• Title/Summary/Keyword: Dental anesthesiology

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Usefulness of lateral cephalometric radiography for successful blind nasal intubation: a prospective study

  • Ito, Kana;Kamura, Ayaka;Koshika, Kyotaro;Handa, Toshiyuki;Matsuura, Nobuyuki;Ichinohe, Tatsuya
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.22 no.6
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    • pp.427-435
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    • 2022
  • Background: This study aimed to investigate the relationship between pharyngeal morphology and the success or failure of blind nasotracheal intubation using standard lateral cephalometric radiography and to analyze the measurement items affecting the difficulty of blind nasotracheal intubation. Methods: Assuming a line perpendicular to the Frankfort horizontal (FH) plane, the reference point (O) was selected 1 cm above the posterior-most end of the hard palate. A line passing through the reference point and parallel to the FH plane is defined as the X-axis, and a line passing through the reference point and perpendicular to the X-axis is defined as the Y-axis. The shortest length between the tip of the uvula and posterior pharyngeal wall (AW), shortest length between the base of the tongue and posterior pharyngeal wall (BW), and width of the glottis (CW) were measured. The midpoints of the lines representing each width are defined as points A, B, and C, and the X and Y coordinates of each point are obtained (AX, BX, CX, AY, BY, and CY). For each measurement, a t-test was performed to compare the tracheal intubation success and failure groups. A binomial logistic regression analysis was performed using clinically relevant items. Results: The items significantly affecting the success rate of blind nasotracheal intubation included the difference in X coordinates at points A and C (Odds ratio, 0.714; P-value, 0.024) and the ∠ABC (Odds ratio, 1.178; P-value, 0.016). Conclusion: Using binomial logistic regression analysis, we observed statistically significant differences in AX-CX and ∠ABC between the success group and the failure group.

Dexmedetomidine for Repeated Sedation in Pediatric Sedation During Consecutive Radiation Therapy

  • Kim, Eun-Jung;Baek, Seung-Hoon;Byeon, Gyeong-Jo;Woo, Mi-Na
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.14 no.4
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    • pp.221-225
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    • 2014
  • External beam radiotherapy (EBRT) causes anxiety and claustrophobia in pediatric patients. To provide exact figures and radiation amounts, an appropriate sedation or anesthesia can be supplied. Alpha 2 agonist dexmedetomidine has been used for sedation and anesthesia in pediatric imaging. Dexmedetomidine has an advantage because it has minimal respiratory depression and no direct effects on myocardial function. We report repeated sedation with dexmedetomidine for 33 consecutive radiation therapies in 5 years old children.

Recurrent ST segment elevations in a patient with asymptomatic early repolarization during head and neck surgery: implications of vasospastic angina

  • Park, Se-Ung;Kim, Sung-Hoon;Kwon, Hye-Mee;Koh, Gi-Ho;Nam, Gi-Byoung;Karm, Myong-Hwan;Kim, Wook-Jong;Ku, Seung-Woo
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.18 no.3
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    • pp.189-193
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    • 2018
  • A 57-year-old woman scheduled for cochlear implant removal exhibited preoperative electrocardiographic findings of early repolarization (ER). Four episodes of transient ST segment elevations during surgery raised suspicion for vasospastic angina (VA). In the post-anesthetic care unit, the patient complained of chest discomfort and received sublingual nitroglycerin with uncertain effect. The patient refused to proceed with postoperative invasive coronary angiography, resulting in inconclusive diagnosis. Intraoperative circumstances limit the diagnosis of VA, which emphasizes the need for further testing to confirm the diagnosis. When VA is suspected in patients with underlying ER, it is reasonable to consider invasive examination to establish the diagnosis and prevent recurrence of VA. If ST changes are observed during surgery in patients with preoperative ER, careful monitoring is recommended. Due to general anesthesia, the absence of patient symptoms limits the definitive diagnosis of those with suspected VA. Therefore, additional postoperative surveillance is recommended.

General Anesthesia for Dental Treatment in the Congenital Hypothyroidism and Psuedohypoparathyroidism (선천성 갑상선기능저하증과 가성부갑상선기능저하증을 동반한 환자의 전신마취 하 치과치료)

  • Seo, Kwang-Suk;Shin, Teo-Jeon;Kim, Hyun-Jeong;Chang, Juhea
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.13 no.3
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    • pp.139-143
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    • 2013
  • The patient who has congenital hypothyroidism and pseudohypoparathyroidism could have mental retardation even though adequate hormone treatment and cannot endure conventional dental treatment. In this case, general anesthesia is selected to administer effective dental treatment. But, there could be symptoms such as anemia, neuropathy, associated pituitary or adrenal hypofunction, cardiac failure even in euthyroid state. And, bradycardia, mental dullness, hypothermia, slow reflexes can appear in case of inadequate thyroid hormone replacement. Especially, macroglosssia, slow drug metabolism, exaggerated responses to anesthetic agents and decreased ventilatory responses could be problem during general anesthesia. The presentation of hypoparathyroidism also varies depending on the chronicity of the result of hypocalcemia. Muscle spasms/tetany, paresthesias, and seizures may occur in an acute onset. Chronic hypocalcaemia causes fatigue, muscle cramps, lethargy, personality changes, and cerebration defects.

Managing general anesthesia for low invasive dental procedures while maintaining spontaneous respiration with low concentration remifentanil: a cross-sectional study

  • Daijiro Ogumi;Shota Abe;Hikaru Sato;Fumihiko Suzuki;Hiroyoshi Kawaai;Shinya Yamazaki
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.23 no.4
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    • pp.221-228
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    • 2023
  • Background: We assessed the relationship between patient age and remifentanil dosing rate in patients managed under general anesthesia with spontaneous breathing using low-dose remifentanil in sevoflurane. Methods: The participants were patients with an American Society of Anesthesiologists Physical Status of 1 or 2 maintained under general anesthesia with low-dose remifentanil in 1.5-2.0% sevoflurane. The infusion rate of remifentanil was adjusted so that the spontaneous respiratory rate was half the rate prior to the induction of anesthesia, and γH (㎍/kg/min) was defined as the infusion rate of remifentanil under stable conditions where the respiratory rate was half the rate prior to the induction of anesthesia for ≥ 15 minutes. The relationship between γH and patient age was analyzed statistically by Spearman's correlation analysis. Results: During dental treatment under general anesthesia using low-dose remifentanil in sevoflurane, a significant correlation was detected between γH and patient age. The regression line of y = - 0.00079 x + 0.066 (y-axis; γH, x-axis; patient's age) was provided. The values of γH provide 0.064 ㎍/kg/min at 2 years and 0.0186 ㎍/kg/min at 60 years. Therefore, as age increases, the dosing rate exhibits a declining trend. Furthermore, in the dosing rate of remifentanil when the patient's respiratory rate was reduced by half from the preanesthetic respiratory rate, the dosing rate provided was around 0.88 mL/h in all ages if the remifentanil was diluted as 0.1 mg/mL. EtCO2 showed 51.0 ± 5.7 mmHg, and SpO2 was controlled within the normal range by this method. In addition, all dental treatments were performed without major problems, such as awakening and body movement during general anesthesia, and the post-anesthetic recovery process was stable. Conclusion: General anesthesia with spontaneous breathing provides various advantages, and the present method is appropriate for minimally invasive procedures.

Circadian variation of IV PCA use in patients after orthognathic surgery - a retrospective comparative study

  • Park, Sookyung;Chi, Seong In;Seo, Kwang-Suk;Kim, Hyun Jeong
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.15 no.3
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    • pp.141-146
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    • 2015
  • Background: An understanding of the features of postoperative pain is essential for optimal analgesic dosing strategies. Using a visual analogue scale (VAS) score and patient controlled analgesia (PCA) infusion pattern analysis, an anesthesiologist can estimate when and how severely patients suffer from pain. Several reports have been published about circadian changes in the pain threshold. Postoperative pain was analyzed retrospectively in 250 patients who underwent orthognathic surgery. Methods: A total of 250 patients were allocated into two groups according to the time of recovery from anesthesia. Patients in the early group (group E) recovered from anesthesia before 06:00 p.m. Patients in the late group (group L) recovered from anesthesia after 06:00 p.m. All patients received intravenous patient controlled analgesia (IV PCA) at the end of the operation. The VAS score of pain intensity was measured. Self-administration of bolus analgesic from the IV PCA device was also analyzed according to actual time and elapsed time. Results: VAS scores showed no difference between the two groups except 36 hours after recovery from anesthesia. On POD1, there were two peaks for self-administration of bolus analgesics in group L and one peak in the morning for group E. Two peaks each in the morning and in the afternoon were shown in both groups on POD2. Conclusions: Diurnal variance in pain should be considered for effective dosing strategies.

A Statistical Analysis of the General Anesthesia for Dental Treatment to Children with Developmental Disability (장애 환자의 소아치과 치료 시 전신마취에 대한 통계적 고찰)

  • Choi, Young-Kyoo;Lee, Sung-Min;Kim, Dong-Ok
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.2 no.2 s.3
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    • pp.101-106
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    • 2002
  • Background: The management of the behavior of handicapped children when providing required dental care is often a problem, whether in the dental office or in a hospital setting. Because of the high incidence of poor cooperation, many of these patients are scheduled for dental care under general anesthesia with preoperative medical assessment. The purpose of this study was to carry out a clinico-statistical survey on dental treatment for handicapped children under general anesthesia. Methods: After approval from the institutional review board, the medical records of 64 handicapped children between 1997 and 2002 were reviewed to determine the patient profiles, anesthesia management, and complications. The charts of these patients, who underwent dental examination, scaling and prophylaxis, and restoration and extraction of teeth under general anesthesia, were reviewed. Results: The mean age was 12.8 years old, and males (53%) predominated females (47%). Twenty-four patients had mental retardation, twelve had autism, six had cerebral palsy, 4 had behavior disorder, others had heart disease, convulsive disorder, etc. Sixty-two had intravenous thiopental with neuromuscular blocker, 2 had intravenous ketamine induction. Nasotracheal intubation was uneventful in 55 patients, nine had orotracheal intubation because of difficult visualization of the larynx. Twenty-one patients experienced postoperative complications in the recovery room, including epistaxis, nasal obstruction, vomiting, airway obstruction, respiratory depression. Conclusions: General anesthesia is a very effective way of completing the dental treatments for disabled children. We emphasize the need to train anesthesiologists in the care of disabled patients.

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Meta-analysis for Efficacy and Safety of Propofol during Dental Sedation

  • Choi, Seong-Seok;Seo, Kwang-Suk;Kim, Hyun-Jeong
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.12 no.2
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    • pp.75-91
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    • 2012
  • Background: Dental sedation reduces fear and phobia during dental treatment and helps patients get quality treatment by inducing adequate consciousness control. Propofol has recently grabbed the spotlight, but no meta-analysis for efficacy and safety of propofol in dentistry has yet been performed. Thus, the purpose of this study was to perform meta-analysis to verify the efficacy and safety of propofol for use in dental sedation. Methods: Articles published between 1980 and 2010 were searched in the web sites, journals and medical database including The Cochrane Library, MEDLINE and EMBASE. And a total of 22 studies were selected among the randomized controlled trials (RCTs) that compared the use of propofol with other sedatives (control group). The data was collected from these studies and meta-analysis for efficacy and safety was performed using Comprehensive Meta-Analysis 5.0 (CMA 5.0). Results: The patient recovered significantly faster and discharged significantly earlier in the propofol group (SMD = -1.442, P < 0.001). The satisfaction of patient and that of operator was higher in the propofol group (P < 0.05). The incidence of arrhythmia and apnea/ hypoventilation was significantly lower in the propofol group (OR = 0.071, P < 0.05), and there was no significant difference in the other side effects. On the level of sedation, although the sedation score was significantly lower in the propofol group (SMD = -0.430, P < 0.05). Conclusions: The present analysis showed that the use of propofol resulted in high satisfaction levels on the part of the patients and operators, a shorter recovery time, and faster hospital discharge. The incidence of complications, however, was lower in the propofol groups or not much different between the propofol and control groups. Thus, the adequate use of propofol in dentistry is believed to be helpful for the effective and safe sedation of the patients.

Anesthetic Management of the Dental Treatment in a Child with Liver Failure Scheduled for Liver Transplantation - A case report - (간이식 예정인 간부전 환아의 치과치료 시 마취관리 -증례 보고-)

  • Park, Chang-Joo;Jang, Ki-Taeg;Yum, Kwang-Won;Kim, Hyun-Jeong
    • Journal of The Korean Dental Society of Anesthesiology
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    • v.2 no.2 s.3
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    • pp.114-117
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    • 2002
  • Special anesthetic considerations were required for children with acute or chronic liver disease. We experienced a case of dental treatment to control infection under general anesthesia in the 2-year-old girl with liver failure. She was also scheduled for liver tansplantation. Her preanesthetic results of liver function test, electrolytes, and coagulation panel were unstable and out of normal ranges. Uneventful anesthetic induction using isoflurane and atracurium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 2 hours. Oozing from multiple extraction sites was sustained, so the transfusion of platelet concentration 1 units, fresh frozen plasma 1 unit, and packed red blood cell 1 unit was done. She was recovered without complication but was transferred to pediatric intensive care unit for wound care with her endotracheal tube kept. She was transferred to a ward without noticeable complications next day. So we report this successful case of anesthetic management for dental treatment in a child with liver failure.

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DENTAL TREATMENT OF A PATIENT WITH TUBEROUS SCLEROSIS ASSOCIATED WITH ESRD AND MENTAL RETARDATION UNDER GENERAL ANESTHESIA (정신지체와 만성신부전을 동반한 결절성경화증 환자의 전신마취 하 치과치료)

  • Seo, Kwang-Suk;Lee, So-Young;Baek, Kyung-Won;Kim, Hyun-Jeong;Yum, Kwang-Won
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.1 no.1
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    • pp.33-36
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    • 2005
  • Manifestations in tuberous sclerosis such as seizure, mental retardation, end-stage renal disease (ESRD), and heart problems present a number of challenges to the dentist and anesthesiologist. Lack of cooperation in addition to the severe medical condition makes dental treatment more difficult. General anesthesia is often required for mentally and physically handicapped patients undergoing extensive dental treatment. We experienced a case of dental treatment under general anesthesia in a 36-year-old male patient with tuberous sclerosis associated with ESRD and mental retardation. He was treated on an outpatient basis followed by hemodialysis without any complications.

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