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Identification of an effective and safe bolus dose and lockout time for patient-controlled sedation (PCS) using dexmedetomidine in dental treatments: a randomized clinical trial

  • Seung-Hyun Rhee;Young-Seok Kweon;Dong-Ok Won;Seong-Whan Lee;Kwang-Suk Seo
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.24 no.1
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    • pp.19-35
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    • 2024
  • Background: This study investigated a safe and effective bolus dose and lockout time for patient-controlled sedation (PCS) with dexmedetomidine for dental treatments. The depth of sedation, vital signs, and patient satisfaction were investigated to demonstrate safety. Methods: Thirty patients requiring dental scaling were enrolled and randomly divided into three groups based on bolus doses and lockout times: group 1 (low dose group, bolus dose 0.05 ㎍/kg, 1-minute lockout time), group 2 (middle dose group, 0.1 ㎍/kg, 1-minute), and group 3 (high dose group, 0.2 ㎍/kg, 3-minute) (n = 10 each). ECG, pulse, oxygen saturation, blood pressure, end-tidal CO2, respiratory rate, and bispectral index scores (BIS) were measured and recorded. The study was conducted in two stages: the first involved sedation without dental treatment and the second included sedation with dental scaling. Patients were instructed to press the drug demand button every 10 s, and the process of falling asleep and waking up was repeated 1-5 times. In the second stage, during dental scaling, patients were instructed to press the drug demand button. Loss of responsiveness (LOR) was defined as failure to respond to auditory stimuli six times, determining sleep onset. Patient and dentist satisfaction were assessed before and after experimentation. Results: Thirty patients (22 males) participated in the study. Scaling was performed in 29 patients after excluding one who experienced dizziness during the first stage. The average number of drug administrations until first LOR was significantly lower in group 3 (2.8 times) than groups 1 and 2 (8.0 and 6.5 times, respectively). The time taken to reach the LOR showed no difference between groups. During the second stage, the average time required to reach the LOR during scaling was 583.4 seconds. The effect site concentrations (Ce) was significantly lower in group 1 than groups 2 and 3. In the participant survey on PCS, 8/10 in group 3 reported partial memory loss, whereas 17/20 in groups 1 and 2 recalled the procedure fully or partially. Conclusion: PCS with dexmedetomidine can provide a rapid onset of sedation, safe vital sign management, and minimal side effects, thus facilitating smooth dental sedation.

Clinical Characteristics and Prognosis of Heat Stroke (열사병의 임상적 특징 및 예후에 관한 연구)

  • Park, Noh Han;Ryoo, Hyun Wook;Seo, Kang Suk;Park, Jung Bae;Chung, Jae Mung
    • Journal of Trauma and Injury
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    • v.19 no.2
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    • pp.113-120
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    • 2006
  • Purpose: The aim of this study was to evaluate the clinical characteristics of classic heat stroke in Korea and to identify factors of prognosis for heat stroke by comparing a survival group with a non-survival group. Methods: We retrospectively analyzed 27 patients with heat stroke who visited the Emergency Department of Kyungpook National University Hospital from March 2001 to February 2005. First, we divided the patients into two groups, the classic heat stroke group and the exertional heat stroke group, and compared them. Second, we compared the survival group with the non-survival group. Age, sex, cause, place where patients were found, underlying diseases, cooling time, performance of endotracheal intubation, initial Glasgow Coma Scale, initial vital sign, and laboratory findings were reviewed. Results: Five of 27 patients in heat stroke died. The classic heat stroke group had 20 patients. They were old and had more patients in the bathroom than the exertional heat stroke group had. The non-survival group showed lower blood pressure, lower initial GCS score, and higher respiratory rate than the survival group. In laboratory findings, the non-survival group also showed lower$HCO_3-$ level, lower albumin level, lower glucose level, more prolonged PT, and higher CK-MB level than the survival group. Delay in recognition of heat stroke and cooling were poor prognostic factors in heat stroke. Conclusion: The classic heat stroke group had patients who were old and found in the bathroom. Early recognition and treatment of heat stroke is important to reduce mortality. Cooling time, initial GCS score, mean arterial pressure, resipratory rate, $HCO_3-$, PT, CK-MB, and albumin seem to be meaningful when forming a prognosis for heat stroke patients.

Estimation of Nursing Cost for Hemodialysis Using RBRVS(Resource Based Relative Value Scale);Severe Hemodialysis Patients (자원기준 상대가치를 이용한 혈액투석실 간호원가 산정;중증 대상자를 중심으로)

  • Kim, Moon-Sil;Han, Su-Jung;Kim, Jung-A;Kim, Ji-Hyun
    • Journal of Korean Academy of Nursing Administration
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    • v.11 no.1
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    • pp.33-44
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    • 2005
  • Purpose: This study was aimed to estimate nursing cost for hemodialysis of tertiary hospitals using Resource Based Relative Value Scale(RVRBS). Method: First, we calculated nursing workload of the each hemodialysis-nursing behaviors compared with basic nursing behavior(check vital sign) for the most severe hemodialysis patients in general hospitals. Second, we measured each spent time according to each nursing behaviors. Third, we computed Resource Based Relative Value(RBRV) scores and nursing expenses of each 14 nursing behavior for hemodialysis. Finally, we estimated nursing cost of each hemodialysis-behavior for the most severe hemodialysis-patients in general hospitals. Result: The mean RBRV scores for each nursing behaviors were from 218.9 to 383.9 points. The highest RBRV socres were 383.9(Complication during hemodialysis). The Nursing behavior that spent the most time was "access the vascular( 31.7 minutes)". Nursing cost per hemodialysis for the patient with severe condition was estimated 63,455(won). Conclusion: Total average workload was 347.6 points and total spent time was 306.5 minutes for 14 hemodialysis nursing behaviors provided to severe patients. There were clear differences in nursing workload and cost according to patient's severity-mild, moderate and severe class.

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A Study of Faculty Practice for Clinical Teaching (임상실습 교육을 위한 간호학 교수의 실무참여에 관한 연구)

  • Kim Moon-Sil
    • The Journal of Korean Academic Society of Nursing Education
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    • v.1 no.1
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    • pp.5-16
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    • 1995
  • Nurse educators are being encouraged to intergrated the role of faculty practice into the role expectations of the education institutes. Schools of nursing are faced with challenge of the faculty who wishes to adopt facilitating practical role. Also directors of nursing department in hospitals point out the lack of competences for nursing care of new graduated nurse. This survey study was conducted to clarify the factors that faculty who engages on practice in the clinical teaching are to facilitate or inhibit. In this study, 55 head nurses of university hospital and 30 professors of nursing school were assigned to complete the questionnaire. Results of this study are as follows : 1) Head nurse : The most actively participated nursing activities in student's clinical teaching are medication, injection, vital sign checking and bed making. The problems of clinical leaching are lack of direct care of Professors, overloaded work of head nurses, passive learning attitudes of nursing students and less priority about clinical teaching of academic administrator's perception. 2) Nursing professor Facilitators of faculty practices are negative perception about clinical practice of both nursing professor and academic administrator. Inhibitors of faculty practice are negligence of the clinical teaching, lack of the practicing capability and lack of administration system on practical education by head of the school. There, following strategies are suggested for facilitating faculty practice : 1. Faculty practice focused on clinical teaching must be emphasized for academic administration. 2. Nurse educators must keep continuing clinical practice in their specific area. 3. Collaboration between school of nursing and hospital promotes effectiveness of the clinical practice for nursing students.

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A Case of Pyoderma Gangrenosum in Rheumotoid Arthritis Patient (류마티스 관절염 환자에서 발생한 괴저성 농피증 1예)

  • Ryu, Dong-Hwan;Kwon, Chang-Mo;Lee, Jung-Hun;Hong, Young-Hun;Lee, Choong-Ki
    • Journal of Yeungnam Medical Science
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    • v.20 no.1
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    • pp.79-84
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    • 2003
  • Pyoderma gangrenosum is uncommon neutrophilic dermatosis characterized by richness of the mature neutrophilic polynuclear dermal infiltrate. Pyoderma gangrenosum is associated with variable diseases, most commonly inflammatory bowel disease, hematological diseases, malignancies, but it is reported rarely in rheumatoid arthritis. We report a case of pyoderma gangrenosum in rheumoid arthritis patient. A 50-year-old woman admitted to our hospital due to painful pretibial ulcerative skin lesions. She had been treated as rheumatoid arthritis for 8 years. At admission, body temperature was $36.5^{\circ}C$ and other vital sign was unremarkable. Physical examination revealed right pretibial ulceration, multiple pustules on left pretibial area and both palms. Laboratory studies revealed WBC count 7,600/uL (neutrophils 60.3%, eosinophil 3.2%), hemoglobin 11.4 g/dL, platelet count 319,000/uL, ESR 65 mm/hour. Other lab findings were also unremarkable. Skin biopsy was done, which showed dense dermal infiltrate of neutrophils and wound culture were negative. By 8 weeks after systemic high dose corticosteroid (1 mg/kg/day), cyclosporine A (5 mg/kg/day), sulfasalazine 2 g therapy, symptoms and skin ulceration were being improved. Without skin relapse, she is followed up our hospital with low dose corticosteroid and sulfasalazine.

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A Clinical Study for the Effect of External Applications Containing Herbal Extracts on Mild Atopic Dermatitis Patients (경증의 아토피 환자에서 한약 추출물 함유 외용제에 대한 임상 연구)

  • Kang, Min-Seo;Kim, Jeung-Beum;Kim, Hee-Taek
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.27 no.3
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    • pp.40-55
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    • 2014
  • Objectives : The purpose of this study is to confirm the effects of external applications(CLANCHE SM A Clinic) containing herbal extracts on patient with atopic dermatitis. Methods : A total of 24 patients who visited Semyung Oriental Medical Center from January 15th, 2014 to February 20th, 2014 were included in the study. In this study, the patients were treated with external applications(CLANCHE SM A Clinic) containing herbal extracts. For 4 weeks of gross examination and instrumental assesment were made before and after the study. Results : 1. In the primary endpoint, SCORAD index showed a statistically significant decline. 2. In the secondary endpoint, index of skin hydration and index of TEWL showed statistical significance. 3. In the secondary endpoint, index of skin pH showed no statistically significant result. 4. To evaluate the safety of the products for the human body, vital sign check were conducted and showed no statistically significant result. And There were no severe adverse events during this study. Therefore, it is suggested that the safety of the products, if used for certain period, should be safe for the human body. 5. In global assesment of efficacy, both experimenter and subjects evaluated external applications were effective. Conclusions : According to the above experiments, it is suggested that external applications(CLANCHE SM A Clinic) containing herbal extracts should be effective for the atopic dermatitis.

A Study on the Performance Activities in Emergency Medical Technology Students Field Training (응급구조과 학생의 현장실습 수행활동 조사 연구)

  • Koh, Bong Yeun;Kwak, Min Chul;Sin, Hyun Nam
    • The Korean Journal of Emergency Medical Services
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    • v.3 no.1
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    • pp.55-64
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    • 1999
  • This study was conducted to acquire the basic materials for effective field training to identify performance activities of emergency medical technology students. The method used in the study was a descriptive survey using a skill checklist. The subjects for the study were 43 emergency medical technology students who were 2nd grade in D college. The collected data were analyzed using the SPSS computer program, yielding frequencies and percentage. The results of study were as follows; 1. In 'emergency treatment skill', 26.6% of subjects are revealed as 'performed' in 'ambulance practice' and 22.1% of subjects are revealed as 'performed' in 'clinical practice'. 2. In 'airway management', 41.9% of subjects are revealed as 'performed' in 'ambulance practice' and 14.1% of subjects are revealed as 'performed' in 'clinical practice'. 3. In 'oxygen therapy', 52.8% of subjects are revealed as 'performed' in 'ambulance practice' and 35.6% of subjects are revealed as 'performed' in 'clinical practice'. 4. In 'ventilation skill', 17.8% of subjects are revealed as 'performed' in 'ambulance practice' and 10.7% of subjects are revealed as 'performed' in 'clinical practice'. 5. In 'vital sign check', 61.1% of subjects are revealed as 'performed' in 'ambulance practice' and 56.3% of subjects are revealed as 'performed' in 'clinical practice'. 6. In 'patient assessment', 40.7% of subjects are revealed as 'performed' in 'ambulance practice' and 20.0% of subjects are revealed as 'performed' in 'clinical practice'. 7. In 'basic life support(CPR)', 1.7% of subjects are revealed as 'performed' in 'ambulance practice' and 11.9% of subjects are revealed as 'performed' in 'clinical practice'. 8. In 'airway obstruction', 6.4% of subjects are revealed as 'performed' in 'ambulance practice' and 1.1% of subjects are revealed as 'performed' in 'clinical practice'. 9. In 'electrical therapy', 0.7% of subjects are revealed as 'performed' in 'ambulance practice' and 20.0% of subjects are revealed as 'performed' in 'clinical practice'.

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A study on improving the surface structure of solar cell and increasing the light absorbing efficiency - Applying the structure of leaves' surface - (태양전지 텍스처 표면구조 개선 및 빛 흡수효율 향상에 관한 연구 - 식물 잎의 표면구조 적용 -)

  • Kim, Taemin;Hong, Joopyo
    • 한국신재생에너지학회:학술대회논문집
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    • 2010.11a
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    • pp.38.2-38.2
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    • 2010
  • Biomimetc is a new domain of learning that proposes a solution getting clues from nature. There seems to be a sign of this phenomenon in fields of Renewable Energy. Foe example, Wind power was imitate the whale's fin that was improve efficiency of generating energy. This study focused on the photovoltaic generation as the instance of applying biomimetic. Efficiency is the most important factor in field of Photovoltaic generation. When given solar cell taking the sun light, most important fields of the study are absorb more light and increase the quantity of generation. For improving efficiency, the solar cell were builded up textures of taking a pyramid form, such a surface structure taking a role for remaining the light. This effects do the role as increasing absorbing efficiency. Such phenomenon calls Light Trapping, locking up the light on the surface of solar cell for a long time. Light is a vital factor to plants in the nature. Plants grow up through the photosynthesis that absorbing light for growth and propagation. So, plants make a effort how can absorb more the light in poor surroundings. This study set up a goal that imitates the minute surface structure of plants and applies to the existing solar cells's surface structure, so it can improve the efficiency of absorbing light. We used Light Tools software analyzing geometrical optics to analyze efficiency about new designed textures on the computer. We made a comparison between existing textures and new designed textures. Consequently, new designed textures were advanced efficiency, absorbing rates of light increasing about 7 percent. In comparison with existing and new textures, advancing about 20 percent in the efficient aspect.

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Pilot Clinical Trial to Evaluate the Efficacy of Needle-Embedding Acupuncture Therapy at Gokji(LI11) on TEWL (곡지혈 매선침 시술이 경피수분 손실량에 미치는 영향)

  • Lee, Ho Chan;Jung, Mi Young;Choi, Jung Hwa;Jeong, Min Yeong;Park, Soo Yeon
    • Journal of Physiology & Pathology in Korean Medicine
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    • v.32 no.4
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    • pp.291-297
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    • 2018
  • The purpose of pilot clinical trial is to evaluate the efiicacy and safety of Needle-Embedding acupuncture therapy on TEWL(Transepidermal Water Loss) and Skin hydration. A total of 24 human who visited Dongshin Oriental Medical Center from December 1st, 2016 to July 31st, 2017 were included in the pilot clinical trial. Needle-Embedding acupuncture therapy performed at Gokji(LI11). We observed change of TEWL(Transepidermal Water Loss), Skin hydration before and after Needle-Embedding acupuncture therapy. In the primary endpoint, index of TEWL showed a statistically insignificant decline ($8.5{\pm}2.12{\rightarrow}7.8{\pm}1.53g/h/m^2$). Index of skin hydration showed a statistically significant result ($38.2{\pm}6.77{\rightarrow}36.8{\pm}6.64$). To evaluate the safety, Adverse events and Vital sign check were conducted and there were no problem. And when the physical response, self-awareness, skin system, musculoskeletal pain, and other abnormal responses were assessed 60 minutes and 24 hours and 7 days after Needle-Embedding acupuncture therapy at Gokji(LI11) for stability assessment, Adverse events disappeared during a pilot clinical trial. According to the above pilot clinical trial, it is suggested Needle-Embedding acupuncture therapy were effective for Skin moisturizing and safe.

The Effect of Respiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease - Preliminary Study - (만성 폐쇄성 폐질환 환자에 있어서 호흡근육 훈련의 효과에 관한 실험적 연구)

  • Kim Mae-Ja
    • Journal of Korean Academy of Nursing
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    • v.16 no.1
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    • pp.55-66
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    • 1986
  • The effect on strength and endurance training (SET) (2 patients) were compared with those of strength training(ST) (2 patients) in patients with-chronic obstructive pulmonary disease. The result of training was assessed by 4 tests: maximal inspiratory pressure(PImax), sustainable inspiratory pressure (SIP), maximal voluntary ventiiation(MVV) and bronchitis-emphysema symptom checklist(BESC). Measurements were repeated before and after training per week for 6 weeks. The SET group performed inspiratory muscle training, using a inspiratory muscle trainer 30 minutes per day, 6 days per week and performing endurance training-12-minute walking-2 days per week for 6 weeks, whereas the ST-only group trained for 30 minutes daily, 6 days per week using inspiratory muscle trainer. SET was no significant increase in exercise performance, whereas ST produced an increase in SIP and a decrease in BESC. There was significant change in BESC betweet the two groups. A simple at home training program using inspiartory muscle trainer was more effective than that of SET program in improving exercise performance of some patients with COPD.h COPD.

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