• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.2
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• pp.111-114
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• 2018

We report a case of pulmonary aspiration during induction of general anesthesia in a patient who was status post esophagectomy. Sudden, unexpected aspiration occurred even though the patient had fasted adequately (over 13 hours) and received rapid sequence anesthesia induction. Since during esophagectomy, the lower esophageal sphincter is excised, stomach vagal innervation is lost, and the stomach is flaccid, draining only by gravity, the patient becomes vulnerable to aspiration. As the incidence of perioperative pulmonary aspiration is relatively low, precautions to prevent aspiration tend to be overlooked. We present a video clip showing pulmonary aspiration and discuss the literature concerning the risk of aspiration and its preventive strategies.

• Journal of the Korean Institute of Electrical and Electronic Material Engineers
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• v.23 no.1
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• pp.76-85
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• 2010

In general, anesthetic depth is evaluated by experience of anesthesiologist based on the changes of blood pressure and pulse rate. So it is difficult to guarantee the accuracy in evaluation of anesthetic depth. The efforts to develop the objective index for evaluation of anesthetic depth were continued but there was few progression in this area. Heart rate variability provides much information of autonomic activity of cardiovascular system and almost all anesthetics depress the autonomic activity. Novel monitoring system which can simply and exactly analyze the autonomic activity of cardiovascular system will provide important information for evaluation of anesthetic depth. We investigated the anesthetic depth as following 7 stages. These are pre-anesthesia, induction, skin incision, before extubation, after extubation, Post-anesthesia. In this study, temporal, frequency and chaos analysis method were used to analyze the HRV time series from electrocardiogram signal. There were NN10-NN50, mean, SDNN and RMS parameter in the temporal method. In the frequency method, there are LF and HF and LF/HF ratio, 1/f noise, alphal and alpha2 of DFA analysis parameter. In the chaos analysis, there are CD, entropy and LPE. Chaos analysis method was valuable to estimate the anesthetic depth compared with temporal and frequency method. Because human body was involved the choastic character.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.6
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• pp.387-395
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• 2020

Background: The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique. Method: Cone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis. Results: Cancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters. Conclusions: The palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.

• Restorative Dentistry and Endodontics
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• v.46 no.1
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• pp.9.1-9.9
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• 2021

Objectives: This randomized clinical trial aimed to assess the effectiveness of buccal infiltration with piroxicam on the anesthetic efficacy of inferior alveolar nerve block (IANB) with buccal infiltration in irreversible pulpitis, with pain assessed using the Heft-Parker visual analogue scale (HP-VAS). Materials and Methods: This study included 56 patients with irreversible pulpitis in mandibular molars, randomly distributed between 2 groups (n = 28). After evaluating the initial pain score with the HP-VAS, each patient received IANB followed by buccal infiltration of 2% lignocaine with adrenaline (1:80,000). Five minutes later, the patients in groups 1 and 2 were given buccal infiltration with 40 mg/2 mL of piroxicam or normal saline, respectively. An access opening procedure (AOP) was performed 15 minutes post-IANB once the individual showed signs of lip numbness as well as 2 negative responses to electric pulp testing. The HP-VAS was used to grade the patient's pain during caries removal (CR), AOP, and working length measurement (WLM). Successful anesthesia was identified either by the absence of pain or slight pain through CR, AOP, and WLM, with no requirement of a further anesthetic dose. A statistical analysis was done using the Shapiro-Wilk and Mann-Whitney U tests. Results: The piroxicam group presented a significantly lower (p < 0.05) mean pain score than the saline group during AOP. Conclusions: Buccal infiltration with piroxicam enhanced the efficacy of anesthesia with IANB and buccal infiltration with lignocaine in patients with irreversible pulpitis.

• The Korean Journal of Pain
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• v.37 no.4
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• pp.332-342
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• 2024

Background: Pre-operative ilioinguinal-iliohypogastric nerve block (II-IHNB) has a proven role in lessening acute postoperative pain and opioid consumption following hernia repair. However, its role in preventing post-herniorrhaphy groin pain (PHGP) is still unknown. The current study aims to assess pre-operative II-IHNB's impact on PHGP three and six months after open inguinal hernia repair under spinal anesthesia. Methods: Seventy patients posted for inguinal hernia surgery were randomly allocated into group A (received ultrasound-guided II-IHNB with 10 mL of 0.5% ropivacaine and 4 mg [1 mL] dexamethasone) and group B (received ultrasound-guided II-IHNB with 11 mL of 0.9% normal saline). The time to first analgesic request, pain scores, opioid consumption, DN4 score, and PHGP at 3 and 6 months were analyzed using appropriate statistical tests. Results: The numerical pain rating scale at movement in group A was significantly reduced at all the time intervals of 3, 6, 12, and 24 hours compared to group B. Total opioid usage was lower in group A (3.71 mg [3.90]) versus group B (12.14 mg [4.90]) with a mean difference of -8.43 mg (95% CI -10.54, -6.32), P < 0.001. The time required for the first rescue analgesic was significantly longer in group A (360 min [180-360]) versus (180 min [180-360]) in group B (P < 0.001). However, there was no difference in the incidence of PHGP at three and six months between the two groups. Conclusions: Pre-operative ultrasound-guided II-IHNB reduces postoperative analgesic requirement but does not reduce the incidence of chronic PHGP following hernia surgery at 6 months.

• The Journal of Korean Physical Therapy
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• v.10 no.1
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• pp.1-6
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• 1998

The purpose of this study was to determine the of effective concentration of procaine iontophoresis for durarion of cutaneous local anesthesia. Forty-five healthy students with an age range of 19 to 34 years$(21\pm2.7)$, were participated in this study. The subjects were randomly assigned into 5 groups. Bach 9 subjects received iontophoresis on the flexor surface of dominant forearm with soft cotton pad $(3.5\times3.5cm)$ soaked in 2ml of $2\%$ (pH 5.28), $4\%$ (pH 5.12), $8\%$ (pH 4,98), $16\%$ (pH 4.72), $32\%$ (pH 4.52) procaine hydrochloride solution at 4mA for 10 minutes (total current 40mA min) using anodal direct current. The study was performed in a randomized, double-blind design, After procaine iontophoresis, the duration of anesthesia were evaluated at five minute intervals on five random locations in the iontophoretically area using a 21-gauge sterile hypodermic needle pressed with 1mm invagination unitl sharp pin-pricking pain sensation returned. The data were analyzed with one-way ANOVA to determine significant differences between groups. Duncan post hoc was performed at level .01. The relationship between anesthetic duration and procaine concentration was assessed with Pearson Product-Moment Correlation Coefficients. ANOVA tests showed significant differences in the anesthetic duration between the concentration of procaine solution (p<.001). Procaine iontophoresis with $4\%$ concentration produced cutaneous Socal anesthesia of significantly longer duration(15.56 min) than iontophoresis with $2\%,\;8\%,\;16\%$, and $32\%$ of procaine GCl(p<.01). Whereas the anesthetic duration had no correlation with concentration of procaine solution (r=-0.41, NS). These results support the $4\%$ procaine solution was an effective concentration of iontophoresis for induced cutaneous local anesthesia.

• Journal of Korean society of Dental Hygiene
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• v.4 no.2
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• pp.277-291
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• 2004

The purpose of this study is to analyze the dental hygienists' overall performance in operative restoration and the clinical performance in operative restoration according to dental hygienists' career and to provide basic data for establishing the appropriate range of dental hygienists' work. Subjects of this study are 339 dental hygienists working at dental clinic and hospital nationwide, selected by their working place, career, type of clinic, and location of clinical institution. The distribution of people who responded to the survey shows that 81 belong to beginner level(less than 2 years since entering clinic), 115 intermediate level(2 to 3 years since entering clinic), 81 higher level(4 to 5 years since entering clinic) and 62 advanced level(more than 6 years since their entering clinic). In terms of the types of clinical institution, 178 belong to dental clinics and 161 belong to dental hospitals. The survey used in this study are focused on perception about clinical performance in operative dentistry and adequacy of the work. Operative dentistry consists of operative restoration and endodontic therapy. The operative restoration consists of 15 categories such as patient welcoming, examination and diagnosis, planning of treatment, anesthesia, control of moisture, cavity preparation, pulp protection, matrix band application, amalgam filling, resin filling, glass ionomer cement filling, abrasive strip removal, rubber dam removal, bite check and polishing, patient education, and arrangement. The reliability was Cronbach's Alpha .9453. SPSS 10.0 for Windows was used to analyze the responses. One way ANOVA was utilized to verify the differences in the dental hygienists' job performance in operative restoration and their job performance according to career. When significant difference was found. Duncan multi comparison post hoc was done. To sum up the results of this study, patient welcoming look the first place in the operative restoration. It was followed by patient education, examination and diagnosis, introducing treatment plan, resin filling, glass ionomer cement filling, amalgam filling, bite check and polishing, anesthesia, pulp protection, control of moisture, abrasive strip removal, cavity preparation, matrix band application, rubber dam removal, and anesthesia. In terms of the clinical performance by career, there were significant differences in 19 activities such as medical eraluation, oral examination, patient charting, intra oral readio graphs, firm developing fixing mounting, curing light gun, education of attention content after operation. Based on the results of this study, the specific range of operative restoration for dental hygienists should be focused on providing basic data for dentists' diagnosis, alleviation of fear and aching accompanied by injection and anesthesia, data providing for dentists' decision of anesthesia degree, and maximization of control of moisture.

• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.1
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• pp.19-25
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• 2004

Dentally disabled person means one who have difficulty in cooperating voluntarily with a dentist for routine dental care. Seoul National University Dental Hospital (SNUDH) Dental Clinic for Disabled has worked for them under outpatient anesthesia concept. The aim of this study was to determine the anesthetic characteristics of the patients attending for dental treatment at SNUDH Dental Clinic for Disabled in order to establish better future treatment plans. The data were drawn from the patients who visited SNUDH Dental Clinic for Disabled from January 1999 to October 2002. Total 93 dental treatments for 83 patients were enrolled in this study. Most patients had mental retardation and the conservative treatments were carried out under general anesthesia. Thiopental and vecuronium were mostly used for induction agent and neuromuscular blocker, respectively. Enflurane, with oxygen and nitrous oxide, was mostly used to maintain the anesthesia. Mean total anesthetic time was $164.4{\pm}57.2$ minutes and mean duration at the post-anesthetic care unit was $106.2{\pm}50.5$ min. Serious postoperative complications were not observed. These results showed our successful anesthetic outcomes without any severe side effect or complication and the needs of more outpatient centers for dental care for disabled.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.4
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• pp.305-314
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• 2022

Introduction: This clinical trial aimed to evaluate the anesthetic effect of the addition of 2 mg (4 mg/ml) of dexamethasone to 2% lidocaine (plain or with 1:80,000 epinephrine). The solutions were injected for a primary inferior alveolar nerve block (IANB) to provide mandibular anesthesia for the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Methods: In a double-blinded setup, 124 patients randomly received either of the following injections: 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, or plain 2% lidocaine mixed with 2 mg dexamethasone, which were injected as a primary IANB. Ten minutes after injection, patients with profound lip numbness underwent electric and thermal pulp sensibility tests. Patients who responded positively to the tests were categorized as "failed" anesthesia and received supplemental anesthesia. The remaining patients underwent endodontic treatment using a rubber dam. Anesthetic success was defined as "no pain or faint/weak/mild pain" during endodontic access preparation and instrumentation (HP visual analog scale score < 55 mm). The effect of the anesthetic solutions on the maximum change in heart rate was also evaluated. The Pearson chi-square test at 5% and 1% significance was used to analyze anesthetic success rates. Results: The 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, and plain 2% lidocaine mixed with 2 mg dexamethasone groups had anesthetic success rates of 34%, 59%, and 29%, respectively. The addition of dexamethasone resulted in significantly better results (P < 0.001, 𝛘² = 9.07, df = 2). Conclusions: The addition of dexamethasone to 2% lidocaine with epinephrine, administered as an IANB, can improve the anesthetic success rates during the endodontic management of symptomatic mandibular molars with irreversible pulpitis.

• The Korean Journal of Pain
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• v.9 no.1
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• pp.145-150
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• 1996

The purpose of this study was to evaluate and compare the effectiveness of ilioinguinal-hypogastric nerve blocks(IHNB) and caudal block in producing post-orchiopexy and post-heniorrhaphy analgesia in children. Forty consenting healthy children, ages 3~10yr, were randomly assigned to receive caudal bupitvacaine (0.125%, 0.5ml/kg), or IHNB bupivacaine (0.25%, 0.3 ml/kg). Blocks were performed following the induction of general anesthesia, be fore the operation. Pre-anesthetic medication in form of atropine 0.01 mg/kg, droperidol 0.05 mg/kg were given intramuscularly one hour before induction to 40 children. Children were induced with thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg intravenously. Anesthesia was maintained with oxygen-nitrous oxide ($FiO_2$ 0.3) and ethrane. When the patients stabilized after induction. IHNB was done in the supine position and caudal block was done in the lateral position. The local anaesthetic was injected after negative aspiration. Postoperative pain was assessed with face pain rating scale (RPRS) at rest on discharge of recovery room, and 5 hours after discharge of recovery room, and the "red and white" visual analogue scale (VAS) at rest and mobilization from supine to sitting position on discharge of recovery room, and 5 hours after discharge of recovery room. Post-operative recovery was quiet and comfortable, without side effect. Relief of ain was complete in both IHNB group and caudal group. Surgeons, parents and recovery room personnel were satisfied. There were no surgical or anesthetic complications. In our study, the postpoerative pain scores were similar in both IHNB group and caudal group. IN conclusion, we found that both IHNB and caudal blocks before the start of surgery for orchiopexy & herniorrhaphy are safe and effective in controlling the postoperative pain of children.