• Journal of Dental Anesthesia and Pain Medicine
• /
• 제23권2호
• /
• pp.111-116
• /
• 2023

We provided general anesthesia management to a patient with advanced atrioventricular block, which was discovered in the remote period after open-heart surgery. A 21-year-old man with Noonan syndrome was scheduled to undergo excision of a median intramandibular tumor. At 2 months of age, the patient underwent endocardial repair for congenital heart disease. During our preoperative examination, an atrioventricular block was detected, which had not been previously noted. Emergency drugs were administered, and a transcutaneous pacemaker was placed. During anesthesia induction, mask ventilation was easy, and intubation was performed smoothly using a video laryngoscope. The transcutaneous pacemaker was activated in demand mode at a pacing rate of 50 cycles/min approximately throughout the anesthesia time, and the hemodynamic status remained stable. The effect of intraoperatively administered atropine was brief, lasting only a few seconds. Although body movements due to thoracoabdominal muscle spasm were observed during pacemaker activation, they did not interfere with surgery. In postoperative patients with congenital heart disease, an atrioventricular block may be identified in the remote period, and preoperative evaluation should be based on this possibility. In addition, during anesthesia management, it is important to prepare multiple measures to maintain hemodynamic status.

• 대한장애인치과학회지
• /
• 제3권2호
• /
• pp.80-86
• /
• 2007

A critical pathway (CP) defines the optimal care process, sequencing and timing of intervention by multi-disciplinary health care teams for a particular diagnosis and procedure. It plays an important role as a cost-effective health care delivery system and a tool for quality control of medical and dental services by means of standardizing medical practices. The aim of this study is to investigate the satisfaction of patients and medical/dental staff after implementation of a critical pathway for dental treatment of disabled children under general anesthesia and its cost effectiveness. Ten patients who underwent dental treatment under general anesthesia were included in the CP group between August and December 2006. The pre-CP group included 20 patients who underwent the same procedure from February 2003. The satisfaction of parent of child patient and medical staff members were compared between two groups. The parents' satisfaction was significantly improved after the implementation of CP and medical/dental staff members were highly satisfied with the usefulness of the critical pathway. In conclusion, the critical pathway for the dental treatment of disabled treatment under general anesthesia can highly improve the satisfaction of parents and medical/ dental staff members.

• 대한장애인치과학회지
• /
• 제13권2호
• /
• pp.114-118
• /
• 2017

협조능력의 부족으로 치과 외래에서의 치과치료가 불가능한 소아 환자의 경우 약물을 이용한 진정법 또는 전신마취 하 치과치료를 고려하게 된다. 하지만 ASA III급 이상의 환자들을 대상으로 외래에서 약물을 이용한 진정법 하에서 치과치료를 진행하기에는 무리가 있으며, 전신마취 또한 엄격한 사전 선별과 관리 감독을 거쳐 진행해야 한다. 저자들은 지적 장애를 동반한 ASA III급에 속하는 환아의 치과 치료를 타 과와의 협진을 통하여 전신마취 하에서 성공적으로 시행하였기에 이를 보고하는 바이다.

• The Korean Journal of Pain
• /
• 제26권4호
• /
• pp.336-346
• /
• 2013

Intrathecal drug delivery is an effective and safe option for the treatment of chronic pathology refractory to conventional pain therapies. Typical intrathecal administered drugs are opioids, baclofen, local anesthetics and adjuvant medications. Although knowledge about mechanisms of action of intrathecal drugs are every day more clear many doubt remain respect the correct location of intrathecal catheter in order to achieve the best therapeutic result. We analyze the factors that can affect drug distribution within the cerebrospinal fluid. Three categories of variables were identified: drug features, cerebrospinal fluid (CSF) dynamics and patients features. First category includes physicochemical properties and pharmacological features of intrathecal administered drugs with special attention to drug lipophilicity. In the second category, the variables in CSF flow, are considered that can modify the drug distribution within the CSF with special attention to the new theories of liquoral circulation. Last category try to explain inter-individual difference in baclofen response with difference that are specific for each patients such as the anatomical area to treat, patient posture or reaction to inflammatory stimulus. We conclude that a comprehensive evaluation of the patients, including imaging techniques to study the anatomy and physiology of intrathecal environment and CSF dynamics, could become essential in the future to the purpose of optimize the clinical outcome of intrathecal therapy.

• 대한소아치과학회지
• /
• 제28권1호
• /
• pp.154-158
• /
• 2001

1997년부터 1999년까지 서울대학교병원 소아치과에서 시행한 37건의 전신마취를 작성된 의무기록을 바탕으로 전신마취의 선택이유, 치료전 전신상태, 연령분포, 치료내용, 합병증과 정기적인 내원여부 등에 대해 조사하여 다음과 같은 결론을 얻었다. 1. 전신마취의 선택이유중 대부분(97%)은 장애인이며, 치료전 전신상태는 ASA Class I 또는 Class II였다. 2. $11\sim15$세 환자들(41%)이 가장 많았다. 3. 전신마취 하에서 평균 8.1개의 수복치료와 3.3개의 발치를 시행하였다. 4. 시술후 합병증은 32%에서 발생하였으나, 대부분 경미하였다. 5. 6개월 이상 정기적인 내원을 한 경우는 12명 (32%)이었다.

• 대한장애인치과학회지
• /
• 제13권1호
• /
• pp.28-32
• /
• 2017

진정 약제에 저산소증 병력을 보였던 레녹스-가스토 증후군의 7세 4개월 여아를 전신마취 하에서 안정적으로 치과치료를 진행하였다. 레녹스-가스토 환자의 철저한 술전 평가와 의과와의 협진을 통해 전신마취 하 치과 치료가 매우 효과적으로 진행될 수 있다고 생각된다.

• 대한장애인치과학회지
• /
• 제13권1호
• /
• pp.47-51
• /
• 2017

Haddad 증후군은 Congenital central hypoventilation syndrome과 Hirschsprung's disease가 함께 나타나는 질환으로 수면 시 호흡 저하를 특징으로 하나, 증상이 심할 경우 깨어있을 때에도 호흡 저하가 나타날 수 있다. 따라서 전신 마취 시, 중추성 억제 약물 사용에 주의를 기울여야 하고, 적절한 환기가 이루어지도록 하는 것이 중요하다. 또한 술 후에도 호흡 저하가 일어나지 않도록 주의를 기울여야 한다.

• 대한소아치과학회지
• /
• 제45권1호
• /
• pp.109-114
• /
• 2018

Chronic infantile neurological cutaneous articular (CINCA) 증후군은 만성 염증성 질환으로, 주기적으로 발열을 일으킨다. 이 증후군의 환아들은 전신적인 염증으로 인해 치과적 문제에 노출되기 쉽다. 협조가 어려운 환자에 있어서 전신마취는 행동 조절 방법으로 널리 사용되어 왔으며, CINCA 증후군의 경우 전신적인 염증성 질환이기 때문에 전신마취를 시행할 때 있어 주의를 기울어야 한다. 본 증례 보고에서는 CINCA 증후군을 가진 비협조적 환아를 전신마취 하 치과 치료 시행한 증례보고와 함께 이러한 환아들에서 치과치료 전 고려사항을 고찰하고자 한다.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제21권2호
• /
• pp.113-118
• /
• 2021

Background: Consumers and patients in the last two decades have increasingly turned to various internet search engines including Google for information. Google Trends records searches done using the Google search engine. Google Trends is free and provides data on search terms and related queries. One recent study found a large public interest in "dental anesthesia". In this paper, we further explore this interest in "dental anesthesia" and assess if any patterns emerge. Methods: In this study, Google Trends and the search term "dental pain" was used to record the consumer's interest over a five-year period. Additionally, using the search term "Dental anesthesia," a top ten related query list was generated. Queries are grouped into two sections, a "top" category and a "rising" category. We then added additional search term such as: wisdom tooth anesthesia, wisdom tooth general anesthesia, dental anesthetics, local anesthetic, dental numbing, anesthesia dentist, and dental pain. From the related queries generated from each search term, repeated themes were grouped together and ranked according to the total sum of their relative search frequency (RSF) values. Results: Over the five-year time period, Google Trends data show that there was a 1.5% increase in the search term "dental pain". Results of the related queries for dental anesthesia show that there seems to be a large public interest in how long local anesthetics last (Total RSF = 231) - even more so than potential side effects or toxicities (Total RSF = 83). Conclusion: Based on these results it is recommended that clinicians clearly advice their patients on how long local anesthetics last to better manage patient expectations.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제16권4호
• /
• pp.283-288
• /
• 2016

Background: Sevoflurane sedation in pediatric and disabled patients has the advantage of faster induction and recovery compared to general anesthesia, as well as minimum influence on the respiratory and cardiovascular functions, and airway protective reflexes. This study aimed to evaluate the clinical efficacy of sevoflurane sedation used in dental treatment at one provincial dental clinic center for the disabled. Methods: We investigated patients' gender, age, reasons for undergoing sedation, medication history prior to treatment, duration of anesthesia, treatment length, type of treatment, and yearly patterns, for 387 cases of dental treatment performed using sevoflurane sedation from January 2013 to October 2016. Results: We analyzed 387 cases (215 male patients, 172 female patients). Male patients aged 20 year or older accounted for 39.0% of all patients, marking the highest proportion. Patient's lack of cooperation was the most common reason for performing dental sedation. Prosthetic treatment was the most frequently practiced, accounting for 174 treatment cases. The mean lengths of the entire treatment and of the dental procedure were 55.2 min and 39.8 min, respectively. Conclusions: Sevoflurane sedation has the advantage of fast anesthesia induction and recovery compared to general anesthesia; therefore, it can be used efficiently to induce anesthesia in pediatric and disabled patients during short dental procedures, enabling stable treatment of these patients.