• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.2
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• pp.111-116
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• 2023

We provided general anesthesia management to a patient with advanced atrioventricular block, which was discovered in the remote period after open-heart surgery. A 21-year-old man with Noonan syndrome was scheduled to undergo excision of a median intramandibular tumor. At 2 months of age, the patient underwent endocardial repair for congenital heart disease. During our preoperative examination, an atrioventricular block was detected, which had not been previously noted. Emergency drugs were administered, and a transcutaneous pacemaker was placed. During anesthesia induction, mask ventilation was easy, and intubation was performed smoothly using a video laryngoscope. The transcutaneous pacemaker was activated in demand mode at a pacing rate of 50 cycles/min approximately throughout the anesthesia time, and the hemodynamic status remained stable. The effect of intraoperatively administered atropine was brief, lasting only a few seconds. Although body movements due to thoracoabdominal muscle spasm were observed during pacemaker activation, they did not interfere with surgery. In postoperative patients with congenital heart disease, an atrioventricular block may be identified in the remote period, and preoperative evaluation should be based on this possibility. In addition, during anesthesia management, it is important to prepare multiple measures to maintain hemodynamic status.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.3 no.2
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• pp.80-86
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• 2007

A critical pathway (CP) defines the optimal care process, sequencing and timing of intervention by multi-disciplinary health care teams for a particular diagnosis and procedure. It plays an important role as a cost-effective health care delivery system and a tool for quality control of medical and dental services by means of standardizing medical practices. The aim of this study is to investigate the satisfaction of patients and medical/dental staff after implementation of a critical pathway for dental treatment of disabled children under general anesthesia and its cost effectiveness. Ten patients who underwent dental treatment under general anesthesia were included in the CP group between August and December 2006. The pre-CP group included 20 patients who underwent the same procedure from February 2003. The satisfaction of parent of child patient and medical staff members were compared between two groups. The parents' satisfaction was significantly improved after the implementation of CP and medical/dental staff members were highly satisfied with the usefulness of the critical pathway. In conclusion, the critical pathway for the dental treatment of disabled treatment under general anesthesia can highly improve the satisfaction of parents and medical/ dental staff members.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.13 no.2
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• pp.114-118
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• 2017

Sedation or general anesthesia is often required to offer dental treatment to patients with special needs. However, patients with ASA classification of III or higher are not indicated for moderate sedation and might be exposed to danger when treated at outpatient dental clinic. For this reason, it is recommended to treat those patients under general anesthesia. The dental team can supervise and monitor the whole procedures during treatment with an appropriately equipped facility. This case report describes the dental treatment of a 7-year-old girl with multiple disabilities. Preoperative evaluation including medical consultation was carried out thoroughly and dental treatment was performed under general anesthesia safely.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.336-346
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• 2013

Intrathecal drug delivery is an effective and safe option for the treatment of chronic pathology refractory to conventional pain therapies. Typical intrathecal administered drugs are opioids, baclofen, local anesthetics and adjuvant medications. Although knowledge about mechanisms of action of intrathecal drugs are every day more clear many doubt remain respect the correct location of intrathecal catheter in order to achieve the best therapeutic result. We analyze the factors that can affect drug distribution within the cerebrospinal fluid. Three categories of variables were identified: drug features, cerebrospinal fluid (CSF) dynamics and patients features. First category includes physicochemical properties and pharmacological features of intrathecal administered drugs with special attention to drug lipophilicity. In the second category, the variables in CSF flow, are considered that can modify the drug distribution within the CSF with special attention to the new theories of liquoral circulation. Last category try to explain inter-individual difference in baclofen response with difference that are specific for each patients such as the anatomical area to treat, patient posture or reaction to inflammatory stimulus. We conclude that a comprehensive evaluation of the patients, including imaging techniques to study the anatomy and physiology of intrathecal environment and CSF dynamics, could become essential in the future to the purpose of optimize the clinical outcome of intrathecal therapy.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.1
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• pp.154-158
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• 2001

We tried to find out the information which can be drawn from the survey of general anesthesia in pediatric clinic at Seoul National University dental hospital from 1997 to 1999. The subjects were 37 patients Collected data were primary reasons for general anesthesia, preoperative physical status, age distribution, peformed dental treatment, complications, follow-up, and etc. Following were the results: (1) Most(97%) of patients treated under general anesthesia were handicapped and preoperative physical status was ASA Class I or Class II. (2) Majority(41%) of patients were between 11 and 15. (3) Average of 8.1teeth were restored and 3.3teeth were extracted. (4) In 32% of patients, there were mild complications. (5) 12(32%) of the patients responded to the six-month recall check.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.13 no.1
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• pp.28-32
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• 2017

Lennox-Gastaut syndrome (LGS) is a type of childhood epilepsy, and this syndrome can compromise dental treatment. LGS represents variable etiologies, multiple types of intractable seizures, and cognitive impairment in most patients. A 7-year-4-month old girl with LGS was referred to our hospital for dental treatment under general anesthesia. Clinically, the patient presented with multiple dental caries. The patient had been prescribed a ketogenic diet for the management of repetitive seizures. In addition, she experienced severe types of hypoxia during medical examination using chloral hydrate. Therefore, dental treatment was performed under general anesthesia. LGS patients have a high risk of seizure during dental treatment and can induce a lot of complications. Dental treatment under general anesthesia for LGS patients can be carried out careful preoperative evaluation and in cooperation with medical care.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.13 no.1
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• pp.47-51
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• 2017

Haddad syndrome, the association of Congenital Central Hypoventilation Syndrome (CCHS) and Hirschsprung's disease (HD), is a disease caused by mutation of PHOX2B gene. This disease, which occurs very rarely worldwide, is characterized by adequate ventilation during wakefulness and hypoventilation during sleep due to decreased ventilatory sensitivity. In this case report, we report a case of dental treatment under general anesthesia in a child with Haddad syndrome. A 3-year-old child with Haddad syndrome visited Seoul National University Dental Hospital for dental treatment. Dental treatment was planned under general anesthesia because of his medical condition. Treatment was successfully done without any postoperative complications. This case suggests that general anesthesia may be advantageous for dental treatment due to the risk of respiratory depression in a child with Haddad syndrome.

• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.1
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• pp.109-114
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• 2018

Chronic infantile neurological cutaneous articular (CINCA) syndrome periodically causes fever along with inflammation in multiple organs. Patients with this condition are vulnerable to dental problems due to systemic inflammation. For uncooperative patients, general anesthesia has been widely used to control negative behavior. However, caution should be exercised when administering general anesthesia in these patients because this syndrome is pro-inflammatory. The present case report describes the clinical considerations of the dental treatment of an uncooperative child with CINCA syndrome who was treated under general anesthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• v.21 no.2
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• pp.113-118
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• 2021

Background: Consumers and patients in the last two decades have increasingly turned to various internet search engines including Google for information. Google Trends records searches done using the Google search engine. Google Trends is free and provides data on search terms and related queries. One recent study found a large public interest in "dental anesthesia". In this paper, we further explore this interest in "dental anesthesia" and assess if any patterns emerge. Methods: In this study, Google Trends and the search term "dental pain" was used to record the consumer's interest over a five-year period. Additionally, using the search term "Dental anesthesia," a top ten related query list was generated. Queries are grouped into two sections, a "top" category and a "rising" category. We then added additional search term such as: wisdom tooth anesthesia, wisdom tooth general anesthesia, dental anesthetics, local anesthetic, dental numbing, anesthesia dentist, and dental pain. From the related queries generated from each search term, repeated themes were grouped together and ranked according to the total sum of their relative search frequency (RSF) values. Results: Over the five-year time period, Google Trends data show that there was a 1.5% increase in the search term "dental pain". Results of the related queries for dental anesthesia show that there seems to be a large public interest in how long local anesthetics last (Total RSF = 231) - even more so than potential side effects or toxicities (Total RSF = 83). Conclusion: Based on these results it is recommended that clinicians clearly advice their patients on how long local anesthetics last to better manage patient expectations.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.4
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• pp.283-288
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• 2016

Background: Sevoflurane sedation in pediatric and disabled patients has the advantage of faster induction and recovery compared to general anesthesia, as well as minimum influence on the respiratory and cardiovascular functions, and airway protective reflexes. This study aimed to evaluate the clinical efficacy of sevoflurane sedation used in dental treatment at one provincial dental clinic center for the disabled. Methods: We investigated patients' gender, age, reasons for undergoing sedation, medication history prior to treatment, duration of anesthesia, treatment length, type of treatment, and yearly patterns, for 387 cases of dental treatment performed using sevoflurane sedation from January 2013 to October 2016. Results: We analyzed 387 cases (215 male patients, 172 female patients). Male patients aged 20 year or older accounted for 39.0% of all patients, marking the highest proportion. Patient's lack of cooperation was the most common reason for performing dental sedation. Prosthetic treatment was the most frequently practiced, accounting for 174 treatment cases. The mean lengths of the entire treatment and of the dental procedure were 55.2 min and 39.8 min, respectively. Conclusions: Sevoflurane sedation has the advantage of fast anesthesia induction and recovery compared to general anesthesia; therefore, it can be used efficiently to induce anesthesia in pediatric and disabled patients during short dental procedures, enabling stable treatment of these patients.