• Journal of The Korean Dental Society of Anesthesiology
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• v.9 no.2
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• pp.119-128
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• 2009

국내에서도 많은 치과의사들이 임상에서 진정법을 시행하고 있으나, 국내에 이와 관련된 지침이 마련되지 않아 임상에서 진정법 시행과 관련하여 어려움을 격기도 하고, 법적인 문제에 휘말리기도 하고 있다. 이에 대한치의학회에서는 치과 진정법 가이드라인을 마련하고자 하고 있다. 이에 참고가 될 만한 미국치과의사협회에서 발간한 진정법 관련 가이드라인을 완역하여 소개한다.

• Journal of The Korean Dental Society of Anesthesiology
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• v.1 no.1 s.1
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• pp.16-20
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• 2001

연구배경: 일반적으로 자가통증조절기가 자가진정조절을 위해 적합한 것으로 알려져 있다. 그러나 이 장치들은 몇몇 진정제 투여 시 너무 긴 최소 폐쇄간격을 가지고 있다 WalkMed사(Medex inc, USA)의 자가통증조절기는 폐쇄간격을 0으로 설정할 수 있으며 30 ml/h로 추가용량을 투여할 수 있다. 이번 연구에서는 환자 개개인의 요구에 맞추어 환자의 진정을 조절하기 위하여 위장치를 이용한 propofol 자가진정조절기의 가능성를 조사하였다. 방법: Propofol과 전산 프로그램된 WalkMed 주입장치를 이용한 자가진정조절법이 치과치료를 받는 24명의 건강한 환자에게 시행되었다. Propofol 지속 주입량은 2 mg/kg/h로, 추가용량은 5 mg으로 조절되었으며 치소 폐쇄간격은 0으로 설정하였다. Ketoloac 30 mg이 통증 조절을 위하여 진정법 시행 전에 근주되었다. 결과: 진정법 시행 동안 주입된 propofol의 평균량은 3.4 mg/kg/h이었으며 평균 추가용량은 1.6 mg/kg/h이었다. 시간 당 추가용량에는 많은 변이가 있었다(0-32). 모든 환자는 진정법 시행 동안 완전한 각성상태였으며 이러한 진정 법에 만족하였다. 진정 법과 관련된 주요한 합병증은 관찰되지 않았다. 결론: WalkMed사의 자가통증조절기를 이용한 propofol 자가진정조절법이 치과 치료를 받는 환자들에게 유용하게 사용될 수 있다.

• Journal of the korean academy of Pediatric Dentistry
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• v.40 no.1
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• pp.28-39
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• 2013

General anesthesia or sedation is an essential for a successful dental treatment for the disabled. The aim of this study is to assess the patients who had dental management under general anesthesia or sedation at Chungnam dental clinic for the disabled, who received dental treatment under general anesthesia, sevoflurane sedation and intravenous sedation from January, 2011 to September 2012. Of the 426 patients studied, 389 patients received dental care under general anesthesia, 20 patients received dental care under sevoflurane sedation and 17 patients received dental care under intravenous sedation. The Rate of general anesthesia was higher than that of sevoflurane sedation, intravenous sedation. Sevoflurane sedation is a useful method for short time treatment such as traumatic pediatric patients. Intravenous sedation is an option for patients who had anxiety and fear such as dentally disabled patients. Sevoflurane or intravenous sedation not only gradually reduces the use of general anesthesia but also useful methods themselves for the dentally disabled.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.1
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• pp.109-116
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• 2016

Sedation is an indispensable part of contemporary pediatric dentistry. The Korean Academy of Pediatric Dentistry (KAPD) organized the dental sedation committee to help members perform safer and more effective sedation. The committee surveyed 111 members who practice dental sedation to figure out the present state of sedation in 2014. According to the survey, 86% of the respondents indicated that they were interested in continuing education of sedation. The most interesting topic was sedation related emergency management, followed by safe dosages of sedative drugs. However, it is not realistic to establish the recommended dosages as a guideline since the selection of agents and dosages depend on various factors. In order to provide successful sedation, pediatric dentist should make an individual sedation plan for each procedure. It is important to understand not only the properties of each sedative, but also interactions with other drugs. This article reviews useful information of commonly used agents for dental sedation and summarizes the recommended dosages from the Physicians' Desk Reference (PDR) and some famous pediatric dentistry textbooks.

• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.1
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• pp.38-44
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• 2015

Children commonly experience orofacial injuries and often need emergency treatment. Due to fear and anxiety, children tend to be uncooperative in emergency rooms. Ketamine hydrochloride is a well-known sedative agent at medical-based emergency rooms which has been used for procedural sedation. In this paper, we will discuss the sedation of uncooperative young patients, who needed dental treatments in the emergency room at Wonju Severance Christian Hospital, using ketamine. We collected the records of patients under 18-years-old who visited the emergency room for dental treatment from January 2010 to May 2014. The data was categorized by age, sex, required dental treatments and application of ketamine sedation. Among 659 pediatric patients who visited for emergency dental treatments, 118 patients were treated under sedation using ketamine. Majority of patients were under the age of 6 (110 patients), and the most frequent cause of sedation was suture of oral laceration (105 patients). Though ketamine should not be used by dentists alone, dentists in emergency rooms can easily meet the patients under deep sedation using ketamine. Hence, dentists in emergency rooms need to be aware of the clinical effects, considerations, and potential adverse effects of ketamine.

• 대한치과마취과학회:학술대회논문집
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• 2005.09b
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• pp.55-59
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• 2005

• Journal of the korean academy of Pediatric Dentistry
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• v.41 no.3
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• pp.257-265
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• 2014

The aim of this study was to establish the appropriate guidelines in the sedation techniques and to organize the continuing education programs for the sedation in future under the direction of Committee on Sedation, Education and Research under the Korean Academy of Pediatric Dentistry(KAPD). The surveys on the sedation technique were performed on 111 organizations which practices the sedation and responded to the survey via online and e-mail by February 2014. The collected survey were analyzed. The purpose of sedation was mainly to manage the children's behavior and its uses were primarily on 3~4 years old children. The most frequent duration of treatment was 1~2 hours to treat both maxillary and mandible. The preferred dosages of sedative drugs were chloral hydrate(CH) 50~70 mg/kg, hydorxyzine(Hx) 1~2 mg/kg, and intramuscular midazolam(Mida IM) 0.1~0.2 mg/kg. The preferred combination of the sedative drugs were CH + Hx + $N_2O/O_2$(67.6%), CH + Hx + Mida submucosal administration (SM) + $N_2O/O_2$(29.7%), and Mida IM + $N_2O/O_2$(23.4%). The administration of additional sedatives was carried out at 48%, mainly using Midazolam. 87.5% of the respondents experienced the adverse effects of the sedation such as vomiting/retching, agitation during recovery, subclinical respiratory depression, staggering, and etc. Among them, only 20% periodically retrain the emergency management protocol. About the discharge criteria for patients after the sedation, the respondents either showed a lack of clear criteria or did not follow the recommended discharge criteria. 86% of the respondents expressed the interests in taking a course on the sedation and they wanted to learn mostly about the sedation-related emergency management, the safe dosage of the sedative drugs, and etc. The use of sedation in pediatric dentistry must be consider a patient's safety as top priority and each dentist must show the evidence of sound practices for the prevention of any possible medical errors. Therefore, KAPD must establish the proper sedation guidelines and it needs to provide the systematic technical training program of sedation-related emergency management for pediatric dentists.

• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.2
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• pp.154-161
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• 2018

Sedation is a useful behavior management technique for dental patients who may be uncontrollable or have medical problems. The aim of this study is to investigate the changes in patterns of sedative treatments in pediatric dentistry by analyzing the distribution of patients and used sedative agents. Patients and sedative agents were reviewed based on the electronic medical records (EMR) of the department of pediatric dentistry in Yonsei University Dental Hospital from 2011 to 2016. The number of patients who were treated under sedation generally increased. Male received more sedation treatment than female by 2014, and they became similar from 2015. The treatment percentage of patients with systemic disease decreased in 2013, remained constantly afterwards. The ratio of sedative treatment for the age 4 - 5 and age 6 - 10 generally increased, while that of the age 0 - 2 and older than age 11 decreased. The ratio of the age 3 remained steady. Nitrous oxide was the most frequently used sedative agent. The use of benzodiazepine increased while the use of chloral hydrate decreased. Although the use of sedation has expanded, multidimensional approaches for ensuring safety have been less focused. Therefore, it is necessary to explore further studies for the safety and efficacy of the use of sedation.

• The Journal of the Korean dental association
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• v.47 no.11
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• pp.736-749
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• 2009

근래 환자의 불안을 조절하는 것이 성공적인 치료에 매우 중요하다는 인식이 확산되면서 의과, 치과, 영상의학과, 응급실 및 외래 수술센터 등에서 진정요법에 대한 필요가 현저하게 늘어났다. 응급상황이거나 아니거나 진정요법의 필요성은 점차 증가하고 있고 대한 소아치과학회는 이러한 진정요법에 대한 지침을 출간한 바 있다. 이번 개정은 진정요법에 필요한 적절한 환자감시(monitoring)의 필요에 관한 최신지견을 반영한 것이나 그럼에도 불구하고 이 지침에 충실하였다고 해서 특정환자의 결과를 보장하지는 못한다. 그러 나 이번에 소개하는 진정요법 protocol은 널리 받아들여지는 것으로 부작용 역시 최소화한 것이다. 소아 환자의 진정요법은 원하는 수준의 진정이나 투여 방법과는 상관없이 호흡기능 저하와 환자의 방어 반응이 소실될 수도 있다는 인식하에 작성되었다. 이번 호에서는 최근 2006년에 미국소아과학회와 미국소아치과학회가 공동으로 개정된 지침(Guideline for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures developed and endorsed by AAP a and AAPD)이 어떻게 변경되는지에 중점적으로 알아보며 새로 변경된 지침에 따라 소아치과의의 진정요 법의 진료와 교육도 영향을 미칠 것이다. 이러한 영향으로 다양한 약 투여방법(Alternative routes of d drug administration)과 다양한 약물의 선택에 대해 알아 보기로 한다.

• Journal of the korean academy of Pediatric Dentistry
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• v.37 no.3
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• pp.338-344
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• 2010

The purpose of this study was to evaluate the effect of children's tonsil size on the behavior during pediatric dental sedation. The sedation records of thirty five children were examined in this study. All the sedations had been performed using chloral hydrate/hydroxyzine, nitrous oxide/oxygen or/and submucosal midazolam, and the subjects were divided into 4 groups according to their tonsil size using Brodsky's tonsil classification. The results were as follows: 1. The patients with enlarged tonsils showed negative behaviors in all behavior rating aspects(sleep, movement, crying, overall behavior) during sedation than those with normal tonsils(p<0.05). 2. Enlarged tonsils were correlated with mouth breathing(p<0.05) but not with snoring and coughing(p>0.05) during sedation. 3. For the patients with enlarged tonsils, significantly higher doses of midazolam were administered during sedation than for those with normal tonsils(p<0.05).