• Journal of Korean Biological Nursing Science
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• v.17 no.3
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• pp.236-244
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• 2015

Purpose: The study was conducted to identify factors affecting the intraoperative core body temperature (CBT) of surgical patients under general anesthesia. Methods: This study was performed through a prospective descriptive research design. The sample consisted of 138 patients who had undergone elective laparotomy surgery. Age, weight, height, the basal preoperative CBT, blood pressure, and heart rate were collected. CBT was again measured at induction of anesthesia, 1 hour, 2 hours, and 3 hours following induction of general anesthesia. Results: Factors affecting intraoperative hypothermia < $36^{\circ}C$ at 1 hour following induction, were CBT at induction and total body fat (TBF) ($R^2=.569$, p<.001); at 2 hours after induction, CBT at induction and TBF ($R^2=.507$, p<.001); at 3 hours after induction, CBT at induction (${\beta}=0.34$), TBF, age and the ambient temperature in the operating room ($R^2=.449$, p<.001). Conclusion: CBT at induction and TBF appear to be factors affecting intraoperative CBT within 2 hours after induction of anesthesia; CBT at induction, TBF, advanced age and the ambient temperature after 3 hours following induction. We recommend keeping surgical patients warm before induction of anesthesia and providing intraoperative warming for surgical patients of advanced age with low TBF and when the duration of general anesthesia will last more than 3 hours.

• Korean Journal of Veterinary Research
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• v.42 no.1
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• pp.123-130
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• 2002

To investigate the cardiopulmonary and anesthetic effects of propofol in dogs, experimental dogs were randomly divided into 4 groups (propofol infusion anesthesia, P/INF, propofol intermittent anesthesia, P/INTER, propofol induction anesthesia, P/ISO, thiopental Na induction anesthesia, T/ISO) and monitored analgesic and anesthetic effects, recovery time, body temperature, heart rate, mean arterial pressure, respiratory rate, systolic and diastolic pressure. In all groups, apnea was not observed. In the P/INF group, the respiratory rate(RR) was slightly decreased, but in the P/INTER group, RR was increased and shallowing. In the groups of P/ISO and T/ISO, the respiratory rate was decreased. Heart rate(HR) was increased after induction anesthesia in all groups, but gradually decreased. Mean arterial pressure(MAP) was decreased after injection anesthesia in the groups of P/INF and P/INTER. In the groups of P/ISO and T/ISO, however, MAP was slightly increased. Systolic and diastolic arterial pressure were gradually decreased after induction anesthesia, but not significantly. In the groups of P/INF and P/ISO, recovery time was shorter than the groups of P/INTER and T/ISO. In all groups, body temperature of animals was decreased gradually according to time but no significant changes were observed. Propofol injection doesn't make the complete loss of responses of animals, especially, in the P/INTER group. In the P/INF group, deep pain was present until the end of anesthetic period. During recovery period, any other side effects except incoordination were not monitored. The present study suggested that infusion anesthesia was superior to intermittent anesthesia as injection anesthetic agent, and propofol was better than thiopental Na as induction anesthetic agent.

• Proceedings of the KOSOMBE Conference
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• v.1996 no.11
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• pp.368-371
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• 1996

Background: Recently, measure of heart rate variability and the nonlinear "complexity" of heart rate dynamics have been used as indicators of cardiovascular health. Several investigators have demonstrated that heart rate variability decreased in aging, congestive heart failure and coronary heart disease. Because hypertensive patients showed alternation of cardiovascular homeostasis, we designed this study to evaluate the effect of anesthesia in hypertensive patients with approximate entropy (ApEn). Methods: With informed consent, eighteen normotensive patients and eighteen hypertensive patients were given no premedication. ECG data were collected from 10 minutes before induction to 15 minutes after induction. Collected ECG data were stored into computer binary files. We calculated ApEn from the collected ECG data. Results: Before induction, ApEn of hypertensive patients was significantly lower than normotensive patients(p<0.05). During induction and maintain of anesthesia, there was no difference of ApEn between two groups. During induction and maintain of anesthesia, in normotensive group, ApEn was significantly lower than that of preinduction(p<0.05). And ApEn during maintain of anesthesia was lower than that of induction(p<0.05). During maintain of anesthesia, in hypertensive group, ApEn was significantly lower than that of preinduction(p<0.05). Conclusions: Before induction, ApTn of hypertensive patients is significantly lower than normotensive patients. As anesthesia was deepened, ApEn of two groups were decreased. Because the baroreflex of hypertensive patients is already decreased, decreasing of ApEn of hypertensive patients during anesthesia is less than that of normotnesive patients.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.2
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• pp.125-132
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• 2011

Background: Adult patients with intellectual disabilities often strongly resist the anesthetic administration for dental procedures. This study aimed to evaluate the effect of midazolam premedication in improving the cooperation level of patients who are likely to be combative and irritated during general anesthesia (GA) induction. Methods: The patients who had received dental treatment under ambulatory GA for more than two times were included. And we selected 13 patients total that needed physical restraint or ketamine IM prior to induction at the first GA, and were prescribed midazolam tablet (7.5-15 mg) at the following GA. We reviewed pre-anesthetic records and anesthesia records, and evaluated cooperative levels of patients (4 levels scale) during anesthesia induction and recovery time retrospectively. Results: All 13 patients (Male 11, Female 2) had severe mental disabilities. The average age of the patients was 24 ${\pm}$ 7 (13-37) years and their average weight was 58 ${\pm}$ 16 (34-91) kg. At the first GA, 10 patients needed physical restraint prior to induction (level 3). And 3 patients were so poorly cooperative that the induction procedure was performed after intramuscular injection of ketamine (level 4). But after the midazolam intake, 7 patients were willing to receive the anesthetic induction (level 1, 2), and 6 patient needed physical restraint (P < 0.05). There were no statistical differences in the duration of general anesthesia and postoperative recovery. Conclusions: Oral intake of midazolam was effective in improvement of cooperation without any complications.

• Journal of Veterinary Clinics
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• v.22 no.3
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• pp.259-263
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• 2005

To compare cardiopulmonary effects and recovery between total intravenous anesthesia (TIVA) with propofol (PRO group, n=5) and volatile induction/maintenance anesthesia (VIMA) with isoflurane (ISO group, n=5), we investigated changes of heart rate, $SpO_2$, arterial pressure, rectal temperature and respiratory rate during 60 minute anesthesia and 40 minute recovery period in beagle dogs, and investigated recovery (extubation, head lift, sternal position and righting) after 60 minute anesthesia. Rectal temperature was significantly low in ISO group (p<0.05) from 10 to 100 minute. Heart rate was significantly low in ISO group (p<0.05) at 40, 50, 60 minute. Respiratory rate was significantly low in PRO group (p<0.05) at induction and 70 minute. $SpO_2$ tendency was similar. Systolic arterial pressure (SAP) was significantly low in ISO group (p<0.05) at induction and during anesthesia. Recovery was similar in two groups. We concluded that TIVA with propofol is useful in stabilizing rectal temperature and arterial pressure during anesthesia and provide fast and stable recovery.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.4
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• pp.245-254
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• 2018

Background: When performing dental treatment under general anesthesia in adult patients who have difficulty cooperating due to intellectual disabilities, anesthesia induction may be difficult as well. In particular, patients who refuse to come into the dental office or sit in the dental chair may have to be forced to do so. However, for adult patients with a large physique, physical restraint may be difficult, while oral sedatives as premedication may be helpful. Here, a retrospective analysis was performed to investigate the effect of oral sedatives. Methods: A hospital-based medical information database was searched for patients who were prescribed oral midazolam or triazolam between January 2009 and December 2017. Pre-anesthesia evaluation, anesthesia, and anesthesia recovery records of all patients were analyzed, and information on disability type, reason for prescribing oral sedatives, prescribed medication and dose, cooperation level during anesthesia induction, anesthesia duration, length of recovery room stay, and complications was retrieved. Results: A total of 97 patients were identified, of whom 50 and 47 received midazolam and triazolam, respectively. The major types of disability were intellectual disabilities, autism, Down syndrome, blindness, cerebral palsy, and epilepsy. Analyses of changes in cooperation levels after drug administration showed that anesthesia induction without physical restraint was possible in 56.0% of patients in the midazolam group and in 46.8% of patients in the triazolam group (P = 0.312). Conclusions: With administration of oral midazolam or triazolam, general anesthesia induction without any physical restraint was possible in approximately 50% of patients, with no difference between the drugs.

• Journal of Veterinary Clinics
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• v.34 no.2
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• pp.135-139
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• 2017

This study was performed to evaluate the clinical efficacy of alfaxalone for induction of inhalation anesthesia in small animal practice. Patient data were collected according to anesthetic records (136 dogs and 14 cats) presented to the Veterinary Medical Teaching Hospital of Seoul National University for surgeries and diagnostic imaging from July 2013 to March 2014. Anesthetic results included signalment, American Society of Anesthesiologists (ASA) grade, premedicated drugs, procedures, induction quality, and recovery after anesthesia. One hundred fifty anesthetic events were classified according to the ASA grade. Three patients were ASA grade I, 52 patients grade II, 86 patients grade III, and 9 patients grade IV, respectively. The most common premedication was midazolam and hydromorphone combination (n = 59, 39.3%) follow by acepromazine and hydromorphone combination (n = 22, 14.7%). The majority of anesthesia procedures were diagnostic imaging (n = 33, 22.0%) and ophthalmic surgeries (n = 31, 20.7%), followed by soft tissue surgeries (n = 27, 18.0%), and orthopedic surgeries (n = 20, 13.3%). Intravenous alfaxalone provided smooth induction for inhalation anesthesia in almost cases, but transient apnea and twitching/paddling were observed after induction and during recovery, respectively. In addition, alfaxalone did not show pain response during intravenous administration. Alfaxalone showed smooth induction of inhalation anesthesia in dogs and cats with mild to severe systemic disease (ASA 2-4). Alfaxalone was considered as an acceptable induction agent for patients with higher risk in small animal practice.

• Korean Journal of Adult Nursing
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• v.12 no.4
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• pp.666-677
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• 2000

The purpose of this study was to identify the needs which were perceived by patients who were received spinal anesthesia for surgery. The subjects consisted of 50 adult patients who were admitted to 2 university hospitals and 2 general hospitals in Pusan city and 1 general hospital in Koje City for surgery under spinal anesthesia. Thirty eight percent of subjects received information about anesthesia before the operation. The instrument for this study was developed by the researcher based on literature and a pretest. Data were collected from December 10, 1999 to February 10, 2000 and were analyzed by content analysis. The results were that there were 533 meaningful statements in the needs of spinal anesthesia patients. The needs of spinal anesthesia patients had 51 items (preoperation (6), induction of anesthesia(5), intraoperation (27), postoperation(13)) and 6 categories (information, emotional welfare, physical welfare, post anesthetic management, control of physical environment, humane treatment). From the results, it can be concluded that: 1. In the pre-operation period, we have to explain anesthesia procedures, adequate position of anesthesia, duration before anesthesia wears off and sensation of paralysis. We have to supply emotional support to relieve anxiety because of anesthesia. 2. In induction of anesthesia, we have to support patient's position for anesthesia, and relieve anxiety so that patients participate in induction of anesthesia well. 3. In intra-operative period, we have to check the level of anesthesia, and keep up a comfortable position for operation and care for physical discomfort such as thirst, nausea, vomiting, dyspnea and to maintain body temperature of the patient. Since the patient is conscious, we have to communicate with the patient to relieve anxiety, maintain privacy, inform the patient of the process of the operation and encourage the surgeon to explain the outcome of the operation. The operating team needs the careful about what they say and to place the instrument well. We have to ventilate the room air and reduce noise. 4. In the post-operative period, we have to explain the purpose and duration of bed rest, complications of anesthesia and care for physical discomfort such as pain, dysuria, headache, backache. Also we have to maintain body temperature of the patient and maintain privacy.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.1
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• pp.57-62
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• 2014

Background: The aim of this study was to analyze outpatient anesthesia for dental treatment in handicapped patients with behavior disorder in order to use data for carrying out better and safe anesthetic management. Methods: The data were drawn from the 100 patients with behavior disorder who visited CNUDH dental clinic for disabled based on anesthesia record to investigate patient's systemic condition, cooperative level, anesthesia method according to patients cooperation, and side effects after recovery time. Results: Mental retardation (58%) is the most reason to choose general anesthesia. The methods of induction according to cooperative level are intravenous propofol injection in 22 cases and inhalation of sevoflurane in 78 cases. Induction time of anesthesia were within 10 seconds in cases of propofol induction and average $48.8{\pm}18.5$ seconds in cases of inhalation induction. The time spent on dental treatment was average $3.2{\pm}1.1$ hours. After the end of treatment, average time to move from unit chair to recovery bed, to recliner, and to discharge from hospital are $10.4{\pm}5.1$, $36.9{\pm}17.1$ and $72.4{\pm}16.0$ minutes, respectively. During recovery, there are nausea with 9%, vomiting with 4%, dizziness with 2%, finger injury with 1%. Conclusions: This study showed our successful anesthetic outcomes without any severe side effects or complications. Through this study, it will be used for safe anesthetic management as useful reference data.

• 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.