Efficacy of intraosseous saline injection for pain management during surgical removal of impacted mandibular third molars: a randomized double-blinded clinical trial

Jawahar Babu. S,Naveen Kumar Jayakumar,Pearlcid Siroraj The Korean Dental Society of Anesthsiology 2023 Journal of Dental Anesthesia and Pain Medicine Vol.23 No.3

Background: Surgical extraction of impacted mandibular third molars is the most common procedure performed by oral surgeons. The procedure cannot be performed effectively without achieving profound anesthesia. During this procedure, patients may feel pain during surgical bone removal (at the cancellous level) or during splitting and luxation of the tooth, despite administration of routine nerve blocks. Administration of intraosseous (IO) lignocaine injections during third molar surgeries to provide effective anesthesia for pain alleviation has been documented. However, whether the anesthetic effect of lignocaine is the only reason for pain alleviation when administered intraosseously remains unclear. This conundrum motivated us to assess the efficacy of IO normal saline versus lignocaine injections during surgical removal of impacted mandibular third molars. The aim of this study was to assess the efficacy of IO normal saline as a viable alternative or adjunct to lignocaine for alleviation of intraoperative pain during surgical removal of impacted mandibular third molars. Methods: This randomized, double-blind, interventional study included 160 patients who underwent surgical extraction of impacted mandibular third molars and experienced pain during surgical removal of the buccal bone or sectioning and luxation of the tooth. The participants were divided into two groups: the study group, which included patients who would receive IO saline injections, and the control group, which included patients who would receive IO lignocaine injections. Patients were asked to complete a visual analog pain scale (VAPS) at baseline and after receiving the IO injections. Results: Of the 160 patients included in this study, 80 received IO lignocaine (control group), whereas 80 received IO saline (study group) following randomization. The baseline VAPS score of the patients and controls was 5.71 ± 1.33 and 5.68 ± 1.21, respectively. The difference between the baseline VAPS scores of the two groups was not statistically significant (P > 0.05). The difference between the numbers of patients who experienced pain relief following administration of IO lignocaine (n=74) versus saline (n=69) was not statistically significant (P > 0.05). The difference between VAPS scores measured after IO injection in both groups was not statistically significant (P >0.05) (1.05 ± 1.20 for the control group vs. 1.72 ± 1.56 for the study group) Conclusion: The study demonstrates that IO injection of normal saline is as effective as lignocaine in alleviating pain during surgical removal of impacted mandibular third molars and can be used as an effective adjunct to conventional lignocaine injection.

Surgical site infection after colorectal surgery according to the main anesthetic agent: a retrospective comparison between volatile anesthetics and propofol

나효석,구본욱,심준보,신현정,김덕우,강성범,도상환 대한마취통증의학회 2016 Korean Journal of Anesthesiology Vol.69 No.4

Background: Anesthetic agents used for general anesthesia are emerging possible influential factors for surgical site infection (SSI). In this retrospective study, we evaluated the incidence of SSI after colorectal surgery according to the main anesthetic agents: volatile anesthetics vs. propofol. Methods: A total 1,934 adult patients, who underwent elective colorectal surgery under general anesthesia between January 2011 and December 2013, were surveyed to evaluate the incidence of SSI: 1,519 using volatile anesthetics and 415 using propofol for main anesthetic agents. Patient, surgery, and anesthesia-related factors were investigated from all patients. Propensity-score matching was performed to reduce the risk of confounding and produced 390 patients in each group. Results: Within the propensity-score matched groups, the incidence of SSI was higher in the volatile group compared with the propofol group (10 [2.6%] vs. 2 [0.5%], OR = 5.0 [95% CI = 1.1–22.8]). C-reactive protein was higher in the volatile group than in the propofol group (8.4 ± 5.6 vs. 7.1 ± 5.3 mg/dl, P = 0.001), and postoperative white blood cells count was higher in the volatile group than in the propofol group (9.2 ± 3.2 × 103/μl vs. 8.6 ± 3.4 × 103/μl, P = 0.041). Conclusions: The results of this study suggest that intravenous anesthesia may have beneficial effects for reducing SSI in colorectal surgery compared to volatile anesthesia.

Improvement of Congenital Muscular Torticollis with Mild Symptoms in Non-Treated Adult after Simple Surgical Myotomy of Sternocleidomastoid Muscle under Local Anesthesia

조영후,박동하,이일재,박명철 대한두개안면성형외과학회 2015 Archives of Craniofacial Surgery Vol.16 No.2

In adult congenital muscular torticollis (CMT) patients, physical therapy is not as effective because the development of sternocleidomastoid muscle (SCM) muscle is complete. While surgical release can address CMT in adult patients, the risk of general anesthesia and visible postoperative scar is a concern, expecially in patients with mild symptoms. In this paper, we report our experience in treating such patients with minimal-incision myotomy under local anesthesia. A review was performed for all adult patients who had undergone the simple myotomy procedure. Surgical indication was reserved for patients with mild fibrotic band in the SCM muscle with minimal lengthdiscrepancybetween the muscles. All patients had recognizable head tiltand palpation of fibrotic band on affected side of the neck. Surgical details are described in the main body of text. Three female patients had undergone the procedure. Torticollis was resolve in all patients with complete restoration of ranage of motion. There were no postoperative complications, and patient satisfaction was high. We have reported three cases of mild CMT in adult female patients, who had undergone minimal-incision myotomy under local anesthesia. Outcomes were satisafactory with no morbidity to report. With careful patient selection, this method offers an alternate treatment option for adult CMT patients with mild symptoms.

Bilateral tension pneumothorax during endoscopic submucosal dissection under general anesthesia diagnosed by point-of-care ultrasound - A case report -

오석경,Cho Seung Inn,Won Young Ju,Yun Jin Hee 대한마취통증의학회 2021 Anesthesia and pain medicine Vol.16 No.2

Background: Endoscopic submucosal dissection has become popular. However, this can cause serious complications. In this case, esophageal perforation caused bilateral tension pneumothorax.Case: A 60-year-old man with esophageal adenoma underwent endoscopic submucosal dissection under general anesthesia. The peak airway pressure was 25 cmH2O after induction but abruptly increased to 40 cmH2O after 30 min. Respiratory sounds were barely heard. The lack of lung sliding in either (right-dominant) lung on ultrasound. Within minutes, oxygen saturation and systolic blood pressure decreased to 52% and 70 mmHg. Emergent needle thoracostomy, followed by chest tube insertion, was performed on right chest and his vital signs stabilized. Upon transfer to intensive care unit, oxygen saturation and blood pressure decreased again; therefore, a left chest tube was inserted. Conclusions: Pneumothorax due to esophageal perforation can lead to life-threatening tension pneumothorax. Anesthesiologists should be aware of the risks and emergency treatment. Ultrasound can be useful for immediate bedside patient-care decisions.

Comparison of Clonidine and Midazolam Premedication Before Endoscopic Sinus Surgery: Results of Clinical Trial

Katarzyna Wawrzyniak,Krzysztof Kusza,Jacek B. Cywinski 대한이비인후과학회 2014 Clinical and Experimental Otorhinolaryngology Vol.7 No.4

Objectives. Premedication with clonidine has been found to reduce the bleeding during endoscopic sinus surgery (ESS), therefore lowering the risk of surgical complications. Premedication is an essential part of pre-surgical care and can potentially affect magnitude of systemic stress response to a surgical procedure. The aim of this study was to compare the efficacy of premedication with clonidine and midazolam in patients undergoing sinus surgery. Methods. Forty-four patients undergoing ESS for chronic sinusitis and polyp removal were enrolled and randomly assigned to receive either oral clonidine or midazolam as a premedication before receiving propofol/remifentanil total intrave- nous anesthesia. The effect of this premedication choice on anesthetic requirements, intraoperative hemodynamic profile, preoperative anxiety and sedation as well as postoperative pain and shivering were examined in each pre- medication group. Results. Total intraoperative remifentanil requirement was lower in the clonidine group as compared to the midazolam group 503.2±147.0 µg vs. 784.5±283.8 µg, respectively (P<0.001). There was no difference between groups in re- quired induction dose of propofol, level of preoperative anxiety, level of sedation and postoperative shivering. Intra- operative systemic blood pressure and heart rate response had a more favorable profile in patients premedicated with clonidine. Postoperative pain assessed by visual analogue scale for pain was lower in the clonidine group compared with to the midazolam premedication group. Conclusion. Premedication with clonidine provides better attenuation of hemodynamic response and reduction of intraop- erative remifentanil requirements in patients undergoing ESS. Postoperative pain seems to be better controlled after clonidine premedication as well.

만성 신부전 환자의 상완 동-정맥루 형성술식을 위한 경추 경막외마취

유승화(Seung Hwa Ryoo),김태준(Tae Joon Kim),옥시영(Si Young Ok),김상호(Sang Ho Kim),박욱(Wook Park),송단(Dan Song),문철(Chul Moon) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6

Purpose: Cervical epidural analgesia is used for pain control in head and neck or upper arm. But it is not commonly used for the purpose of pure regional anesthesia for upper arm surgery. Therefore, we investigated the usefulness of cervical epidural anesthesia (CEA) as a method of regional anesthesia for arteriovenous bridge graft (AVBG) for hemodialysis at upper arm and evaluated the effects of CEA on hemodynamics and respiration. Methods: One hundred-fifty chronic renal failure patients scheduled for AVBG were randomly assigned. In the sitting position, an epidural catheter was inserted at C6-7 or C7-T1 and 15 ml of 0.375% ropivacaine with fentanyl 20㎍ was injected. Analgesic level, blood pressure and heart rate were measured at 5-minute intervals after injection of the drug. Arterial blood sampling was taken for aBGA before and twenty minutes after CEA. Results: Average anesthetic dermatomalsensory levels were C3.4±1.2∼T5.7±2.8. During surgery, hypotension was noted in 49% of patients. It was treated with ephedrine or phenylephrine i.v. Baseline PaCO₂ changed from 42.4±2.9 ㎜Hg to 44.6±3.6 ㎜Hg. Conclusion: The above results suggest that CEA is suitable for AVBG at upper arm as a regional anesthesia.

Feasibility of Surgical Treatment for Laryngomalacia Using the Spontaneous Respiration Technique

차현경,이도영,김은희,이지현,장영은,김희수,권성근 대한이비인후과학회 2021 Clinical and Experimental Otorhinolaryngology Vol.14 No.4

Objectives. In this study, we review our institutional experience with pediatric laryngomalacia (LM) and report our experiences of patients undergoing supraglottoplasty using the spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen (STRIVE Hi) technique. Methods. The medical records of 29 children with LM who visited Seoul National University Hospital between January 2017 and March 2019 were retrospectively reviewed. Surgical management was performed using the STRIVE Hi technique. Intraoperative findings and postoperative surgical outcomes, including complications and changes in symptoms and weight, were analyzed. Results. Of the total study population of 29 subjects, 20 (68.9%) were female. The patients were divided according to the Onley classification as follows: type I (n=13, 44.8%), II (n=10, 34.5%), and III (n=6, 20.7%). Twenty-five patients (86.2%) had comorbidities. Seventeen patients (58.6%) underwent microlaryngobronchoscopy under STRIVE Hi anesthesia. Four patients with several desaturation events required rescue oxygenation by intermittent intubation and mask bagging during the STRIVE Hi technique. However, the procedure was completed in all patients without any severe adverse effects. Overall, 15 children (51.7%) underwent supraglottoplasty, of whom 14 (93.3%) showed symptom improvement, and their postoperative weight percentile significantly increased (P=0.026). One patient required tracheostomy immediately after supraglottoplasty due to associated neurological disease. Conclusion. The STRIVE Hi technique is feasible for supraglottoplasty in LM patients, while type III LM patients with micrognathia or glossoptosis may have a higher risk of requiring rescue oxygenation during the STRIVE Hi technique.

Comparison of the clinical performance of the i-gelTM, LMA SupremeTM, and Ambu AuraGainTM in adult patients during general anesthesia: a prospective and randomized study

Lakshmi Tejashri Chinthavali,Tiwari Tanmay,Agrawal Jyotsna,Kapoor Rajni,Vasanthakumar Vikrannth 대한마취통증의학회 2022 Korean Journal of Anesthesiology Vol.75 No.4

Background: Supraglottic airway devices (SADs) are routinely used for securing the airway. In this study, the clinical performance of three SADs in adult patients under general anesthesia was compared.Methods: American Society of Anesthesiologists physical status I-III subjects were randomly assigned to the i-gelTM (I), LMA SupremeTM (L), or Ambu AuraGainTM (A) group (30 per group). The primary objective of this study was to compare insertion times. Additionally, the ease of insertion, number of attempts, oropharyngeal leak pressure (OLP), airway maneuver requirement, difficulty with gastric tube placement, and complications were assessed.Results: Demographic data did not differ between the groups. Group I (16.9 ± 4.9 s) had a significantly shorter time of insertion than Group L (19.6 ± 5.2 s) and Group A (22.1 ± 5.7 s) (P = 0.001). The OLP for Group A (29.8 ± 3.0 cmH2O) was higher than those for Group L (24.1 ± 6.3 cmH2O) and Group I (9.4 ± 6.1 cmH2O) (P < 0.001). The number of insertion attempts (P = 0.232), ease of insertion (P = 0.630), airway maneuver requirement (P = 0.585), difficulty with gastric tube placement (P = 0.364), and complications (P = 0.873) were not significantly different between the groups.Conclusions: All three devices are convenient and effective for airway management in adults under general anesthesia. However, the shorter insertion time required for the i-gel may make it more suitable for resuscitation and emergencies, while aspiration risk may be reduced with the Ambu AuraGain, given its high OLP.

비강수술 후 구강간호 방법에 따른 갈증과 구강상태 효과 비교: 냉수 거즈 활용 구강 내 닦아주기와 냉수 거즈 물려주기

구안나,유미,김영진,박수연,백경희,김태희 한국간호교육학회 2022 한국간호교육학회지 Vol.28 No.3

Purpose: This study aimed to compare the effects of oral swab and non-swab using cold water gauze on patients’ thirst and oral status following nasal surgery under general anesthesia. Methods: A non-equivalent control group was applied. Participants were divided into a control group (n=30) that was treated by cared for with cold water gauze application without oral swab and an experimental group (n=29) that was treated cared for with oral swab using cold water gauze after nasal surgery at the G University Hospital in Korea. Data were collected from May 14, 2020, to April 30, 2021, and analyzed using descriptive statistics, a chi-squared test, independent t-test, Wilcoxon signed-ranks test, and Mann-Whitney test. Results: The results showed no significant differences between the two groups in thirst (U=-0.04, p=.693) and overall oral condition (U=-0.34, p=.813) after the intervention. However, participants’ thirst and oral condition were significantly improved in each group after intervention. Conclusions: It was confirmed that both oral care methods reduced thirst and improved oral condition after nasal surgery. These findings indicate the need for intervention for patients’ thirst and oral condition after nasal surgery. Furthermore, they show that these oral care protocols can be used as a safe and effective nursing intervention for patients who undergo nasal surgery under general anesthesia.

Prediction of Surgical Anesthesia in Medetomidine/Tiletamine/ Zolazepam Anesthetized Dogs using Electroencephalography

장환수,김정은,권영삼,이만기,장광호,임재현 한국임상수의학회 2010 한국임상수의학회지 Vol.27 No.5

Changes of electroencephalogram (EEG), mean arterial blood pressure (MAP) and heart rate under surgical anesthesia were investigated in medetomidine (MED) and tiletamine/zolazepam (ZT)-anesthetized dogs. To determine the level of surgical anesthesia, pedal withdrawal reflex was regularly tested after ZT injection. The first time point without pain response was regarded as the beginning of surgical anesthesia (SSA). After SSA, the first time point showing positive pain response was considered the end of surgical anesthesia (ESA). Comparing the control, an additional significant decrease of δ2 and α2 was observed at SSA. Comparing the control, δ2 was significantly decreased at ESA. Significant reductions of MAP were observed at pre-ESA and ESA. Heart rate significantly decreased in all stages. These results suggest that δ2 band power is a valuable parameter for correlating surgical anesthesia in dogs anesthetized with MED and ZT.