• 대한치과의사협회지
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• 제51권7호
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• pp.389-397
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• 2013

Sedation is frequently required to relieve anxiety in the field of dentistry. Among sedation techniques, oral sedation has been widely used because it is easy for administration and has a wide acceptability for dentists. This article discuss the pharmacology of oral sedatives and therapeutic considerations of these drugs, and finally how to manage apprehensive patients using oral sedation. Also, we recommend how pertinent drugs should be used to maintain an adequate level of sedation, not deep sedation

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권4호
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• pp.251-255
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• 2015

Prader-Willi syndrome (PWS) is a rare genetic disorder reported rarely in dentistry. Dental practitioners should know the features of PWS because affected patients have a variety of dental symptoms. The current report describes a case of PWS. An 18-year-old male patient presented with traumatic injuries. Initial emergency treatments were performed under sedation, and further treatments were conducted under general anesthesia. After adequate healing, periodic follow-up and dietary management according to the patient's age and nutritional phase were recommended. Dental management of PWS patients consists of active preventive measures in addition to dietary consultation according to age and nutritional phase.

• 대한소아치과학회지
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• 제47권1호
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• pp.53-61
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• 2020

Midazolam은 단기 작용 benzodiazepine 계열의 약물로서 소아치과 영역의 진정치료에 널리 사용되고 있다. 하지만 소아환자의 치과치료시 정주진정법으로서의 midazolam의 임상적인 효과는 연구가 부족한 실정이다. 이번 연구에서는 소아환자의 치과치료시 midazolam 정주진정법 및 아산화질소 흡입진정법의 효과와 안정성에 대해 후향적인 분석을 시행하였다. Midazolam 정주 및 아산화질소 흡입진정법 하 치과치료를 시행한 115명(118례)를 대상으로 하였다. 인구통계학적 요소, 환자의 전신상태, 진정시간, midazolam 및 아산화질소의 용량, 진정법의 성공률에 대해 전자의무기록을 통해 조사하였다. 진정법은 행동조절을 목적으로 주로 사용되었다. 평균 진정 시간은 수술 치료의 경우 56.7분, 수복 치료의 경우 74.4분이었다. 정맥 내 midazolam의 초기 투여량은 0.051 ± 0.019 mg/kg이었다. 34건(28.8%)에서 치료 중 0.036 ± 0.057 mg/kg의 추가적인 midazolam의 투여를 시행하였다. 아산화질소의 농도는 40 - 50%로 유지되었다. 진정법의 성공률은 99%(n = 117)였다. 1 건의 증례에서 후두 경련이 발생하였고 이로 인한 치료 중단 후 환자는 benzodiazepine 길항제인 flumazenil으로 가역되었다. 이 연구에서는 아산화질소 흡입진정을 동반한 midazolam 정주진정법이 임상적으로 효과적인 것으로 나타났다. 성공적인 진정법을 위해서 모든 과정이 훈련받은 전문인력에 의해 시행되어야 하고 가이드라인을 바탕으로 한 적절한 환자 선택이 필요하다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제20권2호
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• pp.87-93
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• 2017

Purpose: Our aim in this study is to investigate efficacy of topical lidocaine spray for sedated esophagogastroduodenoscopy (EGD) in children. Methods: The endoscopy of children aged between 3-18 years who underwent EGD in our endoscopy unit. Intravenous (IV) midazolam and ketamine were used for sedation. Prior to sedation, endoscopy nurse applied topical lidocaine 10% with pump spray at 1 mg/kg dose in group 1, and distilled water via identically scaled pump spray in group 2, in a double blinded fashion. Results: Sedation was not applied in 24.1% of the cases in topical lidocaine spray group (LS group) and in 5.7% of the cases in distilled water spray group (DS group). Gag reflex was observed in 6.5% of cases in LS group and 33.3% of cases in DS group (p=0.024), increased oral secretion was observed in 9.3% of cases in LS group and 51.7% of cases in DS group (p=0.038), sore throat was observed in 3.7% of cases in LS group and 35.6% of cases in DS group (p=0.019) and the difference was statistically significant. Conclusion: The study showed that topical pharyngeal lidocaine reduces both requirement and amount of IV sedation before EGD in children and sore throat, gag reflex and decreased oral secretion increase.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.161-165
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• 2015

Long QT syndrome (LQTs) is a rare congenital disorder of the heart's electrical activity. Patients with LQTs are at increased risk of developing fatal ventricular arrhythmias. Elevated levels of sympathetic stimulation can exacerbate this risk. Successful behavior management is indispensable in the treatment of patients with LQTs. However, many drugs involved in pharmacologic behavior management are known to adversely affect the QT interval. Therefore, careful selection of a sedative drug is essential in avoiding such incidences. A 10-year-old boy with a known diagnosis of LQTs required restorative treatment due to dental caries at the permanent molar. He required sedation since treatment was painful and dental phobia can trigger sympathetic stimulation, creating a dangerous situation for patients with LQTs. Therefore, the treatment was performed over two sessions under moderate sedation involving propofol combined with nitrous oxide. Restorative treatment was successful without any complications under sedation with a target-controlled infusion (TCI) of propofol. There was no significant QT prolongation during pulpal treatment. Propofol TCI may be a good candidate for sedation in patients with LQTs.

• 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.

• 대한임상독성학회지
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• 제14권1호
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• pp.9-15
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• 2016

Purpose: In most emergency department (ED), sedation is required before carrying out an invasive procedure on a pediatric patient. In the ED setting, it is essential to determine the optimal dose and administration route of CH for successful sedation. The aim of this study was to determine the optimal dose of CH for an invasive procedure and to examine the effectiveness of the drug's different administration routes. Furthermore, in this study, we performed simple survey using questionnaire which composed of Likert-scale to evaluate satisfaction of medical staffs in ED with administration routes. Methods: This study was conducted prospectively. The study participants were pediatric patients under 8 years old who visited the ED in two tertiary hospitals in South Korea within a period of 12 months. Results: Overall, 300 patients were included in this study. The age, sex, and weight of the patients were not shown to influence the sedation time. Chloral hydrate dosage is the independent factor to influence the both sedation and discharge time (p<0.01). In the comparison of the groups, groups 1, 2, and 5 showed no significant difference. On the other hand, groups 3 and 4 were shown to be statistically significantly different from group 1. Conclusion: Up to 100 mg/kg CH is safe to use in the emergency department for pediatric patients, but the initial dose of 50 mg/kg for oral administration should be considered in advance because it can provide safe and effective sedation with a lower possibility of causing an adverse effect.

• 대한소아치과학회지
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• 제40권1호
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• pp.28-39
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• 2013

전신마취 및 진정법은 소아 및 장애인에게 성공적 치과치료를 위해서 필수불가결하다. 이 연구의 목적은 충남장애인구강진료센터에 치과치료를 위해 시행된 전신마취와 진정법의 실태를 평가하기 위함이다. 2011년 1월부터 2012년 9월까지 전신마취, 세보플루란진정 및 정주진정을 받은 소아와 장애인 426명을 대상으로 조사분석하였으며 389명이 전신마취, 20명이 세보플루란진정 그리고 17명이 정주진정하에서 치과진료를 받았다. 전신마취의 비율이 두 진정법에 비해 높았다. 세보플루란진정은 소아환자의 외상처럼 짧고 간단한 치료에 유용하게 사용되었다. 정주진정은 공포와 불안을 가진 치과적장애환자에게 선택되었다. 세보플루란과 정주진정은 점차적으로 전신마취의 사용을 줄이고 치과적장애환자를 위한 유용한 방법이었다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권4호
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• pp.261-262
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• 2020

• 대한소아치과학회지
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• 제23권4호
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• pp.937-945
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• 1996

Nitrous oxide has acquired widespread use as a tool for management of anxious and comprehensive pediatric dental patients. Clinical impressions have suggested that inhalation sedation with $N_2O/O_2$ reinforces the effect of other sedatives. Fifteen uncooperative children, mean age of 37months, who were regarded as fail in the first treatment using chloral hydrate-hydroxyzine orally, midazolam orally or intranasally, were sedated with the same sedatives in conjunction with $N_2O/O_2$. All the children were restrained in a pediwrap and were monitored with pulse oximeter for their heart rate and oxygen saturation. Degree of sleep, crying and movement were evaluated. The clinical results indicated that a satisfactory level of sedation was achieved in approximately two thirds of the cases (about 66 %) under those sedation manner. Complications were rare and those of treatments were successfully completed without difficulty.