• 대한치과마취과학회지
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• 제5권2호
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• pp.107-111
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• 2005

Background: Nasotracheal intubation for general anesthesia is preferred for many oral and maxillofacial procedures because it ensures unhindered access to the operative site. Epistaxis and tube insertion failures are recognized complications of nasotracheal intubation. The aim of our study was to elucidate whether the nostril side used influenced epistaxis and insertion failure incidence. Methods: We studied 434 patients undergoing nasal intubation (July 2004- February 2005) with permission. Randomly, one side of nostril was selected with chart ID number. During nasotracheal intubation, epistaxis severity and tube insertion failure was observed by the anesthesiologist who inserted nasotracheal tube. Results: There was no significant difference between either nostril in epistaxis severity (chi-square test P = 0.860) and in the incidence of insertion failure (P = 0.867). Conclusions: In this study, both nostrils showed equal epistaxis and insertion failure incidence.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권2호
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• pp.179-181
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• 2021

• 대한치과마취과학회지
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• 제14권3호
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• pp.167-172
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• 2014

Background: Propofol is the most commonly used anesthetic for sedation and target-controlled infusion (TCI) is useful for dental treatment. However, it is important to assess and maintain an adequate depth of sedation in patients with severe intellectual disabilities Therefore, in this study we aimed to evaluate the adequate propofol target concentration for dental treatment in severely intellectually disabled patients. Methods: We undertook retrospective review of the sedation records of severely intellectually disabled patients who underwent dental treatment under TCI propofol sedation from September 2011 to April 2012. We evaluated the initial target concentration, stabilized concentration of propofol and monitored vital signs, including BIS score using sedation records. Results: Total 20 patients (10 male and 10 female patients) were included in the study. Every participant was severely intellectually disabled. The mean sedation duration was $70{\pm}16$ (45-100) minutes. The initial propofol target concentration infusion amount was $2.7{\pm}0.45$ (2.0-3.0) mcg/ml. The propofol effect site concentration (Ce) was $2.6{\pm}0.7$ (1.0-4.0) mcg/ml. The average value of BIS was $52.6{\pm}13$ (28-81). During the treatment period, there were no severe complications. Conclusions: The average propofol Ce for deep sedation without any complications in intellectually disabled patients was 2.6 mcg/ml.

• 대한치과마취과학회지
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• 제11권1호
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• pp.9-15
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• 2011

배경: 술 후 통증은 술 후 합병증의 발생가능성을 증가시키며 생체기능의 회복을 방해한다. 술 후 통증을 효과적으로 조절하기 위해선 통증의 정도를 객관적으로 평가하는 것이 필요하다. 술 후 통증은 수술의 침습도와 관련이 높을 가능성이 많다. 본 연구에서는 수술 침습도의 정도와 술 후 통증의 정도 사이의 상관관계를 확인하고자 한다. 방법: 총 153명의 환자를 수술의 침습도에 따라 4개의 그룹으로 나누었다(그룹 1: 악성종양 수술 (malignancy surgery), 그룹 2: 양악수술(bimaxillary surgery), 그룹 3: 양성 종양수술(benign cancer surgery) 그룹 4: 임플란트 & 골절 수술(implant & frature)) 수술이 끝나갈 무렵 fentanyl 700 ${\mu}g$, ketorolac 1,500 mg (총 용적 120 ml)가 포함된 자가통증조절장치를 정맥로에 연결하였다. 술 후 통증의 정도는 시각통증등급(visual analogue scale)을 이용하여 측정하였고 자가통증조절장치의 총 사용시간, 투여된 진통제의 양, bolus 투여 총 횟수를 측정하였다. 결과: 술 후 시각통증등급은 술 후 1일부터 3일까지 그룹 1, 2 군에서 유의하게 높았다. 또한 시각통증등급 3점 이상의 통증을 호소하는 환자의 비율 역시 그룹 1, 2 군에서 유의하게 높았다. 진통제 총 투여용량 및 자가로 주입한 진통제의 양 역시 그룹 1, 2군에서 3, 4 군에 비해 유의하게 높은 것을 확인하였다. 결론: 본 연구결과 외과적 수술의 침습도가 술 후 통증의 정도를 결정하는데 있어 중요한 요소임 을 확인하였다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권3호
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• pp.185-191
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• 2016

Background: Failure to maintain a patent airway can result in brain damage or death. In patients with mandibular prognathism or retrognathism, intubation is generally thought to be difficult. We determined the degree of difficulty of airway management in patients with mandibular deformity using anatomic criteria to define and grade difficulty of endotracheal intubation with direct laryngoscopy. Methods: Measurements were performed on 133 patients with prognathism and 33 with retrognathism scheduled for corrective esthetic surgery. A case study was performed on 89 patients with a normal mandible as the control group. In all patients, mouth opening distance (MOD), mandibular depth (MD), mandibular length (ML), mouth opening angle (MOA), neck extension angle (EXT), neck flexion angle (FLX), thyromental distance (TMD), inter-notch distance (IND), thyromental area (TMA), Mallampati grade, and Cormack and Lehane grade were measured. Results: Cormack and Lehane grade I was observed in 84.2%, grade II in 15.0%, and grade III in 0.8% of mandibular prognathism cases; among retrognathism cases, 45.4% were grade I, 27.3% grade II, and 27.3% grade III; among controls, 65.2% were grade I, 26.9% were grade II, and 7.9% were grade III. MOD, MOA, ML, TMD, and TMA were greater in the prognathism group than in the control and retrognathism groups (P < 0.05). The measurements of ML were shorter in retrognathism than in the control and prognathism groups (P < 0.05). Conclusions: Laryngoscopic intubation was easier in patients with prognathism than in those with normal mandibles. However, in retrognathism, the laryngeal view grade was poor and the ML was an important factor.

• 대한치과마취과학회지
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• 제11권2호
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• pp.172-176
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• 2011

For dental treatment of children with severe dental phobia, sedation or general anesthesia is usually selected for enhancement of cooperation. But in the case of mouth opening limitation due to temporomandibular disorders, general anesthesia administration is a challenge for anesthesiologist. Because airway management failure was concerned, awake fibroscopic intubation is selected first. But, skillful fibroscopic intubation is not easy in case of uncooprative children patients. In this report, we present two cases of pediatric patients with mouth opening limitation. In the first case, the patient was 52 months old and the maximum opening distance was 1.2 cm, and in the second case the patient was 38 months old and the maximum opening distance was 1.5 cm. Both patients showed severe dental phobia. After sevoflurane inhalation without any intravenous drug, we successfully performed intubation using a fibroscope.

• 대한치과마취과학회지
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• 제7권1호
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• pp.18-21
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• 2007

Pelizaeus-Merzbacher disease (PMD) can be defined as an X-linked recessive leukodystrophy that is caused by a mutation in the proteolipid protein gene on chromosome Xq22. PMD is one of a group of progressive, degenerative disorders of the cerebral white matter known as the leukodystrophies. Due to the progressive nature of the disorders and their devastating effects on the central nervous system, these children frequently require anesthesia during imaging procedures such as MRI or during various surgical procedures. Anesthetic concerns in theses cases include high prevalence of seizure disorders, gastroesophageal reflux with the risk of aspiration, airway complications related to poor pharyngeal muscle control and copious oral secretions, and mental retardation. We report a successful anesthetic management in a patient with PMD for dental procedures.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권1호
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• pp.39-43
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• 2023

Nasotracheal intubation is commonly performed under general anesthesia in oral and maxillofacial surgery. For the convenience of surgery, nasal Ring-Adair-Elwyn (RAE) tubes are mainly used. Because the nasal RAE tubes were bent in an "L" shape, the insertion depth was limited. Particularly, it is necessary to accurately determine the appropriate depth of the RAE tubes in children. Several types of nasal RAE tubes are used in the medical market, which vary in material and length. We performed endotracheal intubation using a nasal RAE tube for double-jaw surgery, but air leakage persisted even when the air pressure in the cuff was increased. When checked with a laryngoscope, it was confirmed that the tube was pushed out, and the cuff was caught on the vocal cords, causing air leakage. Since inserting the tube deeply did not solve the problem, replacing it with a nasal RAE tube (Polar^TM, Preformed Tracheal Tube, Smith Medical, Inc., USA) did not cause air leakage; thus, we reported this case.

• 대한치과마취과학회지
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• 제12권2호
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• pp.111-114
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• 2012

Attention deficit hyperactivity disorder (ADHD) is characterized by inattention, impulsivity, and hyperactivity. Given high incidence of ADHD, many children with ADHD is likely to present for anesthesia. This case report suggests intramuscular premedication as an alternative method for anesthetic induction. A 9-year-old male patient with ADHD was transferred for dental treatment under general anesthesia. The patient refused to go into dental clinic office. Oral midazolam was given to the patient, however, he was resistant to take midazolam via oral route. Instead, we administer midazolam and ketamine via intramuscular route. After less than 10 miniutes, the patient became drowsy and was transferred to dental chair. Intravenous access and mask inhalation was possible. The patient received dental treatment under general anesthesia and recovered in a non-complicated way. In this case, intramuscular sedation with midazolam and ketamine was used as a premedication in highly uncoopearive patient refused to take oral sedative medication.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권3호
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• pp.233-237
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• 2022

Postpolio syndrome (PPS) is widely known to manifest as muscle weakness in patients affected by poliomyelitis in early childhood. This is caused by the long-term overwork of motor nerves regenerated from surviving nerve cells. We report a characteristic delay in recovery from muscle relaxation after administering rocuronium to a patient with PPS under general anesthesia with desflurane. A 59-year-old woman was scheduled to undergo surgical debridement for jaw osteonecrosis. She had a history of poliomyelitis at the age of 2 years, and was diagnosed with PPS at the age of 51 years. General anesthesia was induced with 80 mg propofol, 50 ㎍ fentanyl, and 30 mg (0.69 mg/kg) rocuronium, and maintained with desflurane and remifentanil. The durations of train-of-four (TOF) count 0 and 1 were 96 and 37 min, respectively. Five minutes after discontinuing desflurane, the TOF count was 4. Three minutes after administering 200 mg sugammadex, the TOF ratio was 0.83, and the tracheal tube was subsequently removed. In summary, the effect of a single dose of rocuronium on twitch in TOF monitoring was significantly prolonged in a patient with PPS, which may have been exacerbated by desflurane.