• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.2
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• pp.125-128
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• 2018

In cases of a difficult intubation where numerous intubation methods, including laryngoscopy, have failed, yet oral intubation is still necessary, the method of tube exchange after fiberoptic nasal intubation may be attempted. Fiberoptic nasal intubation allows intubation to be performed relatively easily when the laryngeal view grade is poor. We report a case in which our attempt at oral intubation for total maxillectomy with laryngoscopy and fiberoptic oral intubation had failed due to an unexpected difficult airway; subsequently, we successfully completed the surgery by performing fiberoptic nasal intubation to secure the airway, followed by using a tube exchanger to exchange to an oral endotracheal tube.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.2
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• pp.93-97
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• 2012

Background: Some disabled patients show insufficient cooperation during dental treatment, and general anesthesia in an outpatient setting can be successfully administered. To minimize post-anesthetic complications is an essential issue, and strict discharge protocols are required for the safety of the patients. Post-anesthetic follow-ups using telephone calls can be applied to improve the quality of the outpatient care system. The authors evaluated the post-operative condition of patients after dental treatment under general anesthesia. Methods: Total 143 patients and their caregivers included in this study. The patients received general anesthesia for dental treatment in Seoul National University Dental Hospital, Clinic for Persons with Disabilities from July, 2011 to April, 2012. Telephone calls were given to the patients or their caregivers to collect information about the patients' systemic condition and anesthesia-related complications. Results: Among 131 patients with responses of telephone calls, 87 patients (66.4%) reported no discomfort, while 44 patients (33.6%) presented post-anesthetic complications. A total of 20 patients reported mild fever, 10 patients had vomiting, and 7 patients had sore throat. Other complications included nausea, fatigue, nasal bleeding, skin sore, and body rash. Among the patients with the history of epilepsy, 63.6% showed post-anesthetic discomfort or complication (P = 0.027, ${\chi}^2$ test). Conclusions: One third of dental patients who received general anesthesia due to insufficientcooperation complained discomfort after discharged from outpatient anesthetic care.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.1
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• pp.25-31
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• 2012

We report a case of 15 year-old Jehovah's Witness patient with mild anemia who underwent a successful orthognathic two-jaw surgery. Jehovah's Witness patients refuse transfusion of blood or blood products even in life threatening situations. The use of recombinant human erythropoietin and iron supplement increased hemoglobin during preoperative period. Intraoperatively, meticulous surgical hemostasis, acute normovolemic hemodilution and induced hypotension enabled the completion of the operation without the use of blood products.

• Journal of The Korean Dental Society of Anesthesiology
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• v.9 no.1
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• pp.9-16
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• 2009

Background: This study aimed to evaluate the cooperative levels of dental patients requiring general anesthesia during dental treatments. Anesthetic induction methods for patients were also recorded and analyzed using descriptive statistics. Methods: Total 566 patients who visited Seoul National University Dental Hospital Clinic for Persons with Disabilities were reviewed on pre-anesthetic review and anesthesia records. The cooperative levels of patients were graded by 4 levels and induction methods used for the patients during general anesthesia application were analyzed. Results: More than half of patients(55.8%) were willing to receive the anesthetic induction(cooperative level 1), 18.6% were minimally cooperative(level 2), 20.8% needed physical restraint prior to induction(level 3), and 4.8% was poorly cooperative and induction procedure was performed under an unconscious condition after ketamine intramuscular injection(level 4). There was no gender difference in cooperative levels(P=0.11). Patients over 30 years revealed better cooperation levels compared to other age groups(P<0.05). For patients of level 1, 53.5% were anesthetized in a way of intravenous induction, while 77.1% out of patients of level 3 were anesthetically induced through inhalation method. Conclusion: Many dental patients with special needs were not cooperative to receive anesthetic induction. Additional behavioral support may be applied to poorly cooperative patients for the safe and successful clinical outcome.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.5
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• pp.295-300
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• 2019

Complex regional pain syndrome (CRPS) is rare, characterized by pain from diverse causes, and presents as extreme pain even with minor irritation. General anesthesia may be required for dental treatment because the pain may not be controlled with local anesthesia. However, treatment under general anesthesia is also challenging. A 38-year-old woman with CRPS arrived for outpatient dental treatment under general anesthesia. At the fourth general anesthesia induction, she experienced severe pain resulting from her right toe touching the dental chair. Anesthesia was induced to calm her and continue the treatment. After 55 minutes of general anesthesia, the patient still complained of extreme toe pain. Subsequently, two administrations for intravenous sedation were performed, and discharge was possible in the recovery room approximately 5 h after the pain onset. The pain was not located at the dental treatment site. Although the major factor causing pain relief was unknown, ketamine may have played a role.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.3
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• pp.219-221
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• 2024

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.1
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• pp.22-28
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• 2008

Background: Cerebral palsy (CP) is non-progressive disorder of motion and posture. In CP patient, there are difficulties in dental treatment because of uncontrolled movement of limb and head, and conjoined disabilities such as cognitive impairment, sensory loss, seizures, communication and behavioral disturbances. It is reported that CP patients have high incidence in caries and a higher prevalence of periodontal disease. But, despite the need for oro-dental care, these patients often are unlikely to receive adequate treatment without sedation or general anesthesia because of uncontrolled movements of the trunk or head. Methods: We reviewed the 58 cases of 56 patients with CP who underwent outpatient general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 19 (2-54) years. The number of male patient was 40 and that of female was 18. They all had severe spastic cerebral palsy and 22 had sever mental retardation, 15 epilepsy, 8 organic brain disorder, 1 blindness, 2 deafness and cleft palate. For anesthesia induction, 14 cases was needed physical restriction who had sever mental retardation and cooperation difficulty, but 44 cases showed good or moderate cooperation. Drugs used for anesthesia induction were thiopental (37 cases), sevoflurane (14 cases), ketamine (3 cases ) and propofol (4 cases). All patients except one were done nasotracheal intubation for airway management and 4 cases were needed difficult airway management and 1 patient already had tracheostomy tube. Mean total anesthetic time was $174{\pm}56$ min and staying time at PACU was $88{\pm}39$ min. There was no death or long term hospitalization because of severe complications. Conclusion: If general anesthesia is needed, pertinent diagnostic tests and workup about anomaly, and appropriate anesthetic planning are essential for safety.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.2
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• pp.209-213
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• 2010

Anxiety and fear is two main factors that keep patients from going to dental clinic. Especially, patients may feel implants operations are more traumatic. Intravenous conscious sedation for dental treatment can make patient comfortable and relaxable. Midazolam is more popular for sedation for dental treatment, but target-controlled infusion (TCI) of propofol and remifentanil is gaining wide popularity. A 54-year-old female patient who had severe dental phobia was referred to our dental hospital. She had past history of 2 times of hyperventilation and syncope during dental treatment. The patient showed a lot of dental anxiety and fear to dental treatments and stress reduction protocol was needed. We administered intravenous conscious sedation using target controlled infusion system with remifentanil and propofol. During sedation, we monitored the status of consciousness with bispectral index and vital signs. Dental treatment could be finished successfully without any problems.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.10 no.2
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• pp.97-100
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• 2014

We experienced a case of dental treatment under general anesthesia in a 22-year-old female patient with dysphagia and dental phobia following partial glossectomy. She was diagnosed of squamous cell carcinoma of tongue and received surgical, radiation treatment two years ago. We report the experiences of anesthetic management for dental treatment in a patient with dysphagia and dental phobia following partial glossectomy.

• Journal of Dental Anesthesia and Pain Medicine
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• v.19 no.4
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• pp.239-244
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• 2019

The effectiveness of dental implants in patients with disability, who are non-compliant during treatment, is controversial because of their poor oral health. Thus, oral health-care and management in such patients is concerning. Moreover, limited information is available on prognosis after implant placement. Herein, we describe a patient with schizophrenia who underwent dental implantation under multiple inductions of general anesthesia (5 times) and required conservative treatment and tooth extraction for multiple dental caries and retained roots because of inadequate oral health-care. Postoperatively, fracture of the prosthodontics and progression of dental caries were observed, and with 3 additional inductions of general anesthesia, conservative treatment, implant surgery, and prosthesis implantation were conducted. Postoperative 12-month follow-up since the last prosthesis implantation showed successful results. For patients with schizophrenia, multiple implantation can reduce horizontal bone loss and achieve aesthetic results compared to treatment with removable prosthodontics and could serve as an alternative treatment modality.