미국심장협회의 고급소생술의 최신 경향

감명환,Karm, Myong-Hwan 대한치과의사협회 2020 대한치과의사협회지 Vol.58 No.10

As a dentist, we should be prepared for emergencies that can occur at any time in dental practice. In addition, we must be able to provide first aid to patients with the latest knowledge when an emergency actually occurs. It has been revised every five years since the American Heart Association published advanced cardiovascular life support (ACLS) guidelines. The current final guideline is the 2015 version. It is expected that the 2020 version will be released around the winter of 2020. Therefore, at this point, the latest version (2015 ver.) will be important. Many changes were made from 1995 to 2015. I would like to summarize the parts of the revised parts that remain important.

새로운 진정진료지침

감명환 대한치과의사협회 2023 대한치과의사협회지 Vol.61 No.4

The American Dental Association states that the administration of local anesthesia, sedation and general anesthesia is an integral part of dental practice. It is significant that the American Dental Association defines sedation as well as local anesthesia as an integral part of dental practice. A new sedation guideline was published in Korea in 2022. This guideline has been published to help both anesthesiologists and non-anesthesiologists provide safe and effective moderate sedation to patients consistently, without limitation, at any medical institution. This guideline was developed with a focus on moderate sedation before, during, and after examinations or procedures for diagnostic and therapeutic purposes. Considering that there is a possibility of transition from moderate to deep sedation depending on the drug administered and the characteristics of each patient, the guideline also includes items for monitoring and coping with complications that may occur due to cardiovascular and respiratory depression. It consists of recommendations for a total of 15 PICO (participants, intervention, comparator, outcome) questions. Individual items covered include education on sedation providers, requirements for supplying drugs and equipment for sedation, selection of appropriate patients, referral to an anesthesiologist when performing sedation for high-risk patients, fasting before sedation, and typical use in adults and children. Comparison of drugs, monitoring of respiratory system, cardiovascular system, depth of sedation during sedation, measures to cope with respiratory complications during sedation in children, and discharge criteria after sedation are included.

1:200,000 에피네프린 리도카인의 소개

감명환(Myong-Hwan Karm) 대한치과의사협회 2018 대한치과의사협회지 Vol.56 No.1

INTRODUCTION The most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars. METHODS Sixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in two separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analogue scale pain scores obtained immediately after surgical extraction were primarily evaluated for the two groups receiving different epinephrine concentrations. Visual analogue scale pain scores obtained 2, 4, and 6 h after administering an anesthetic, onset and duration of analgesia, onset of pain, intraoperative bleeding, operator’s and participant’s overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the two groups. RESULTS There were no statistically significant differences between the two groups in any measurements except hemodynamic factors (P > .05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine (P ≤ 01). CONCLUSION The difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted mandibular third molars in hemodynamically unstable patients.

Air leakage due to the cuff hanging on the vocal cords during nasotracheal intubation: a case report

유승화,감명환,박세웅,김현정,서광석 대한치과마취과학회 2023 Journal of Dental Anesthesia and Pain Medicine Vol.23 No.1

Nasotracheal intubation is commonly performed under general anesthesia in oral and maxillofacial surgery. For the convenience of surgery, nasal Ring-Adair-Elwyn (RAE) tubes are mainly used. Because the nasal RAE tubes were bent in an “L” shape, the insertion depth was limited. Particularly, it is necessary to accurately determine the appropriate depth of the RAE tubes in children. Several types of nasal RAE tubes are used in the medical market, which vary in material and length. We performed endotracheal intubation using a nasal RAE tube for double-jaw surgery, but air leakage persisted even when the air pressure in the cuff was increased. When checked with a laryngoscope, it was confirmed that the tube was pushed out, and the cuff was caught on the vocal cords, causing air leakage. Since inserting the tube deeply did not solve the problem, replacing it with a nasal RAE tube (PolarTM, Preformed Tracheal Tube, Smith Medical, Inc., USA) did not cause air leakage; thus, we reported this case.

The predictive performance of infusion strategy nomogram based on a fluid kinetic model

최병문,감명환,정겨운,여영구,최규택 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.2

Background: In a previous study, fluid kinetic models were applied to describe the volume expansion of the fluid spaceby administration of crystalloid and colloid solutions. However, validation of the models were not performed, it is necessaryto evaluate the predictive performance of these models in another population. Methods: Ninety five consenting patients undergoing elective spinal surgery under general anesthesia were enrolled inthis study. These patients were randomly assigned to three fluid groups i.e. Hartmann’s solution (H group, n = 28), VoluvenⓇ (V group, n = 34), and HextendⓇ (X group, n = 33). After completion of their preparation for surgery, the patientsreceived a loading and maintenance volume of each fluid predetermined by nomograms based on fluid pharmacokineticmodels during the 60-minute use of an infusion pump. Arterial samples were obtained at preset intervals of 0, 10, 20, and30 min after fluid administration. The predictive performances of the fluid kinetic modes were evaluated using the fractionalchange of arterial hemoglobin. The relationship between blood-volume dilution and target dilution of body fluidspace was also evaluated using regression analysis. Results: A total of 194 hemoglobin measurements were used. The bias and inaccuracy of these models were -2.69 and35.62 for the H group, -1.53 and 43.21 for the V group, and 9.05 and 41.82 for the X group, respectively. The bloodvolumedilution and target dilution of body-fluid space showed a significant linear relationship in each group (P < 0.05). Conclusions: Based on the inaccuracy of predictive performance, the fluid-kinetic model for Hartmann’s solutionshowed better performance than the other models.

Patient-controlled sedation using remimazolam during third molar extraction: a case report

박경남,감명환,서광석,김현정,유승화 대한치과마취과학회 2024 Journal of Dental Anesthesia and Pain Medicine Vol.24 No.1

Dental sedation plays a pivotal role in alleviating patient anxiety during various procedures. Remimazolam, a benzodiazepine derivative, stands out for its distinctive attributes, particularly its rapid onset of sedation coupled with a brief duration, making it an invaluable option for dental applications. The patient was admitted for the extraction of impacted third molars via patient-controlled sedation and not only demonstrated stable vital signs but also expressed a high level of satisfaction with the procedure. An in-depth analysis of plasma remimazolam concentrations and changes in the Patient State Index revealed negative correlation patterns, highlighting the inherent potential of remimazolam in achieving effective sedation. This expanded research scope aims to provide a more nuanced understanding of the pharmacological responses to remimazolam in dental sedation scenarios. This case report offers valuable insights into the evolving landscape of dental sedation methodologies and paves the way for a more informed and evidence-based approach to the use of remimazolam in patient-controlled sedation.

Analysis of changes and trends in the use of sedatives in dental sedation using data from the National Health Insurance in Korea

김혁,류승화,감명환,서광석,김현정 대한치과마취과학회 2022 Journal of Dental Anesthesia and Pain Medicine Vol.22 No.1

Background: Although dental sedation helps control anxiety and pain, side effects and serious complications related to sedation are gradually increasing. Due to the introduction of new drugs and sedation methods, insurance rates, legal regulations, drugs, and methods used for dental sedation are inevitably changed. In the Republic of Korea, National Health Insurance is applied to all citizens, and this study investigated changes in the use of sedatives using this big data. Methods: This study used customized health information data provided by the Healthcare Insurance Review & Assessment Service of Korea. Among patients with a record of use of at least one of eight types of sedatives for dental sedation between January 2007 and September 2019 were selected; the data of their overall insurance claims for dental treatment were then analyzed. Results: The number of patients who received dental sedation was 786,003, and the number of dental sedation cases was 1,649,688. Inhalational sedation using nitrous oxide (N2O) accounted for 86.8% of all sedatives that could be claimed for drugs and treatment. In particular, it was confirmed that the number of requests for sedation using N2O sharply increased each year. Midazolam showed an increasing trend, and in the case of chloral hydrate, it gradually decreased. Conclusion: According to our analysis, the use of N2O and midazolam gradually increased, while the use of chloral hydrate gradually decreased.

The utilization of video laryngoscopy in nasotracheal intubation for oral and maxillofacial surgical procedures: a narrative review

유승화,박경남,감명환 대한치과마취과학회 2024 Journal of Dental Anesthesia and Pain Medicine Vol.24 No.1

The video laryngoscope is a novel instrument for intubation that enables indirect visualization of the upper airway. It is recognized for its ability to enhance Cormack-Lehane grades in the management of difficult airways. Notably, video laryngoscopy is associated with equal or higher rates of intubation success within a shorter time frame than direct laryngoscopy. Video laryngoscopy facilitates faster and easier visualization of the glottis and reduces the need for Magill forceps, thereby shortening the intubation time. Despite the advanced glottic visualization afforded by video laryngoscopy, nasotracheal tube insertion and advancement occasionally fail. This is particularly evident during nasotracheal intubation, where oropharyngeal blood or secretions may obstruct the visual field on the monitor, thereby complicating video laryngoscopy. Moreover, the use of Magill forceps is markedly challenging or nearly unfeasible in this context, especially in pediatric cases. Furthermore, the substantial blade size of video laryngoscopes may restrict their applicability in individuals with limited oral apertures. This study aimed to review the literature on video laryngoscopy, discuss its clinical role in nasotracheal intubation, and address the challenges that anesthesiologists may encounter during the intubation process.

Effects of Nefopam on Streptozotocin-Induced Diabetic Neuropathic Pain in Rats

남재식,정유선,감명환,안호수,심지훈,김진선,최성수,임정길 대한통증학회 2014 The Korean Journal of Pain Vol.27 No.4

Background: Nefopam is a centrally acting non-opioid analgesic agent. Its analgesic properties may be related to the inhibitions of monoamine reuptake and the N-methyl-D-aspartate (NMDA) receptor. The antinociceptive effect of nefopam has been shown in animal models of acute and chronic pain and in humans. However, the effect of nefopam on diabetic neuropathic pain is unclear. Therefore, we investigated the preventive effect of nefopam on diabetic neuropathic pain induced by streptozotocin (STZ) in rats. Methods: Pretreatment with nefopam (30 mg/kg) was performed intraperitoneally 30 min prior to an intraperitoneal injection of STZ (60 mg/kg). Mechanical and cold allodynia were tested before, and 1 to 4 weeks after drug administration. Thermal hyperalgesia was also investigated. In addition, the transient receptor potential ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) expression levels in the dorsal root ganglion (DRG) were evaluated. Results: Pretreatment with nefopam significantly inhibited STZ-induced mechanical and cold allodynia, but not thermal hyperalgesia. The STZ injection increased TRPM8, but not TRPA1, expression levels in DRG neurons. Pretreatment with nefopam decreased STZ-induced TRPM8 expression levels in the DRG. Conclusions: These results demonstrate that a nefopam pretreatment has strong antiallodynic effects on STZ-induced diabetic rats, which may be associated with TRPM8 located in the DRG.

Anesthetic management for separation of thoracopagus twins with complex congenital heart disease -a case report-

서미숙,정인선,감명환,오지미,신원정 대한마취통증의학회 2015 Korean Journal of Anesthesiology Vol.68 No.3

Although thoracopagus twins joined at the upper chest are the most common type of conjoined twins, the separation surgery in these cases has a higher mortality rate. Here, we describe an anesthetic management approach for the separation of thoracopagus conjoined twins sharing parts of a congenitally defective heart and liver. We emphasize the importance of vigilant intraoperative hemodynamic monitoring for early detection of unexpected events. Specifically, real-time continuous monitoring of cerebral oximetry using near-infrared spectroscopy allowed us to promptly detect cardiac arrest and hemodynamic deterioration.