Clinico-statistical Analysis of Cooperation and Anesthetic Induction Method of Dental Patients with Special Needs

Background: This study aimed to evaluate the cooperative levels of dental patients requiring general anesthesia during dental treatments. Anesthetic induction methods for patients were also recorded and analyzed using descriptive statistics. Methods: Total 566 patients who visited Seoul National University Dental Hospital Clinic for Persons with Disabilities were reviewed on pre-anesthetic review and anesthesia records. The cooperative levels of patients were graded by 4 levels and induction methods used for the patients during general anesthesia application were analyzed. Results: More than half of patients(55.8%) were willing to receive the anesthetic induction(cooperative level 1), 18.6% were minimally cooperative(level 2), 20.8% needed physical restraint prior to induction(level 3), and 4.8% was poorly cooperative and induction procedure was performed under an unconscious condition after ketamine intramuscular injection(level 4). There was no gender difference in cooperative levels(P=0.11). Patients over 30 years revealed better cooperation levels compared to other age groups(P<0.05). For patients of level 1, 53.5% were anesthetized in a way of intravenous induction, while 77.1% out of patients of level 3 were anesthetically induced through inhalation method. Conclusion: Many dental patients with special needs were not cooperative to receive anesthetic induction. Additional behavioral support may be applied to poorly cooperative patients for the safe and successful clinical outcome

Research for prediction of segmental body composition using multi-frequency bio-impedance

의공학과/석사[한글]신체 구성 성분은 신체의 신진대사를 확인하고 이상여부를 판단하는 기준 데이터로 매우 중요한 기본 임상 자료이다[7]. 체성분 평가를 위한 여러 가지 방법 중에 체임피던스법은 측정이 간편하고 비교적 정확하여 비만의 예방과 치료, 그리고 영양상태의 평가를 위해 다양하게 활용되고 있다. 그러나 기존의 체임피던스법인 손목-발목(Wrist-Ankle) 체임피던스법은 몸을 하나의 원통으로 모델링 하여 전체 체임피던스를 반영하지 못하는 한계점을 가지고 있다. 그래서 본 논문에서는 단일 주파수 체임피던스법과 손목-발목 체임피던스법의 문제점을 보완한 2kHz～300kHz 다중주파수, 부분체임피던스 측정이 가능한 체임피던스 측정시스템을 개발하였다. 그리고 50명의 피검자를 대상으로 DEXA실험을 실시하여 전체 및 부분체성분(제지방, 체지방, 근육량, 무기질)의 기준 데이터를 획득하고, 기준데이터와 다중 주파수 부분체임피던스값을 이용하여 전체 및 부분 체성분 예측을 위한 다중선형회귀분석을 개발하였다. 개발된 임피던스 측정 장치의 정확성은 HP4294A(Agilent, USA)를 이용하여 확인 하였으며, 기존 체임피던스 측정 방법인 손목-발목 측정법과 본 논문에서 설계한 부분체임피던스법의 제지방 추정에 대한 결정계수를 비교한 결과, 부분체임피던스법의 경우 결정계수(R2)는 0.921, 손목-발목 측정법은 0.917로 부분체임피던스가 제지방과의 유의성이 더 높은 것을 확인하였다. 전체 체성분 예측을 위한 회귀분석 결과 전체 제지방과 근육량 모두에서 300kHz의 체임피던스가 가장 높은 유의성을 보였으며, 제지방 예측 시 상관계수(R)는 0.981(P<0.001), 표준오차(S)는 1.90Kg으로 높은 상관성과 낮은 오차를 나타냈다. 또한 전체 근육량 예측을 위해 회귀분석 결과 상관계수(R)는 0.980(P<0.001), 표준오차(S)는 1.80Kg의 결과를 보였다. 또한 부분 체성분 예측을 위한 회귀분석결과 부위별 제지방과 근육량에서 각각 H2/ZLA300kHz, H2/ZLL300kHz, H2/ZRA50kHz, H2/ZRL200kHz, H2/ZTrunk200kHz가 가장 상관성이 높은 것으로 나타났으며, 이를 독립변수로 하여 제지방과 근육량에 대한 부분체성분 예측 회귀방정식을 개발하였다. 회귀 분석 결과 모든 부분체성분에 있어 상관계수(R)가 0.92(P<0.001)이상이며 표준오차(S)는 사지의 경우 0.5Kg에서 0.8Kg 사이이며, 몸통의 경우 2.3Kg 이하로 통계적으로 높은 연관성과 낮은 오차 결과를 확인하였다. 이상의 결과로 부터, 기존의 손목-발목 체임피던스 측정법에 비해 부분체임피던스 측정을 통한 체성분 예측이 향상된 결과를 얻을 수 있음을 확인하였으며, 실험을 통해 본 논문에서 설계한 다중주파수 부분체임피던스 분석 장치에 적합한 전체 체성분(제지방, 근육량, 체지방, 무기질)과 부분 체성분(제지방, 근육량, 무기질)을 예측할 수 있는 한국인에 적용이 적합한 회귀방정식을 개발하였다. [영문]Among many ways of estimating body composition, bio-impedance is variously applied for obesity prevention and treatment, and nutritive condition evaluation because of it''s simplicity in measurement and relative accuracy. But wrist to ankle bio-impedance can''t reflect whole bio-impedance because it models human body only as a cylinder. In this study, weak points of single-frequency bio-impedance and wrist to ankle bio-impedance were complemented and therefore, a new bio-impedance measuring system that can measure 2kHz~300kHz multi-frequency segmental bio-impedance is developed. DEXA experiments were done on 50 subjects to get reference data of whole and segmental body composition(Fat Free Mass, FAT, Muscle, Mineral). Multi-linear regression analysis using reference data and multi-frequency segmental bio-impedance data was done for whole and segmental body composition prediction. The segmental bio-impedance method designed in this study and the existing wrist to ankle method were compared in coefficient of determination R2 for estimating FFM. R2 of segmental bio-impedance was 0.921, and that of wrist to ankle method was 0.917. Therefore, segmental bio-impedance method having higher significance was verified. Regression analysis for predicting whole body composition showed that from both whole FFM and Muscle 300kHz bio-impedance had the highest significance, and also in predicting FFM, correlation coefficient R value 0.981(P<0.001) and standard error S 1.90Kg showed high correlation and low error. Moreover, from the regression anaylsis results to predict whole muscle mass, R was 0.980(P<0.001) and S was 1.80Kg and from those to predict segmental body composition, FFM and Muscle showed the highest correlation respectively in H2/ZLA300kHz, H2/ZLL300kHz, H2/ZRA50kHz, H2/ZRL200kHz, H2/ZTrunk200kHz and those were used as independent variables in making segmental body composition prediction equations for FFM and muscle. From the regression results, R value was over 0.92(P<0.001) in every segmental body composition and S value was in between 0.5Kg and 0.8Kg for the limbs and under 2.3Kg for the trunk and showed statistically high correlation and low error. From the results above, body composition prediction using segmental mio-impedance measurement rather than existing wrist to ankle bio-impedance measurement is proved to be better in results, and through the experiment, regression equations for predicting whole body composition(FFM, Muscle, FAT) and segmental body composition(FFM, Muscle, Mineral) that are adequate for the multi-frequency segmental bio-impedance analyzing system designed in this study were developed.ope

Forward lumped parameter 기반의 non-uniform hybrid electrical impedance model 과 양손 임피던스 시스템의 유효성 검증을 통한 심기능 평가

Dept. of Biomedical Engineering/박사In this dissertation, cardiac output using non-uniform hybrid electrical impedance model, which is based on the forward lumped parameter and the both-hands impedance measurement system,is proposed. This noninvasive method for cardiac output monitoring has been clinically accepted as areplacement for thermo dilution, the gold standard in cardiac output measurement.Alternatively, measurement using impedance cardiogram, which has several distinctadvantages, has been identified as a promising method for cardiac output measurements. Thethoracic impedance cardiogram (ICG) has been proposed as a noninvasive, continuous,operator-independent, and cost-effective method for cardiac output monitoring. However, thismethod is generally regarded to be restrictive because measurements are performed using aband or spot-type electrode adhered to the body. Traditionally, lead has been used for suchmeasurements, thus rendering the entire system highly inconvenient because the assistance of a specialist is required. Further, the development and attachment of the lead electrode, used with the traditional system, is both expensive and complicated. In this dissertation, we evaluate the effectiveness of the proposed non-uniform hybrid model, which is based on the forward lumped parameter. This system seeks to combine the existing lumped parameter method and the non-uniform hybrid model to create a coherent system capable of leveraging the advantages of both approaches. For developing an effectiveness rating for cardiac output measurements using both hands, the presented model was mathematically interpreted and the relevant results were compared and analyzed against the stroke volume and the cardiac output of the thoracic impedance measurements (Physio FlowⓇ-PF104D, Manatec Biomedical, France). To develop the non-uniform hybrid electrical impedance model, based on the forward lumped parameter and the both-hands impedance measurement system, 80 subjects (58 male, 22 female) from Yonsei University and the surrounding areas, aged 18–74 years, participated in this study. All participating subjects completed stroke volume and cardiac output tests through PhysioFlow and the developed system. In the developed system, electrodes are used to gripping on both-hands instead of attaching to the chest. Similar to previously adopted noninvasive cardiac output tests, the developed system measures stroke volume through impedance changes over each cardiac cycle. Additionally, this study compares cardiac output measurements in the thorax and in both hands. These measurements and comparisons were verified using the presented non-uniform hybrid model.To verify the proposed approach, statistical methods such as correlation analyses, pairedT-test, and the Bland-Altman plot were used. For verification of the non-uniform hybridelectrical impedance model, the presented value of r, scatter plot, and the Bland-Altman plotof measured and estimated SV and CO were used. The results were as follows: 1) The SV/CO obtained from the PhysioFlow and the proposed approach (developed system) showed significant correlation in both male and female SV (r = 0.715, P < 0.001; r = 0.704, P < 0.001, respectively) and CO (r = 0.826, P < 0.001; r =0.804, P < 0.001, respectively). 2) The SV/CO obtained from the PhysioFlow and the proposed approach (non-uniform hybrid electrical impedance model based on the forward lumped parameter) demonstrated significant correlation in both male and female SV (r = 0.735,P < 0.001; r = 0.827, P < 0.001, respectively) and CO (r = 0.767, P < 0.001; r = 0.853, P <0.001, respectively). 3) The SV/CO obtained from the non-uniform hybrid electrical impedance model and the development system showed significant correlation in both male and female SV (r = 0.788, P < 0.001; r = 0.812, P < 0.001, respectively) and CO (r = 0.802, P < 0.001; r = 0.823, P < 0.001, respectively). From these results, it can be concluded that SV and CO can be measured using the bothhands cardiac output measurement method at low cost and convenient without the help of a specialist. Furthermore, this system was verified by using the developed model as a substitute for the existing method.This noninvasive method for cardiac output monitoring has been clinically accepted as a replacement for thermo dilution, the gold standard in cardiac output measurement. Alternatively, measurement using impedance cardiogram, which has several distinct advantages, has been identified as a promising method for cardiac output measurements. The thoracic impedance cardiogram (ICG) has been proposed as a noninvasive, continuous, operator-independent, and cost-effective method for cardiac output monitoring. However, this method is generally regarded to be restrictive because measurements are performed using a band or spot-type electrode adhered to the body. Traditionally, lead has been used for such measurements, thus rendering the entire system highly inconvenient because the assistance of a specialist is required. Further, the development and attachment of the lead electrode, used with the traditional system, is both expensive and complicated.In this dissertation, we evaluate the effectiveness of the proposed non-uniform hybrid model, which is based on the forward lumped parameter. This system seeks to combine the existing lumped parameter method and the non-uniform hybrid model to create a coherent system capable of leveraging the advantages of both approaches. For developing an effectiveness rating for cardiac output measurements using both hands, the presented model was mathematically interpreted and the relevant results were compared and analyzed against the stroke volume and the cardiac output of the thoracic impedance measurements (Physio Flowⓡ-PF104D, Manatec Biomedical, France).To develop the non-uniform hybrid electrical impedance model, based on the forward lumped parameter and the both-hands impedance measurement system, 80 subjects (58 male, 22 female) from Yonsei University and the surrounding areas, aged 18?74 years, participated in this study. All participating subjects completed stroke volume and cardiac output tests through PhysioFlow and the developed system. In the developed system, electrodes are used to gripping on both-hands instead of attaching to the chest. Similar to previously adopted noninvasive cardiac output tests, the developed system measures stroke volume through impedance changes over each cardiac cycle. Additionally, this study compares cardiac output measurements in the thorax and in both hands. These measurements and comparisons were verified using the presented non-uniform hybrid model. To verify the proposed approach, statistical methods such as correlation analyses, paired T-test, and the Bland-Altman plot were used. For verification of the non-uniform hybrid electrical impedance model, the presented value of r, scatter plot, and the Bland-Altman plot of measured and estimated SV and CO were used.The results were as follows: 1) The SV/CO obtained from the PhysioFlow and the proposed approach (developed system) showed significant correlation in both male and female SV (r = 0.715, P < 0.001; r = 0.704, P < 0.001, respectively) and CO (r = 0.826, P < 0.001; r = 0.804, P < 0.001, respectively). 2) The SV/CO obtained from the PhysioFlow and the proposed approach (non-uniform hybrid electrical impedance model based on the forward lumped parameter) demonstrated significant correlation in both male and female SV (r = 0.735, P < 0.001; r = 0.827, P < 0.001, respectively) and CO (r = 0.767, P < 0.001; r = 0.853, P < 0.001, respectively). 3) The SV/CO obtained from the non-uniform hybrid electrical impedance model and the development system showed significant correlation in both male and female SV (r = 0.788, P < 0.001; r = 0.812, P < 0.001, respectively) and CO (r = 0.802, P < 0.001; r = 0.823, P < 0.001, respectively).From these results, it can be concluded that SV and CO can be measured using the both-hands cardiac output measurement method at low cost and convenient without the help of a specialist. Furthermore, this system was verified by using the developed model as a substitute for the existing method.ope

Clinical application of photoplethysmography waveform for noninvasive blood pressure estimation during general anesthesia

학위논문(박사)--서울대학교 대학원 :의학과 마취과학 전공,2006.Docto

부비동내시경수술을 받은 환자에게 시행한 자가진정통증조절법의 유효성에 대한 평가

학위논문(석사)--서울대학교 대학원 :의학과 마취과학전공,2001.Maste

The Status of Comprehensive Dental Treatment and Type of Disabilities of the Patients Treated under Outpatient General Anesthesia at the Clinic for the Disabled in Seoul National University Dental Hospital

Background: The number of patients with disabilities who require general anesthesia for dental treatment is increasing. Methods: We reviewed the cases of 538 patients with disabilities who underwent outpatient general anesthesia for dental treatment at the clinic for the disabled in Seoul national university dental hospital according to the types of disabilities and comprehensive treatments. Results: The patients mean age was 17.4 years and fifty-eight percent of the patients had epilepsy, autism, mental retardation and cerebral palsy. About twenty-five percent of the patients were medically compromised such as brain disease, heart disease and genetic problem. In 142 cases, more than two dentists from the clinical departments systemically co-worked to provide the patients with comprehensive treatment as accurately and quickly as possible under general anesthesia. Conclusions: The number of medically compromised patients was high and the system of comprehensive dental treatment was well run

Emergency Airway Management using a Laryngeal Mask Airway (LMA) Following Extubation in an Infant with a Congenital Facial Anomaly − A case report −

A female infant (4 months-old) with Goldenhar syndrome was scheduled for cheiloplasty to treat a transverse facial cleft and congenital macrostomia. There was no past history of difficulty during feeding or airway obstruction. Following induction of anesthesia using an inhalational anesthetic technique, conventional oro-tracheal intubation was possible. However, following extubation of the endotracheal tube she developed an upper airway obstruction. Her lungs could not be ventilated using a facial mask and oxygen saturation was decreased. A #1 laryngeal mask airway (LMA) was inserted immediately, which allowed us to ventilate her lungs and restore the oxygen saturation. Here we describe the use of a LMA for emergency airway management in an infant

Anesthetic Management of a Mentally Retarded Child during Dental Treatment -A case report -

General anesthesia is often required for mentally retarded children undergoing extensive dental treatment. We experienced a case of dental treatment under general anesthesia in a 14-year-old boy with mental retardation. He was treated on an outpatient basis. He was diagnosed of Noonan syndrome and received heart surgery when he was six years old. Induction using thiopental and vecuronium was uneventful and nasotracheal intubation were carried out. General anesthesia was maintained with sevoflurane for 2.5 hours. After monitoring the patient for 2 hours and confirming his recovery, he was discharged from the day care unit. In summary, we report this successful anesthetic management of a mentally retarded child during dental treatment in as an out-patien

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

Pneumonia after Dental Treatment under Ambulatory General Anesthesia in Mentally Retard Patient -A Case Report-

A 15-years-old female patient with seizure disorder and pervasive developmental disorder was scheduled for dental treatment under ambulatory general anesthesia. She had past history of pneumonia and herpes encephalitis when she was 3 year old. Because of sever mental retardation and behavior disorder, routine laboratory test was substituted with physical exam and medical records of department of pediatrics. A few days before general anesthesia, she showed slight common cold, but pediatric consult had reported that there was minimal risk in general anesthesia. After 4-hour general anesthesia, she became critically sick with high fever, cough and malaise. After 10-day hospitalization with pneumonia and sepsis, she could go home