• 대한임상검사과학회지
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• 제37권2호
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• pp.96-101
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• 2005

Status epilepticus is a medical emergency, so that rapid and vigorous treatment is required to prevent neuronal damage and systemic complication. Status epilepticus is generally defined as a continuous or intermittent seizure or an unconscious condition after the onset of seizure, lasting for 30 minutes or more. We report here the outcome of status epilepticus. We retrospectively reviewed medical record of 15 patients who were diagnosed with status epilepticus at the Asan Medical Center from January 2003 to February 2004. This outcome was evaluated considering various factors such as age of patients, history of seizures, neurologic impairment, etiology, mortality, return to baseline and initial electroencephalogram (EEG) findings. The range of age was between 1 to 79 years old and the longest duration of treatment was 118 days. Most patients were treated by using pentobarbital, midazolam, phenobarbital and other antiepileptic drugs. The overall mortality was 5 (33%) out of 15 patients. The mortality was related to etiology, underlying other medical conditions and initial EEG findings. 5 (55%) out of the 9 patients with acute etiology, 5 (71%) out of the 7 patients with a multifocal or burst-suppression EEG activity, and 3 (60%) out of the 5 patients with other medical disease were related to mortality. This data demonstrate high mortality due to status epilepticus. Mortality is related to etiology, other medical conditions and abnormalities on the initial EEG.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제22권4호
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• pp.436-441
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• 2000

The purpose of this retrospective study is to investigate the effects of conscious sedation in an outpatient setting. Data from 292 patients (154 males, 138 females), sedated for minor oral surgery, were studied using various parameters including age and sex distribution, as well as according to procedures and each drug group. Results show that this intravenous conscious sedation technique is a safe and effective method of controlling behaviour, but one has to be prepared to deal with any emergencies or complications. The specific results are as follows: 1. Most procedures (265/292) were used to Valium mixed with Demerol and Midazolam mixed with Demerol. 2. Valium revealed a high incidence of pain upon injection and symptoms limited to daily activity and thrombophlebitis. 3. Nausea and vomiting manifested in the procedure using Demerol. 4. The patient manifested comfort similar in response to the same drugs used in another treatment.

• 대한치과마취과학회지
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• 제3권2호
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• pp.87-91
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• 2003

Background: The purpose of this study was to compare the availability of propofol and fentanyl (P + F) with diazepam and morphine (D + M) for intravenous conscious sedation during third molar surgery. Methods: Forty patients without systemic disease were operated under IV conscious sedation administered by either of the two techniques. Monitoring consisted of continuous observation of pulse rate, blood pressure, oxygen saturation, and the respiratory rate and were recorded every 15 minutes. Cooperation score was measured 5 and 15 minutes after induction of IV sedation. Following the operation, the surgeon and patients completed questionnaires including pain visual analog scale, amnesia, and side effects. Results: The P + F group was significantly more cooperative than the D + M group. The side effects of D + M group included pain on injection, nausea/vomiting and abdominal pain. The side effects of P + F group included talkativeness, nausea/vomiting, temporary apnea, pain on injection and vertigo. Conclusions: In this study, there were following benefits in the P + F group; more cooperative status and less pain perception. But respiratory depression developed in some patients.

• Journal of Dental Anesthesia and Pain Medicine
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• 제17권2호
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• pp.157-161
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• 2017

In sedation via the submucosal route, the drug is administered through the maxillary buccal submucosa. It is time saving, effective, and safe. Patients with autism, a mental disorder, often find it hard to make relationships with other people. These patients display a strong resistance to dental treatment and sedation. This study reports a successful case of behavioral management during dental treatment, using sedation via the submucosal route. The patient was strongly resistant to sedation via the oral, intramuscular, and intravenous routes. The drug used was 9 mg (0.1 mg/kg) of midazolam. Through this case report, we reaffirm the significance of sedation via the submucosal route, and expect that it will be used more frequently for patients with autism, who display behaviors that are difficult to manage, patients with other disabilities, and children.

• 대한임상약리학회:학술대회논문집
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• 대한임상약리학회 2003년도 제12차 추계학술대회
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• pp.15-15
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• 2003

• The Korean Journal of Pain
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• 제10권1호
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• pp.117-120
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• 1997

Cancer is a devastating disease, and the treatment of related pain is an extremely challenging task. Providing adequate analgesia while avoiding unnecessary drug effects often requires a polypharmacologic approach in cancer pain management. A 36-year old woman with breast cancer metastatic to the axial skeleton and bilateral hip joints was admitted to hemato-oncology service with complaints of intractable abdominal and hip pain. Despite rapidly increasing doses of intravenous morphine up to 350 mg per day; transdermal fentanyl; midazolam; ketorolac; lorazepam; dexamethasone, the patient continued to describe her pain as 10 of 10, refusing all surgical/diagnostic interventions not directly related to pain control. She did, however, consent to lumbar epidural catheter placement. The patient was sedated with titrating doses of propofol to assist with positioning. Even though the procedure was not successful due to significant thoracolumbar scoliosis, the patient admitted feeling better than she has in months during attempted placement. After continuous infusion of propofol was initiated at subhypnotic dose, the patient's analgesic demand was drastically reduced and described her pain as "1 to 3" of "10". Approximately 96 hours after the propofol infusion was started, the patient expired comfortably. There had been no change in her medical regimen during fecal 48 hours. In the case described, propofol was extremely advantageous as an adjuvant in the management of cancer related pain.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.448-450
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• 2014

Nefopam, a centrally acting analgesic, has been used to control postoperative pain. Reported adverse effects are anticholinergic, cardiovascular or neuropsychiatric. Neurologic adverse reactions to nefopam are confusion, hallucinations, delirium and convulsions. There are several reports about fatal convulsive seizures, presumably related to nefopam. A 71-year-old man was admitted for surgery for a lumbar spinal stenosis. He was administered intravenous analgesics : ketorolac, tramadol, orphenadrine citrate and nefopam HCl. His back pain was so severe that he hardly slept for several days; he even needed morphine and pethidine. At 4 days of administration of intravenous analgesics, the patient suddenly started generalized tonic-clonic seizures for 15 seconds, and subsequently, status epilepticus; these were not responsive to phenytoin and midazolam. After 3 days of barbiturate coma therapy the seizures were controlled. Convulsive seizures related to nefopam appear as focal, generalized, myoclonic types, or status epilepticus, and are not dose-related manifestations. In our case, the possibility of convulsions caused by other drugs or the misuse of drugs was considered. However, we first identified the introduced drugs and excluded the possibility of an accidental misuse of other drugs. Physicians should be aware of the possible occurrence of unpredictable and serious convulsions when using nefopam.

• The Korean Journal of Pain
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• 제19권1호
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• pp.77-80
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• 2006

Background: Painful experiences during procedures such as prolotherapy and intramuscular stimulation are stressful to patients and can affect the treatment outcome. We present a method for relieving pain and increasing the level of patient comfort during the procedure. Methods: Twenty six patients who requested sedation anesthesia during the procedure were examined. All patients were injected with 500 ml of 0.9% normal saline and were monitored by electrocardiography, blood pressure and pulse oximetry. The patients were supplied with oxygen (3 L/min) through a nasal cannula. Midazolam (0.02 mg/kg) and alfentanil ($8{\mu}g/kg$) was injected before the procedure and a bolus injection was administered during the procedure if patients felt any pain. The duration of the procedure, the total amount of drugs, the changes in the systolic blood pressure, heart rate, pulse oxygen saturation, sedation and pain level during procedure, satisfaction scale after the procedure, complications and the incidence of amnesia were evaluated. Results: Twenty one patients had a moderate level of sedation, 15 patients did not feel any pain during the procedure, 17 patients had high level of satisfaction (8-10). No patient experienced complications after the procedure, or unstable vital signs, and 6 patients could not remember the procedure. Conclusions: Sedation anesthesia is a safe method for relieving pain during the procedure, and most patients had a high level of satisfaction.

• 대한의용생체공학회:학술대회논문집
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• 대한의용생체공학회 1995년도 추계학술대회
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• pp.147-150
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• 1995

최근의 마취과학에 관한 연구에 있어서의 주된 경향은 마취심도 및 의식수준의 결정을 신경생리학적인 관점에서 분석하고자 하는 것이다. 즉, 마취와 의식에 관한 인간의 뇌가 가지고 있는 기능이나 약리학적인 반응을 대표할 수 있는 생체신호를 검출, 분석하여 정량화하고 이들을 이용하면 마취심도 및 의식수준과의 큰 상관관계를 얻을 수 있을 것이라 가정하는 것이다. 본 연구에서는 청각유발전위 (LAEP, Long latency Auditory Evoked Potential)를 검출하여 추출된 변수들과 마취제 투여량간의 변화에 따른 상관성을 분석하고자 하였다. 수술환자(17명)를 대상으로 실험을 실시하였으며 마취제로서는 Midazolam과 Diazepam을 인체로 투여하고 1 KHz와 2 KHz의 청각자극을 제시하였을 때 피검자로부터 발생되는 LAEP를 검출하였다. 검출된 LAEP로부터 추출된 N100과 P300의 진폭은 마취량의 증가에 따라서 간소함을 알 수 있었으며, 이러한 유의한 상관성을 보이는 진폭의 변화는 마취제의 투여에 따른 의식수준의 변화를 나타내는 지수(index)의 설정 및 알고리듬의 수립에 이용될 수 있을 것이다.

• 대한치과마취과학회지
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• 제1권1호
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• pp.10-15
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• 2001

Background: This prospective study was designed to compare the cardiovascular response to endotracheal insertion of either an orotracheal tube or a nasotracheal tube Methods: 120 ASA physical status I and II surgical patients requiring general anesthesia and tracheal intubation were studied and assigned to two groups: orotracheal intubation group (n = 60) and nasotracheal intubation group (n = 60). Patients were premedicated with midazolam 0.05 mg/kg and glycopyrrolate 0.005 mg/kg intramuscularly and anesthesia was induced with thiopental sodium 5 mg/kg and succinylcholine 0.1 mg/kg intravenously. Systolic blood pressure (SBP), diastolic blood pressure (DBP). mean arterial pressure (MAP) and heart rate (HR) were assessed noninvasively before induction of anesthesia and immediately after intubation, 1 min, 2 min, 3 min, and 5 min after intubation. Results: Cardiovascular responses such as SBP, DBP, MAP and HR were similar for both techniques and no significant differences between two groups were observed until 5 min after intubation. Conclusions: In healthy ASA I and II patients with normal blood pressure, induction doses of thiopental sodium 5 mg/kg and succinylcholine 0.1 mg/kg didn't attenuated the cardiovascular response to laryngoscopy and tracheal intubation. Insertion of an endotracheal tube may be the most invasive stimulus during intubation procedures. (JKDSA 2001; 1: 10-15)