• 대한치과마취과학회지
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• 제3권2호
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• pp.98-102
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• 2003

Patients in end-stage renal disease (ESRD) and chronic renal failure present a number of challenges to the anesthesiologist. They may be chronically iii and debilitated and have the potential for multiorgan dysfunction. A 65-year-old male patient with ESRD was scheduled for oral cancer surgery under general anesthesia. He was in regular hemodialysis three times a week and secondary hypertension with left ventricular hypertrophy was accompanied. He also had chronic metabolic acidosis and hyperkalemia. The day after hemodialysis, general anesthesia was carried out. Uneventful anesthetic induction using thiopental and vecuronium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 9 hours. During the anesthesia, he did not have any problem but persistently increasing serum potassium level. After anesthetic emergence, he was transferred to intensive care unit for mechanical ventilation. So we report this successful case of anesthetic management in a patient with ESRD for oral cancer surgery, which massive bleeding and long anesthetic time were inevitable in, from the preoperative preparation to anesthetic emergence.

• The Korean Journal of Pain
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• 제30권3호
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• pp.207-213
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• 2017

Background: Surgeon satisfaction and patient analgesia during the procedure of laparoscopic surgery are important issues. The aim of this work was to study if an intrathecal (IT) Bupivacaine combined with Magnesium sulfate may or may not provide good surgeon satisfaction in addition to improvement of intraoperative and postoperative analgesia. Methods: Sixty female patients were enrolled in this prospective, randomized, double-blind controlled clinical trial study. All patients were operated for gynecological laparoscopic surgery under spinal anesthesia. Patients were divided into two groups (Bupivacaine and Magnesium). Group Bupivacaine (30 patients) received intrathecal Bupivacaine 0.5% only (15 mg), while 30 patients in group Magnesium received intrathecal Bupivacaine (15 mg) in addition to intrathecal Magnesium sulfate (50 mg). The sensory block level, the intensity of motor block, the surgeon satisfaction, the intraoperative visual analog scale (VAS) for pain assessment, the postoperative VAS, and side effects were recorded during the intraoperative period and within the first 24 hours after surgery in the post-anesthesia care unit. Results: Surgeon satisfaction, intraoperative shoulder pain, postoperative pain after 2 h, and perioperative analgesic consumption (ketorolac) were significant better in group Magnesium than in group Bupivacaine. (P < 0.05). The onset of motor and sensory blocks was significant longer in group Magnesium than the other one. The incidence of PONV, pruritus and urinary retention was insignificant statistically between both groups. Conclusions: Magnesium sulfate if used intrathecally as an adjuvant to Bupivacaine would provide a better surgeon satisfaction and would improve the analgesic effect of spinal anesthesia used for gynecological laparoscopic surgery.

• 한국치위생학회지
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• 제13권6호
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• pp.987-993
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• 2013

Objectives : The aim of the study is to offer basic data that help to reduce dental fear by measuring adult dental fear level with DFS scale. Methods : The subjects were 300 persons including college students in W University and their parents in Jeollabuk-do Province. Data were collected by convenience sampling from May 1 to May 30, 2013. Results : 1. Dental clinic visit provoked pain in 99 people(47.4%). Oral examination and preventive treatment evoked pain in 13 people(6.2%). 2. Women tended to feel much pain than men. Both women and men felt the thrilling fear when a needle pricks the flesh. 3. Respondents having dental caries, gum bleeding, halitosis, shaking tooth, and painful tooth had a higher dental fear level. 4. The direct pain experience(p<0.001) had the greatest influence. The next influencing factor was the insufficient anesthesia(p<0.05). 5. The explanatory power that the pain experience has influence upon dental fear is $R^2$=0.151. Conclusions : The direct pain experience and the insufficient anesthesia experience have the great influence upon patients' dental fear level. Anesthetics and analgesics can be considered as one of the positive methods for pain control.

• Journal of Yeungnam Medical Science
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• 제7권2호
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• pp.121-130
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• 1990

영남대학교 마취과학교실에서 하지에 국한된 수술을 받는 환자 40예를 대상으로 각군 20예씩 0.5% 고비중 tetracaine 2ml와 0.5% 순수 bupivacaine 2.5ml을 사용하여 척추마취를 실시한 결과 다음과 같은 성적을 얻었다. 1. 각군의 연령, 성별, 신장 및 체중은 비슷하였다. 2. 양군 모두 감각차단이 $T_{12}$분절에 도달되는 시간은 4분정도였고, 감각차단 최고분절높이도 $T_{6-7}$이었으며 최고높이에 도달되는 시간도 20분 정도였다. 3. 운동차단정도도 양군이 비슷하여 10분에 대부분이, 20분이내에 전예에서 완전차단이 초래되었다. 4. Bupivacaine군은 감각차단이 $T_{12}$분절이상에서 유지된 시간이 3시간, 술후 진통시간이 7시간으로 tetracaine군보다 작용시 간과 진통시간이 의의있게 길었다(P<0.05). 5. 수축기 혈압의 감소는 bupivacaine군이 훨씬 적었으며(P<0.05), 혈압은 마취후 20~30분에 심하게 감소되었다. 6. 마취후 발생된 부작용은 전체 대상환자에서 두통(3예), 다리저림(5예), 배뇨곤란(3예) 및 배부통(4예) 등이었고 양군사이에 발생빈도의 차이는 없었다. 이 상의 결과로 bupivacaine 척추마취의 임상적 특징은 감각차단 및 운동차단이 나타나는 양상과 마취후 부작용은 고비중 tetracaine과 비슷하고, 고비중 tetracaine보다 혈압감소가 적고 작용시간이 걸고 술후 진통효과가 좋은 점등의 장점이 있으므로 0.5% 순수 bupivacaine은 하지수술을 위한 척추마취제로 유용하게 사용될 수 있을 것으로 사료된다.

• The Korean Journal of Pain
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• 제33권4호
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• pp.378-385
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• 2020

Background: The thoracic paravertebral block is an effective analgesic technique for postoperative pain management after breast surgery. The ultrasound-guided retrolaminar block (RLB) is a safer alternative to conventional paravertebral block. Thus, we assessed the analgesic efficacy of ultrasound-guided RLB for postoperative pain management after breast surgery. Methods: Patients requiring breast surgery were randomly allocated to group C (retrolaminar injection with saline) and group R (RLB with local anesthetic mixture). The RLB was performed at the level of T3 with local anesthetic mixture (0.75% ropivacaine 20 mL + 2% lidocaine 10 mL) under general anesthesia before the skin incision. The primary outcome was cumulative morphine consumption using intravenous patient-controlled analgesia (IV-PCA) at 24 hour postoperatively. The secondary outcomes were the visual analogue scale (VAS) scores at 1, 6, 24, and 48 hour postoperatively and the occurrence of adverse events and patient satisfaction after the surgery. Results: Forty-six patients were included, 24 in group C and 22 in group R. The cumulative morphine consumption using IV-PCA did not differ between the two groups (P = 0.631). The intraoperative use of remifentanil was higher in group C than in group R (P = 0.025). The resting and coughing VAS scores at 1 hour postoperatively were higher in group R than in group C (P = 0.011, P = 0.004). The incidence of adverse events and patient satisfaction was not significantly different between the two groups. Conclusions: A single injection of ultrasound-guided RLB did not reduce postoperative analgesic requirements following breast surgery.

• 한국임상수의학회지
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• 제27권5호
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• pp.540-545
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• 2010

Medetomidine (MED)과 tiletamine/zolazepam (ZT)으로 마취한 개에서 외과 마취 상태 하에서의 뇌전도, 혈압 및 심박수 변화를 조사하였다. 외과 마취 수준을 결정하기 위해 ZT 주사 후, pedal withdrawal reflex를 규칙적으로 평가하였다. 통증반응을 보이지 않은 최초 시간은 외과마취 개시기로 결정하였다. 외과마취 개시기 후 처음으로 통증에 양성반응을 보이는 시간을 외과마취 종료기로 하였다. 대조군과 비교할 때 외과마취 개시기에 ${\delta}2$와 ${\alpha}2$의 유의적인 감소가 나타났으며 외과마취 종료기에, ${\delta}2$의 유의적인 변화가 관찰되었다. 외과마취 종료기 직전과 외과마취 종료기에 혈압이 유의적으로 감소하였다. 심박수는 전실험기간 유의적인 감소를 보였다. 이런 결과로 미루어 ${\delta}2$ band power는 MED와 ZT로 마취한 개에서 외과마취와 관련된 가치있는 지표로 판단되었다.

• The Korean Journal of Pain
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• 제2권1호
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• pp.66-71
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• 1989

It has been standard practice in many institutions to use a combination of a light general anesthesia and an epidural block for lower abdominal and pelvic surgery. This combination of a balanced anesthesia can provide various benefits to the patient such as less bleeding in the surgical field, the use of a lower concentration of general anesthetics, less muscle relaxant, and post operative pain management. However, there are several problems associated with hemodynamics such as bradycardia and hypotension etc. In order to block the pain of the high surgical area with a lumbar epidural puncture postoperatively, a large volume of local anesthetic is required and consequently an extensive blockade of sympathetic, sensory and motor functions can occur causing motor weakness, numbness and postural hypotension. Therefore, the patient is unable to have early ambulation postoperatively. In this study, thoracic epidural catheterization was undertaken to locate the tip of the catheter exactly at the surgical level for upper abdominal surgery, and was followed by general anesthesia. Twenty-one patients scheduled for upper abdominal surgery were selected. Fifteen of them had hepatobiliary operations and the remaining 6 had gastrectomies. Thoracic epidural punctures were performed mostly at T9-T10 (57.1%) and T8-T9. Neuromuscular blocking agents were not used in half of the cases and the, mean doses of relaxant were $3.5{\pm}1.0mg$ in gastrectomies, and $2.7{\pm}0.9mg$ in cases of hepatobiliary operation. Epidural morphine was injected 1 hour before the end of the operation for postoperative pain control. Eight patients did not require additional analgesics and the mean dose of epidural morphine was $2.2{\pm}0.9mg$, and 13 cases were given 0.125% epidural bupivacaine when patients complained of pain. Their initial doses of epidural morphine were $1.9{\pm}0.4mg$ and the mean duration of bupivacaine was 6 hours 20 minutes${\pm}40$ minutes. In conclusion. thoracic epidural analgesia is valuable to reduce postoperative pain in patients with upper abdominal surgery, However, it is not easy to maintain this balanced anesthesia with high epidural analgesia-and light general anesthesia for upper abdominal surgery because of marked hemodynamic changes. Therefore, further practice will be required.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권3호
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• pp.187-193
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• 2024

Background: Patients with autism spectrum disorder (ASD) present challenges in dental treatment cooperation owing to deficits in communication skills and social interaction. Behavioral guidance, sedation, and general anesthesia may be employed to ensure the quality of dental care for individuals with ASD. This study aimed to examine the trends in dental treatment for patients with ASD who visited the Department of Pediatric Dentistry at Dankook University Jukjeon Dental Hospital, an oral health center for the disabled in the Gyeonggi region, over the past 10 years. Methods: This study utilized the order communication system to gather data on sex, age, cooperation level, number of quadrants treated, and administration of sedation or general anesthesia for patients with ASD who visited the Department of Pediatric Dentistry at Dankook University Jukjeon Dental Hospital between January 2013 and December 2022. Results: The total number of patients with ASD increased annually, possibly due to an increase in ASD prevalence and the hospital's designation as a center for disabled oral health. General anesthesia was predominant before 2017, with a shift towards N₂O-O₂ sedation. The most common age group for sedation or general anesthesia was 6-9 years, with a higher prevalence in males than in females. Notably, N₂O-O₂ and midazolam sedation resulted in better cooperation and fewer treated teeth than general anesthesia. Conclusion: This study highlights the evolving trends in dental treatment for individuals with ASD, indicating a shift towards outpatient methods, particularly N₂O-O₂ sedation. The sex distribution aligns with national statistics, emphasizing a higher prevalence of ASD in males than in females. These findings underscore the need for further research to establish evidence-based guidelines for optimal dental care strategies tailored to the unique needs of individuals with ASD.

• 기본간호학회지
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• 제11권2호
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• pp.195-202
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• 2004

Purpose: This descriptive study was conducted to project the number of nurse anesthetists needed in hospital settings, up to the year 2015. Method: Necessary data and information were collected from various funded reports, professional literature, web sites and personal visits to national and private institutions. The number of nurse anesthetists needed was projected after considering the total number of cases requiring anesthesia including deliveries, workload ratio for caesarean section to total number of deliveries, and percent of deliveries requiring and anesthesia. Result: The projected number of nurse anesthetists needed for hospital settings are as follows: 1. The number of registered anesthesia personnel in Korea in 2002 was 2,481 anesthesiologists and 543 nurse anesthetists but only 60% of anesthesiologists and 30% of nurse anesthetists (147) were actually practicing in the field of surgery. 2. By the year 2015, the total number of projected nurse anesthetists needed in hospital settings will be between 214 and 265. Conclusion: In order to match the supply to the need, the professional organizations should direct efforts towards enacting legislation. Educational systems should identify strategies to initiating an adequate number of nurse anesthetist programs at the master's level as well as standardizing curriculums across programs.

• 성인간호학회지
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• 제23권1호
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• pp.87-99
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• 2011

Purpose: The study was designed to identify the factors that influence the length of stay of elderly people in the recovery room. Methods: The design of the study was descriptive correlation. The subjects were 196 general anesthesia patients. The data were analyzed by SPSS/WIN 17.0 program. Results: The average length of stay in the recovery room was 62.62 minutes. The length of stay in the recovery room was influenced by age (27.50%); number of diseases (12.97%) and albumin level (6.75%). Other related post operative factors (30.98%) were abnormal ABGA, shivering, PAR score, pain, arrhythmia, amount of bleeding, cardiovascular complication, hypertension and delirium. Those factors explained 78.2% out of the total variance of the length of stay. The strongest effector was the abnormal ABGA (${\beta}$=.226) and then shivering (${\beta}$=.222). Conclusion: The influencing factors should be assessed and monitored for the aged before and after surgery. Further research is needed to find the exact factors for ICU transfer elderly from recovery room and emergency surgery target.