exerted a dose-dependent bradycardic effect in anesthetized rats. Intracerebroventricular injection of cyclobuxine D caused a fall in blood pressure and an increase in heart rate, but those effects were not significant. Cyclobuxine D prolonged the PR interval and RaT interval (${\alpha}$ Tindicates the apex of T), but was without significant effects on the duration of the QRS complex and PRc in urethane anesthetized rats.

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