• Title/Summary/Keyword: Dental anesthesiology

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MIDAZOLAM ORAL PREMEDICATION IN AUTISTIC PATIENT WHO IS AFRAID TO ENTER DENTAL OFFICE -A CASE REPORT- (치과 진료실에 들어오지 않으려는 자폐환자에서 미다졸람 경구투여 -증례보고-)

  • Lee, Jung-Hoo;Seo, Kwang-Suk;Shin, Teo-Jeon;Kim, Hyun-Jeong;Chang, Ju-Hea
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.5 no.2
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    • pp.100-103
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    • 2009
  • Dental treatment of mentally challenged patients under general anesthesia is a series of challenging procedures not only for dental operators but also for dental anesthesiologists. Patients presenting with uncooperative behavior often resist the perioperative management for adesthestic administration. This case report suggests oral premedication as a conjuctive method for anestheitic induction. A 26-year-old male dental patient with autism was referred to dental treatment under general anesthesia. The patient refused to enter dental clinic office and was not able to receive preoperative assessment. In the day of operation, 15 mg of midazolam was given to the patient for oral premedication prior to anesthetic induction. Ater 20 minutes, the patient presented with drowziness and was transferred to the office. Anesthestic staff were able to achieve appropriate intravenous access and mask inhalation. The patient recieved 8 hrs long dental treatment and recovered in a noncomplicated way. Oral midazolam is commonly used to reduce anxiety for combative and irritated pateints. In this case, oral midazolam sedation was used as a preanesthetic management of a highly uncoopearive patient.

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Risk factors affecting the difficulty of fiberoptic nasotracheal intubation

  • Rhee, Seung-Hyun;Yun, Hye Joo;Kim, Jieun;Karm, Myong-Hwan;Ryoo, Seung-Hwa;Kim, Hyun Jeong;Seo, Kwang-Suk
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.20 no.5
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    • pp.293-301
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    • 2020
  • Background: The success rate of intubation under direct laryngoscopy is greatly influenced by laryngoscopic grade using the Cormack-Lehane classification. However, it is not known whether grade under direct laryngoscopy can also affects the success rate of nasotracheal intubation using a fiberoptic bronchoscpe, so this study investigated the same. In addition, we investigated other factors that influence the success rate of fiberoptic nasotracheal intubation (FNI). Methods: FNI was performed by 18 anesthesiology residents under general anesthesia in patients over 15 years of age who underwent elective oral and maxillofacial operations. In all patients, the Mallampati grade was measured. Laryngeal view grade under direct laryngoscopy, and the degree of secretion and bleeding in the oral cavity was measured and divided into 3 grades. The time required for successful FNI was measured. If the intubation time was > 5 minutes, it was evaluated as a failure and the airway was managed by another method. The failure rate was evaluated using appropriate statistical method. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were also measured. Results: A total of 650 patients were included in the study, and the failure rate of FNI was 4.5%. The patient's sex, age, height, weight, Mallampati, and laryngoscopic view grade did not affect the success rate of FNI (P > 0.05). BMI, the number of FNI performed by residents (P = 0.03), secretion (P < 0.001), and bleeding (P < 0.001) grades influenced the success rate. The AUCs of bleeding and secretion were 0.864 and 0.798, respectively, but the AUC of BMI, the number of FNI performed by residents, Mallampati, and laryngoscopic view grade were 0.527, 0.616, 0.614, and 0.544, respectively. Conclusion: Unlike in intubation under direct laryngoscopy, in the case of FNI, oral secretion and nasal bleeding had a significant effect on FNI difficulty than Mallampati grade or Laryngeal view grade.

Anaphylactic reaction after local lidocaine infiltration for retraction of retained teeth

  • Kim, Hyerim;Lee, Jung-Man;Seo, Kwang-Suk;Kwon, Seok Min;Row, Hyung Sang
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.19 no.3
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    • pp.175-180
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    • 2019
  • Although allergic reactions are not rare complications in drug use, anaphylaxis or anaphylactoid reactions to some widely used drugs can embarrass clinicians because anaphylaxis is not easily diagnosed at the time of the event and treatment is unfamiliar to many. Lidocaine is a very popular drug in dental procedures and anaphylactoid reaction to it has been rarely reported. Clinicians who use lidocaine daily should, however, be aware of the possibility of anaphylaxis after its use. Once it occurs, anaphylaxis can be fatal, but if it is quickly diagnosed or suspected, treatment is simpler than most clinicians believe. An 86-year-old woman experienced an anaphylactic reaction 30 min after local infiltration of lidocaine for retraction of retained teeth. The dentist called an anesthesiologist for assistance. Fortunately, an anaphylactic reaction was quickly suspected and after subsequent rapid treatment with the administration of fluid and drug therapy, the patient recovered completely.

The Survey and Evaluation of CPR Skill in Dental Students (치의학대학원생의 심폐소생술 지식 및 심폐소생술 수행능력에 대한 조사연구)

  • Seo, Kwang-Suk;Lee, Jung-Man;Cho, Kyoung Ah;Kim, Hyun-Jeong;Shin, Teo Jeon;Hyun, Hong-Keun;Kim, Young-Jae;Kim, Jung-Wook;Jang, Ki-Taeg;Lee, Sang-Hoon;Kim, Chong-Chul
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.12 no.4
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    • pp.209-214
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    • 2012
  • Background: This study evaluates the existing cardiopulmonary resuscitation (CPR) knowledge and skills of 1 st year dental students and also compares their CPR performance skill with those of 4 th year students. Methods: Incoming 1 st year and 4 th year dental students were surveyed about the level of their CPR knowledge before conventional CPR instruction. After we trained them for CPR performance, we tested CPR performance skill to randomly selected 10 1st year and 4 th year dental students and compared their CPR performance. Results: Overall CPR knowledge was low for both 1 st and 4 th year dental students. Especially, only 1 among 89 fourth year dental students answered the right sequence of CPR revised in 2010. Overall CPR performance was relatively low for both 1 st and 4 th year dental students. Irrespective of previous experiences of CPR education, their CPR performance was not statistically different. Conclusions: Retraining of CPR is a necessity. Information about the existing CPR knowledge for dental students will aid in establishing the goal of future CPR training and improve the current deficiency.

High stakes anesthesia: Anesthetic considerations and implications for complete dental extraction in a patient with complex comorbidities

  • Panchamia, Rohan K.;Samuels, Jon D.
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.19 no.3
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    • pp.167-173
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    • 2019
  • This case report describes a frail, middle-aged woman with multiple comorbidities who was scheduled to undergo extraction of all remaining teeth in anticipation of cardiac quadruple valve intervention. Dental and anesthetic management of the patient are discussed. Medical care of the patient with a high burden of comorbidities requires a multidisciplinary approach even for a routine dental procedure.

Effects site concentrations of propofol using target-controlled infusion in dental treatment under deep sedation among different intellectual disability types

  • Keyling, S;Salmeron, Salinas;Kim, Hyun Jeong;Seo, Kwang-Suk
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.19 no.4
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    • pp.217-226
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    • 2019
  • Background: We aimed to assess the dose needed to achieve the propofol effect-site concentration using target-controlled infusion in intellectually disabled patients and to detail the most effective method for achieving a safe level of consciousness without hemodynamic changes as well as detail any resulting adverse effects. Methods: We performed a retrospective review of sedation service records of 138 intellectually disabled patients (51, mental retardation; 36, autism; 30, brain lesion, 12 genetic diseases, 9 dementia) aged over 15 years and weighing over 30 kg. These patients had received propofol via target-controlled infusion in the special care dental clinic of Seoul National University Dental Hospital from May 2008 to September 2018 for restorative treatment (112), minor surgery (13), prosthodontics (7), periodontics treatment (5), and implant (1). Results: For all groups, the duration of dental treatments was $43{\pm}18$ minutes, total sedation time was $73{\pm}23$ minutes, and total BIS values was $57{\pm}12$. The propofol maintenance dosage values for each group were: mental retardation, $3{\pm}0.5(2-4){\mu}g/ml$; autism, $3.1{\pm}0.7(2-5){\mu}g/ml;$; brain lesion, $2.8{\pm}0.7(1.5-5){\mu}g/ml;$; genetic disease, $2.9{\pm}0.9(1-4){\mu}g/ml;$ and dementia $2.3{\pm}0.7(1-3.4){\mu}g/ml;$. Conclusions: The dementia group needed a lower dosage to reach a safe, effective propofol effect-site concentration than the other groups. Since there were no complications, deep sedation is a great alternative to general anesthesia for dental treatment of intellectually disabled patients.

INTRAVENOUS SEDATION OF CEREBRAL PALSY PATIENT FOR DENTAL IMPLANT CT TAKING -A CASE REPORT (정신지체가 동반된 뇌성마비 환자의 임플란트 치료를 위한 CT 촬영 시 진정법 시행 -증례보고-)

  • Seo, Kwang-Suk;Lee, Ju-Hwan;Shin, Teo-Jeon;Yi, Young-Eun;Kim, Hyun-Jeong;Yum, Kwang-Won;Kim, Myung-Jin
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.4 no.1
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    • pp.21-25
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    • 2008
  • A 33-years-old female pateint with cerebral palsy showing spastic quardriplegia and severe mental retardation was scheduled for dental implant restorations. Before implant surgery we had to take implant CT. But, because of her involuntary motion and communication difficulty, sedation was needed in order to take CT. After 8 hour NPO, propofol infusion sedation with TCI (target controlled infusion) system was administered. The propofol blood concentration of the patient was maintained 2-3 ${\mu}$/ml to keep deep sedation to prevent uncontolled movement. During sedation, we monitored ECG, pulse oximetry, blood pressure, capnometry for patient safety. Oxygen was administered via nasal prong for preventing hypoxemia and to keep airway during sedation some bands were applied to lift mandible. Total duration was 20 minutes for taking CT, and she was discharged from hospital after 30 minute rest without complication.

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Identifying the more suitable nostril for nasotracheal intubation using radiographs

  • Chi, Seong In;Park, Sookyung;Joo, Li-Ah;Shin, Teo Jeon;Kim, Hyun Jeong;Seo, Kwang-Suk
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.16 no.2
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    • pp.103-109
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    • 2016
  • Background: One nostril must be selected for nasotracheal intubation. In some cases, structural anomalies within the nasal cavity hinder the insertion of the tube or complications, such as epistaxis, develop. This study examined the possibility of using radiography to select the nostril that would induce fewer complications. Methods: Four hundred and five patients who underwent nasotracheal intubation under general anesthesia were studied. A 7.0-mm internal diameter nasal right angle endotracheal (RAE) tube and 6.5-mm internal diameter nasal RAE tube were inserted into men and women, respectively. Complications were considered to have developed in cases in which insertion of the tube into the nasal cavity failed or epistaxis occurred. The tube was inserted into the other nostril for insertion failures and hemostasis was performed in cases of epistaxis. The degree of nasal septal deviation was determined from posteroanterior skull radiographs or panoramic radiographs; the incidence of complications was compared depending on the direction of the septal deviation and the intubated nostril. Results: The radiographs of 390 patients were readable; 94 had nasal septum deviation. The incidence of complications for cases without nasal septum deviation was 16.9%, that for cases in which the tube was inserted into the nostril on the opposite side of the deviation was 18.5%, and that for cases in which the tube was inserted into the nostril with the deviation was 35.0%, showing a high incidence of complications when intubation is performed through the nostril with septum deviation (chi-square test, P < 0.05 ). Conclusions: Although there were no differences in the incidence rates of complications between intubation through the left nostril and that through the right nostril, radiological findings indicated that incidence of complications significantly increased when the tube was inserted into the nostril with the septum deviation.

Local anesthesia of the temporomandibular joint to reduce pain during mouth opening for dental treatment in a patient with spinal muscular atrophy

  • Chi, Seong In;Kim, Hyun Jeong;Seo, Kwang-Suk;Lee, Jong Ho;Chang, Juhea
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.16 no.2
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    • pp.137-140
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    • 2016
  • Spinal muscular atrophy (SMA) is an autosomal recessive, severe neuromuscular disorder in which degeneration of alpha motor neurons in the spine progressively weakens and ultimately paralyzes the proximal muscles. It occurs in one per 6,000-10,000 infants, and is a genetic disorder with the second-highest mortality rate worldwide. An 18-year-old male patient with SMA was referred for general anesthesia for difficulty in performing dental treatment due to limited mouth opening caused by temporomandibular joint (TMJ) pain. However, the patient had a high risk of general anesthesia complications, so TMJ pain during mouth opening was reduced through local anesthesia of the TMJ. Fortunately, the anesthesia was successful in reducing pain during mouth opening, enabling the patient to receive dental treatment with an adequate mouth opening.

Deep Sedation with Sevoflurane in Patients with Double Outlet of Right Ventricle (양대혈관 우심실 기시 환아의 Sevoflurane을 이용한 깊은 진정 하 치과치료)

  • Hyun, Hong-Keun;Shin, Teo Jeon;Kim, Young-Jae;Kim, Jung-Wook;Jang, Ki-Taeg;Lee, Sang-Hoon;Kim, Chong-Chul;Kim, Hyun-Jeong;Seo, Kwang-Suk;Lee, Jung-Man;Shin, Soonyoung
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.12 no.2
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    • pp.115-119
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    • 2012
  • Double outlet of right ventricle (DORV) refers to a congenital heart disease in which pulmonary and systemic circulation originates from the right ventricle. In the patient with DORV, it is important to maintain the balance between pulmonary and systemic circulation in anesthetic management. A 4-year-old boy with DORV, who underwent a Blalock-Taussig shunt operation, was transferred to the clinic with a chief complaint of multiple caries. Due to poor cooperability, it was impossible to treat the caries without sedation or general anesthesia. We planned to sedate him with consideration with detrimental effects associated with positive pressure ventilation for dental treatment. After a prophylactic administration of antibiotics, sevoflurane was administered through T-cannula site. Throughout the treatment, His blood remained stable around 80/40 mmHg, oxygen saturation remained around 91%. After 3 hour of sedation with sevoflurane (end-tidal sevoflurane con 1-1.8 vol%), he fully regained consciousness, and discharged from hospital without complications. In case of DORV patient, deep sedation with sevoflurane may be used as effective method of behavioral management during dental treatment.