• Journal of Yeungnam Medical Science
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• v.39 no.2
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• pp.172-177
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• 2022

Takotsubo or reverse Takotsubo cardiomyopathy is a well-known cardiac complication of subarachnoid hemorrhage (SAH) that shows transient left ventricular wall motion abnormalities with electrocardiogram (ECG) changes. ST change followed by T inversion is a common ECG finding complicated with these disorders, left bundle branch block (LBBB) may be a potential ECG pattern which is seen. In this case, we describe the clinical profile and outcomes of a patient with LBBB and reverse Takotsubo cardiomyopathy after anesthetic induction, which was scheduled as an emergent external ventricular drainage after SAH. This is the first report of an LBBB pattern in reverse Takotsubo cardiomyopathy.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.5 no.2
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• pp.100-103
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• 2009

Dental treatment of mentally challenged patients under general anesthesia is a series of challenging procedures not only for dental operators but also for dental anesthesiologists. Patients presenting with uncooperative behavior often resist the perioperative management for adesthestic administration. This case report suggests oral premedication as a conjuctive method for anestheitic induction. A 26-year-old male dental patient with autism was referred to dental treatment under general anesthesia. The patient refused to enter dental clinic office and was not able to receive preoperative assessment. In the day of operation, 15 mg of midazolam was given to the patient for oral premedication prior to anesthetic induction. Ater 20 minutes, the patient presented with drowziness and was transferred to the office. Anesthestic staff were able to achieve appropriate intravenous access and mask inhalation. The patient recieved 8 hrs long dental treatment and recovered in a noncomplicated way. Oral midazolam is commonly used to reduce anxiety for combative and irritated pateints. In this case, oral midazolam sedation was used as a preanesthetic management of a highly uncoopearive patient.

• Journal of Yeungnam Medical Science
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• v.2 no.1
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• pp.45-51
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• 1985

It is well known that intracranial pressure (ICP) and mean arterial pressure (MAP) are increased by laryngoscopy and endotracheal intubation during induction of general anesthesia, and It may be very dangerous in neurosurgical patients who had increased ICP. Therefore, this study was performed to know the range of ICP increase during induction of the conventional general anesthesia with intubation following thiopental and succinylcholine injections. Intracranial pressure and MAP were measured in 13patients who underwent cramotomy. All the patients were monitored cerebral epidural ICP and intra-arterial pressure pre-operatively. The results were as follow: 1. Intracranial pressure was increased of $7.1{\pm}7.23mmHg$. 2. Arterial pressure was increased of $43.5{\pm}25.46mmHg$. 3. Cerebral perfusion pressure was increased of $33.3{\pm}27.53mmHg$. It is stressed that certain procedures are necessary to prevent from further increase of ICP due to induction of general anesthesia in patients with increased ICP.

• Restorative Dentistry and Endodontics
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• v.22 no.1
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• pp.278-290
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• 1997

The purposes of this study were to evaluate and compare the pulpal anesthesia induced by an inferior alveolar nerve block and that by Gow-Gates technique, and to investigate the relationship between pulpal anesthesia and intraoral soft tissue responses. After one side of mandibule was anesthetized with inferior alveolar nerve block or Gow-Gates technique using 2 % lidocaine with 1 : 100,000 epinephrine in 19 volunteers of ages between 24 and 29 (16 males and 3 females, average age 25.9 yrs.), electric pulp tests were done on the canine teeth of the anesthetized side and contralateral one before, at 1 min, continued at every 5 minutes until 60 min, and every 10 minutes until 100 min after completion of local anesthetic injection. Degree of pulpal anesthesia was classified as anesthetic failure, possible anesthesia and complete anesthesia by the criteria based on the thresholds to electric pulp test of contralateral canine and the currents of the electric pulp tester. Subjective signs on the lower lip and tongue were checked and prick-pin tests were done on the buccal gingiva of the first molar, buccal and lingual gingiva of the canine tooth at 5, 10 and 20 min after the completion of anesthetic injection. Thresholds to electric pulp test, degree of pulpal anesthesia and relationship between the pulpal anesthesia and soft tissue responses were analyzed with SPSS, paired t-test, Wilcoxon matched-pairs signed-ranks test and correlation analysis. The results were as follows : No significant differences were found in the peak thresholds to electric pulp test, in the induction time to it and in the depth of pulpal anesthesia between inferior alveolar nerve block and Gow-Gates technique (p>0.05). There was no significant relationship between pulpal anesthesia and soft tissue responses in both inferior nerve block and Gow-Gates technique.

• Acute and Critical Care
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• v.33 no.4
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• pp.276-279
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• 2018

In pediatric patients, a laryngeal mask airway (LMA) is usually used during minor surgeries that require general anesthesia. No esophageal injury has been reported after insertion of an LMA. We report a case of an esophageal injury with intramural dissection after an $i-gel^{(R)}$ (size, 1.5; Intersurgical Ltd.) insertion in a pediatric patient. A 2-month-old male infant was hospitalized for left inguinal herniorrhaphy. After induction of anesthesia, a trained resident tried to insert an $i-gel^{(R)}$. However, it was only successful after three attempts. Dysphagia was sustained until postoperative day 10, and the pediatrician observed duplication of the esophagus on gastroendoscopy. However, a whitish mucosal lesion, which looked like a scar, was observed, and previous lesions suggestive of esophageal duplication were almost healed on postdischarge day 11. His condition was diagnosed as dysphagia and esophagitis due to an esophageal laceration, not esophageal duplication. He was scheduled for symptomatic treatment with a proton pump inhibitor. In conclusion, although an esophageal injury or perforation in pediatric patients is rare, an LMA insertion or a procedure such as aspiration or nasogastric tube insertion should be performed gently to avoid a possible injury to the esophagus in pediatric patients.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.379-386
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• 2013

Background: Shivering related to spinal anesthesia may interfere with monitoring and is uncomfortable. The aim of the present study was to investigate low-dose intrathecal meperidine for the prevention of shivering after induction of spinal anesthesia in parturients with cesarean section. Methods: This was a prospective randomized, double-blind, placebo-controlled trial including 100 parturients, of American Society of Anesthesiologists (ASA) physical status I or II, scheduled for elective cesarean section under spinal anesthesia who were randomly assigned to a meperidine (0.2 mg/kg) plus hyperbaric lidocaine (5%, 75 mg, n = 50; group M) group or a placebo plus hyperbaric lidocaine (5%, 75 mg, n = 50; group L) group. Demographic and surgical data, adverse events, and the mean intensity for each parturient were assessed during the entire study period by a blinded observer. Results: There were no significant differences between the two study groups regarding the demographic and surgical data (P > 0.05). The incidence of shivering during the entire study period significantly decreased in the group of parturients who received intrathecal meperidine (P = 0.04). There were no significant differences in nausea and vomiting between the two groups. Conclusions: Low-dose intrathecal meperidine (10 mg) is safe and effective in reducing the incidence and severity of shivering associated with spinal anesthesia in parturients with cesarean section.

• Archives of Reconstructive Microsurgery
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• v.22 no.1
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• pp.1-6
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• 2013

Rats and mice are commonly used in experimental laboratories and anesthetic drugs are important for researchers to understand the details. Administration of fluids helps to stabilize the experimental animals before anesthesia via intravenously through the lateral vein in rats and in case of difficulty in catheterization and maintenance, fluids are usually administered as boluses. Large volumes of cool fluids will rapidly lead to hypothermia and all parenteral fluids must be warmed to body temperature before administration. Premedication with a sedative may ease induction with volatile anesthetic drugs. The first choice for rodent anesthesia is complete inhalational anesthesia. The second option is using injectable anesthesia. Recovery from the volatile agents that have been used rapid when the agent is no longer administered. Anesthetic monitoring equipment is an infant-size bell sthethoscope that can be used to ausculate the heart and lungs. Supplemental heating should be provided to reduce the heat loss supply and maintain core body temperature. The kinds of drugs, characteristics, route of administration and care after surgery were reviewed and summarized from the references. Anesthetic drugs, maintenance, monitoring and aftercare are important in the laboratories to keep the animal safe in all experimental procedures.

• Journal of Korean Clinical Nursing Research
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• v.17 no.2
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• pp.192-203
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• 2011

Purpose: The purpose of this study was to compare the body temperature (BT), blood pressure (BP) and shivering in patients undergoing operation under general anesthesia between the heated humidification circuit tube (HHCT) group and the non-HHCT group. Methods: Data were extracted from the participants' medical records from September 1st to December 30th, 2009. The HHCT group consisted of 50 cases who were applied with heated and humidified gas via a specially designed circuit under general anesthesia. The HHCT which was adjusted at $41^{\circ}C$ was applied from induction of general anesthesia to extubation. In comparison, the non-HHCT group consisted of 50 cases who were applied with gas through standard breathing circuit without heat and humidification. Collected data were analyzed by $x^2$ test, t-test and repeated measures ANOVA. Results: The BT and shivering were significantly different between two groups (p<.001). But the BP was was not signigicantly different between the HHCT group and the non-HHCT group. Conclusion: The application of heated and humidified gases to patients under general anesthesia was effective in preserving the body temperature and reducing the shivering.

• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.428-434
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• 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 Dental Anesthesia and Pain Medicine
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• v.18 no.4
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• pp.235-244
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• 2018

Background: Patients with intellectual disability (ID) often require general anesthesia during oral procedures. Anesthetic depth monitoring in these patients can be difficult due to their already altered mental state prior to anesthesia. In this study, the utility of electroencephalographic indexes to reflect anesthetic depth was evaluated in pediatric patients with ID. Methods: Seventeen patients (mean age, $9.6{\pm}2.9years$) scheduled for dental procedures were enrolled in this study. After anesthesia induction with propofol or sevoflurane, a bilateral sensor was placed on the patient's forehead and the bispectral index (BIS) was recorded. Anesthesia was maintained with sevoflurane, which was adjusted according to the clinical signs by an anesthesiologist blinded to the BIS value. The index performance was accessed by correlation (with the end-tidal sevoflurane [EtSevo] concentration) and prediction probability (with a clinical scale of anesthesia). The asymmetry of the electroencephalogram between the left and right sides was also analyzed. Results: The BIS had good correlation and prediction probabilities (above 0.5) in the majority of patients; however, BIS was not correlated with EtSevo or the clinical scale of anesthesia in patients with Lennox-Gastaut, West syndrome, cerebral palsy, and epilepsy. BIS showed better correlations than SEF95 and TP. No significant differences were observed between the left- and right-side indexes. Conclusion: BIS may be able to reflect sevoflurane anesthetic depth in patients with some types of ID; however, more research is required to better define the neurological conditions and/or degrees of disability that may allow anesthesiologists to use the BIS.