• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.3
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• pp.167-172
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• 2014

Background: Propofol is the most commonly used anesthetic for sedation and target-controlled infusion (TCI) is useful for dental treatment. However, it is important to assess and maintain an adequate depth of sedation in patients with severe intellectual disabilities Therefore, in this study we aimed to evaluate the adequate propofol target concentration for dental treatment in severely intellectually disabled patients. Methods: We undertook retrospective review of the sedation records of severely intellectually disabled patients who underwent dental treatment under TCI propofol sedation from September 2011 to April 2012. We evaluated the initial target concentration, stabilized concentration of propofol and monitored vital signs, including BIS score using sedation records. Results: Total 20 patients (10 male and 10 female patients) were included in the study. Every participant was severely intellectually disabled. The mean sedation duration was $70{\pm}16$ (45-100) minutes. The initial propofol target concentration infusion amount was $2.7{\pm}0.45$ (2.0-3.0) mcg/ml. The propofol effect site concentration (Ce) was $2.6{\pm}0.7$ (1.0-4.0) mcg/ml. The average value of BIS was $52.6{\pm}13$ (28-81). During the treatment period, there were no severe complications. Conclusions: The average propofol Ce for deep sedation without any complications in intellectually disabled patients was 2.6 mcg/ml.

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.1
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• pp.62-69
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• 2006

Objective : This study was conducted to investigate as to whether obesity have any effects on conscious sedation outcomes. Methods : Forty children (mean age 30.5 months, mean height and weight were 91.3cm, 14.3kg respectively) were sedated with chloral hydrate (60 mg/kg) and hydroxyzine (25mg). The relative obesity rate of the patients was obtained by the proportion of height to weight and the tonsil size of the patients was classified by Brodsky's scale. The overall sedation outcomes were evaluated by Houpt's scale. The pulse and respiratory rates during sedation were also evaluated. Results: The obesity of the patients had no statistically significant effects on movement, crying during sedation. However, an increase in obesity had negative effects on the overall conscious sedation outcomes. Conclusion: This investigation demonstrated that increased obesity may cause detrimental effects on pediatric conscious sedation outcomes.

• Korean Journal of Acupuncture
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• v.36 no.3
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• pp.171-180
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• 2019

Objectives : Although the tonification and sedation method such as mountain-burning fire method and heaven-penetrating cooling method, is one of the important techniques that have been claimed to increase the effect of acupuncture, research on this has been sparse. The aim of this study is to provide an understanding of tonification and sedation methods in the "Yeongsochimgugyeong". Methods : We analyzed the similarities and differences by comparing the contents of the tonification and sedation method described in books "Yeongsochimgugyeon" and "Complete Compendium of Acupuncture and Moxibustion" Results : A total of 28 out of the 33 tonification and sedation methods described in "Yeongsochimgugyeon" were compared with those in "Complete Compendium of Acupuncture and Moxibustion". As a result, we found that many of the tonification and sedation methods recorded in "Yeongsochimgugyeon" were based on more detailed and specific clinical cases. Conclusions : The tonification and sedation methods in "Yeongsochimgugyeon" were not only descriptive and consistent in describing that methods, but also contains valuable information for clinical use. In the future, based on this research, we will be able to clinically implement these tonification and sedation methods and quantitatively evaluate them.

• 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 Dental Anesthesia and Pain Medicine
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• v.15 no.1
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• pp.1-4
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• 2015

In pediatric dentistry, chloral hydrate is habitually selected for sedation of uncooperative children. Although chloral hydrate has been used for decades, various adverse effects are reported and necessity for new alternative drugs has increased. Dexmedetomidine was approved by FDA for sedation at intensive care units (ICU) in 1999. Compared to conventional sedative drugs, dexmedetomidine has not only analgesic and sedative effects but also it barely suppresses the respiratory system. Due to these characteristics, dexmedetomidine is known as safe sedative drug for children and elderly patients. Furthermore, approved by KFDA in 2010 in Korea, the frequency of sedation using dexmedetomidine is increasing. However, due to its intravenous administration method, it was difficult to apply in pediatric dentistry. Recently, intranasal administration method was introduced which might be a new possible alternative of oral sedation. In this study, we compare the mechanisms, pros and cons of chloral hydrate and dexmedetomidine, introducing new possibilities.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.2
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• pp.157-161
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• 2017

In sedation via the submucosal route, the drug is administered through the maxillary buccal submucosa. It is time saving, effective, and safe. Patients with autism, a mental disorder, often find it hard to make relationships with other people. These patients display a strong resistance to dental treatment and sedation. This study reports a successful case of behavioral management during dental treatment, using sedation via the submucosal route. The patient was strongly resistant to sedation via the oral, intramuscular, and intravenous routes. The drug used was 9 mg (0.1 mg/kg) of midazolam. Through this case report, we reaffirm the significance of sedation via the submucosal route, and expect that it will be used more frequently for patients with autism, who display behaviors that are difficult to manage, patients with other disabilities, and children.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.2
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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.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.3
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• pp.107-118
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• 2020

Chloral hydrate is the oldest and most common sedative drug used in moderate sedation for pediatric dental patients. Hence, the purpose of this article is to review the safety and possible adverse events of this drug when used for pediatric dental treatment. A bibliographic search in PubMed, MEDLINE, Cochrane Library and KMbase, KISS, DBpia, KoreaMed, and RISS databases was performed. Using the keywords "dental sedation," "chloral hydrate," and "children or adolescent," 512 scientific articles were found. Subsequently, 183 studies were individually assessed for their suitability for inclusion in this literature review. Altogether, 24 studies were selected. They included 12 cases of death before, during, or after chloral hydrate sedation for dental treatment, majorly due to dosing error and use of multiple sedatives. Additionally, intraoperative adverse events were mostly respiratory problems such as hypoxia and apnea, but most events were temporary. After treatment, prolonged sedation, including excessive sleep and less activity were the most common postoperative adverse events, and even death cases were reported. Despite the wide acceptance of chloral hydrate as a sedative-hypnotic agent, the risk of adverse events and adequate dose should be of great concern when using it for pediatric dental sedation.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.1
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• pp.85-92
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• 2016

The Korean Academy of Pediatric Dentistry (KAPD) organized the Committee on Sedation, Education and Research to establish appropriate guidelines in dental sedation and to help to the safety of dental sedation of society members through continuous education. The purpose of this study was to try to evaluate the satisfaction rating of the society members of the sedation symposium and BLS course that was held during the KAPD annual congress in 2015. The committee created a questionnaire to target the KAPD members who participated in the annual congress. The questionnaire was given to the 143 total members and were carried out based on the satisfaction evaluation of the symposium. The 23 total members who participated in the BLS course, reported satisfactory evaluations of the BLS course. Both the symposium and BLS courses confirmed a high level of satisfaction from the KAPD members. In addition, the committee learned about the future direction of the education offered by the KAPD the members wish for it to take. KAPD will endeavor to consistently provide advanced education and the systematic training program of emergency management situation for KAPD members.

• Journal of the korean academy of Pediatric Dentistry
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• v.47 no.2
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• pp.109-119
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• 2020

This retrospective study assessed the effectiveness and side effects of conscious sedation using chloral hydrate, hydroxyzine, and N₂O/O₂ in the sedation of 149 pediatric patients over 188 sedation sessions, and to identify associated variables. The effectiveness of the sedation was evaluated using the Houpt scale, and was considered effective for scale categories of excellent or good. Effectiveness and side effects were assessed every 15 minutes. The effectiveness decreased and side effects increased over time. The effectiveness of sedation during 60 minutes was 57.4%, and one or more side effects occurred in 18.1% of sessions. Effectiveness of sedation increased with body mass index (BMI). When patients were sedated at the beginning of the procedure, the effectiveness was greater. Side effects increased with patient age. When sedation was divided into two sessions, the number of sedation did not affect the effectiveness or side effects. It can be suggested that sedation should be performed over two separate sessions, as a single prolonged session may lead to reduced effectiveness and increased side effects. To maximize effectiveness and minimize side effects, several variables such as BMI, whether to sedate at the beginning of the procedure and age should be considered thoroughly before sedation.