• 한국임상수의학회지
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• 제31권4호
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• pp.350-353
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• 2014

A 13-year-old, castrated male, Shih Tzu dog with a history of acute ataxia was referred to veterinary medical teaching hospital and anesthetized for diagnostic magnetic resonance imaging of cervical intervertebral disk disease. After preanesthetic evaluation including physical examination, blood chemistry, radiography and ultrasound, the patient was premedicated with intravenous butorphanol (0.2 mg/kg). Anesthesia was induced by intravenous propofol (6 mg/kg) and maintained with isoflurane at 1.2 minimal alveolar concentrations. Because the mean arterial pressure (MAP) decreased from 70 to 58 mmHg at 70 minutes after induction, dobutamine was administered by constant rate infusion ($5{\mu}g/kg/min$) to treat hypotension. However MAP did not increase, and heart rate rapidly decreased from 100 to 55 beats per minute (bpm). To treat bradycardia, intravenous glycopyrrolate ($5{\mu}g/kg$) was administered, and heart rate increased to 165 bpm. After extubation of endotracheal tube, the patient showed normal recovery without any problems related to cardiovascular system. Unexpected dobutamine-induced bradycardia was considered as Bezold-Jarisch reflex. It is recommended that clinicians know and prepare the possibility of bradycardia during dobutamine therapy under general anesthesia.

• 대한소아치과학회지
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• 제23권2호
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• pp.525-536
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• 1996

The purpose of this study was to investigate the effect of electrical anesthesia induced by non-acupuncture point stimulation on inhibition of amplitude of digastric EMG evoked by noxious electrical stimuli in teeth and gingiva. Experiments were performed with dogs anesthetized with intraperitoneal pentobarbital sodium in an initial dose of 30mg/kg. Maintenance doses of 4.0ml/hour were given through a cannula in the femoral vein using a constant infusion pump. Anterior belly of digastric muscle was exposed and a pair of 0.1mm wire electrodes were inserted for E.M.G. recording. Bipolar electrodes were inserted into the labial and lingual surface of upper canine and the labial area of upper gingiva. Noxious stimuli were delivered to the tooth and gingiva through those electrodes by electric stimulator. Non-acupuncture point stimulation of 2Hz was delivered bilaterally to the femoral area. Amplitudes of digastric E.M.G. were measured from the oscilloscope and the monitor connected to amplifier at different intensities of electronic anesthesia of 1 volt, 4 volt and 10 volt. The inhibited rate of the amplitudes of digastric E.M.G. were analysed statistically with paired t-test. The following results were obtained : 1. Non-acupuncture point stimulation with intensities of 1 volt, 4 volt and 10 volt showed the inhibitory effect on pain of 15%, 25% and 16% in teeth and 15%, 18% and 12% in gingiva respectively 2. In tooth, statistical significance was observed between control and each group. In gingiva, there was statistical significance between control and group 1, 2 except group 3 From these results, low frequency electrical stimulation of non-acupuncture point resulted in reducing of dental and gingival pain, it could be used as adjunct to other pain control methods.

• 한국임상수의학회지
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• 제24권3호
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• pp.422-425
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• 2007

6개월령 수컷 진도종 개가 교통사고에 의한 골반 골절 교정술을 위하여 내원하였다. 일반적인 수술 전 검사에서 마취와 관련해 위험성 있는 이상은 발견되지 않았다. 이 개는 아트로핀으로 전처치하고, 유도마취로 thiopental을 주사하였으며 유지 마취 약물로 isoflurane을 사용하였다. 수술 시작 40분 후 갑자기 서맥이 발생하여 아트로핀(18ug/kg)을 천천히 정맥주사 하였으나 즉시 맥박이 증가하지 않고 오히려 heart rate가 감소하며 방실 전도 차단($2^{nd}$ degree type I)이 발생하였다. 따라서 ephedrin을 즉각적으로 주사하였으며, 투여 7분 후 정상 심박으로 회복되었다. 본 증례는 개에서 고용량 atropine 투여로 드물게 발생하는 역설적 방실전도 차단 임상예이다.

• Archives of Plastic Surgery
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• 제34권6호
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• pp.799-802
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• 2007

Purpose: The masserteric space is an important tissue compartment of the face, but a disease in it is difficult to diagnose and treat. The submasseteric abscess is located between the masseter muscle and mandibular ramus with different appearances such as sepsis, infection, or tumor. Especially the common misdiagnosis of submasseteric abscess is acute or chronic parotitis. The purpose of this report is to pay special attention to the possible diagnosis of submasseteric abscess for the symptoms of unilateral cheek swelling and tenderness that accompany marked trismus. Methods: A 11-year-old boy came to our hospital because of facial swelling, tenderness, and trismus in a history of left cheek swelling and toothache. We diagnosed his case as submasseteric abscess by CT scan and surgical intervention was performed. Under general anesthesia, the abscess was opened by the intraoral incision and considerably massive pus was drained. Results: Swelling, tenderness, and trismus became to subside during postoperative 10 days and general condition and vital signs became stable. After 6 months, CT scan showed that both masseteric muscles were symmetric and there was no periosteal reaction of the mandible. Conclusion: In conclusion, submasseteric abscess is a rare infection with the symptoms of cheek tenderness and marked trismus. A detailed medical history and clinical examination of a patient as well as computed tomography(CT) are important tools in the accurate diagnosis and efficient treatment of the submasseteric abscess. Adequate drainage, removal of cause, and antibiotic infusion are the management of choice.

• 대한약리학회지
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• 제12권1호
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• pp.57-62
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• 1976

Using modified technique of Schmidt et al, as described previously (Korean J. Pharmacol 9 : 17, 1973), the stomach of female rats were perfused with physiological saline under urethane anesthesia. The acid-secretory response of the perfused stomach to i.v. hypertonic glucose (50%), casein hydrolysate (20%) or saline (6%) solution were studied with or without histamine or methacholine stimulation. A significant decrease of acid secretion from the rat stomach was induced by i.v. hypertonic glucose or saline solution. The histamine-stimulated acid secretion was also decreased by simultaneous administration of the hypertonic glucose or saline. However, methacholine-stimulated acid response was not affected by the hypertonic glucose. Intravenous infusion of 20% casein hydrolysate solution resulted in an increase in acid output from the stomach under histamine stimuli. These results lead to the conclusion that the inhibitory responses of acid secretion due to i.v. hypertonic glucose solution are brought through the effect of histaminergic, not cholnergic mechanism(s) in the gastric secretion.

• Journal of Korean Neurosurgical Society
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• 제48권1호
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• pp.88-90
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• 2010

Retroperitoneal hematoma (RH) due to radiologic intervention for an intracranial lesion is relatively rare, difficult to diagnose, and can be lifethreatening. We report a case of RH that developed in a patient on anticoagulant therapy following endovascular coiling of a ruptured anterior communicating artery (AcoA) aneurysm. An 82-year-old man presented with a 12-day history of headache. Computed tomography (CT) on admission demonstrated slight subarachnoid hemorrhage, and left carotid angiography revealed an AcoA aneurysm. The next day, the aneurysm was occluded with coils via the femoral approach under general anesthesia. The patient received a bolus of 5,000 units of heparin immediately following the procedure, and an infusion rate of 10,000 units/day was initiated. The patient gradually became hypotensive 25 hours after coiling. Abdominal CT showed a huge, high-density soft-tissue mass filling the right side of the retroperitoneum space. The patient eventually died of multiple organ failure five days after coiling. RH after interventional radiology for neurological disease is relatively rare and can be difficult to diagnose if consciousness is disturbed. This case demonstrates the importance of performing routine physical examinations, sequentially measuring the hematocrit and closely monitoring systemic blood pressures following interventional radiologic procedures in patients with abnormal mental status.

• Journal of Trauma and Injury
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• 제27권2호
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• pp.33-37
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• 2014

Central venous catheterization through a subclavian approach is indicated for some special purposes but it may cause many complications such as infection, bleeding, pneumothorax, thrombosis, air embolization, arrhythmia, myocardial perforation, and nerve injury. A case involving a mistaken central venous catheterization into the right vertebral artery through the subclavian artery is presented. A 33-year-old man who had deteriorated mentality after head injury underwent an emergency craniotomy for acute epidural hematomas on the right frontal and temporal convexities. His mentality improved rapidly, but he complained of continuous severe pain in the right posterior neck even though he had no previous symptom or past medical history of such pain. Three-dimensional cervical spine computed tomography (3D-CT) was performed first to rule out unconfirmed cervical injuries and it revealed a linear radiopaque material intrathoracically from the level of the 1st rib up to the level of C6 in the right vertebral foramen. An additional neck CT was performed, and the subclavian catheter was indwelling in the right vertebral artery through right subclavian artery. For the purpose of proper fluid infusion and central venous pressure monitoring, the subclavian vein catheterization had been performed in the operation room after general anesthesia induction before the craniotomy. Sufficient anatomical consideration and prudence is essential because inadvertent arterial cannulation at a non-compressible site is a highly risky iatrogenic complication of central venous line placement.

• 대한관절경학회지
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• 제2권2호
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• pp.119-123
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• 1998

In order to obtain a good result in Arthroscopic ACL Reconstruction by immediate postoperative physical therapy, sufficient analgesia was needed. This study analyzes the analgesic effect of the intra-articular injection with ketorolac, Morphine together with bupivacaine in 80 male patients who had Arthroscopic ACL Reconstruction. On completion of the surgery under spinal anesthesia, the knee was injected with 30ml of 0.25% bupivacaine. Each of the study group received ketorolac and/or morphine, either through parenteral or intra-articular. Total amount of the drug used by Patient Controlled Analgesia(PCA) and Visual Analgesia Scale(VAS) for pain were measured and analyzed. The group which received intra-articular ketorolac or Morphine had a better analgesic effect than other group which received none. The group which received both did not do better in analgesic effect. Intra-articular infusion with either ketorolac or Morphine improved postoperative analgesia in Arthroscopic ACL Reconstruction surgery. However, combined injection did not offer more advantage.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권1호
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• pp.1-8
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• 2016

Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, these potential alternate causes should be considered. In this clinical review, we have presented a case of referred pain from the digastric muscle (Patient 1), of pulpectomized (Patient 2), and of pulpectomized pain (Patient 3) to illustrate referred, neuromodulatory, and neuropathic pain, respectively. The Patient 1 was advised muscle stretching and gentle massage of the trigger points, as well as pain relief using a nonsteroidal anti-inflammatory and the tricyclic antidepressant amitriptyline. The pain in Patient 2 was relieved completely by the tricyclic antidepressant amitriptyline. In Patient 3, the pain was controlled using either a continuous drip infusion of adenosine triphosphate or intravenous Mg2+ and lidocaine administered every 2 weeks. In each case of abnormal dental pain, the patient's diagnostic chart was used (Fig.2 and 3). Pain was satisfactorily relieved in all cases.

• The Korean Journal of Pain
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• 제27권2호
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• pp.103-111
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• 2014

Nefopam (NFP) is a non-opioid, non-steroidal, centrally acting analgesic drug that is derivative of the nonsedative benzoxazocine, developed and known in 1960s as fenazocine. Although the mechanisms of analgesic action of NFP are not well understood, they are similar to those of triple neurotransmitter (serotonin, norepinephrine, and dopamine) reuptake inhibitors and anticonvulsants. It has been used mainly as an analgesic drug for nociceptive pain, as well as a treatment for the prevention of postoperative shivering and hiccups. Based on NFP's mechanisms of analgesic action, it is more suitable for the treatment of neuropathic pain. Intravenous administration of NFP should be given in single doses of 20 mg slowly over 15-20 min or with continuous infusion of 60-120 mg/d to minimize adverse effects, such as nausea, cold sweating, dizziness, tachycardia, or drowsiness. The usual dose of oral administration is three to six times per day totaling 90-180 mg. The ceiling effect of its analgesia is uncertain depending on the mechanism of pain relief. In conclusion, the recently discovered dual analgesic mechanisms of action, namely, a) descending pain modulation by triple neurotransmitter reuptake inhibition similar to antidepressants, and b) inhibition of long-term potentiation mediated by NMDA from the inhibition of calcium influx like gabapentinoid anticonvulsants or blockade of voltage-sensitive sodium channels like carbamazepine, enable NFP to be used as a therapeutic agent to treat neuropathic pain.