• Journal of Yeungnam Medical Science
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• 제36권1호
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• pp.50-53
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• 2019

Awareness during general anesthesia occurs in approximately 0.1-0.2% of cases; nevertheless, particular attention is required because it can lead to critical complications including insomnia, depression, anxiety, and post-traumatic stress disorder. To prevent these complications, bispectral index (BIS) and end-tidal anesthetic gas (ETAG) concentration monitoring are commonly used to examine patient consciousness during surgery. In the present case, an 80-year-old man was scheduled for total gastrectomy. Anesthesia was maintained using desflurane 4.0-5.0% vol, oxygen, and nitrous oxide. The authors simultaneously monitored BIS, which was maintained between 37 and 43, and ETAG, which was maintained between 0.9 and 1.2 minimum alveolar concentration (MAC). After the operation, however, the authors were surprised to learn that the patient complained of awareness during anesthesia. Although BIS and ETAG concentration monitoring are useful in preventing awareness during anesthesia, they cannot be completely trusted. Even though BIS was maintained at approximately 40 and ETAG at 0.7-1.3 MAC, awareness during anesthesia occurred.

• Archives of Plastic Surgery
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• 제44권1호
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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.

• Tuberculosis and Respiratory Diseases
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• 제73권3호
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• pp.151-161
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• 2012

Background: Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation. Methods: A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS) was conducted in the SAG. Results: In the SAG, the dose of midazolam was significantly reduced by control of sedation (day 1, $1.3{\pm}0.5{\mu}g/kg/min$; day 2, $0.9{\pm}0.4{\mu}g/kg/min$; p<0.01), and was significantly lower than the ECG on day 2 (p<0.01). Likewise, on day 2, sedation levels were significantly lower in the SAG than in the ECG. Significant relationship was found between Ramsay sedation scale and Richmond agitation-sedation scale (RASS; $r_s$=-0.57), Ramsay Sedation Scale and Bispectral Index (BIS; $r_s$=0.77), and RASS and BIS ($r_s$=-0.79). In 10 patients, who didn't require re-sedation after DIS, BIS showed the earliest and most significant changes among the sedation scales. Ventilatory parameters showed significant but less prominent changes, and hemodynamic parameters didn't show significant changes. No seriously adverse events ensued after the implementation of DIS. Conclusion: Active assessment and control of sedation significantly reduced the dosage of sedatives in patients receiving mechanical ventilation. DIS, conducted in limited cases, suggested its potential efficacy and tolerability.

• 융합보안논문지
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• 제13권2호
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• pp.3-13
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• 2013

최근 발생하고 있는 학교폭력은 저연령화, 집단화 되는 경향을 보이고 있으며, 폭력의 유형도 다양해 질 뿐만 아니라 피해수준도 증가하고 있다. 학교폭력은 가정 학교 사회적 요인에 의해 발생되고 있지만, 폭력에 대한 인식부족과 신고의식의 저조 탓도 폭력의 간접적 방조로 작용하고 있다. 학교폭력을 최소화하기 위해서는 폭력이 유발된 장소인 학교만을 대상으로 법적 제도적 장치를 마련하는 것은 한계가 있을 수밖에 없고 그 실효성도 미미하다. 학교폭력 문제를 청소년 범죄 문제와 연계하여 예방과 관리, 처벌이 복합적이고 중층적으로 이루어져야 한다. 2005년을 기점으로 각 지방자치단체에서는 학교폭력의 최소화를 위해 스쿨폴리스, 배움터지킴이, 학교보안관 제도 등을 운용하고 있지만 가시적이고 상징적인 효과 외에는 실질적인 도움에 한계를 가지고 있다. 학교안전지킴이에 대한 교육기관이나 전문 인력이 전무한 상태에서 물리적 감시 기능만 강조 된 '경비'형태의 시스템은 태생적으로 한계를 가지고 출발한다. 또한 학교지킴이에게 적합한 역할과 특별한 권한도 주어지지 않은 상태에서 범죄행위나 폭력사태를 예방한다고 하는 것도 제도적인 문제점이다. 신고 외에는 별 다른 역할을 기대할 수도 없다. 따라서 학교폭력예방을 위해서는 제도적인 개선과 전문 인력의 양성이 선행되어야 하고, 가정과 학교, 사회적 측면에서 지원과 대책이 있어야 한다.