• 대한신경집중치료학회지
• /
• 제11권2호
• /
• pp.93-101
• /
• 2018

Background: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). Methods: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. Results: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was $55.5{\pm}12.6$ years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Follow-up angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. Conclusion: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.

• 대한소아치과학회지
• /
• 제24권1호
• /
• pp.280-292
• /
• 1997

The purpose of this study was to assess the sedative effect of three kinds of medication for management of the uncooperative 60 children aged from 16 months to 87 months required extensive treatment. The patients were given randomly a dose of 75mg/kg of chloral hydrate and hydroxyzine 25mg orally or 0.5mg/kg of midazolam orally or 0.3mg/kg of midazolam intranasally. All the children were restrained in a Pediwrap and were monitored with Pulse oximeter for assessing the safety of patients. According to rating scale, sleep, crying, movement, and overall behavior were checked for evaluation of the clinical sedative effect. The results were as follows: 1. In the evaluation of sleep, rating scale of chloral hydrate/hydroxyzine was superior to the other group(p<0.05). 2. In the evaluation of crying and movement at beginning of treatment, rating scale of chloral hydrate/hydroxyzine was superior to the other group(p<0.05), but during the treatment, rating scale of each group was not significantly different (p>0.05). 3. In the evaluation of overall behavior, 80% children of chloral hydrate/hydroxyzine were rated good or very good. With the oral and intranasal midazolam, 60% children were rated good or very good respectively. 4. There were no clinical signs of significant cyanosis and respiratory depression. Clinically, chloral hydrate/hydroxyzine was proved to be more effective sedation than any other sedative method. Oral and intranasal midazolam were also safe and effective sedation in young children undergoing pediatric dental procedures.

• 대한소아치과학회지
• /
• 제38권2호
• /
• pp.181-186
• /
• 2011

자폐는 사회적 상호작용의 장애, 의사소통의 장애, 행동, 관심 및 활동이 한정되고 반복적이며 상동적인 양상을 나타내는 것으로 정의 될 수 있다. 자폐아의 경우 치과 치료시 협조를 얻어내는 것이 용이하지 않으며 자폐의 심도나 환아의 협조도 구강 상태 및 전신상태 등을 고려하여 행동 수정법, 약물을 이용한 진정요법, 전신마취 등을 통해 보다 효율적인 치과치료를 시행할 수 있다. 치과치료에 협조가 가능한 경증의 행동장애 또는 중등도의 행동장애를 보이는 경우 일반적인 행동 수정법과 진정요법으로 치료가 가능할수 있다. 그러나 환아의 협조도가 매우 불량하고 많은 양의 치과치료가 필요한 경우 한 번의 전신마취를 통해 환자는 여러번의 내원으로 인한 비용, 시간, 불안감을 줄일 수 있다. 본 증례는 충치치료를 주소로 연세대학교 원주기독병원 소아치과에 내원한 자폐로 진단받은 환아에서 각각의 자폐 심도에 따른 행동 조절법을 적용한 치과치료를 시행하고 다소의 지견을 얻었기에 보고하고자 한다.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제23권1호
• /
• pp.70-76
• /
• 2001

Purpose : To evaluate the efficacy of arthrocentesis for treatment of closed lock. Material : 42 patients were diagnosed to closed lock by physical, radiographic examriation and undergone arthrocentesis. All patients have a pain and mouth opening limitation on affected site. Method : Arthrocentesis was done under conscious sedation and local infiltration anesthesia, normal saline and some steroid was injected on upper compartment of tempormandibular joint. After pumping and lavage, manual reduction procedure of anterially displaced disc was done. All the patients wear an anterior repositioning splint just after arthrocentesis. The result of arthrocentesis was assessed by pain and difference of mouth opening. Result : Difference of mouth opening after arthrocentesis was improved to 18.85mm and pain was gradually decreased. All patients were worn stabilization type splint after mean 1.84 months. 6 patients had relapse of mouth opening limitation so done arthrocentesis again and delivered good results.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제18권5호
• /
• pp.301-304
• /
• 2018

Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. The cases of 2 patients (1 male, 1 female) who underwent oral maxillofacial surgery are reported. They received $50{\mu}g$ of fentanyl 2-3 times (total $2.2-2.3{\mu}g/kg$) at intervals of approximately 2 min. Oxygen was administered via a mask at 6 L/min, and 0.5 mg of midazolam was administered 1-4 times (total 0.02-0.05 mg/kg) at intervals of approximately 2 min. A tracheal tube was inserted through the nasal cavity after topical anesthesia was applied to the epiglottis, vocal cords, and into the trachea through the fiberscope channel. All patients were successfully intubated. This is a useful and safe method for awake fiberoptic nasotracheal intubation.

• 대한장애인치과학회지
• /
• 제12권2호
• /
• pp.66-71
• /
• 2016

Intellectual disability is accompanied by a high incidence of congenitally absent teeth and supernumerary teeth, and is observed more frequently than are disorders of location and order during delayed eruption, when accompanied by other symptoms. Furthermore, it is associated with a higher occurrence of dental anomalies such as conical teeth, microdontia, and amelogenesis imperfecta. As it is difficult to obtain adequate cooperation from patients with intellectual disabilities, physical restraint and conscious sedation using medication and general anesthesia can be considered. Reshaping of conical teeth with resin composite may be helpful to rehabilitate patients with oligodontia and a conical tooth shape. Diagnostic wax-up and a silicone matrix formed the basis for the successful reconstruction of the anterior teeth. This case describes the treatment of a patient with intellectual disability who had oligodontia and conical-shaped incisors. Under general anesthesia, the patient was treated using direct composite resin restoration.

• 대한소아치과학회지
• /
• 제31권3호
• /
• pp.412-420
• /
• 2004

최근 의식하 진정요법에 많이 이용되고 있는 Midazolam의 임상적 효과로는 항불안, 진정, 수면, 항경련, 근이완, 기억상실 등이 있는데, 이중 기억상실효과는 주로 선행성 건망증(anterograde amnesia)으로 약물투여 후 약물의 작용이 지속되는 동안에 경험한 일들을 기억하지 못하는 현상이다. 이는 시술 중환자의 협조를 얻을 수 있으면서도 시술 후 환자는 시술중의 불편한 과정을 기억하지 못하는 효과를 얻을 수 있다는 임상적 장점이 있다. 본 연구는 Midazolam 투여 시 선행성 건망증의 발현 양상을 평가할 목적으로 약물에 대한 기왕력이 없으며 미국 마취학회 전신상태 평가기준에 따라 1등급으로 판정된 조선대학교 치과대학에 재학중인 학생 15명을 대상으로 위약, 경구용 Midazolam투여 주사용 Midazolam의 비강내 투여 후 Snograss와 Vanderwart에 의해 표준화된 260개 그림 시리즈를 이용하여 선행성 건망증의 발현정도를 평가한 결과 다음과 같은 결론을 얻었다. 1. Midazolam의 경구투여와 비강내 투여 시 선행성 건망증의 정도가 위약에 비해 유의하게 높았다(P<0.01). 2. Midazolam의 비강내 투여시 선행성 건망증의 정도가 경구투여보다 높았으나 유의한 차이는 없었다(P>0.01). 3. Midazolam의 경구투여와 비강내 투여 모두 약물투여 15분 후부터 선행성 건망증을 보이기 시작하여 경구투여시는 45분, 비강내 투여시는 30분에 가장 높은 효과를 보였다. 4. 약물투여 30분이 지나면서 비강내 투여보다 경구투여에서 선행성 건망증의 정도와 진정정도가 더 높았으나 유의한 차이는 없었다(P>0.01). 본 결과로 미루어 보아Midazolam을 투여한 후 선행성 건망증은 경구투여와 비강내 투여 모두 약물투여 15분 후부터 나타났으며 30분전까지는 비강내 투여에서, 30분이 지나면 경구투여에서 더 높은 효과를 보이는 경향이 관찰된 바, 치과치료 시 Midazolam의 경구투여와 비강내 투여를 이용한 의식진정요법을 시행함에 있어 국소마취 등의 고통스러운 과정은 최소 약물투여 15분 후 시행하는 것이 향후 치과진료에 대한 환자의 긍정적 자세를 유도하는데 도움이 되리라 사료된다.

• 대한치과마취과학회지
• /
• 제5권1호
• /
• pp.15-21
• /
• 2005

Autism is characterized with an abnormality of reciprocal social relatedness and of communication development. Also, autistic children show repetitive and stereotypical behavior pattern and deficiency of endurance against change. Dental problems related to autism are self-injury and trauma from accidents. Sometimes self-injury is due to discomfort resulting from restoration and local anesthesia. Also, gingivitis and multiple caries are common because of poor oral hygiene. Autistic children are anxious about visual and auditory stimuli because they don't understand the dental procedure. If the face of any changes in their daily life, their behavior becomes uncontrollable. In a setting such as the outpatient office, an autistic child's uncontrollable behavior makes it difficult to carry out proper treatment. If they need treatment under general anesthesia, it is very difficult to manage them in a ward as they are severly anxious about being admitted to a hospital. Therefore it is necessary to treat these children according to a specific management program under general anesthesia in an outpatient office. This case study reports of a 14 year old autistic teenager who although became uncontrollable because of the pain from multiple caries and from anxiety of the dental treatment eventually received treatment under general anesthesia and under conscious sedation in an outpatient office.

• Tuberculosis and Respiratory Diseases
• /
• 제71권5호
• /
• pp.359-362
• /
• 2011

Streptococcus parasanguinis is a Viridans group bacteria that is most often discovered in the oral cavity and causes dental plaque and endocarditis in a rat model. It has low virulence but an unknown relationship to human respiratory infections. We report on a 61-year-old woman who developed hemoptysis followed by pleuritic chest pain after conscious sedation during a gastroscopic polypectomy and was diagnosed with pneumonia and parapneumonic effusion from Streptococcus parasanguinis isolated in pleural fluid. Microaspiration during the procedure was presumed to play a role in the pathogenesis.

• 대한장애인치과학회지
• /
• 제13권1호
• /
• pp.43-46
• /
• 2017

본 증례는 함입 주소로 내원한 9세 4개월 뇌성마비 남환을 미다졸람 근주를 이용한 의식하 진정법으로 해당치아의 수술 적 재위치 및 근관치료를 시행하였다. 5년이 지난 현재 유착 소견 및 부분적인 치근흡수가 보이나 양호한 상태로 유지되고 있다. 뇌성마비 환자의 경우 치아 및 주위조직에 취약하며, 치료 시 적절한 행동조절 및 치료 방법을 선택하는 임상의의 노력이 필요하다.