• 대한간호학회지
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• 제21권3호
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• pp.268-280
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• 1991

The nursing intervention for the prevention of the pulmonary complication and of the function lowering of pulmonary ventilation which emerge with high generation frequency during the nursing of operation patient is necessary for performing the qualitative nursing for operation patient. So, this researcher tried this study so as to obtain the data which can be utilized for the trial of nursing intervention, by grasping the effect that the deep breathing with Incentive Spirometer has on the function of pulmonary ventilation, analysing the factor to have influence on the function of pulmonary ventilation, and applying the effective method of deep breathing to the clinic. By making 42 patients who underwent the operation of upper abdomen after admitting G Hospital in Seoul from Mar. 7, 1991 to Apr.30, 1991 as the object, they were classified into the experiment group that the deep breathing was made with the use of Incentive Spiromenter and the comparison group that the deep breathing exercise was made without the use of Incentive Spirometer. And then, by measuring Tidal Volume and Forced Vital Capacity with Respirometer and $O_2$ Saturation with Pulse Oximeter at preoperation postoperation 24 hours, 72 hours, and 120 hours data were collected. The collected data were analyzed with of, average, standard deviation, x$^2$-test, t-test and ANOVA by SPSS. The result of this study is as follows : 1. As for the hypothesis that the function of pulmonary ventilation at postoperation 24 hours, 72 hours and 120 hours will be better in the experiment group that the deep breathing was made with the use of Incentive Spirometer, in comparison with the comparison group that deep breathing was made without the use of Incentive Spirometer, experiment group and comparison group didn't show the significant difference in Tidal Volume, Foreced Vital Capacity and $O_2$ Saturation at postoperation 24 hours and 72 hours. But experiment group and comparison group showed the significant difference in Tidal Volume at postoperation 120 hours (p＜0.01). So, this hypothesis was supported partially. 2. The variables that there were the significant differences about the function of pulmonary ventilation in experiment group at postoperation 24 hours stastically were smoking existence (p＜0.05), and the variables that there were not significant differences about the function of pulmonary ventilation were distinction of sex, age, anesthetic duration, smoking extent, body weight, surface area of body, existence of narcotic use, regular exercise existence, and past experience existence of respiratory disease. As above result, it appeared that the method of deep breathing with the use of the Incentive Spirometer is more effective for the function recovery of pulmonary ventilation, in comparison with the deep breathing without use of Incentive Spirometer and that smoking existence was the factor to have influence on the function of pulmonary ventilation. In the aspect of clinic, the trial of nursing intervention of deep breathing with use of Incentive Spirometer is expected. And, in the aspect of study, the study through various operative site patients about the effect of Incentive Spirometer use at the clinic will have to be confirmed.

• Journal of Oral Medicine and Pain
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• 제30권1호
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• pp.25-34
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• 2005

측두하악장애 및 구강안면통증 환자들 중 근막통증에 의한 기능제한이나 통증을 호소하는 경우를 흔히 볼 수 있다. 근막통증환자를 치료할 때 여러 가지 물리치료가 유용하지만, 즉각적인 통증완화효과를 나타내는 발통점주사요법이 근막통증의 치료로서 널리 적용되고 있다. 발통점주사요법에 흔히 사용하는 화학약제로 생리식염수, 국소마취제, 스테로이드 등이 있으며, 국소마취제는 근육에 대한 부작용이 보고되어 있어 사용상 주의가 필요하다. 이 연구는 상품화된 lidocaine과, dexamethasone 주사제의 혼합용액을 근육내 주사한 후 조직학적 변화를 관찰함으로써 근육에 대한 위해성 여부를 평가하고자 하였다. 또한 용액의 농도에 따라 각각 조직학적 변화를 관찰함으로써 위해성이 없는 적정한 농도를 제시하고자 하였다. 이 연구에서는 생후 9주된 BALB/c 생쥐 (자성) 63마리를 7군으로 분류하여, 앞정강근 (전경골근, tibialis cranialis) 에 각각 생리식염수, dexamethasone, 2.0% lidocaine, 생리식염수와 혼합한 1.0% lidocaine, 생리식염수와 혼합한 1.5% lidocaine, dexamethasone과 혼합한 1.0% lidocaine, dexamethasone과 혼합한 1.5% lidocaine을 주사하였다. 그 후 1일, 7일, 14일째에 희생시켜 실험부위를 절취한 후 조직절편을 만들어 HE염색과 Van-Gieson염색을 거쳐 광학현미경으로 관찰하여 다음의 결론을 얻었다. Lidocaine과 dexamethasone의 혼합용액을 근육내 주사하였을 때, lidocaine의 농도가 1.5% 이하인 경우 조직학적으로 유해하지 않았으며, 통증완화효과와 항염증작용을 동시에 기대할 수 있을 것으로 생각된다. 향후 상기 혼합용액을 발통점주사요법의 약제로 사용할 경우, 인체에서도 동일한 결과가 나올 것인가에 대해서는 추가적인 연구가 필요하다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제33권5호
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• pp.485-493
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• 2007

Purpose: Heart rate variability(HRV) is the clinical consequence of various influences of the autonomic nervous system(ANS) on heart beat. HRV can estimate the potential physiologic rhythm from the interval between consecutive beats(RR interval or HRV data). It is known as RSA which represents respiration-related HR rhythmic oscillation. Previous studies demonstrated a specific breathing pattern(0.1Hz, 6breaths/min) to improve a physiological body condition related to the stress. In this paper, the level of stress would be evaluated in terms of three phases of the dental treatment, combined with 6breaths/min. Methods: These phases include before, during and after tooth extraction or anesthesia or something.36 patients' stresses were assessed using HRV stress analyzer in each phase in Kangdong Sacred Heart Hospital, and Chuncheon Sacred Heart Hospital, Hallym University Medical Center from Jun. to Sept. of 2007. HRV 5-min data collected were analyzed in time-domain and frequency-domain to evaluate the activity of autonomic nervous system(ANS) which represents the level of stress. Results: All HRV parameters including HF(high frequency), LF(low frequency) and LF/HF ratio showned a significant change affecting the ANS balance. There was a 6.4% difference between R(LF/HF)s on general breathing pattern for balance of Autonomic nervous system, but on controlled breathing pattern, 0.1Hz, was made narrow till 1.4%. The activity of ANS has increased by 1.4% on general breathing pattern, and by 2.9% on controlled breathing pattern, 0.1Hz. Conclusion: After analysis of preoperative stress changes and effect of breathing pattern of 0.1 Hz on the stress in 36 patients who have undergone third molar extraction, following was concluded. In the preoperative stage, the sympathetic change was the greatest?after the?anesthetic injection, and stress was relieved by controlling the breathing pattern to a frequency of 0.1Hz.

• 대한소아치과학회지
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• 제45권4호
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• pp.508-513
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• 2018

세보플루란에 의한 일회 환기량은 낮은 용량에서는 호흡수의 증가로 안정적이다. 그러나 진정 깊이가 증가하면 폐포 환기는 세보플루란에 의해 감소되어 결과적으로는 $PaCO_2$가 증가한다. 호흡 억제의 발생은 깊이 진정된 장애 환자에서 심한 저산소증과 고탄산혈증의 위험을 증가시킨다. 세보플루란 흡입 마취는 여러 위험성이 내제되어 있으며 체내 산 염기 상태에 따라 혈역학적 변화가 발생하기에 예기치 못한 문제 상황이 발생할 수 있다. 세보플루란으로 장애인의 마취 유도 시 발생하는 호흡 억제로 인한 체내 산 염기 상태가 안정한지 알아보고자 이 연구를 진행하였다. 마취 유도는 4 vol% 세보플루란, 4 L/min 아산화질소, 4 L/min 산소를 자발 호흡 하에서 환자 안면부에 마스크를 거치하여 유도하였다. 그 뒤 환자의 의식소실 및 근육 긴장 완화 후 즉시 전문가에 의해 IV line을 거치한 뒤 정맥 채혈을 하여 정맥 내 혈액가스 분석을 하였다. 깊은 진정 상태에서 전체 환자의 평균 pH는 $7.36{\pm}0.06$으로 측정되었다. $PvCO_2$는 전체 환자에서는 평균 $48.8{\pm}8.50mmHg$로 측정되었다. $HCO_3{^-}$는 전체 환자에서 평균 $27.2{\pm}3.0mmol/L$로 측정되었다. 결론적으로 장애인을 대상으로 한 치과 진료시 세보플루란을 이용한 흡입 진정에 대한 체내 산 염기 반응은 비교적 안정적이었다.

• 대한치과마취과학회지
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• 제9권2호
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• pp.108-115
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• 2009

Trauma to any nerve may lead to persistent paresthesia. Trauma to the nerve sheath can be produced by the needle. The patient frequently reports the sensation of an electric shock throughout the distribution of the nerve involved. It is difficult for the type of needle used in dental practice to actually sever a nerve trunk or even its fibers. Trauma to the nerve produced by contact with the needle is all that is needed to produce paresthesia. Hemorrhage into or around the neural sheath is another cause. Bleeding increases pressure on the nerve, leading to paresthesia. Injection of local anesthetic solutions contaminated by alcohol or sterilizing solution near a nerve produces irritation; the resulting edema increases pressure in the region of the nerve, leading to paresthesia. Persistent paresthesia can lead to injury to adjacent tissues. Biting or thermal or chemical insult can occur without a patient's awareness, until the process has progressed to a serious degree. Most paresthesias resolve in approximately 8 weeks without treatment. In most situations paresthesia is only minimal, with the patient retaining most sensory function to the affected area. In these cases there is only a very slight possibility of self injury. But, the patient complaints the discomfort symptoms of paresthesia, such as causalgia, neuralgiaform pain and anesthesia dolorosa. Most paresthesias involve the lingual nerve, with the inferior alveolar nerve a close second. This is the report of a case, that had the persistent paresthesia care on left lingual & buccal shelf regions after the lingual and long buccal nerve block anesthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권3호
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• pp.129-135
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• 2020

Background: Postoperative fluid retention is a factor that causes delay in recovery and unexpected adverse events. It is important to prevent intraoperative fluid retention, which is putatively caused by intraoperative release of stress hormones, such as ADH (anti-diuretic hormone) or others. We hypothesized that intraoperative analgesia may prevent pathological fluid retention. We retrospectively explored the relationship between analgesics and in-out balance in surgical patients from anesthesia records. Methods: Anesthetic records of 80 patients who had undergone orthognathic surgery were checked in this study. Patients were anesthetized with either TIVA (propofol and remifentanil) or inhalational anesthesia (sevoflurane and remifentanil). During surgery, acetated Ringer's solution was infused for maintenance at a rate of 3-5 ml/kg/h at the discretion of the anesthetist. The perioperative parameters, including the amount of crystalloid and colloid infused, and the amount of urine and bleeding were checked. Furthermore, we checked the amount and administration rate of remifentanil during the surgical procedure. The correlation coefficient between the remifentanil dose and the in-out balance or the urinary output was analyzed using the Pearson correlation coefficient. The contributing factor to fluid retention, including urinary output, was statistically examined by means of multivariate logistic regression analysis. Results: A significant positive correlation was found between remifentanil dose and urinary output. Urinary output less than 0.04 ml/kg/min was suggested to cause positive fluid balance. Although in-out balance approaches zero balance with increase in remifentanil administration rate, no contributing factor for near-zero fluid balance was statistically picked up. The remifentanil administration rate was statistically picked up as the significant factor for higher urinary output (> 0.04 ml/kg/min) (OR, 2,644; 95% CI, 3.2-2.2 × 10⁶) among perioperative parameters. Conclusions: In conclusion, remifentanil contributes in maintaining the urinary output during general anesthesia. Although further prospective study is needed to confirm this hypothesis, it was suggested that fluid retention could be avoided through suppressing intraoperative stress response by means of appropriate maintenance of remifentanil infusion rate.

• 한국콘텐츠학회논문지
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• 제17권9호
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• pp.203-211
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• 2017

본 연구의 목적은 일부 성인의 치과공포증과 우울 증상, 스트레스의 연관성을 파악하는 것이다. 치주치료를 받기 위해 치과에 내원한 환자 중 연구 참여에 동의하고 선정 기준에 적합한 68명을 대상으로 하였다. 치과공포, 우울 증상 설문조사와 혈압, 맥박, 그리고 정신적 스트레스를 객관적으로 평가할 수 있는 타액코티졸을 측정하여 분석하였다. 분석 결과, 우울 증상은 '치료약속을 연기', '치료약속을 취소', '근육의 긴장이 증가', '치과에 들어서면 호흡이 빨라짐', '치과에서 진땀이 난 적이 있음', '구역질이 난 적이 있음', '다음 치료약속 시 두려움', '대기실에서 기다릴 때 두려움', '병원 냄새를 맡았을 때 두려움', '치과의사를 쳐다볼 때 두려움', '마취 주사바늘을 볼 때 두려움', '치아 삭제용 기구가 돌아가는 소리를 들을 때 두려움', '치아가 삭제되는 느낌을 받을 때 두려움', '치과에 대한 전체적인 두려움'에서 우울 정도가 높게 나타났다(p<0.05). 스트레스 증상은 '치과에서 진땀이 난 적이 있음', '맥박이 빨라짐', '치과에 들어설 때 두려움', '치과에 대한 전체적인 두려움'에서 높게 나타났다(p<0.05). 이와 같은 결과를 바탕으로 치과에 내원한 환자의 우울 증상과 스트레스를 조절할 수 있는 효과적인 방법에 대한 연구가 필요하며 치과공포 환자를 위한 이완요법 등의 방안 마련을 하는 지속적인 관리가 필요하다고 사료된다.

• 대한약리학회지
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• 제22권2호
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• pp.88-95
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• 1986

백서에서 열판법을 이용하여 과민동통을 일으키는 약물로 알려진 phenobarbital의 동통에 대한 효과를 재검토하고 그 기전을 알고저 phenobarbital 단기 또는 장기처리에 의한 뇌내 ${\beta}-endorphin$함량, opiate 수용체 및 시험관내 실험으로 functional opiate 수용체의 변동유무를 검토하여 다음과 같은 결과를 얻었다. 1) 마취에 미달하는 용량의 phenobarbital 1회 복강내 투여는 일시적인 HPL단축에 이어 이를 지연시켰고 phenobarbital 장기 처리는 HPL을 현저히 지연시켰다. 2) Naloxone 자체는 HPL을 현저히 단축시켰고, naloxone처리는 phenobarbital의 HPL 지연 효과를 억제하였다. 3) Phenobarbital 1회 복강내 투여는 뇌내 ${\beta}-endorphin$ 함량에 영향을 미치지 못하였으나 phenobarbital 장기처리는 이를 현저히 증가시켰다. 4) Phenobarbital 1회 복강내 투여는 [3H]-morphine binding에 영향을 미치지 못하였으나, phenobarbital 장기처리는 Kd치와는 달리 Bmax를 현저히 감소시켰다. 5) Phenobarbital 장기처리에 의한 HPL변동, 뇌내 ${\beta}-endorphin$함량변동 그리고 opiate receptor Bmax변동 삼자간에는 유의한 상관관계가 있었다. 6) 적출vas deferens 표본에서 phenobarbital 장기처리는 morphine의 ID50은 증가시키고 maximum effect는 감소시키나 naloxone에 대한 $pA_2 $치에는 영향을 미치지 못하였다. 이상의 실험성적은 phenobarbital이 일시적인 과민동통 효과에 이어 진통효과를 갖고 있으며, phenobarbital의 진통효과는 뇌내 ${\beta}-endorphin$함량 증가와 이로 인한 functional opiate 수용체의 숫적 변동에 기인함을 시사하였다.

• The Korean Journal of Physiology and Pharmacology
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• 제16권6호
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• pp.413-422
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• 2012

The purpose of this study is to investigated the mechanism of pharmacological action of local anesthetic and provide the basic information about the development of new effective local anesthetics. Fluorescent probe techniques were used to evaluate the effect of lidocaine HCl on the physical properties (transbilayer asymmetric lateral and rotational mobility, annular lipid fluidity and protein distribution) of synaptosomal plasma membrane vesicles (SPMV) isolated from bovine cerebral cortex, and liposomes of total lipids (SPMVTL) and phospholipids (SPMVPL) extracted from the SPMV. An experimental procedure was used based on selective quenching of 1,3-di(1-pyrenyl)propane (Py-3-Py) and 1,6-diphenyl-1,3,5-hexatriene (DPH) by trinitrophenyl groups, and radiationless energy transfer from the tryptophans of membrane proteins to Py-3-Py. Lidocaine HCl increased the bulk lateral and rotational mobility of neuronal and model membrane lipid bilayes, and had a greater fluidizing effect on the inner monolayer than the outer monolayer. Lidocaine HCl increased annular lipid fluidity in SPMV lipid bilayers. It also caused membrane proteins to cluster. The most important finding of this study is that there is far greater increase in annular lipid fluidity than that in lateral and rotational mobilities by lidocaine HCl. Lidocaine HCl alters the stereo or dynamics of the proteins in the lipid bilayers by combining with lipids, especially with the annular lipids. In conclusion, the present data suggest that lidocaine, in addition to its direct interaction with proteins, concurrently interacts with membrane lipids, fluidizing the membrane, and thus inducing conformational changes of proteins known to be intimately associated with membrane lipid.

• 한국가스학회지
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• 제13권6호
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• pp.34-38
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• 2009

마취가스로 사용되는 아산화질소($N_2O$)는 만성건강 잠재위험을 일으킬 수 있기 때문에 근무자를 보호하기 위해 아산화질소 노출을 감시하고 제어하는 것이 필요하다. 이 연구에서는 아산화질소 노출평가를 위해서 흡착제로는 molecular sieve 5A를 사용하였고 $7m{\ell}$ vial에 보관한 후 heating block에서 $100^{\circ}C$로 12시간 이상 가열하여 GC-ECD를 이용하여 분석, 평가하였다. GC-ECD에 의한 검량선 설명력계수($R^2$)는 0.9992이며 검출한계는 $0.96{\mu}g$/injection, 정량한계는 $3.21{\mu}g$/injection, 탈착효율은 평균 $94.78\;{\pm}\;4.50%$이다. 파과는 각 농도대비 10% 범주 내에 있었다. GC-ECD에 의한 $N_2O$의 수술 전과 수술 중의 노출평가에서는 수술 전의 평균농도는 5.12ppm이고 수술 중의 평균 농도는 42.33ppm으로 수술 중의 아산화질소의 농도가 높게 나타났고 중대한 차이가 있다(P<0.05). GC-ECD에 의한 $N_2O$의 근무자의 근무위치에 따른 노출 평가에서는 중대한 차이가 없고(P>0.005), 시료채취 법에서는 능동식 시료채취 법에서의 $N_2O$ 농도가 높게 나타났다(P<0.05).