• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.4
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• pp.710-716
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• 1998

It is one of difficulties to control children who show definitely negative behavior in dental clinic. In such a case, the pharmacologic management has been used to provide quality care, minimize the extremes of disruptive behavior, promote a positive psychologic response to treatment and patient welfare and safety. Deep sedation can be defined as a controlled, pharmacologically-induced state of depressed consciousness from which the patient is not easily aroused which may be accompanied by a partial loss of protective reflexes. In this retrospective report, the sedation records of 200 pediatric dental patients of ASA Class I & II who were not successfully treated under conscious sedation were used for analysis. Most frequently used regimen of deep sedation was the co-medication of midazolam(0.3mg/kg), enflurane(1.0-2.0 vol%) and 50-70% $N_2O_2$. The average age and weight of the patients was 4.6 yr (S.D: 2.72) and 18.7kg(S.D: 6.35) respectively. The average operative time was 52 minutes and midazolam (0.1-0.2cc) was additionally administered intranasally to prolong the operative time as needed. The episodes of untoward side effects were reported during and/or after the procedure in 58 patients. Serious adverse reactions such as cyanosis or laryngospasm were even reported in 7 patients but without mortality. Deep sedation is a very effective way of completing the dental treatments for those who failed to respond well to the conscious sedation. This technique has many practical advantages over general anesthesia case but the demands for the rigid monitoring criteria limit its use in general practice setting. The continuous efforts to improve the safety of the medication and the technique are required for the benefits of the patients and parent.

• Tuberculosis and Respiratory Diseases
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• v.71 no.1
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• pp.59-61
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• 2011

Obstructive Fibrinous Tracheal Pseudomenbrane (OFTP) is a rarely known but potentially fatal complication of endotracheal intubation. Sudden respiratory failure shortly after extubation is not infrequent in the ICU. However, these cases are commonly diagnosed as laryngospasm, retention of secretion or laryngeal edema. A 68-year-old woman presented with a 6-day history of progressive dyspnea. She had undergone invasive ventilator care for 24 hours. The patient was discharged from the hospital with improvement after having an extubation. However, after 3 days she revisited the emergency department with progressive dyspnea. The patient was diagnosed with OFTP from the results of chest CT and bronchoscopy. This is the first case studied in detail using CT images, pulmonary function test, and bronchoscopy.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.22-26
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• 2011

Background: There is controversy regarding the relative perioperative benefits of desflurane when used for induction of anesthesia. Inhalation induction with desflurane alone causes adverse airway events, such as coughing, bronchospasm, laryngospasm, and copious secretion of varying severity. The aim of this study was to determine whether desflurane minimize cardiovascular activation during induction. Methods: Sixty ASA I and II patients were randomized to receive 1 MAC or 1.5 MAC of desflurane during manual vernilation or not. Patients received propofol (2 mg/kg) to induce loss of consciousness (LOC). Rocuronium (0.8 mg/kg) was given at LOC and the trachea was intubated after 90 seconds of manual breathing support with or without inhaled anesthetics. Vital signs and adverse airway events were recorded until 10 minutes post-intubation. Results: A significant increase in blood pressure and heart rate were seen in no desflurane group. The stable vital signs were seen in desflurane groups. The adverse airway events were increased in 1.5 MAC group but 1 MAC group. Conclusions: Desflurane was able to be stable blood pressure and heart rate at 1 MAC but adverse airway events were increased at 1.5 MAC of desflurane.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.313-316
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• 2007

Negative pressure pulmonary edema (NPPE) during anesthetic recovery is a rare, but potentially serious complication for patients who are undergoing different surgical procedures. The proposed mechanism is the generation of high negative pressure during markedly respiratory effort and upper airway obstruction from glottis closure and laryngospasm, and this all leads to pulmonary edema. We report here on a case of a healthy 26-year-old male who immediately developed NPPE and hemoptysis following extubation after partial rib resection due to benign rib tumor; the patient was treated conservatively. We also include a review of the review literatures.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1991.06a
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• pp.14-14
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• 1991

후두의 생리적 기능은 하기도를 보호하는 방어기능과 호흡기능 그리고 발성기능으로 대별할 수 있는데 이 가운데 계통발생적으로 가장 원시적이지만 중요한 기능은 하기도 방어기능으로 이는 다른 기능과 달리 전적으로 불수의적이고 반사적으로 이루어진다. 이 기능은 후두내 점막에 존재하는 촉각 수용체(tactile receptor)가 자극되면서 후두근육이 수축 반사를 일으켜 성문이 닫히는 성문폐쇄반사(glottic closure reflex)로서 다접합뇌간반사(polysynaptic brain stem response)이다. 현재까지 후두의 신경장애에서 그 부위나 정도 또는 신경재생 상태 등을 검사하는 방법으로 근전도검사가 주로 쓰여져 왔으나 그것이 주는 정보가 극히 제한되어 있다. 그러나 최근 청각뇌간유발반응과 같이 후두뇌간유발반응 이라 명명된 wave가 존재한다는 사실이 밝혀져 이에 대한 연구가 이루어지고 있어 이것이 임상에 쓰여질 수 있다면 현재 성문폐쇄반사의 소실이나 이상이 원인으로 사료되는 idiopathic laryngospasm, gastroesophageal reflux, spastic dysphonia, stuttering, sudden infant death syndrome과 같은 질환의 진단과 치료에 커다란 진전이 있을 것이다. 이에 저자들은 고양이 6마리를 이용하여 상후두신경을 전기적으로 자극하여 유발되는 반응을 far field recording을 이용 평균 가산법으로 그 wave를 측정하여 다음과 같은 결과를 얻었다. 1. 상후두신경자극(2㎃, stimuli frequency 3/s, Band filter 320-1000, 0.2 ㎳ duration)에 의한 반회신경에의 유발 반응을 기록하였고 그 잠복시간은 평균 8.2 ㎳ 였다. 2. 상후두신경을 자극하여 후두뇌간유발반응을 기록하였고 후두뇌간유발반응은 4개의 양 wave와 4개의 음 wave로 구성되었다. 3. 각 wave의 평균 잠복시간은 P1은 0.8㎳, P2는 2.3㎳, P3는 3.6㎳, P4는 4.3㎳였고 N1은 1.5㎳, N2 은 2.7㎳, N3는 3.9㎳, N4는 5.5㎳ 였다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.22 no.3
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• pp.217-224
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• 2019

Purpose: Various publications on the use of sedation and anesthesia for diagnostic procedures in children have demonstrated that no ideal agent is available. Although propofol has been widely used for sedation during esophagogastroduodenoscopy in children, adverse events including hypoxia and hypotension, are concerns in propofol-based sedation. Propofol is used in combination with other sedatives in order to reduce potential complications. We aimed to analyze whether the administration of midazolam would improve the safety and efficacy of propofol-based sedation in diagnostic esophagogastroduodenoscopies in children. Methods: We retrospectively reviewed the hospital records of children who underwent diagnostic esophagogastroduodenoscopies during a 30-month period. Demographic characteristics, vital signs, medication dosages, induction times, sedation times, recovery times, and any complications observed, were examined. Results: Baseline characteristics did not differ between the midazolam-propofol and propofol alone groups. No differences were observed between the two groups in terms of induction times, sedation times, recovery times, or the proportion of satisfactory endoscopist responses. No major procedural complications, such as cardiac arrest, apnea, or laryngospasm, occurred in any case. However, minor complications developed in 22 patients (10.7%), 17 (16.2%) in the midazolam-propofol group and five (5.0%) in the propofol alone group (p=0.010). Conclusion: The sedation protocol with propofol was safe and efficient. The administration of midazolam provided no additional benefit in propofol-based sedation.

• Journal of the korean academy of Pediatric Dentistry
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• v.47 no.1
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• pp.53-61
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• 2020

Midazolam is a short-acting benzodiazepine that is widely used in pediatric dental sedation. However, its clinical effectiveness as an intravenous sedative agent in children has not been widely documented. A retrospective study was conducted to evaluate the efficacy and safety of intravenous midazolam and nitrous oxide inhalation sedation in pediatric dental treatment. The subjects were 115 patients (118 cases) who received dental treatment under intravenous midazolam and nitrous oxide inhalation sedation. Demographic factors, general health status, sedation time, midazolam and nitrous oxide dosage, and success rate of sedation were evaluated from electronic medical records. Behavioral management was the main reason of choosing sedation. Mean duration of sedation was 56.7 minutes for surgical treatment, and 74.4 minutes for restorative treatment. The initial dosage of intravenous midazolam was 0.051 ± 0.019 mg/kg. In 34 cases (28.8%), additional midazolam of 0.036 ± 0.057 mg/kg was delivered during the treatment. The concentration of nitrous oxide was maintained between 40% and 50%. The success rate of sedation was 99% (n = 117). In 1 case, laryngospasm occurred and the patient was reversed with benzodiazepine antagonist, flumazenil. Intravenous midazolam sedation with nitrous oxide was shown to be clinically effective for the dental treatment in children, if administered by trained personnel and patients are carefully selected in accordance with guidelines.