• 대한치과마취과학회지
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• 제6권2호
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• pp.113-120
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• 2006

Recently, sedation in dentistry is gaining more and more interests of dental practitioners. Moreover. 'dental sedation', 'sleep dentistry', or 'pain-free dental treatment' become everyday words familiar to ordinary persons. Sedation clinic in Hanyang University Medical Center was open on Mar 2006 as specialty clinic at department of dentistry. Our aim is performing comfortable and safe dental treatments for patients who have problems for routine dental treatments because of extreme fear and anxiety or for patients who are supposed to have stressful and painful time-consuming treatment, such as sinus elevation and bone graft for implant placement. Our sedation was focused on conscious sedation, especially intravenous sedation using midazolam alone in technique. In two series, the sedation protocol at our Sedation Clinic will be described in details and then, analysis of our cases will be presented to help beginners for sedation in dentistry.

• 대한치과마취과학회지
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• 제10권1호
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• pp.27-33
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• 2010

The gag reflex is a physiologic reaction which safeguards the airway from foreign bodies. But, an exaggerated gag reflex can be a severe limitation to a patient's ability to accept dental care and for a clinician's ability to provide it. The overactive gag reflex can be due to psychological factors or physiological factors, or both. Psychological factors can include fear of loss of control and past traumatic experiences. A 58-year-old man, scheduled for extraction of left upper second molar, left lower second and third molar and implantation of left upper second molar, and left lower second molar had no specific underlying medical problems. He had exaggerated gag reflex. Dental treatment was successfully performed using intravenous sedation. Intravenous sedation with midazolam and propofol was a useful management technique for reflex control during dental treatment extended to the posterior regions in the oral cavity.

• 대한치과마취과학회지
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• 제12권2호
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• pp.69-74
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• 2012

Background: The purpose of this study is to investigate the efficacy and safety of the sedation technique for implant surgery by combining the use of inhalation of nitrous oxide/oxygen with intravenous midazolam. Methods: Patients requiring surgery for the placement of dental implants were randomly allocated to two groups receiving intravenous midazolam or a combined technique using nitrous oxide/oxide and intravenous midazolam. Safety parameters, cooperation scores, anxiety scales, total amount of midazolam administered and recovery time were recorded and compared. Results: There were a statistically significant reduction in the amount of midazolam required to achieve optimal sedation (P<0.01), an overall significant reduction in recovery time (P<0.01), a significant reduction in anxiety scales (P<0.05), and a significant improvement in cooperation (P<0.05) and peripheral oxygen saturation (P<0.05) when a combined technique of inhalational $N_2O/O_2$ and midazolam was used. Conclusions: For implant surgery, this combining sedation technique could be safe and reliable, demonstrating reduction of total dose of midazolam and level of patient's anxiety and improvement in patient's recovery and cooperation.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권3호
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• pp.153-162
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• 2023

Background: Recent animal studies have suggested the role of GABA type A (GABA-_A) receptors in salivation, showing that GABA-_A receptor agonists inhibit salivary secretion. This study aimed to evaluate the effects of propofol (a GABA-_A agonist) on salivary secretions from the submandibular, sublingual, and labial glands during intravenous sedation in healthy volunteers. Methods: Twenty healthy male volunteers participated in the study. They received a loading dose of propofol 6 mg/kg/h for 10 min, followed by 3 mg/kg/h for 15 min. Salivary flow rates in the submandibular, sublingual, and labial glands were measured before, during, and after propofol infusion, and amylase activity was measured in the saliva from the submandibular and sublingual glands. Results: We found that the salivary flow rates in the submandibular, sublingual, and labial glands significantly decreased during intravenous sedation with propofol (P < 0.01). Similarly, amylase activity in the saliva from the submandibular and sublingual glands was significantly decreased (P < 0.01). Conclusion: It can be concluded that intravenous sedation with propofol decreases salivary secretion in the submandibular, sublingual, and labial glands via the GABA-_A receptor. These results may be useful for dental treatment when desalivation is necessary.

• 대한치과마취과학회지
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• 제4권1호
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• pp.17-20
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• 2004

Chronic periodontitis is one of the most common disease in clinical dentistry, which needs various surgical interventions to treat the moderate to severe destruction of supporting periodontium. Most patients have fear and anxiety to these surgical procedures and some dentists also have problems to deal with these patients. Applying the conscious sedation technique in outpatient units, periodontists have become to manage their patients successfully without any fear and anxiety and increased the level of patients' satisfaction. Particularly, periodontal treatments require relative long chair-time and patients are usually reluctant to the periodontal instruments used in the oral cavity. This study is focused on the sedation procedure with intravenous midazolam infusioon performed in Department of Periodontology, Ewha Womans University Hospital. The whole procedure of intravenous midazolam sedation is briefly reviewed from patient selection to patient discharge.

• 대한치과마취과학회지
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• 제12권2호
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• pp.105-109
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• 2012

The gag reflex is a physiological reaction, but, an exaggerated gag reflex can be a severe limitation not only to treat dental caries but also to do oral exam. Procedures such as surface anesthesia of the palate and pharyngeral area, sedation, or general anesthesia can be options as behavioral management. But, there are no golden rule for the sever gag reflex patients. We present a case report of propofol intravenous sedation using TCI pump for simple dental treatment. A 44-year-old man, who had past history of general anesthesia for dental treatment because of severe gag reflex, was scheduled intravenous sedation for simple dental treatment. After 8 hour fasting he entered the clinic for persons with disabilities. We explained about intravenous deep sedation and got informed consent. First, we kept intravenous catheter (22G) in the arm and started monitoring ECG, non-invasive blood pressure, pulse oximetry and end-tidal $CO_2$ through nasal cannula. We started propofol infusion with TCI pump at the target concentration of 3 mcg/ml. The patient became sedated, but he showed involuntary movement during dental treatment, so we increased the target concentration to 4 mcg/ml. We finished the dental treatment without complications during 30 min. And after 40 min recovery room stay he was discharged without any complications.

• 대한치과마취과학회지
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• 제7권1호
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• pp.13-17
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• 2007

2006년 3월부터 2007년 2월까지 한양대의료원 치과 진정요법클리닉은 모두 80명의 환자를 대상으로 총 92건의 치과치료를 위하여 미다졸람을 단독으로 사용하는 정주의식진정요법을 시행하였다. 이전 논문에서 이미 본원의 진정요법 프로토콜을 자세히 설명하였고 이번 논문에서는 지금까지의 진정요법 결과들을 후향적으로 분석하였다. 이러한 근거에 기반한 접근법으로, 이번 연구는 일반 치과의사들도 미다졸람을 이용한 정주의식진정요법을 안전하고 효과적으로 시행할 수 있도록 도움이 될 것이다.

• 대한치과마취과학회지
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• 제10권2호
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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.

• 대한소아치과학회지
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• 제33권4호
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• pp.710-716
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• 2006

소아치과에서 진정요법은 치과 환경에 대하여 공포를 가진 아동, 협조 전 단계의 아동, 장애를 가진 아동 그리고 구토반사 등을 보이는 환자에게 사용될 수 있다. 본 증례에서는 다발성 치아 우식증을 주소로 본원에 내원한 환아에서 1.0mg/kg 케타민과 $0.03{\sim}0.06mg/kg$ 미다졸람 그리고 아트로핀 정주 병용투여 하에 수복치료를 시행하였다. 치료시간의 연장과 적절한 진정 상태 유지를 위하여 케타민(0.33mg/kg)과 미다졸람 $1mg(0.03{\sim}0.05mg/kg)$을 혼합하거나 각각 추가 투여하였다. 지속적으로 환자의 활력징후를 관찰하면서 약물의 추가투여 용량을 결정하였다. 모니터링 장비로 맥박 산소 측정법(pulse oximetry), 전자심전도(electrocardiogram), 비혈관식혈압(NIBP : Noninvasive Blood Pressure)을 사용하여 맥박, 호흡수, 혈압, 산소 포화도 등을 측정하였다. 진료 과정동안 안전을 위해 미국 소아치과 학회(American Academy of Pediatric Dentistry ; AAPD)의 권고 사항을 준수하였다.

• 대한치과마취과학회지
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• 제11권1호
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• pp.32-37
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• 2011

Pulsus paradoxus has been defined as a decrease in systolic blood pressure (SBP) of 10 mmHg or more during inspiration. This report describes pulsus paradoxus detected by pulse oximetry during dental procedure. Case: A 10 years old boy who had impacted mandibular premolar with malformation scheduled for extraction under intravenous sedation with Fentanyl and Propofol. The patient showed upper airway obstruction with stridor and pulsus paradoxus. Though pulsus paradoxus is generally critical condition, in this case, respiration and other vital sign was maintained comparatively well with care in administering oxygen and considerate monitoring of pulse oximetry and capnography. Discussion: Noninvasive continuous monitoring of pulse oximetry allows recognition of pulsus paradoxus which can lead to serious problems. Clinicians should know very well about it and be able to manage of this kind of situation.