• Tuberculosis and Respiratory Diseases
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• v.82 no.4
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• pp.335-340
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• 2019

Background: Snoring is the cardinal symptom of obstructive sleep apnea (OSA). Snoring and upper airway obstruction associated with major oxygen desaturation may occur in populations undergoing flexible bronchoscopy. Methods: To evaluate the prevalence of patients at a high risk of having OSA among patients undergoing bronchoscopy with sedation and to investigate whether snoring during the procedure predicts patients who are at risk of OSA, we prospectively enrolled 517 consecutive patients who underwent the procedure with moderate sedation. Patients exhibiting audible snoring for any duration during the procedure were considered snorers. The STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure-Body mass index, Age, Neck circumference and Gender) questionnaire was used to identify patients at high (score ${\geq}3$ out of 8) or low risk (score <3) of OSA. Results: Of the 517 patients, 165 (31.9%) snored during bronchoscopy under sedation. The prevalence of a STOP-Bang score ${\geq}3$ was 61.9% (320/517), whereas 200 of the 352 nonsnorers (56.8%) and 120 of the 165 snorers (72.7%) had a STOP-Bang score ${\geq}3$ (p=0.001). In multivariable analysis, snoring during bronchoscopy was significantly associated with a STOP-Bang score ${\geq}3$ after adjustment for the presence of diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and stroke (adjusted odds ratio, 1.91; 95% confidence interval, 1.26-2.89; p=0.002). Conclusion: Two-thirds of patients undergoing bronchoscopy with moderate sedation were at risk of OSA based on the screening questionnaire. Snoring during bronchoscopy was highly predictive of patients at high risk of OSA.

• Journal of The Korean Dental Society of Anesthesiology
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• v.9 no.2
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• pp.116-118
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• 2009

The automatic implantable cardioverter defibrillator (AICD) has been widely used to treat recurrent malignant ventricular arrhythmia. Here, we case report 18 yr old patients implanted with Automatic implantable cardioverter defibrillator (AICD) who underwent surgical extraction under intravenous sedation and discuss the anesthetic implications for surgery.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.2
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• pp.153-158
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• 2011

Midazolam is known to produce sedation as well as amnesia. Many articles reported about anterograde amnesia, but it is rare that articles about retrograde amnesia. The 61-year-old female patient (64 kg, 154 cm, ASA physical status I) was administered 3.02 mg (0.047 mg/kg) of midazolam during 2 hours. The patient's Modified Observer's Assesment of Alertness/Sedation Scale was 4. The patient who had been consciously sedated with midazolam, exhibited profound amnesia, both anterograde and retrograde after implantation. The patient's memory restoration was begun after 6 hours.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.2
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• pp.69-74
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• 2012

Background: The purpose of this study is to investigate the efficacy and safety of the sedation technique for implant surgery by combining the use of inhalation of nitrous oxide/oxygen with intravenous midazolam. Methods: Patients requiring surgery for the placement of dental implants were randomly allocated to two groups receiving intravenous midazolam or a combined technique using nitrous oxide/oxide and intravenous midazolam. Safety parameters, cooperation scores, anxiety scales, total amount of midazolam administered and recovery time were recorded and compared. Results: There were a statistically significant reduction in the amount of midazolam required to achieve optimal sedation (P<0.01), an overall significant reduction in recovery time (P<0.01), a significant reduction in anxiety scales (P<0.05), and a significant improvement in cooperation (P<0.05) and peripheral oxygen saturation (P<0.05) when a combined technique of inhalational $N_2O/O_2$ and midazolam was used. Conclusions: For implant surgery, this combining sedation technique could be safe and reliable, demonstrating reduction of total dose of midazolam and level of patient's anxiety and improvement in patient's recovery and cooperation.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.6
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• pp.527-545
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• 2021

The aim of this systematic review was to determine the success rate of nitrous oxide-oxygen procedural sedation (NOIS) in dentistry. A systematic digital search was conducted for publications or reports of randomized controlled trials evaluating the clinical performance of NOIS. Abstracts of research papers were screened for suitability, and full-text articles were obtained for those who met the inclusion and exclusion criteria accordingly. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool (RoB 2). A total of 19 articles (eight randomized clinical trials with parallel intervention groups and 11 crossover trials), published between May 1988 and August 2019, were finally selected for this review. The studies followed 1293 patients reporting NOIS success rates, with a cumulative mean value of 94.9% (95% CI: 88.8-98.9%). Thirteen trials were conducted on pediatric populations (1098 patients), and the remaining six were conducted on adults (195 patients), with cumulative efficacy rates of 91.9% (95% CI: 82.5-98.1%) and 99.9% (95% CI: 97.7-100.0%), respectively. The difference was statistically significant (P = 0.002). Completion of treatment and Section IV of the Houpt scale were the most used efficacy criteria. Within the limitations of this systematic review, the present study provides important information on the efficacy rate of NOIS. However, further well-designed and well-documented clinical trials are required and there is a need to develop guidelines for standardization of criteria and definition of success in procedural sedation. Currently, completion of treatment is the most used parameter in clinical practice, though many others also do exist at the same time. To maximize NOIS efficacy, clinicians should strictly consider appropriate indications for the procedure.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.6
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• pp.348-355
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• 2022

Objectives: To compare the vital sign stability and cost of two commonly used sedatives, midazolam (MDZ) and dexmedetomidine (DEX). Patients and Methods: This retrospective study targeted patients who underwent mandibular third molar extractions under intravenous sedation using MDZ or DEX. The predictor variable was the type of sedative used. The primary outcome variables were vital signs (heart rate and blood pressure), vital sign outliers, and cost of the sedatives. A vital sign outlier was defined as a 30% or more change in vital signs during sedation; the fewer changes, the higher the vital sign stability. The secondary outcome variables included the observer's assessment of alertness/sedation scale, level of amnesia, patient satisfaction, and bispectral index score. Covariates were sex, age, body mass index, sleeping time, dental anxiety score, and Pederson scale. Descriptive statistics were computed including propensity score matching (PSM). The P-value was set at 0.05. Results: The study enrolled 185 patients, 103 in the MDZ group and 82 in the DEX group. Based on the data after PSM, the two samples had similar baseline covariates. The sedative effect of both agents was satisfactory. Heart rate outliers were more common with MDZ than with DEX (49.3% vs 22.7%, P=0.001). Heart rate was higher with MDZ (P=0.000). The cost was higher for DEX than for MDZ (29.27±0.00 USD vs 0.37±0.04 USD, P=0.000). Conclusion: DEX showed more vital sign stability, while MDZ was more economical. These results could be used as a reference to guide clinicians during sedative selection.

• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.3
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• pp.226-232
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• 2015

Critical pathway (CP) defines the optimal care process, sequencing and timing of intervention by multidisciplinary health care teams for a particular diagnosis and procedure. The aim of the study was to evaluate the clinical usefulness and the satisfaction of patients and dental staff after implementation of a critical pathway for the dental treatment of disabled children and adolescents under conscious sedation. Thirty patients are divided in two groups (Pre-CP and CP) at the department of Pediatric Dentistry of Pusan National University Dental Hospital. The satisfaction levels of patients/guardians and the staff members were collected by survey questionnaire. The parents' satisfaction was significantly improved after the implementation of CP. Also, medical/dental staff members were highly satisfied with its usefulness. The application of a critical pathway for disabled children and adolescents might be useful and improve the satisfaction of the parents and medical/dental staff members.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.15 no.1
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• pp.29-34
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• 2019

Prader-Willi Syndrome (PWS) is a rare neurologic disorder with a prevalence 1/10,000-30,000. The cause of PWS is an abnormalities of chromosome 15q11.2-q13 which is an imprinting gene. Obesity and hyperphagia are characteristic features on a PWS adult. On the other hand, the birth weight, height and body mass index (BMI) of PWS infants are 15-20% lower than those of normal babies and there is a failure to thrive until 24-month-old. Most of PWS patients are treated under general anesthesia and conscious sedation. This case is a treatment of severe caries in a PWS 46 month-old child without general anesthesia and conscious sedation. He came to the Department of Pediatric Dentistry, Kyung Hee University Dental Hospital at Gangdong, Seoul, Korea with a trauma history. He had a medical history with heart surgery and needed to take antibiotics prophylaxis. The luxated left upper primary tooth were removed and caries treatment were done as an outpatient without general anesthesia, conscious sedation.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.2
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• pp.262-269
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• 2005

The purpose of this study was to compare the efficacy and complications of two oral sedative regimens, chloral hydrate (60mg/kg)/hydroxyzine(25mg) versus midazolam(1mg/kg)/meperidine(1mg/kg) for the sedation of pediatric dental patients. Fifteen patients(mean age 36.2months, range 24-47months), ASA Class I or II, who needed at least two restorative dental procedures were selected in this double-blind, randomized study. All subjects were randomly assigned to receive either chloral hydrate/hydroxyzine or midazolam/meperidine and 50% $N_2O/O_2$ was administered at each appointment. Behavior assessment(sleep, movement, crying, overall behavior) was made using Houpt Sedation Rating Scale and physiologic parameters(pulse rate, oxygen saturation) were monitored using pulse oximeter. The incidence of hypoxia($SpO_2$ 90% or less, at least 10s duration) and vomiting was recorded. Patients sedated with chloral hydrate/hydroxyzine showed significantly better overall behavior score than patients sedated with midazolam/meperidine. There was no clinically significant difference in the incidence of hypoxia and vomiting. It was concluded that oral administration of chloral hydrate/hydroxyzine is more effective than midazolam/meperidine for the sedation of pediatric dental patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.18 no.3
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• pp.160-167
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• 2015

Purpose: We aimed to analyze the effectiveness and safety of low-dose midazolam and ketamine combination for upper gastrointestinal endoscopy (UGIE) in children. Methods: The study included the children (n=425, $10.78{\pm}3.81years$) who underwent UGIE for diagnostic purpose during 1 year period. All children were sedated with low dose midazolam (0.1 mg/kg) and ketamine (0.5 mg/kg) intravenously. Effectiveness of the sedation and complications during the procedure and recovery period were recorded. Results: Endoscopic procedure was successfully completed in 414 patients (97.4%; 95% confidence interval, 95.8-98.9). $Mean{\pm}standard$ deviation (SD) duration of procedure was $6.36{\pm}1.64minutes$ (median, 6.0 minutes; range, 4-12 minutes). Minor complications occurred during the procedure in 39.2% of the patients. The most common complication was increased oral secretion (33.1%). No major complications were observed in any patient. Age and Ramsay sedation scores of patients with complications during the procedure were lower than the others ($9.49{\pm}4.05years$ vs. $11.61{\pm}3.43years$, p=0.002 and $2.10{\pm}1.46$ vs. $4.37{\pm}1.16$, p=0.001). Mean recovery time was 22 minutes (range, 10-90 minutes; $mean{\pm}SD$, $25{\pm}12.32minutes$). Minor complications developed during recovery in 60.1% of the patients. The most common complication was transient double vision (n=127, 30.7%). Emergence reaction was observed in 5 patients (1.2%). Conclusion: The procedure was completed with high level of success without any major complication in our study. Combination of low-dose midazolam and ketamine is a suitable sedation protocol for pediatric endoscopists in UGIE.