• Journal of Korean Academy of Oral Health
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• v.42 no.4
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• pp.238-241
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• 2018

Williams syndrome is a rare congenital disorder with various physical abnormalities and characterized by facial, oral, and dental features. Individuals with Williams syndrome typically have eating disorders in the early childhood, which lead to prolonged night feeding. Prolonged night feeding is a risk factor for rampant dental caries. Williams syndrome is caused by the microdeletion of chromosome 7, resulting in elastin deficiency. Elastin is integral to cardiovascular health. Many patients with Williams syndrome have complex cardiovascular abnormalities that must be considered a part of dental management. Complications related to cardiovascular diseases may induce adverse effects such as dangerously elevated blood pressure. This may occur in patients during stressful dental treatment. In addition, characteristics of auditory hyperalgesia and anxiety disorders among patients with William syndrome, complicate receiving routine dental management. Therefore, dental treatment under sedation or general anesthesia may be preferable for patients with Williams syndrome; in particular, patients who are very uncooperative and/or needs extensive dental treatment. A thorough evaluation of each patient's physical condition is required before making decisions regarding dental treatment. Careful monitoring and preparation for emergencies are very important during and shortly after dental treatment under general anesthesia or sedation. Monitoring is critical until vital signs have stabilized and return to normal. A 28-month-old man diagnosed as having Williams syndrome, visited the Dental Hospital of ${\bigcirc}{\bigcirc}$ University for the management of rampant dental caries. We reported on the management of this patient who had peripheral pulmonic stenosis, and received dental treatment under general anesthesia. We also reviewed the characteristics of Williams syndrome and discussed considerations for dental treatment under general anesthesia.

• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.3
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• pp.226-232
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• 2015

Critical pathway (CP) defines the optimal care process, sequencing and timing of intervention by multidisciplinary health care teams for a particular diagnosis and procedure. The aim of the study was to evaluate the clinical usefulness and the satisfaction of patients and dental staff after implementation of a critical pathway for the dental treatment of disabled children and adolescents under conscious sedation. Thirty patients are divided in two groups (Pre-CP and CP) at the department of Pediatric Dentistry of Pusan National University Dental Hospital. The satisfaction levels of patients/guardians and the staff members were collected by survey questionnaire. The parents' satisfaction was significantly improved after the implementation of CP. Also, medical/dental staff members were highly satisfied with its usefulness. The application of a critical pathway for disabled children and adolescents might be useful and improve the satisfaction of the parents and medical/dental staff members.

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.2
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• pp.113-117
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• 2008

Background: The purpose of this study was to compare the use of midazolam only with midazolam with fentanyl or propofol in IV sedation. Methods: 24 cases were divided to midazolam group (M group), midazolam + fentanyl group (MF group), midazolam + propofol group (MP group) and midazolam + fentanyl + propofol group (MFP group). In M group, 2 ml midazolam was injected at first, than at 2 minutes interval 1-2 ml injected continuously depending on the level of sedation. In MP, MFP groups, propofol was injected at the speed of 15-20 ml/hr by infusion pump. In this study, the sedation level was evaluated by using OAA/S scale. In each groups, the recovery time was measured until OAA/S scale score level was 5, and pre and postoperative blood pressure change was measured. Each group's data was statistically analyzed using one-way ANOVA. If significant statistical difference were observed, Dunnet test was performed, and control group was M group. Results: Pre and postoperative blood pressure change were not represent significant statistical difference in 4 groups (P value = 0.679 [systolic], P value = 0.206 [diastolic]). But recovery time were represent significant statistical difference (M group: 35.6, MF group: 32.5, MP group: 17.9, MFP group: 19.6 [P value = 0.002]). The result of Dunnet test on recovery time showed significant statistical difference on MF, MFP group when M group was control group. In MFP group, sedation was increased by using supplemental fentanyl, and postoperative pain control was dominant. Conclusion: To achieve the effect of anxiolysis, analgesia, amnesia effectively, and short recovery time, MFP group is mostly recommended.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.6
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• pp.449-454
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• 2012

Purpose: Intravenous sedation with midazolam is common in contemporary dentistry. That is effective for anxious patients, but additional analgesic agent needs to be used, because midazolam alone doesn't have an analgesic effect. This study was performed to select an analgesic agent between an opioid agent, and nonsteroidal anti-inflammatory drugs as adjunctives in intravenous sedation with midazolam. Methods: The subjects were 60 patients who visited the Department of Oral and Maxillofacial Surgery, Sacred Heart Hospital, Hallym University, between August 2009 and February 2010. Conscious sedation was performed on 20 patients of 3 groups (control group, ketorolac group, and fentanyl group), who were divided randomly. The analgesic agent was administrated preoperatively. For sedation, vital signs were recorded. After sedation and operation, subjective questionnaires of the patient and operator were implemented. Results: All of the $SPO_2$, blood pressure, and heart rates stayed within the normal range for sedation. The sedation depth and analgesic effect of the ketorolac group and fentanyl group were similar. In the case of sedation depth, 12 patients in the ketorolac group and 14 patients in the fentanyl group had no memory of surgery. In the case of analgesic effect, the visual analogue scale of pain scored 2~3 in 13 patients in the ketorolac group, and 0~2 in 12 patients in the fentanyl group. The satisfaction of patients and doctors was also similar. Conclusion: Considering the management and complication of an opioid agent, non-steroidal anti-inflammatory drugs is more effective than an opioid agent.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.1
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• pp.38-46
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• 1998

Management of children who show negative response to treatment was difficult. Usually the dentist used the restraintor sedatives for these children. Especially it is very difficult to management of definitely negative behavior patients who resist to ordinary sedative technics including psychosedation and various sedatives. These patients were managed with general anesthesia. Midazolam was used for sedation of non-cooperative pediatric patients and halothane for induce initial sleepness, If the patient shows negative response to management after 15 minutes of midazolam administration, used the halothane in 30 to 120 seconds for calm down the patient. After induce sleepness, cut off the halothane administration and maintain the sedation with $N_2O$ in 50-70 vol.% concentration. This technic reduce the toxity and untoward effects of major anesthetics. To compare the difference of sedation effect by dosage, dose of 0.2mg/kg and 0.3mg/kg were injected respectively. Though there's no statistical difference in duration and results between two dosage but show the increment of score with age, If the patients show positive response to management after midazolam administered. try to conscious sedation with nitrous oxide in 30 to 70 vo.% concentration. Nitrous oxide concentration was administered slowly according to their consciousness and response to treatment by increment or decrement. The success rate of conscious sedation were 21.2% in 0.2mg/kg and 30.3% in 0.3mg/kg. There's many factors in proceed of conscious sedation. The most important factors are age of patient and experience of children for dental care.

• Journal of the korean academy of Pediatric Dentistry
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• v.47 no.2
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• pp.228-234
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• 2020

Chloral hydrate (CH) has been used in sedation for over 100 years. CH was first synthesized in 1832, the sedative properties were observed in 1861. Because of its easy synthesis, its use was widespread since 1869. There is a record of the use of CH in children as early as 1894. Recently there have been many controversies about safety of CH. Because of the low cost and relatively safe experience CH has still been used for dental sedation in children. After the US FDA recommendation in 2006, US pharmaceutical companies no longer produce commercial CH. However, CH has been used in the form of suspensions prepared from raw materials in many areas of the United States, and reports of adverse events related to death have continued. CH is the most commonly used drug for sedation in Korea, and there have been some reports of side effects. Dexmedetomidine, propofol and midazolam were introduced as an alternative for CH. There are various limitations in using them in the pediatric dentistry area and there are many things to consider. The purpose of this review is to analyze the complications of CH and status of use in Korea, and to introduce alternatives to CH.

• Journal of The Korean Dental Society of Anesthesiology
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• v.5 no.2 s.9
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• pp.101-106
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• 2005

Purpose: This retrospective study assessed the effectiveness of submucosal (SM) midazolam (M), oral chloral hydrate (CH), hydroxyzine (H), and nitrous oxide (N) 99 uncooperative pediatric dental patients over 182 sedation sessions. Methods: Selection criteria included good medical health (ASA I), from 2 to 6 years of age, uncooperative behavior, and the need for restorations and dental surgery. The children who was administerated with CH H, N was Group 1 (48 case). The children who was administerated with CH, H, N, M was Group 2 (51 case). All the patients received oral CH (50-70 mg/Kg), H (1 mg/Kg) and N (less than 50%). Additionally the Group 2 received SM midazolam (0.1-0.2 mg/kg). Behavior response was rated as quiet (Q), crying (C), movement (M), or struggling (S) every 5 minutes through operative procedures. Behavior response rating was assigned to Houpt scale of Overall behavior. Data was analyzed using Chi-Square Test. Results: The Group 2 had more effective (88.2%) than the Group 1 (68.8%)(P = 0.05). Also, vomiting response decreased in the Group 2 (94.4%) than those with oral administration of chloral hydrate alone without SM midazolam (77.1%)(P = 0.05). Conclusions: SM midazolam improved the quality of sedation and vomiting response.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.1
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• pp.34-44
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• 2010

The causes for airway obstruction include foreign body aspiration, congenital structural abnormalities of the airway, infection, etc. And the potential causes of acute respiratory distress contain many situations, like hyperventilation, vasodepressor syncope, asthma, etc. A major factor that leads to the exacerbation of respiratory disorders is undue stress, either physiologic or psychologic. Psychologic stress in dentistry is the primary factor in the exacerbation of preexisting medical problems. Adequate pretreatment medical and dental evaluation of the prospective patient can often prevent respiratory problems from developing. The dentist can modify patient management to minimize the risk of exacerbating these conditions. When dental anxiety is a major factor, the use of psychosedative procedures and other stress-reduction techniques should also be considered. This is the report of a children case of airway obstruction and respiratory distress owing to sedation complication by use of Chloral hydrate and Ketamine before extraction of the mesiodens in a patient with bronchial asthma and tonsillar hyperplasia. After these situations, the patient was consulted & referred to the department of Pediatrics and Otorhinolaryngology.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.11 no.2
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• pp.76-80
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• 2015

Mental retardation is one of the major disorders covered in special care dentistry. Patients show poor oral health and are a challenge for the dentist due to lack of cooperation. Triazolam is a short-acting benzodiazepine and has been used in the dental office for many years because of its favorable properties. In this study, five patients with mental retardation were sedated with triazolam on a dental out-patient setting. Patients were administrated with 0.25 mg or 0.5 mg of triazolam on the first dose according to the patient's cooperation. Twenty minutes after the initial dose, patients received 0.25 mg of triazolam. Triazolam was administrated sublingually to one patient and orally to four patients. Hydroxyzine was also administrated to three patients in order to prevent nausea and vomiting. All patients were inhaled with 50% nitrous oxide during the sedation. Treatment time ranged from 20 minutes to 55 minutes. Two patients showed paradoxical reactions and were administrated with intramuscular injections of flumazenil. In result, depending on the range of dental treatment and level of intellectual disability, we can assume that triazolam may be beneficial for sedation in disabled patients.

• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.3
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• pp.205-216
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• 2022

Background: People with special needs tend to require diverse behavioral management in dentistry. They may feel anxious or uncomfortable or may not respond to any communication with the dentists. Patients with medical, physical, or psychological disorders may not cooperate and therefore require sedation (SED) or general anesthesia (GA) to receive dental treatment. Using the healthcare big data in Korea, this study aimed to analyze the trends of SED and GA in special needs patients undergoing dental treatment. It is believed that these data can be used as reference material for hospitals and for preparation of guidelines and related policy decisions of associations or governments for special needs patients in dentistry. Methods: The study used selected health information data provided by the Korean National Health Insurance Service. Patients with a record of use of one of the eight selected drugs used in dental SED between January 2007 and September 2019, those with International Classification of Diseases-10 codes for attention deficit hyperactivity disorder (ADHD), phobia, brain disease, cerebral palsy, epilepsy, genetic disease, autism, mental disorder, mental retardation, and dementia were selected. The insurance claims data were analyzed for age, sex, sedative use, GA, year, and institution. Results: The number of special needs patients who received dental treatment under SED or GA from January 2007 to September 2019 was 116,623. Number of SED cases was 136,018, performed on 69,265 patients, and the number of GA cases was 56,308, implemented on 47,257 patients. In 2007, 3100 special needs patients received dental treatment under SED while in 2018 the number of cases increased 6 times to 18,528 SED cases. In dentistry, ADHD was the most common disability for SED cases while phobia was the most common cause of disability for GA. The male-to-female ratio with respect to SED cases was higher for males (M : F = 64.36% : 35.64%). Conclusion: The application of the SED method and GA for patients with special needs in dentistry is increasing rapidly; thus, preparing guidelines and reinforcing the education and system are necessary.