• The Korean Journal of Physiology
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• v.21 no.2
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• pp.313-321
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• 1987

To investigate whether the cervical sympathetics contains specific secretory fibers for the salivary glands, reflex salivation was evoked and the role of the sympathetics or the reflex was examined in ketamine-anesthetized cat. Stimulation of the central end of the glossopharyngeal nerve produced a copious secretion from the submaxillary gland and the response was not affected by the section of the cervical sympathetics or by the administration of phenoxybenzamine, whereas the response was abolished by severing the chorda tympani or by the administration of atropine. The salivary response was always associated with an increase in glandular blood flow. Both salivary and blood flow responses were decreased markedly by the superimposed stimulation of the cervical sympathetics or by the administration of norepinephrine. The decreased submaxillary blood flow always preceded the decrease in salivary flow on stimulation of the cervical sympathetics and the decreased blood flow recovered prior to the salivary flow upon cessation of the sympathetic stimulation. The inhibitory effects of the sympathetics and norepinephrine were completely abolished by the pretreatment with phenoxybenzamine. These results indicate that the glossopharyngeal nerve is one of the afferent limbs of the submaxillary salivary reflex and the chorda tympani is the only efferent limb of the reflex pathway. Thus, it is suggested that the cervical sympathetics does not contain the specific secretory fibers for the gland, but plays a role in inhibiting the reflex secretion by decreasing the blood flow to the gland.

• Journal of Trauma and Injury
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• v.33 no.3
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• pp.195-203
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• 2020

The following key questions and recommendations are presented herein: when is airway intubation initiated in severe trauma? Airway intubation must be initiated in severe trauma patients with a GCS of 8 or lower (1B). Should rapid sequence intubation (RSI) be performed in trauma patients? RSI should be performed in trauma patients to secure the airway unless it is determined that securing the airway will be problematic (1B). What should be used as an induction drug for airway intubation? Ketamine or etomidate can be used as a sedative induction drug when RSI is being performed in a trauma patient (2B). If cervical spine damage is suspected, how is cervical protection achieved during airway intubation? When intubating a patient with a cervical spine injury, the extraction collar can be temporarily removed while the neck is fixed and protected manually (1C). What alternative method should be used if securing the airway fails more than three times? If three or more attempts to intubate the airway fail, other methods should be considered to secure the airway (1B). Should trauma patients maintain normal ventilation after intubation? It is recommended that trauma patients who have undergone airway intubation maintain normal ventilation rather than hyperventilation or hypoventilation (1C). When should resuscitative thoracotomy be considered for trauma patients? Resuscitative thoracotomy is recommended for trauma patients with penetrating injuries undergoing cardiac arrest or shock in the emergency room (1B).

• Journal of Korean Academy of Nursing
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• v.36 no.3
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• pp.523-531
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• 2006

Purpose: The purpose of this study was to examine the effects of the ulmus root-bark dressing on tissue regeneration in experimentally-induced pressure ulcers in rats. Method: A randomized pretest/post-test control group time-series study design was used. Thirty-three male Sprague-Dawley rats were used in this study. The rats were anesthetized with 100mg/kg of ketamine. Pressure ulcers were induced at 140mmHg for three hours using a personally-designed pressing apparatus. For four weeks, the ulmus root-bark dressing was applied every other day in the experimental group (n=18) and a wet gauze dressing in the control group (n=15). For data analysis, the statistical program SPSS WIN 12 was used. The wounds were examined by light microscopy andelectron microscopy. Result: There were significant statistical differences in the size of the pressure ulcers as time went by(p=0.006). It should be noted that there were no significant statistical differences in the number of capillaries. Using light microscopy the inflammatory infiltration and neovascularization in the dermis in the experimental group emerged densely in the early stages, but recovered rapidly at the latter stages. In addition, the reepithelization of the epidermis occurred earlier than in the control group. By electron microscopy, the cell organelles of the capillary endothelial cells and the basal lamina of capillaries in the experimental group showed a more rapid maturation during the latter stages, compared with the control group. Conclusion: According to this study, it can be concluded that the ulmus root-bark dressing is effective regarding the healing of pressure ulcers.

• Journal of The Korean Dental Society of Anesthesiology
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• v.2 no.2 s.3
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• pp.101-106
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• 2002

Background: The management of the behavior of handicapped children when providing required dental care is often a problem, whether in the dental office or in a hospital setting. Because of the high incidence of poor cooperation, many of these patients are scheduled for dental care under general anesthesia with preoperative medical assessment. The purpose of this study was to carry out a clinico-statistical survey on dental treatment for handicapped children under general anesthesia. Methods: After approval from the institutional review board, the medical records of 64 handicapped children between 1997 and 2002 were reviewed to determine the patient profiles, anesthesia management, and complications. The charts of these patients, who underwent dental examination, scaling and prophylaxis, and restoration and extraction of teeth under general anesthesia, were reviewed. Results: The mean age was 12.8 years old, and males (53%) predominated females (47%). Twenty-four patients had mental retardation, twelve had autism, six had cerebral palsy, 4 had behavior disorder, others had heart disease, convulsive disorder, etc. Sixty-two had intravenous thiopental with neuromuscular blocker, 2 had intravenous ketamine induction. Nasotracheal intubation was uneventful in 55 patients, nine had orotracheal intubation because of difficult visualization of the larynx. Twenty-one patients experienced postoperative complications in the recovery room, including epistaxis, nasal obstruction, vomiting, airway obstruction, respiratory depression. Conclusions: General anesthesia is a very effective way of completing the dental treatments for disabled children. We emphasize the need to train anesthesiologists in the care of disabled patients.

• Journal of The Korean Dental Society of Anesthesiology
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• v.9 no.1
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• pp.9-16
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• 2009

Background: This study aimed to evaluate the cooperative levels of dental patients requiring general anesthesia during dental treatments. Anesthetic induction methods for patients were also recorded and analyzed using descriptive statistics. Methods: Total 566 patients who visited Seoul National University Dental Hospital Clinic for Persons with Disabilities were reviewed on pre-anesthetic review and anesthesia records. The cooperative levels of patients were graded by 4 levels and induction methods used for the patients during general anesthesia application were analyzed. Results: More than half of patients(55.8%) were willing to receive the anesthetic induction(cooperative level 1), 18.6% were minimally cooperative(level 2), 20.8% needed physical restraint prior to induction(level 3), and 4.8% was poorly cooperative and induction procedure was performed under an unconscious condition after ketamine intramuscular injection(level 4). There was no gender difference in cooperative levels(P=0.11). Patients over 30 years revealed better cooperation levels compared to other age groups(P<0.05). For patients of level 1, 53.5% were anesthetized in a way of intravenous induction, while 77.1% out of patients of level 3 were anesthetically induced through inhalation method. Conclusion: Many dental patients with special needs were not cooperative to receive anesthetic induction. Additional behavioral support may be applied to poorly cooperative patients for the safe and successful clinical outcome.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.46-56
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• 1996

Many surgeons and anesthesiologists prefer using vasoconstrictor mixed with local anesthetic agent to reduce the incidence of side effects and prolong the duration of analgesia because most local anesthetic agents, except cocaine, were believed to possess vasodilating effect. However, some investigators recently reported vasoconstricting effect of local anesthetic agents. There is still controversy on the vasoactive effect of local anesthetic agents. So this study is aimed to clarify the vasoactive effect of local anesthetics in the animal model resembling clinical settings. Rabbits were anesthesized with ketamine and haloghane, and respirations were controlled with Harvard animal ventilator. Lidocaine (0.5%, 1.0%, 1.5%) and bupivacaine (0.125%, 0.25% and 0.5%) with or without 1:100,000 epinephrine were subdermaly injected on the femoral bupivacaine of the femoral artery were measured with Doppler flow meter in vivo. The mean arterial pressure, pulse rate, arterial blood gases, pH and level of serum electrolytes were measured at every 2 minute interval for 30 minutes. Results were as follows: 1) There was no significant vasoconstriction with 0.5% lidocaine and 0.125% bupivacaine. 2) Statistically significant (p<0.05) vasodilations were observed with lidocaine (1.0~2.0%) and bupivacaine (0.25~0.5%). 3) There were no changes on the duration of vasodilation induced by local anesthetic agents of various concentrations. 4) Onset of vasodilation induced by local anesthetic agents of high concentration were faster than that of lower concentrations. 5) In the mixed injection group of epinephrine and local anesthetic agent, the vasoconstriction induced by epinephrine was completely reversed by local anesthetics, approximately 5 minutes later. In conclusion, local anesthetic agents at dose exceeding 1.0% lidocaine and 0.25% bupivacaine increase local blood flow significantly in animal study in vivo which is applicable in human clinical settings. The increase blood flow may be due to dilatation of blood vessel. Further study on the analysis of association between amount of absorbed local anesthetics in blood vessels and dilatation of blood vessels is needed.

• The Korean Journal of Pain
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• v.19 no.2
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• pp.223-227
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• 2006

Complex regional pain syndrome (CRPS) is clinically characterized by pain, abnormal regulation of blood flow and sweating, edema of skin and subcutaneous tissues, sensory and motor disturbances, and trophic changes of the skin. A 21-year-old man was suffering from pain and swelling in his right hand and forearm. His arm had been in splints for 3 weeks following an extension injury of the right fingers and wrist, with the pain having developed 2 weeks after the splinting. He was treated with various nerve blocks including continuous epidural infusion, thoracic sympathetic block and peripheral nerve blocks, and squeezing his edematous region under general anesthesia as well as intravenous lidocaine and ketamine infusions. However, all of the performed treatments had no effect on the patient's pain or hand swelling. As a next line therapy, spinal cord stimulation should be considered because of intractable severe pain and swelling to almost all other modalities of therapy. We therefore performed an early intervention of spinal cord stimulation for the patient with refractory CRPS type I 5 months after the onset of pain and have got an excellent result.

• Archives of Plastic Surgery
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• v.44 no.1
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• pp.5-11
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• 2017

Background Conscious sedation has been widely utilized in plastic surgery. However, inadequate research has been published evaluating adequate drug dosage and depth of sedation. In clinical practice, sedation is often inadequate or accompanied by complications when sedatives are administered according to body weight alone. The purpose of this study was to identify variables influencing the depth of sedation during conscious sedation for plastic surgery. Methods This prospective study evaluated 97 patients who underwent plastic surgical procedures under conscious sedation. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and glucose levels were measured. Midazolam and ketamine were administered intravenously according to a preset protocol. Bispectral index (BIS) recordings were obtained to evaluate the depth of sedation 4, 10, 15, and 20 minutes after midazolam administration. Associations between variables and the BIS were assessed using multiple regression analysis. Results Alcohol intake and female sex were positively associated with the mean BIS (P<0.01). Age was negatively associated with the mean BIS (P<0.01). Body mass index (P=0.263), creatinine clearance (P=0.832), smoking history (P=0.398), glucose (P=0.718), AST (P=0.729), and ALT (P=0.423) were not associated with the BIS. Conclusions Older patients tended to have a greater depth of sedation, whereas females and patients with greater alcohol intake had a shallower depth of sedation. Thus, precise dose adjustments of sedatives, accounting for not only weight but also age, sex, and alcohol consumption, are required to achieve safe, effective, and predictable conscious sedation.

• Journal of Embryo Transfer
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• v.25 no.4
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• pp.291-295
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• 2010

Four estrus-induced Himalayan tahrs (Hemitragus jemlahicus) were inseminated with frozen-thawed semen by laparoscopic or transcervical insemination techniques with no regard to the site of ovulation in non-breeding season. In June and July, 2009, estrus was synchronized by Eazi-Breed $CIDR^{(R)}$ (Controlled internal drug release; Pfizer Animal Health, New Zealand) insertion for 16 days and PG 600 (PMSG 400IU, hCG 200 IU; Intervet, Netherlands) injection (IM) a day before removing $CIDR^{(R)}$. Forty eight hours later, laparoscopic or transcervical insemination was done to each of two tahrs under anesthetic condition inducted by ketamine (1.5 mg/kg) and medetomidine (0.09 mg/kg). For examination of estradiol and progesterone, blood was collected right before $CIDR^{(R)}$ insertion, PG 600 injection, $CIDR^{(R)}$ removal and insemination. Estradiol levels of four tahrs (No. 1, 2, 3, 4) before $CIDR^{(R)}$ insertion and insemination were 13.3, 8.8, 14.3, 12 pg/ml and 23.5, 25.5, 21.1, 11.5 pg/ml, respectively. Progesterone levels of four tahrs (No. 1, 2, 3, 4) before $CIDR^{(R)}$ insertion and insemination were 1.8, 0.05, 0.63, 0.61 ng/ml and 1.03, 0.37, 1.48, 2.12 ng/ml. Except for No. 4 tahr, cervices showed cervical mucus and opened enough to penetrate with embryo transfer gun sheet usually used for cows. Therefore, No.4 was laparoscopically inseminated together with No. 1. In conclusion, none of four Himalayan tahrs was pregnant. However, we proved that estrus could be induced by CIDR and PG 600 injection in non-breeding season, and laparoscopic or transcervical insemination with frozen-thawed semen could be one of assisted reproductive techniques in Himalayan Tahr.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.35 no.3
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• pp.158-163
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• 2009

Objective : Recently, we are interested in bisphosphonate related osteonecrosis of the jaw (BRONJ). Most of patients with osteonecrosis have taken medicine bisphosphonate for a long time. But the mechanism of osteonecrosis in BRONJ was not clarified yet. The aim of this study is to evaluate the difference of bone healing effect after bone graft from ilium to maxillary sinus in rabbits between zoledronate-treated and zoledronate-not treated groups. Method : The subjects was divided into two groups. The experimental group was 9 rabbits, treated with intraperitoneal administration of zoledronate(0.06mg/kg) once per week for 3 weeks. In control group, same procedure was applied but administerd saline instead of zoledronate. After 4 weeks, surgical operation under local anesthesia (ketamine 3.0cc, xylazine 1.0cc) was done. At postoperative 1, 2, 4, 8 weeks later, each rabbits were sacrificed and removed the bone grafted area. Gross, radiologic and histopathologic exminations of bone grafted area were performed. Result : There were no conspicuous differences of radiological findings between experimental and control groups in any experimental weeks. In experimental group, new bone formation appeared earlier than control group at 1 week after operation, and maturation of bony tissue were more conspicuous at 2 and 4 weeks after operation, compared with control group. In 8 weeks after operation, similar microscopic findings were noted in both groups. Conclusion : In the bisphosphonate-treated rabbits, new bone formation in the bone grafted area appeared earlier and bony maturation was more concpicuous, even though there were no significant differences of gross and radiological findings. These findings suggest that bisphosphonate might be promotive effect in the healing process in early stage after administration.