• Korean Journal of Veterinary Research
• /
• v.56 no.3
• /
• pp.133-137
• /
• 2016

Changes in the cardiovascular and bispectral index score were evaluated in dogs subjected to constant rate infusion (CRI) with alfaxalone. Fifteen dogs were assigned to three groups of 5. Groups and doses of alfaxalone were as follows: group 1, 3 mg/kg for induction and 6 mg/kg/h for CRI; group 2, 3 mg/kg for induction and 8 mg/kg/h for CRI; and group 3, 3 mg/kg for induction and 10 mg/kg/h for CRI. CRI was maintained for 1 h. Respiratory rates and blood pressures showed minimal changes; however, mild tachycardia and mild hypoxemia occurred, especially in group 3. There were some disparities between bispectral index score, electromyography and pedal withdrawal reflex test when measuring anesthetic depth. Additional premedications and/or analgesic agents would be helpful to avoid adverse effects of alfaxalone and provide improved cardiopulmonary functions.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.29 no.3
• /
• pp.169-172
• /
• 2003

Purpose : We examined the relationship between BIS, sedation score and plasma midazolam concentration to verify the usefulness of BIS to assess the patient's consciousness during sedation. Patients and Methods : Twenty-five young, healthy adult volunteers participated in this clinical study. Midazolam was administered intravenously up to 0.08 mg/kg to induce unconsciousness and we monitored the patient's physiological and conscious status until complete recovery from sedation. BIS and sedation score were measured before sedation, 10, 20, 30 minutes after midazolam administration. Plasma midazolam concentration was measured 10 minutes after midazolam administration. BIS was measured using A-2000 BISTM monitor (Aspect Medical Systems, USA) and the degree of sedation was evaluated with the sedation score. Results : The BIS score correlated with the sedation score (r = 0.676; P < 0.05). With the decreased plasma midazolam concentration, the correlation was better with sedation score (r = -0.656). Although BIS values did not correlate with calculated plasma concentration of midazolam (r = 0.467) at 10 minutes after midazolam administration, values after sedation were well distinguished from those before sedation. Conclusions : BIS is known for an effective predictor of patient's hypnotic state, and it is correlated with the sedation score. But, it doesn't always coincide with the clinical parameters of depth of sedation. So more attention is needed using BIS only during sedation, and it is advisable that the patient's consciousness is monitored with variable sedation score systems every several minutes.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.1 no.1 s.1
• /
• pp.21-25
• /
• 2001

연구배경: 임상적으로 진정법을 시행할 경우 뇌의 상태에 대한 접근은 매우 중요하다. 환자의 뇌에 대한 마취제의 영향을 측정하기 위해 개발된 Bispectral Index (BIS)는 환자의 진정을 방해하지 않고 객관적인 진정정도를 평가할 수 있다. 그러나 이는 항상 진정 깊이의 임상적인 척도와는 일치하지 않는다. 이번 연구에서는 진정법 시행시 환자의 진정 정도를 측정하기 위한 BIS의 유용성을 검증하기 위하여 BIS, 진정점수, 그리고 midazolam의 혈중 농도와의 관계를 연구하였다. 방법: 25명의 건강한 성인 지원자들을 대상으로 무의식을 유도하기 위하여 midazolam 0.08 mg/kg을 정맥으로 주입하였으며 환자의 의식 상태를 진정 회복 시까지 관하였다. BIS와 진정점수는 진정 전과, midazolam 투여 후 10, 20, 30분 간격으로 측정하였다. Midazolam의 혈중 농도는 주입 후 10분 경과 후에 정맥혈 채취 후 HPLC를 이용하여 측정하였다. BIS는 BISTM monitor (Aspect Medical Systems, USA)으로 측정하였으며 또한 진정 정도는 진정 점수로도 평가하였다. 결과: BIS 수치는 진정점수와 유의한 상관관계를 보였다(r = 0.676, p < 0.05). 혈중 midazolam 농도가 감소함에 따라 혈중 농도는 진정점수와 유의한 상관관계를 보였다(r = -0.656). Midazolam 투여 후 10분에서 BIS 수치와 midazolam의 혈중 농도는 유의한 상관관계를 보이지 않았지만(r =0.467) 진정 후 수치는 진정 전 수치와 명확히 구분되었다. 결론: BIS는 환자의 수면상태의 효과적인 척도로 알려져 있으며 진정점수와도 높은 상관관계를 보였다. 그러나 항상 진정 깊이를 나타내는 임상적인 척도와는 일치하지 않았다. 그러므로 진정법 시행동안 BIS 만을 사용하는 것은 더욱 많은 주의가 필요하며 매 주어진 시간마다 다양한 진정 점수 측정방법으로 환자의 의식을 감시하는 것이 추천된다.

• Korean Journal of Veterinary Service
• /
• v.39 no.2
• /
• pp.93-99
• /
• 2016

The anesthetic depth and cardiovascular effect of alfaxalone constant rate infusion in dogs premedicated with xylazine or acepromazine were evaluated. Ten dogs were randomly allocated into 2 groups. In group AA, dogs were premedicated with 0.02 mg/kg of intravenous acepromazine at 15 min before induction. In group XA 1.1 mg/kg of intravenous xylazine was premedicated at 5 min before induction. The anesthesia was maintained with 6 mg/kg/hr of alfaxalone after induction with 2 mg/kg alfaxalone in both groups. In both of groups, the qualities of induction were satisfactory without any adverse event, but adequate analgesia could not be provided, according to the withdrawal test. $PaO_2$ and $SaO_2$ implied a slight hypoxemia state in XA group, while those values of group AA were not significantly changed. The acepromazine and alfaxalone combination induce mild tachycardia. The bispectral index score were significantly decreased in group XA, compared with that in group AA. The premedication of xylazine before alfaxalone constant rate infusion in this study could provide adequate analgesia during 30 min, while the premedication with acepromazine could not.

• Journal of Korean Neurosurgical Society
• /
• v.47 no.4
• /
• pp.252-257
• /
• 2010

Objective : Barbiturate coma therapy (BCT) is a useful method to control increased intracranial pressure (IICP) patients. However, the complications such as hypotension and hypokalemia have caused conditions that stopped BCT early. The complications of low dose BCT with $Bispectral^{TM}$ index (BIS) monitoring and those of high dose BCT without BIS monitoring have been compared to evaluate the efficacy of low dose BCT with BIS monitoring. Methods : We analyzed 39 patients with high dose BCT group (21 patients) and low dose BCT group (18 patients). Because BIS value of 40-60 is general anesthesia score, we have adjusted the target dose of thiopental to maintain the BIS score of 40-60. Therefore, dose of thiopental was kept 1.3 to 2.6 mg/kg/hour during low dose BCT. However, high dose BCT consisted of 5 mg/kg/hour without BIS monitoing. Results : The protocol of BCT was successful in 72.2% and 38.1% of low dose and high dose BCT groups, respectively. The complications such as QT prolongation, hypotension and cardiac arrest have caused conditions that stopped BCT early. Hypokalemia showed the highest incidence rate in complications of both BCT. The descent in potassium level were $0.63{\pm}0.26$ in low dose group, and $1.31{\pm}0.48$ in high dose group. The treatment durations were $4.89{\pm}1.68$ days and $3.38{\pm}1.24$ days in low dose BCT and high dose BCT, respectively. Conclusion : It was proved that low dose BCT showed less severe complications than high dose BCT. Low dose BCT with BIS monitoring provided enough duration of BCT possible to control ICP.

• Journal of Veterinary Clinics
• /
• v.30 no.6
• /
• pp.428-434
• /
• 2013

The combinations of alfaxalone and remifentanil constant rate infusion in dogs premedicated with xylazine or acepromazine were compared. Ten beagle dogs were used and assigned randomly into 2 groups (5 dogs for each group). In group AAR, dogs were premedicated with 0.02 mg/kg of intravenous acepromazine at 15 min before induction. In group XAR, 1.1 mg/kg of intravenous xylazine was premedicated at 5 min before induction. In both groups, anesthesia was induced with alfaxalone and maintained with the combination of alfaxalone (6 mg/kg/hr, IV) and remifentanil (0.05 ${\mu}g/kg/min$, IV). bispectral index score was decreased after induction of anesthesia compared with baseline in both groups and no steep increase was observed during anesthesia. Bispectral index scores and electromyographs in group XAR were significant decreased compared with those in group AAR. Although the pulmonary depression in group XAR and tachycardia in group AAR should be considered to use these regimes, the combinations of alfaxalone and remifentanil constant rate infusion in dogs premedicated with xylazine or acepromazine provided adequate analgesia and anesthesia in this study.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.48 no.6
• /
• pp.348-355
• /
• 2022

Objectives: To compare the vital sign stability and cost of two commonly used sedatives, midazolam (MDZ) and dexmedetomidine (DEX). Patients and Methods: This retrospective study targeted patients who underwent mandibular third molar extractions under intravenous sedation using MDZ or DEX. The predictor variable was the type of sedative used. The primary outcome variables were vital signs (heart rate and blood pressure), vital sign outliers, and cost of the sedatives. A vital sign outlier was defined as a 30% or more change in vital signs during sedation; the fewer changes, the higher the vital sign stability. The secondary outcome variables included the observer's assessment of alertness/sedation scale, level of amnesia, patient satisfaction, and bispectral index score. Covariates were sex, age, body mass index, sleeping time, dental anxiety score, and Pederson scale. Descriptive statistics were computed including propensity score matching (PSM). The P-value was set at 0.05. Results: The study enrolled 185 patients, 103 in the MDZ group and 82 in the DEX group. Based on the data after PSM, the two samples had similar baseline covariates. The sedative effect of both agents was satisfactory. Heart rate outliers were more common with MDZ than with DEX (49.3% vs 22.7%, P=0.001). Heart rate was higher with MDZ (P=0.000). The cost was higher for DEX than for MDZ (29.27±0.00 USD vs 0.37±0.04 USD, P=0.000). Conclusion: DEX showed more vital sign stability, while MDZ was more economical. These results could be used as a reference to guide clinicians during sedative selection.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.14 no.1
• /
• pp.11-15
• /
• 2014

Background: It is imperative that adequate sedation level should be maintained for safe and effective dental sedation. Cerebral state index (CSI) is a empirically derived parameter calculated from the processed electroencephalography (EEG). We investigated whether CSI can be used as a sedation depth indicator. Methods: We continuously recorded CSI and bispectral index (BIS) values from 10 healthy children aged 3.6 yr undergoing dental sedation. We also evaluated sedation level using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S). The correlation between CSI and BIS, or CSI and sedation score were sought a regression analysis. Results: There were good linearity between CSI values and sedation score. (r = 0.916, P < 0.001) The paired CSI and BIS values showed a significant correlation between the two values. (r = 0.895, P < 0.001) The difference between CSI and BIS values was not statistically significant at deep and conscious sedative levels. Conclusions: The CSI monitor can be easy to monitor sedation depth during dental sedation for children.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.28 no.3
• /
• pp.441-446
• /
• 2001

Flumazenil is a competitive antagonist of benzodiazepines. It is usually administered intravenously. However, if the intravenous route is not available then other routes of drug administration should be considered. This study was designed to evaluate the reversal effects of flumazenil after nasal administration. Twenty-five young, healthy adult volunteers participated in this clinical trial. The dosage of 0.08mg/kg midazolam was administered intravenously to induce deep sedation. Ten minutes after midazolam administration, 0.5mg of flumazenil was dropped nasally, over a period of one minute. Blood samples were taken to measure the concentration of midazolam and flumazenil at 0, 5, 10, and 20min after nasal administration of flumazenil, using High Performance Liquid Chromatography. The degree of sedation was evaluated with sedation score and bispectral index (BIS), Statistical analysis was performed by multivariate ANOVA and correlation analysis (P<0.05). Peak serum flumazenil concentration was reached in 10min. Sedation score decreased after midazolam administration and showed a significant increase after flumazenil administration. However, BIS decreased during the first 10min after midazolam administration and then no significant changes after flumazenil administration. There were two instances representing rapid and complete reversal of midazolam after intranasal administration of flumazenil. In conclusion, intranasal flumazenil administration may be effective in some patients when intravenous route is not available in condition of benzodiazepine overdose.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.43 no.4
• /
• pp.229-238
• /
• 2017

Objectives: The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intravenous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction. Materials and Methods: Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer's assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05. Results: Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; however, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction. Conclusion: The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral surgery under IVS. The amnesia about the procedure affects patient satisfaction positively.