Intravenous Sedation in Dentistry

치과의사에게는 익숙하지 않은 정맥로 확보의 어려움으로 인하여 정주진정법은 치과영역에서 그렇게 각광을 받지 못해온 것이 사실이다. 그러나 최근 다양한 정주진정제, 여러가지 정주 장치 및 기법의 도입으로 치과영역에서도 정주진정법은 치과마취과의사, 구강악안면외과의사나 일부 개업의들을 중심으로 점차 활용도가 증가하고 있다. 이는 마취과영역에서 전신마취 시 흡입마취제 대신 정맥마취제만을 사용하여 장점을 극대화하려는 완전정맥마취(total intravenous anesthesia; TIVA)에 점차 관심이 고조되는 것과 밀접한 연관이 있는 것으로 생각된다. 또한 정주진정법은 여러 정주진정제의 약력학적 표준과 효과처농도 등의 약력학과 약동학적 이론들이 정립되고 있어 더욱 효율적이고 안전한 진정법으로 발전할 것이 예상된다

(The) cognitive performance in relation to motor function recovery in stroke patients

보건정책 및 관리학/석사[한글] 이 연구의 목적은 뇌졸중 환자의 지적상태가 포괄적인 재활치료후 운동기능회복에 미치는 효과를 알아보는데 있다. 연구대상은 연세대학교 의과대학 재활병원에 입원하였던 뇌졸중 환자 41명을 대상으로 하였으며, 연구기간은 1997년 9월 1일부터 1998년 5월 5일까지였다. 지적상태의 정도를 Mini-Mental State Examination(MMSE)으로 평가하였고, 운동기능회복은 Motor Assessment Scale(MAS)로 평가하였다. 자료분석은 SAS를 이용하여 일원분산분석, 짝비교 t검정, 피어슨 상관계수, 독립된 t검정 등으로 분석하였으며 결과는 다음과 같다. 1. 포괄적인 재활치료전·후의 운동기능회복에는 유의한 차이를 보였다. 2. 성별, 연령, 뇌졸중 원인, 마비측, 경직의 정도에 따른 치료전·후의 운동기능회복의 차이는 없었다. 그러나 치료 받은 기간에 따른 치료전·후에는 통계학적으로 유의한 차이를 보였다. 3. 지적상태의 정도에 따라 포괄적인 재활치료후 운동기능회복량 사이에는 유의한 차이를 보였다. 4. 지적상태 하부항목과 운동기능회복 사이의 상관관계에서는 지남력, 주의집중 및 계산, 언어기능 항목에서 순 상관관계가 있었다. 이상의 결과로 미루어 볼 때 지적상태는 뇌졸중 환자의 포괄적인 재활치료후 운동기능회복에 영향을 미치는 요소로 나타났으며, 향후 운동기능회복에 대한 질적평가와 지능검사를 동반한 지적상태 검사가 필요하리라고 사료된다. [영문] The objective of this study was to identify the effects of the cognitive performance of stroke patients on their motor function recovery after comprehensive rehabilitation management . The subjects of this study were 41 stroke in-patients of the Rehabilitation Hospital, College of Medicine, Yonsei University, hospitalized during the period from September 1, 1997 to May 5, 1998. The cognitive performance was measured using a Mini-Mental State Examination(MMSE) and the motor function recovery using Motor Assessment Scale(MAS). The data were analyzed by the paired t-test, independent t-test, a one way ANOVA, and Pearson's correlation coefficiency. The findings were as follows: 1. There was a significant difference found in the motor function recovery level after the comprehensive rehabilitation management. 2. There was no significant difference found in relation to sex, age, cause of stroke, laterality of paralysis and the level of spasticity. However, there was a big difference between pre- and post-treatment regarding the treatment period. 3. In line with the cognitive performance level, there was a significant difference found in the motor function recovery level after the comprehensive rehabilitation management. 4. The correlation between the elements of the cognitive performance and the motor recovery was found to be high in orientation, attention, calculation, and language. Those elements were expected to give larger effects on motor recovery after the comprehensive rehabilitation management. Based on this study, the cognitive performance level was found to play an important role in bringing effects on motor recovery after the comprehensive rehabilitation management of stroke patients. And the evaluation on the motor recovery based on quality would be also expected to be examined, as well as the cognitive performance level test accompanied by Intelligence Quality(IQ) test.restrictio

쥐의 신경집세포주 RT4-D6P2T에 대한 Bupivacaine의 유해효과에 관한 연구

Thesis(doctoral)--서울대학교 대학원 :치의학과 치과마취과학전공,2004.Docto

Propofol Patient-Controlled Sedation Using fm (B. Braun, Germany) Infusion Pump in Dental Patients-Preliminary Study

Background: Patient-controlled sedation (PCS) has been blown for a safe and effective sedative method on the same pharmacological concepts of patient-controlled analgesia. Many different kinds of infusion devices have been used but they often have too long nominal infusion rate and lockout time. fm (B. Braun, Germany) is a new PCA device with 999.9 ml/hr nominal infusion rate and minimum 1 min lockout time. In this study, the feasibility of propofol PCS using fm was examined in order to provide a safe satisfactory sedation for dental patients. Methods: Eleven healthy patients presenting for oral surgery were studied. Propofol PCS was performed using fm, which was set to deliver a bolus dose of 5 mg with 999.9 ml/hr nominal infusion rate and 1 min lockout time. Propofol loading dose was randomly assigned to a bolus dose 0, 2, and 3 (initial bolus). Patients were told to press the bolus button as often as they needed to relieve discomfort. Results: Total infused dose of propofol was mean 1.8 mg/kg/hr and D (Delivery)/A (Attempt) ratio was mean 72.8%. All patients was awake and there were no clinically significant intraoperative side effects during the sedation. Almost all patients were very satisfied with this type of PCS. Conclusion: Propofol PCS using fm infusion pump provided good conscious sedation for dental procedures

Anesthetic Management of the Dental Treatment in a Child with Liver Failure Scheduled for Liver Transplantation

Special anesthetic considerations were required for children with acute or chronic liver disease. We experienced a case of dental treatment to control infection under general anesthesia in the 2-year-old girl with liver failure. She was also scheduled for liver tansplantation. Her preanesthetic results of liver function test, electrolytes, and coagulation panel were unstable and out of normal ranges. Uneventful anesthetic induction using isoflurane and atracurium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 2 hours. Oozing from multiple extraction sites was sustained, so the transfusion of platelet concentration 1 units, fresh frozen plasma 1 unit, and packed red blood cell 1 unit was done. She was recovered without complication but was transferred to pediatric intensive care unit for wound care with her endotracheal tube kept. She was transferred to a ward without noticeable complications next day. So we report this successful case of anesthetic management for dental treatment in a child with liver failure

Intraoperative Anaphylatic Reaction to Enflurane -A Case Report -

Anaphylactic reactions to anesthetic drugs could potentially produce life-threatening immune-mediated crisis. Most published reports are associated with neuromuscular blockers and anaphylactic reactions to inhalation anesthetics are rare. A 25-year-old male patient with no significant medical history and no previous abnormal drug reaction was scheduled for orthognathic surgery under general anesthesia. After uneventful anesthetic induction and nasotracheal intubation, generalized urticaria and erythema were detected during the maintenance period with -enflurane. No severe changes of vital signs and no ventilation problem were accompanied. The operation was cancelled and the cutaneous lesions were faded away during the recovery with 100% . The skin-prick and intradermal tests showed that he was hypersensitive to all halogenated inhalation anesthetics including enflurane and not to intravenous anesthetics and neuromuscular blockers. The re-operation was safely carried out under intravenous anesthesia with propofol-fentanyl-vecuronium. We report this case of intraoperative anaphylactic reaction to enflurane with literature review

Postanesthetic Cerebral Infarction Following Neck Dissection

Postoperative stroke is uncommon even in elderly patients, who have a higher incidence of all types of postoperative complications. The mechanism of postoperative stroke is not certain, but can be explained by intravascular clottings originated from thrombus or embolus or by intracranial hemorrhage. In a 66-year-old male patient with current hypertension medication, who underwent both neck dissection for malignancy metastasis under general anesthesia, the left hemiparesis and delayed emergency were found postoperatively. After transferred to intensive care unit, he got the thrombolytic therapy and then the therapies to decrease the swelling of the brain on the diagnosis of cerebral infarction in the vascular distribution of the middle cerebral artery. A brain MRI definitely showed the midline deviation to the left of the right brain hemisphere due to the progressing edematous changes. As he got worse, the emergency neurosurgical operation was proposed but rejected by his family. He died at postoperative 3 days. In this hypertensive patient. perioperative stroke could be originated from the surgical stimuli on major vessels, which were inevitable in neck dissection during the operation. We report this case of the postoperative stroke, which could be highly possible to be associated with extensive head and neck surgery

General Anesthesia in a Child with Possible Spinal Muscular Atrophy Combined with Gingival Hyperplasia -A Case Report -

Spinal muscular atrophies are inherited neurodegenerative disorders affecting anterior hem cells. There are various problems, especially weakness of respiratory muscle and abnormal reaction to muscle relaxants during the general anesthesia. And gingival hyperplasia can make the proper airway management difficult. Experience with anesthetic management in a patient with spinal muscular atrophy combined with gingival hyperplasia has been very rare. We report the anesthetic experience of a wheel-chair-bound child, who underwent gingivectomy under general anesthesia. The child was safely managed with fibroscopic nasotracheal intubation under sevoflurane without muscle relaxants. Also, there was no deterioration of her underlying neurologic conditions

Comparative Study for the Anesthetic Efficacy between Articaine HCl and Lidocaine HCl during the Surgical Extraction of Bilateral Mandibular Impacted Third Molars

Background: Articaine, a new amide-type local anesthetic, was recently commercially available in Korea. The purpose of this study was to compare the anesthetic efficacy between articaine HCl and lidocaine HCl for the surgical extraction of bilateral mandibular impacted third molars. Patients and Methods: Forty young and healthy patients with bilateral impacted third molars were selected with permission. Randomly, one side of impacted third molar was operated under local anesthesia using 4% articaine and the other side under 2% lidocaine after 1 or 2 week recovery time. Intraoperative pain was evaluated via 0-10 cm visual analog scale (VAS) by both the patient and operator immediately after the operation. After 1 day and 7 days, the complications of local anesthesia were checked. Results: The pain VAS scores in articaine group, evaluated by both the patient and operator, were lower than those in lidocaine group, but they were not statistically significant (P = 0.44 and 0.54, respectively). The incidence of complications of local anesthesia between articaine and lidocaine was similar. Conclusion: In this study, articaine showed at least equal efficacy compared to lidocaine. The further dose-controlled study with more pharmacokinetic parameters will be needed

Anesthetic Management of the Oral and Maxillofacial Surgery in a Patient with End-Stage Renal Disease -A case report -

Patients in end-stage renal disease (ESRD) and chronic renal failure present a number of challenges to the anesthesiologist. They may be chronically iii and debilitated and have the potential for multiorgan dysfunction. A 65-year-old male patient with ESRD was scheduled for oral cancer surgery under general anesthesia. He was in regular hemodialysis three times a week and secondary hypertension with left ventricular hypertrophy was accompanied. He also had chronic metabolic acidosis and hyperkalemia. The day after hemodialysis, general anesthesia was carried out. Uneventful anesthetic induction using thiopental and vecuronium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 9 hours. During the anesthesia, he did not have any problem but persistently increasing serum potassium level. After anesthetic emergence, he was transferred to intensive care unit for mechanical ventilation. So we report this successful case of anesthetic management in a patient with ESRD for oral cancer surgery, which massive bleeding and long anesthetic time were inevitable in, from the preoperative preparation to anesthetic emergence