• Clinical Endoscopy
• /
• v.56 no.2
• /
• pp.188-193
• /
• 2023

Background/Aims: Data on the incidence of adverse respiratory events during recovery from gastrointestinal endoscopy are limited. The aim of this study was to investigate the incidence of these complications. Methods: In this retrospective cohort study, data were obtained from the electronic records of 657 consecutive patients, who underwent gastroenterological procedures under sedation. Results: Pulse oximetry oxygen saturation (SpO₂) <90% for <60 seconds occurred in 82 patients (12.5%), and in 11 patients (1.7%), SpO₂ of <90% for >60 seconds occurred in 79 patients (12.0%) and in 14 patients (2.1%), and SpO₂ <75% occurred in four patients (0.6%) and in no patients during the procedure and recovery period, respectively. No major complications were noted. The occurrence of desaturation during recovery was correlated with desaturation during the procedure (p<0.001). Higher American Society of Anesthesiologists score (odds ratio [OR], 1.867; 95% confidence interval [CI], 1.008-3.458), ischemic heart disease (OR, 1.815; 95% CI, 0.649-5.080), hypertension (OR, 1.289; 95% CI, 0.472-3.516), and diabetes mellitus (OR, 2.406; 95% CI, 0.950-6.095) increased the occurrence of desaturation during recovery. Conclusions: We found no major complications during recovery after balanced propofol-based sedation administered by a gastroenterologist-nurse team. Patients with the identified risk predictors must be monitored carefully.

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

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.8 no.2
• /
• pp.113-117
• /
• 2008

Background: The purpose of this study was to compare the use of midazolam only with midazolam with fentanyl or propofol in IV sedation. Methods: 24 cases were divided to midazolam group (M group), midazolam + fentanyl group (MF group), midazolam + propofol group (MP group) and midazolam + fentanyl + propofol group (MFP group). In M group, 2 ml midazolam was injected at first, than at 2 minutes interval 1-2 ml injected continuously depending on the level of sedation. In MP, MFP groups, propofol was injected at the speed of 15-20 ml/hr by infusion pump. In this study, the sedation level was evaluated by using OAA/S scale. In each groups, the recovery time was measured until OAA/S scale score level was 5, and pre and postoperative blood pressure change was measured. Each group's data was statistically analyzed using one-way ANOVA. If significant statistical difference were observed, Dunnet test was performed, and control group was M group. Results: Pre and postoperative blood pressure change were not represent significant statistical difference in 4 groups (P value = 0.679 [systolic], P value = 0.206 [diastolic]). But recovery time were represent significant statistical difference (M group: 35.6, MF group: 32.5, MP group: 17.9, MFP group: 19.6 [P value = 0.002]). The result of Dunnet test on recovery time showed significant statistical difference on MF, MFP group when M group was control group. In MFP group, sedation was increased by using supplemental fentanyl, and postoperative pain control was dominant. Conclusion: To achieve the effect of anxiolysis, analgesia, amnesia effectively, and short recovery time, MFP group is mostly recommended.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.51 no.2
• /
• pp.109-131
• /
• 2024

This review aims to examine safety concerns in pediatric dental care and underscore the need for comprehensive patient safety initiatives within the Korean Academy of Pediatric Dentistry. Drawing insights from the prevailing patient safety policies of the American Academy of Pediatric Dentistry, case reports, and systematic reviews, this review elucidates issues such as dental fires during sedation, ocular complications from local anesthesia, and surgical emphysema. This review highlights the significance of safety toolkits encompassing infection control, medical error reduction, dental unit waterline infection, and nitrous oxide safety in pediatric dental settings, underscoring the need to foster a safety culture. Furthermore, this study explores the curriculum for pediatric dentistry residency programs, emphasizing concepts such as high-reliability organizations and mortality and morbidity conferences. The study suggests the need for initiatives to enhance patient safety, including establishing safety committees, expanding reporting systems, policy development, and supporting research related to patient safety. In conclusion, this study underlines key messages, emphasizing the utmost priority of patient safety, acknowledging the inevitability of human error, promoting effective communication, and cultivating a patient safety culture. These principles are vital for advancing patient safety in pediatric dental care and improving outcomes among pediatric patients.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.9 no.2
• /
• pp.169-175
• /
• 2006

Purpose: Esophagogastroduodenoscopy (EGD) is a very useful procedure in diagnosing gastrointestinal diseases. However, there can be some difficulty in performing this procedure in children due to the associated discomfort. Recently, sedative agents such as midazolam have been introduced to alleviate this problem quite successfully. In our study, we attempted to confirm the safety and efficacy of midazolam use by monitoring the vital signs of children undergoing endoscopy. Methods: We analyzed data on 244 children who received EGD in the department of pediatrics at Severance Hospital, Yonsei University between August 2003 and July 2005. We evaluated $O_2$ saturation, heart rate and change of mental status before and during the procedure and analyzed the results using the SPSS 12.0 package (Chi-square test, cross table method, etc.). Results: There was no significant difference in vital signs measured before and during EGD between midazolam treated and non treated children. There was no significant relationship between the amount of midazolam given and $O_2$ saturation or a change of mental status. Regarding the $O_2$ saturation, it was decreased during EGD in both groups with p<0.01 though no difference was noted between the groups; the $O_2$ level was maintained above 95% in all patients. The heart rate was also increased during EGD in both groups with a p<0.01; however, no significant difference was noted between the groups. Conclusion: We confirmed the safety of low dose midazolam by evaluating the vital signs of children during endoscopies. However, the doses used were not sufficient for sedation or to obtain an amnestic effect.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.5 no.2 s.9
• /
• pp.101-106
• /
• 2005

Purpose: This retrospective study assessed the effectiveness of submucosal (SM) midazolam (M), oral chloral hydrate (CH), hydroxyzine (H), and nitrous oxide (N) 99 uncooperative pediatric dental patients over 182 sedation sessions. Methods: Selection criteria included good medical health (ASA I), from 2 to 6 years of age, uncooperative behavior, and the need for restorations and dental surgery. The children who was administerated with CH H, N was Group 1 (48 case). The children who was administerated with CH, H, N, M was Group 2 (51 case). All the patients received oral CH (50-70 mg/Kg), H (1 mg/Kg) and N (less than 50%). Additionally the Group 2 received SM midazolam (0.1-0.2 mg/kg). Behavior response was rated as quiet (Q), crying (C), movement (M), or struggling (S) every 5 minutes through operative procedures. Behavior response rating was assigned to Houpt scale of Overall behavior. Data was analyzed using Chi-Square Test. Results: The Group 2 had more effective (88.2%) than the Group 1 (68.8%)(P = 0.05). Also, vomiting response decreased in the Group 2 (94.4%) than those with oral administration of chloral hydrate alone without SM midazolam (77.1%)(P = 0.05). Conclusions: SM midazolam improved the quality of sedation and vomiting response.

• Clinical and Experimental Pediatrics
• /
• v.49 no.7
• /
• pp.726-731
• /
• 2006

Purpose : We reported previously that intramuscular ketamine with adjunctive midazolam is more effective than ketamine alone in pediatric procedural sedation, but with limited satisfactory sedation by suboptimal ketamine dose. The optimal dose of intramuscular ketamine in children has never been studied in Korea. In this study, we investigated the effectiveness and adverse events of ketamine 4mg/kg with adjunctive midazolam in pediatric laceration repair. Methods : From Jan. 2005 to July 2005, we enrolled 60 children, aged 3 months-7 years, who needed laceration repair under sedation. After verbal consent from parents, patients were randomly assigned to KMA group(IM ketamine 4 mg/kg＋atropine 0.01 mg/kg＋intramuscular midazolam 0.05 mg/kg) or KA group(without midazolam). We compared both groups with the induction time, recovery time, total sedation time, efficacy of sedation, adverse effects, and the satisfaction score of treating physicians. Results : Potentially confounding variables, age, weight, injury site and anxiety score, were similar between groups. The induction time, recovery time and total sedation time were not different statistically. In KMA group, 90.9 percent of patients showed satisfactory sedation compared to 66.7 percent of KA group(P=0.02) and the occurrence rate of significant adverse effect was 0.0 percent and 37.0 percent respectively. Conclusion : We found adjunctive midazolam with ketamine doses of 4 mg/kg IM produced more effective, satisfactory sedation and less adverse effect than without midazolam in pediatric laceration repair. The emergence phenomenon(agitation during recovery) only occurred in 9 KA group patients. In spite of adverse effect, all patients recovered, were discharged and there were no reported delayed events.

• 대한치과마취과학회:학술대회논문집
• /
• 2003.06a
• /
• pp.54-54
• /
• 2003

• Journal of the korean academy of Pediatric Dentistry
• /
• v.43 no.4
• /
• pp.435-442
• /
• 2016

The aim of this study was to analyze physiological changes, clinical and subjective symptoms by different $N_2O$ concentrations and administration method. This study surveyed 65 men and women ages 19 to 35 and all subjects were healthy volunteers, with no contraindication for use of $N_2O$ sedation. The $N_2O$ sedation was carried out in a way that increases by 10 percent to one-minute interval or increases at once the desired level. Each method was required to reach 30 or 50 percent $N_2O$ concentration. The way to gradually raise the $N_2O$ concentration can reduce the risk by decreasing the pulse reduction rate at the same $N_2O$ concentration. $SpO_2$ has no statistical significance according to $N_2O$ concentration and method of administration. Pulse rate reduced significantly when 50% $N_2O$ increase at once during sedation and 100% $O_2$ after 5 minutes. The way to gradually raise the $N_2O$ concentration is safe for reducing pulse rate.

• Tuberculosis and Respiratory Diseases
• /
• v.80 no.2
• /
• pp.194-200
• /
• 2017

Background: Medical thoracoscopy (MT) is a minimally invasive, endoscopic procedure for exploration of the pleural cavity under conscious sedation and local anesthesia. MT has been performed at the Seoul National University Hospital since February 2014. This paper summarizes the findings and outcomes of MT cases at this hospital. Methods: Patients who had undergone MT were enrolled in the study. MT was performed by pulmonologists, using both rigid and semi-rigid thoracoscopes. During the procedure, patients were under conscious sedation with fentanyl and midazolam. Medical records were reviewed for clinical data. Results: From February 2014 to January 2016, 50 procedures (47 cases) were performed (diagnostic MT, 26 cases; therapeutic MT, 24 cases). The median age of patients was 66 years (59-73 years), and 38 patients (80.9%) were male. The median procedure duration from initial incision to insertion of the chest tube was 37 minutes. The median doses of fentanyl and midazolam were $50{\mu}g$ and 5 mg, respectively. All procedures were performed without unexpected events. Of the 26 cases of pleural disease with an unknown cause, 19 were successfully diagnosed using MT. Additionally, diagnostic MT provided clinically useful information in the other six patients. Therapeutic MT was very effective for treatment of malignant pleural effusion or empyema. The median number of days with chest tube drainage was 6 (3 days for diagnostic MT and 8 days for therapeutic MT). Conclusion: MT is a useful and necessary procedure for both diagnosis and treatment of pleural diseases.