• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.3
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• pp.241-244
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• 2011

Introduction: Intravenous sedation is performed to ensure smooth and safe surgery. Dental anxiety is a reaction to an unknown danger. The Spielberger's state-trait anxiety inventory (STAI) can be used to simultaneously evaluate the levels of state and trait anxiety. State anxiety is defined as subjective feelings of nervousness. This study assessed the presurgical anxiety using STAI and performed intravenous sedation for patients whose level of state anxiety was > stage IV. Based on our clinical experience, it is believed that higher doses of sedatives are needed to induce the desired levels of sedation in patients with a high level of state anxiety. Objectives: This study examined whether the sedative consumption of the patient with a high anxiety level increased. Patients and Methods: Patients with state anxiety scores of ${\geq}$51 were included in Group V, and those with state anxiety scores ranging from 42 to 50 were placed in Group IV. To induce sedation, intravenous access was established, and a bolus dose of 3.0 mg midazolam was administered intravenously. Sedation was maintained by administering a continuous infusion of propofol, which was aimed at achieving an Observer's Assessment of Alertness/Sedation scale of 10-12/20. In this study, midazolam was initially administered when the body movements appeared to occur or the blood pressure increased. This was followed by the administration of higher doses of propofol if low sedation was observed. Results: There were no significant differences in the patient demographics, duration of sedation, and doses of local anaesthetic agents between Groups IV and V. The midazolam dose and mean propofol dose needed to maintain comparable levels of sedation were significantly higher in Group V than in Group IV. Conclusion: In female patients, whose level of preoperative state anxiety is more than Stage V of STAI, a large quantity of sedatives is needed for intravenous sedation.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.3
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• pp.151-155
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• 2014

Background: Dexmedetomidine is known to be administered for sedation safely even in a very elderly patient. The purpose of this study was to determine the effect of age on clinically optimal dose of dexmedetomidine for sedation. Methods: We enrolled 50 patients ASA class I and II, scheduled for lower extremity surgery that need. They were classified into a young group (n = 26), aged below 75 and an old group (n = 24), aged above 75. Dexmedetomidine was continuously infused $0.5{\mu}g/kg$ within 10 min, followed by maintenance at a dose of $0.5{\mu}g/kg/min$, initially. The next dose was selected using the Dixon's up-and-down method. Results: The cED50 of dexmedetomidine required to maintain optimal sedation level in young and old group were 0.50 and $0.48{\mu}g/kg$, respectively. With isotonic regression, cED95 of dexmedetomidine was $0.71{\mu}g/kg$ (95% confidence intervals $0.57-1.06{\mu}g/kg$) and $0.58{\mu}g/kg$ (95% confidence intervals $0.51-0.67{\mu}g/kg$). There were no significant differences in cED50 (P = 0.21), recovery variables, or incidence of side effects between the two groups. Conclusions: Clinically optimal dose of dexmedetomidine was not affected to the age during sedation.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.2
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• pp.153-158
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• 2011

Midazolam is known to produce sedation as well as amnesia. Many articles reported about anterograde amnesia, but it is rare that articles about retrograde amnesia. The 61-year-old female patient (64 kg, 154 cm, ASA physical status I) was administered 3.02 mg (0.047 mg/kg) of midazolam during 2 hours. The patient's Modified Observer's Assesment of Alertness/Sedation Scale was 4. The patient who had been consciously sedated with midazolam, exhibited profound amnesia, both anterograde and retrograde after implantation. The patient's memory restoration was begun after 6 hours.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.6
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• pp.395-404
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• 2022

Hydroxyzine is one of the most popular oral sedatives used in pediatric dentistry. This study aimed to investigate the safety and possible side effects of sedation using hydroxyzine in pediatric dentistry. "Hydroxyzine," "Dental sedation," "Child," and "Safety" and their associated synonyms were searched using the Cochrane Library, Embase, PubMed, KISS, KMBASE, and KoreaMed databases. Academic information and portals of DBpia and RISS were also perused. Altogether, 340 papers were found, among which a total of 24 papers were selected according to the detailed criteria. Nine studies used hydroxyzine as monotherapy, and 10 studies compared its safety when hydroxyzine used as multitherapy. In addition, seven studies employed a drug regimen wherein hydroxyzine was one of the components. All these studies revealed that the adverse events specific to hydroxyzine usage were drowsiness and dryness of the mouth, and that there were respiratory complications due to a synergistic reaction of hydroxyzine. Although classified as a histamine blocker, hydroxyzine with its sedative, antiemetic, anticonvulsant, and anticholinergic properties is an oral sedative available without serious adverse events, If the proper dosage of the drug is used and its synergistic effects with other drugs are ascertained in the route of administration.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.2
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• pp.117-128
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• 2022

Background: Moderate sedation is an integral part of dental care delivery. Target-controlled infusion (TCI) has the potential to improve patient safety and outcome. We compared the effects of using TCI to administer remifentanil/manual bolus midazolam with manual bolus fentanyl/midazolam administration on patient safety parameters, drug administration times, and patient recovery times. Methods: In this retrospective chart review, records of patients who underwent moderate intravenous sedation over 12 months in a private dental clinic were assessed. Patient indicators (pre-, intra-, and post-procedure noninvasive systolic and diastolic blood pressure, respiration, and heart rate) were compared using independent t-test analysis. Patient recovery time, procedure length, and midazolam dosage required were also compared between the two groups. Results: Eighty-five patient charts were included in the final analysis: 47 received TCI-remifentanil/midazolam sedation, and 38 received manual fentanyl/midazolam sedation. Among the physiological parameters, diastolic blood pressure showed slightly higher changes in the fentanyl group (P = 0.049), respiratory rate changes showed higher changes in the fentanyl group (P = 0.032), and the average EtCO₂ was slightly higher in the remifentanil group (P = 0.041). There was no significant difference in the minimum SpO₂ levels and average procedure length between the fentanyl and remifentanil TCI pump groups (P > 0.05). However, a significant difference was observed in the time required for discharge from the chair (P = 0.048), indicating that patients who received remifentanil required less time for discharge from the chair than those who received fentanyl. The dosage of midazolam used in the fentanyl group was 0.487 mg more than that in the remifentanil group; however, the difference was not significant (P > 0.05). Conclusion: The combination of TCI administered remifentanil combined with manual administered midazolam has the potential to shorten the recovery time and reduce respiration rate changes when compared to manual administration of fentanyl/midazolam. This is possibly due to either the lower midazolam dosage required with TCI remifentanil administration or achieving a stable, steady-state low dose remifentanil concentration for the duration of the procedure.

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.1
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• pp.16-21
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• 2008

Recently combining regimen of minimal doses of chloral hydrate, hydroxyzine and midazolam is good in sedation of children. Midazoalm, water soluble benzdiazepine, has rapid onset and relatively short duration of action. And midazolam has prospective amnesic effect. With these advantages midazolam is popular in conscious sedation for children. This study was to reveal the dose-dependency of behavior and physiologic effects of sublingual midazolam. Sedation records were surveyed retrospectively, of which the patients admitted from April, 2005 to July, 2007. we assigned three groups according the dose of midazolam, 0.1 mg/kg, 0.2 mg/kg and 0.3 mg/kg, respectively and the behavioral evaluation was analyzed with Houpt scale statistically. Combined sublingual midazolam increased the success rate in sedation and the vital signs were stable during sedation.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.1
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• pp.85-92
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• 2016

The Korean Academy of Pediatric Dentistry (KAPD) organized the Committee on Sedation, Education and Research to establish appropriate guidelines in dental sedation and to help to the safety of dental sedation of society members through continuous education. The purpose of this study was to try to evaluate the satisfaction rating of the society members of the sedation symposium and BLS course that was held during the KAPD annual congress in 2015. The committee created a questionnaire to target the KAPD members who participated in the annual congress. The questionnaire was given to the 143 total members and were carried out based on the satisfaction evaluation of the symposium. The 23 total members who participated in the BLS course, reported satisfactory evaluations of the BLS course. Both the symposium and BLS courses confirmed a high level of satisfaction from the KAPD members. In addition, the committee learned about the future direction of the education offered by the KAPD the members wish for it to take. KAPD will endeavor to consistently provide advanced education and the systematic training program of emergency management situation for KAPD members.

• Journal of the korean academy of Pediatric Dentistry
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• v.48 no.3
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• pp.313-323
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• 2021

The purpose of this study was to investigate trends in dental sedation of Korean children and adolescents. A retrospective study was conducted on patients under 20 years of age who received dental treatment under sedation using National Health Insurance Service-National Sample Cohort Database from 2002 to 2015. Based on the 1 million standard data, there were 436 cases of dental treatment under sedation in 2002, but 4002 cases in 2015, showing a trend increasing every year. The 3 - 5 year old group accounted for the largest portion (54.2%), while the 6 - 8 year old group increased recently. Nitrous oxide inhalation sedation is the most commonly used, accounting for 45.9% in 2002, but increased to 89.5% in 2015. Combination of nitrous oxide inhalation sedation, chloralhydrate and hydroxyzine was the most common, accounting for 5.7% in 2002, but decreased to 2.9% in 2015. There is a trend to use the sedation method more safely and in a way that reduces side effects.

• Journal of Dental Anesthesia and Pain Medicine
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• v.24 no.3
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• pp.205-211
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• 2024

A 7-year-old girl visited the Samsung Medical Center emergency room for primary tooth aspiration during primary tooth extraction under conscious sedation with N₂O. The patient showed no signs of respiratory complications. Chest radiography and CT revealed a tooth in the right bronchi. Foreign body removal using rigid bronchoscopy was performed on the day of aspiration. With close monitoring of the airway in the pediatric ICU, extubation was performed the next day, and the patient was discharged the same day. The primary objective of this case report was to highlight the potential risk of aspiration associated with the use of N₂O gas for conscious sedation.

• The Journal of the Korean dental association
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• v.56 no.1
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• pp.49-57
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• 2018

The most widely used method of pain control in dental practice is to block the pathway of painful impulses by local anesthesia. For a maximum effect of pain control at outpatient minor operation, regional anesthesia including nerve block must be performed. This issue includes various dental local anesthetic techniques on mandible, maxilla and considerations for selection of dental local anesthetics according to patient's age, duration of operation. Additionally, current conscious sedation technique combined with local anesthesia will be introduced for control of patient's anxiousness. Based on patient's general condition, severity of operation, local anesthesia sometimes must be changed into general anesthesia to avoid failure of dental practice. The exact choice of anesthetic techniques for minor operations at dental outpatient clinic must not be underestimated for complete success of pain control.