• 대한치과의사협회지
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• 제54권11호
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• pp.923-931
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• 2016

Managing uncooperative behaviors related to dental treatment is necessary for guiding children and adolescence to more favorable behaviors. The first approach should be controlling their behaviors using non-phamarcologic behavior management techniques. However, if this approach fails, it is helpful to control negative behaviors pharmacologically. Accordingly, sedation is frequently used to relieve anxiety related to dental treatment. Also, general anesthesia has been applied to the situations in which sedation is either ineffective or impossible to gain cooperation during treatment. This article discusses the pharmacology of widely used sedatives for children and adolescence and clinical considerations of managing uncooperative children and adolescence with the use of sedation. Furthermore, we recommend clinical indication of selecting general anesthesia rather sedation for the purpose of behavior management.

• 대한장애인치과학회지
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• 제2권1호
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• pp.1-9
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• 2006

Patients with severe mental problems have difficulty maintaining good oral hygiene, so that the incidence of dental disease is greater, the disease is more severe, and the progression is much faster in these patients. Generally, they require physical restraint, drug-induced sedation, and general anesthesia since they are not cooperative. In many cases, these patients have systemic disease, so that the prognosis after dental treatment depends highly on the management of existing diseases. The problems related to treating these patients are examined and methods of using general anesthesia and sedatives are further examined to propose better ways of treating these patients.

• Journal of Yeungnam Medical Science
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• 제25권1호
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• pp.78-83
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• 2008

Lesch-Nyhan syndrome is an inborn error of purine metabolism resulting from hypoxanthine-guanine-phosphoribosyltransferase (HGPRT) deficiency and leading to excess purine production and uric acid over-production. It is a very rare X-linked recessive disorder, characterized by movement disorder, cognitive deficits, and self-injurious behavior. However, because of the high incidence of calculi, patients may present for surgery of urinary tract, and have increased risk of difficult intubation, aspiration pneumonia, renal insufficiency or sudden death. We report the case of a 5-year-old boy with Lesch-Nyhan syndrome who underwent successive extracorporeal shockwave lithotripsy under general anesthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• 제18권2호
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• pp.119-123
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• 2018

In cases of intellectually disabled patients, there is sometimes difficult to obtain sufficient information due to the intellectual disorder, even though the patient has significant medical problems. Herein, we report a case of decreased oxygen saturation and inadequate air exchange during general anesthesia in an intellectually disabled patient. We also describe the subsequent management, including the diagnosis of tracheomalacia (TM) using bronchoscopy, and the management of airway compromise with manual and/or controlled respiration, which led to the prevention of complications.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권4호
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• pp.245-252
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• 2016

Regional anesthesia in the maxillofacial region is safer and more efficient than general anesthesia when its indications are carefully considered. In addition, the majority of medical institutions in developing countries are not well equipped for proper anesthesia and elective surgery. In this review, we describe regional anesthesia and cutaneous nerve divisions in the maxillofacial region. In addition, we summarize detailed regional anesthetic techniques adapted for representative cleft lip cases in developing countries.

• The Korean Journal of Pain
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• 제19권1호
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• pp.77-80
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• 2006

Background: Painful experiences during procedures such as prolotherapy and intramuscular stimulation are stressful to patients and can affect the treatment outcome. We present a method for relieving pain and increasing the level of patient comfort during the procedure. Methods: Twenty six patients who requested sedation anesthesia during the procedure were examined. All patients were injected with 500 ml of 0.9% normal saline and were monitored by electrocardiography, blood pressure and pulse oximetry. The patients were supplied with oxygen (3 L/min) through a nasal cannula. Midazolam (0.02 mg/kg) and alfentanil ($8{\mu}g/kg$) was injected before the procedure and a bolus injection was administered during the procedure if patients felt any pain. The duration of the procedure, the total amount of drugs, the changes in the systolic blood pressure, heart rate, pulse oxygen saturation, sedation and pain level during procedure, satisfaction scale after the procedure, complications and the incidence of amnesia were evaluated. Results: Twenty one patients had a moderate level of sedation, 15 patients did not feel any pain during the procedure, 17 patients had high level of satisfaction (8-10). No patient experienced complications after the procedure, or unstable vital signs, and 6 patients could not remember the procedure. Conclusions: Sedation anesthesia is a safe method for relieving pain during the procedure, and most patients had a high level of satisfaction.

• 임상간호연구
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• 제23권1호
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• pp.30-39
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• 2017

Purpose: The aim of this study was to evaluate the effects of favorite music therapy on the stress response of hysterectomy patients undergoing general anesthesia. Methods: Date were collected from June 29, 2015 to January 18, 2016 and the participants were 79 hysterectomy patients (experimental group 40 and control group 39). The experimental group listened to their favorite music through earphones from the moment they entered the surgical waiting room until they exited from the post anesthesia care unit. Results: There were statistically significant differences in anxiety (F=15.92, p<.001), systolic blood pressure (F=4.23, p=.008), diastolic blood pressure (F=3.07, p=.033), and heart rate (F=19.93, p<.001) between participants in the experimental group and the control group according to measurement times. Conclusion: The study results show that favorite music therapy considering patients' preferences is effective in reducing anxiety among patients undergoing a hysterectomy under general anesthesia, thus leading to a stable change in their blood pressure and heart rate.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권2호
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• pp.117-122
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• 2016

Background: The aim of this study was to compare the effectiveness and duration of action of two concentrations of bupivacaine with adrenaline for postoperative pain in patients undergoing surgical removal of four third molars under general anesthesia. Methods: Sixty patients undergoing surgical removal of four wisdom teeth received bupivacaine 0.5% (n = 30) or 0.25% (n = 30). The severity of pain in the immediate recovery period and at 2 and 24 h after surgery was recorded using the visual analogue scale. Differences were assessed by box and whisper plot and the Student's t-test. Results: The analgesic effects of the 0.25% and 0.5% doses were significantly different (P = 0.022) at 30 min after surgery but not after 2 and 24 h. The difference of mean of 0.25% and 0.5% was much higher after 0.5 h but less after 2 and 24 h. Conclusions: Bupivacaine 0.5% was statistically better for pain control during the immediate postoperative period, but there was no significant difference in pain control between the two dose strengths at 2 and 24 h after surgery.

• 대한치과마취과학회지
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• 제3권2호
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• pp.98-102
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• 2003

Patients in end-stage renal disease (ESRD) and chronic renal failure present a number of challenges to the anesthesiologist. They may be chronically iii and debilitated and have the potential for multiorgan dysfunction. A 65-year-old male patient with ESRD was scheduled for oral cancer surgery under general anesthesia. He was in regular hemodialysis three times a week and secondary hypertension with left ventricular hypertrophy was accompanied. He also had chronic metabolic acidosis and hyperkalemia. The day after hemodialysis, general anesthesia was carried out. Uneventful anesthetic induction using thiopental and vecuronium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 9 hours. During the anesthesia, he did not have any problem but persistently increasing serum potassium level. After anesthetic emergence, he was transferred to intensive care unit for mechanical ventilation. So we report this successful case of anesthetic management in a patient with ESRD for oral cancer surgery, which massive bleeding and long anesthetic time were inevitable in, from the preoperative preparation to anesthetic emergence.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.147-151
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• 2015

The difficult oral healthcare in intellectually disabled patients with poor behavioral control has led to debate over the cost-effectiveness and validity of implant treatment in these patients. The patient in the present report had schizophrenia that had led to poor oral care and severe dental caries in the full mouth. Tooth extraction and a removable prosthesis were planned, but the guardian wanted an implant procedure. Since the guardian showed strong will and cooperation with regard to the patient's oral healthcare, extraction followed by immediate implant placement was performed across two rounds of general anesthesia. Since the outcome appears successful, we present this case report. Immediate implant placement after tooth extraction requires fewer surgeries and rounds of general anesthesia, reduces horizontal bone resorption, and can achieve better esthetic results. Therefore, as long as a certain degree of oral care is possible, this can be a positive option for restoration of a partially edentulous mouth, even in intellectually disabled patients.