치과시술에 사용되는 국소마취제

김철홍,윤지영,Kim, Cheul Hong,Yoon, Ji Young 대한치과마취과학회 2013 Journal of Dental Anesthesia and Pain Medicine Vol.13 No.3

Local pain management is the most critical aspect of patient care in dentistry. Local anesthesia is a reversible blockade of nerve conduction in an applied area that produces loss of sensation. The chemical agents used to produce local anesthesia stabilize neuronal membranes by inhibiting the ionic fluxes required for the propagation of neural impulses. Proper local anesthesia permits the dental surgeon to perform the necessary surgical procedure in a careful, gentle fashion that will be less stressful for both the operator and the patient. The improvements in agents for local anesthesia are probably the most significant advances that have occurred in dental science. Today's anesthetics are safe, effective, and can be administered with insignificant soft tissue damage and minimal concerns for allergic reactions. This article reviews the widely used local anesthetic agents for obtaining local anesthesia, and also discusses some frequently seen complications.

마취유도시 Desflurane의 효과

김철홍,Kim, Cheul-Hong 대한치과마취과학회 2011 Journal of Dental Anesthesia and Pain Medicine Vol.11 No.1

Background: There is controversy regarding the relative perioperative benefits of desflurane when used for induction of anesthesia. Inhalation induction with desflurane alone causes adverse airway events, such as coughing, bronchospasm, laryngospasm, and copious secretion of varying severity. The aim of this study was to determine whether desflurane minimize cardiovascular activation during induction. Methods: Sixty ASA I and II patients were randomized to receive 1 MAC or 1.5 MAC of desflurane during manual vernilation or not. Patients received propofol (2 mg/kg) to induce loss of consciousness (LOC). Rocuronium (0.8 mg/kg) was given at LOC and the trachea was intubated after 90 seconds of manual breathing support with or without inhaled anesthetics. Vital signs and adverse airway events were recorded until 10 minutes post-intubation. Results: A significant increase in blood pressure and heart rate were seen in no desflurane group. The stable vital signs were seen in desflurane groups. The adverse airway events were increased in 1.5 MAC group but 1 MAC group. Conclusions: Desflurane was able to be stable blood pressure and heart rate at 1 MAC but adverse airway events were increased at 1.5 MAC of desflurane.

치과시술을 위한 정주진정

김철홍(Cheul Hong Kim),윤지영(Ji Young Yoon) 대한치과의사협회 2013 대한치과의사협회지 Vol.51 No.7

Apprehension and phobia regarding dental procedures are represent the most common deterrents in patients seeking dental care and very common. For these individuals, and others who cannot cooperateduring care, procedural sedation may permit completion of intraoralprocedures. In mostcases, the level of sedation may be kept at minimal to moderate levels permitting patient maintenance of their airway patency and ventilation. Unlike many medical procedures, the majority of dental procedures, no matter the depth of sedation, are performed in the presence ofcomplete analgesia provided by local anesthesia. Therefore, the goal of procedural sedation is to primarily suppress patient fear and apprehensionand gain cooperation. Any issues regarding actual pain are usually limited to that produced by the local anesthetic injections or, rarely, theextent of the procedure. For the extremely phobic patient, however, allaying apprehension may be very challenging. Intravenous titration of sedative drugs is the most effective route of administration to achieve this goal but requires advanced training beyond that provided in undergraduate training.

덱스메데토미딘의 임상적인 사용

윤지영,김철홍,Yoon, Ji Young,Kim, Cheul Hong 대한치과마취과학회 2013 Journal of Dental Anesthesia and Pain Medicine Vol.13 No.4

Dexmedetomidine is a potent alpha-2-adrenergic agonist, more selective than clonidine, with widespread actions on the mammalian brain. A large body of recent work supports its analgesia and sympatholytic properties. Dexmedetomidine is a useful medication with many clinical applications. The medication has shown efficacy in decreasing the need for opioids, benzodiazepines, propofol, and other sedative medications. Dexmedetomidine has been used effectively for sedation during invasive procedures and in the ICU. Short-term sedation has been shown to be safe in studies, although hypotension and bradycardia are the most significant side effects. Dexmedetomidine is emerging as an effective therapeutic agent in the management of a wide range of clinical conditions with an efficacious, safe profile.

혈관미주신경실신의 새로운 기전 -삼차신경-심장반사-

윤지영,김철홍,Yoon, Ji Young,Kim, Cheul Hong 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.3

A vasovagal reaction is defined as the 'development of hypotension and bradycardia associated with the typical clinical manifestations of pallor, sweating and weakness'. The most profound degree of vasovagal reaction results in fainting or syncope. Incidence of vasovagal reactions in the local anesthetic department of a dental hospital is around 2%. The pathophysiology of the hypotension/bradycardia reflex responsible for vasovagal syncope is not completely understood. Central as well as peripheral mechanisms have been implicated in its pathogenesis: however their relative contribution is not fully elucidated. Recently, trigeminocardiac reflex, previously known as oculocardiac reflex, may serve as syncope. The management of vasovagal syncope is evolving. Non-pharmacological treatment options are a fundamental first step of all treatment pathways. In this article, we would like to review new mechanism of vasovagal syncope and hope to be of help to manage the syncopal patients.

전신마취를 시행한 구강외과 환자에서 어려운 기관내삽관: 후향적 연구

권오선,김철홍,Kwon, O-Seon,Kim, Cheul-Hong 대한치과마취과학회 2008 Journal of Dental Anesthesia and Pain Medicine Vol.8 No.2

Background: This retrospective study aims to describe the airway management and to search predictive parameter for difficult intubation in 700 patients undergoing oromaxillary surgery. Methods: The medical records of 700 patients undergone oromaxillary surgery were reviewed for airway management during perioperative period. The cases of difficult intubation were selected and those radiologic findings were reviewed. The mandibular depth (MD), mandibular length (ML), thyromental distance (TMD) were measured. Results: In 41 cases difficult intubation were recorded in anesthetic record. The grade of Cormack and Lehane was III in 36 patients and IV in 5 cases. The MD of difficult intubation cases was $4.2{\pm}3.2\;cm$. The ML of difficult intubation cases was $10.1{\pm}3.8\;cm$. The TMD of difficult intubation cases was $5.9{\pm}4.3\;cm$. Under the fiberoptic guided awake intubation was undertaken in 75 patient. In none of the cases was failed nasotracheal intubation. Conclusions: The patients undergoing oromaxillar surgery have a potentially difficult airway but, if managed properly during perioperative preiod, morbidity and mortality can be reduced or avoided. The radiologic findings were poor predict for difficult intubation. The fiberoptic guided awake intubation is a safe alternative to direct laryngoscopic intubation.

술후 발생한 기관 삽관성 육아종의 임상적 연구

이재열,김용덕,김철홍,김종렬,Lee, Jae-Yeol,Kim, Yong-Deok,Kim, Cheul-Hong,Kim, Jong-Ryoul 대한악안면성형재건외과학회 2007 Maxillofacial Plastic Reconstructive Surgery Vol.29 No.5

Post-intubation granuloma of the larynx is a rare complication of general inhalation anesthesia, which is associated with direct mechanical irritation of laryngeal mucosa from trauma, prolonged period of endotracheal intubation, multiple intubations and endotracheal movement. This study was performed retrospectively to evaluate symptoms, incidence, duration and site for prevention of the intubation granuloma. The authors investigated 16 patients of intubation granuloma among 719 patients during 1 year period from August, 2005 to July, 2006 at the Department of Oral & Maxillofacial Surgery, Pusan National University Hospital. The results were as follows. 1. The incidence was 16/719 cases(2.2%) 2. The female to male ratio was 7:1 3. Hoarseness was the main symptom 4. Most cases occurred after 2-jaw orthognathic surgery.

유도 저혈압하 양악 교정술 시 Nicardipine과 Remifentanil의 혈역학적 비교

김은수,황부영,김철홍,Kim, Eun-Soo,Hwang, Boo-Young,Kim, Cheul-Hong 대한치과마취과학회 2010 Journal of Dental Anesthesia and Pain Medicine Vol.10 No.2

Background: Controlled hypotension is used to reduce bleeding and improve surgical conditions during surgery. Nicardipine and remifentanil have been used to induce controlled hypotension in healthy patients. This study compared controllability of nicardipine and remifentanil on hemodynamic stability during controlled hypotension. Methods: Forty healthy patients scheduled for orthognathic two jaw surgery were randomly allocated to nicardipine (group N) and remifentanil (group R) group. After induction of anesthesia, group N (n = 20) was infused with nicardipine to induce hypotension and group R (n = 20) was infused with remifentanil. Mean arterial pressure (MAP) and heart rate (HR) were measured over 5 minute interval. Surgical field rating and blood loss were measured after surgery. Results: HR was lower in group R than group N. MAP was maintained at 50-60 mmHg during controlled hypotension but the fluctuation of blood pressure and HR were more frequent in group N than group R. There were no significant differences in the surgical field rating and blood loss between the groups. Conclusions: Nicardipine and remifentanil enabled controlled hypotension and provided good surgical conditions, but the fluctuation of hemodynamic parameters was more frequent in nicardipine group.

비출혈 환자에서 굴곡성 기관지를 이용한 맹목적 기관내 삽관

이승현,윤지영,김철홍,Lee, Seung-Hyun,Yoon, Ji-Young,Kim, Cheul-Hong 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.2

Nasotracheal intubation is an essential procedure during general anesthesia for dental treatment. Fiberoptic intubation is best accomplished by those who perform it as part of their daily practice. But nasal approach of fiberoptic intubation has some complications such as epistaxis and laryngeal injury. Especially, epistaxis is common and it make fiberoptic intubation because of limited view. When the epistaxis obstruct the field of vision we have to withdraw the fiberoptic bronchoscope and consider the other method for securing the airway. We succeeded in securing the airway of patient who had epistaxis during the fiberoptic nasotracheal intubation without withdrawing the fiberoptic bronchoscope. We used blind intubation guided by light source placed the tip of fiberoptic bronchscope applied to lightwand intubation.

상하악 치조골 결손 환자에서 전신 마취 전 발생한 혈관미주신경성 실신

윤상용,윤지영,김철홍,Yoon, Sang-Yong,Young, Yoon-Ji,Kim, Cheul-Hong 대한치과마취과학회 2011 Journal of Dental Anesthesia and Pain Medicine Vol.11 No.2

Vasovagal syncope accounts for the majority of adverse events that occur in dental offices and is normally related to emotional or somatic factors. The factors trigger intense parasympathetic state, leading to bradycardia and hypotension. We experienced a case of vasovagal syncope just before general anesthesia. A 49-year-old woman with alveolar bone deficiency on maxilla and mandible was planned to undergo an alveolar bone graft with mandibular body under general anesthesia. She didn't have any histories of disease, medication or syncope. Though she showed a little anxiety from admission, she had no pre-operative medication. After she was guided to the operating room, she had signs and symptoms of vasovagal syncope without any prodromes. The patient was resuscitated soon only by the conservative treatment and was operated under general anesthesia.