• Journal of Chest Surgery
• /
• v.25 no.7
• /
• pp.736-738
• /
• 1992

We report the successful use of Nifedipine in the treatment of acute pulmonary hypertension in an young child after a cardiac operation. This patient had undergone patch closure of large ventricular septal defect. She had signs of severe pulmonary artery hypertension unresponsive to hyperventilation, oxygenation, sedation, and a myriad of vas-oactive drugs. Nifedipine, 0.3mg /kg every 4 hours, effectively treated her pulmonary artery hypertension and allowed for a smooth postoperative course and positive outcome. The drug lowered systemic diastolic pressure, but not systolic pressure.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.21 no.5
• /
• pp.461-469
• /
• 2021

Background: The global population is aging rapidly, and accordingly, the number of patients with dementia is increasing every year. Although the need for dental treatment increases for various reasons in patients with dementia, they cannot cooperate during dental treatment. Therefore, behavioral management, including sedation (SED) or general anesthesia (GA), is required for patients with dementia. Thus, this study aimed to investigate the trends and effects of SED or GA in patients with dementia undergoing dental treatment in South Korea based on the Korean National Health Insurance claims data. Methods: This study utilized customized health information data provided by the Health Insurance Review and Assessment Service. Among patients with records of using sedative drugs during dental treatment from January 2007 to September 2019, patients with the International Classification of Diseases-10 code for dementia (F00, F01, F02, F03, and G30) were selected. We then analyzed the full insurance claims data for dental care. Age, sex, sedative use, and dental treatment of patients were analyzed yearly. In addition, the number of cases of GA or SED per year was analyzed, and changes in behavioral management methods with increasing age were investigated. Results: Between January 2007 and September 2019, a total of 4,383 (male, 1,454; female, 2,929) patients with dementia received dental treatment under SED or GA. The total number of SED and GA cases were 1,515 (male, 528 ; female, 987 ) and 3,396 (male, 1,119 ; female, 2,277) cases, respectively. The total number of cases of dental treatment for 4,383 patients with dementia was 153,051 cases, of which 2.22% were under GA and 0.98% were under SED. Midazolam was the most commonly used drug for SED. Conclusion: Although gingivitis and pulpitis were the most common reasons for patients with dementia to visit the dentist, GA or SED for patients with dementia was frequently used in oral and maxillofacial or periodontal surgery.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.22 no.3
• /
• pp.205-216
• /
• 2022

Background: People with special needs tend to require diverse behavioral management in dentistry. They may feel anxious or uncomfortable or may not respond to any communication with the dentists. Patients with medical, physical, or psychological disorders may not cooperate and therefore require sedation (SED) or general anesthesia (GA) to receive dental treatment. Using the healthcare big data in Korea, this study aimed to analyze the trends of SED and GA in special needs patients undergoing dental treatment. It is believed that these data can be used as reference material for hospitals and for preparation of guidelines and related policy decisions of associations or governments for special needs patients in dentistry. Methods: The study used selected health information data provided by the Korean National Health Insurance Service. Patients with a record of use of one of the eight selected drugs used in dental SED between January 2007 and September 2019, those with International Classification of Diseases-10 codes for attention deficit hyperactivity disorder (ADHD), phobia, brain disease, cerebral palsy, epilepsy, genetic disease, autism, mental disorder, mental retardation, and dementia were selected. The insurance claims data were analyzed for age, sex, sedative use, GA, year, and institution. Results: The number of special needs patients who received dental treatment under SED or GA from January 2007 to September 2019 was 116,623. Number of SED cases was 136,018, performed on 69,265 patients, and the number of GA cases was 56,308, implemented on 47,257 patients. In 2007, 3100 special needs patients received dental treatment under SED while in 2018 the number of cases increased 6 times to 18,528 SED cases. In dentistry, ADHD was the most common disability for SED cases while phobia was the most common cause of disability for GA. The male-to-female ratio with respect to SED cases was higher for males (M : F = 64.36% : 35.64%). Conclusion: The application of the SED method and GA for patients with special needs in dentistry is increasing rapidly; thus, preparing guidelines and reinforcing the education and system are necessary.

• Korean Journal of Veterinary Research
• /
• v.43 no.3
• /
• pp.501-505
• /
• 2003

The chemical immobilization in giraffes (Giraffa camelopardalis reticulata) remains a challenge because of their size, behavior, and anatomic and physiologic characteristics that commonly create life threatening problems during immobilization. The drug combination medetomidine (MED) and ketamine (KET) was administered by remote injection. The dosages of MED and KET were correlated to the giraffe's shoulder height (SH), become recumbent with a dosage of $114{\mu}g$ of MED and 2.1 mg of KET, $320{\mu}g$ of atipamezole per cm of SH, respectively. After injection of the drugs, initial signs of sedation including ataxia were noticed at 3 minutes followed by lateral recombency at 12 minutes. The mean heart rate, respiratory rate and rectal temperature recorded during the procedures were 55 beats per minute, 48 breaths per minute and $36.6^{\circ}C$, respectively. Atipamezole was administered, after 33 minutes result in death. Assuming that 24 hours fasting times were short and light esteemed of atipamzole adverse effects like vomiting, passive regurgitation.

• CELLMED
• /
• v.6 no.4
• /
• pp.27.1-27.4
• /
• 2016

Anxiety is a common clinical presentation. Primary anxiety poses a significant problem in its management. Many among the current treatment options of anxiety are habit forming causing significant withdrawal symptoms. There are dose dependent responses often associated with drug adversities. Day time sedation is an undesired effect of many drugs used for anxiety management limiting its usage. Ayurveda recommends a bio- physical procedure to manage anxiety. Shirodhara, a dripping procedure is utilized as a front line therapy for anxiety in Ayurveda. Seeing the limitations of conventional biomedical management of anxiety requiring an improvement upon the existing protocols of managements, and also seeing the use of shirodhara for anxiety management in ayurvedic clinics, a pragmatic study to evaluate the effect of shirodhara in generalized anxiety disorder was done. This was a pragmatic study consisting of shirodhara with ksheer bala oil as an intervention upon generalized anxiety disorder patients. The study was conducted upon 13 patients and observations were done for six weeks. The responses observed through the changes in Hamilton Anxiety Scale were evaluated using paired t test to observe the pre-post significance.

• Sleep Medicine and Psychophysiology
• /
• v.8 no.2
• /
• pp.144-147
• /
• 2001

Chemical restraint or "rapid tranquilization" is another option in treating patients who are a danger to themselves or others and struggle violently once physically restrained. The most commonly used drugs are benzodiazepines and antipsychotics. The use of benzodiazepines, either alone or in combination with high potency neuroleptics, has increased in recent years. Benzodiazepines are extremely safe but may cause respiratory depression and hypotension. Respiratory depression is more likely with intravenous administration, therefore these medications should be given slowly and titrated to the desired effect. Special care should be taken when sedating patients who are under the influence of alcohol or narcotics and are sleep apneic patients. This report deals with a case of respiratory distress in a patient with sleep apnea syndrome after the rapid tranqulization. All patients receiving chemical restraint must be carefully monitored. For critically ill patients who require sedation or chemical restraint, the constant attendance of a physician may be warranted.

• The Journal of the Korean dental association
• /
• v.53 no.8
• /
• pp.530-537
• /
• 2015

Conceptually, the emergency is classified as an urgency and an emergency. The Urgency is not immediately life threatening, but could become so if not resolved promptly. So, it requires prompt patient care same as in the emergency situation. However, the emergency is immediately life threatening and requires immediate action, such as calling 119 and basic life support. Most medical emergencies in the dental clinic cases are urgencies. The incidence of true emergencies is approximately 1/1,000,000. Adequate managing medical urgencies are important because the chance of encountering medical emergencies in the dental clinic is high and higher these days especially because of rapidly aging Korean society. Many dentists indicate that many dentists feel difficulties to recognize and treat medical problems. This paper reviews the concept of medical emergencies and how to cope with commonly occurring urgencies in the dental clinic such as loss of consciousness, hypoglycemia, hyperventilation syndrome. The best treatment for medical urgencies and emergencies in the dental clinic is prevention. Also, it is required to make preparation for emergency situations such as CPR education for dentists and being well-acquainted with equipment and drugs for the emergency care as well as to systemic medical evaluation, patient monitoring, and sedations for controlling patient's anxiety and pain. In this paper, simple algorithms based on guidelines for common urgencies in the dental clinic are suggested. In conclusion, every dentist has competencies to do the urgency care adequately and basic life support. Also, advanced cardiac life support is strongly recommended when sedation is performed in the clinic.

• Biomolecules & Therapeutics
• /
• v.7 no.3
• /
• pp.242-248
• /
• 1999

Diazepam, a benzodiazepine (BDZ) agonist, produces sedation and flumazenil, a BDZ antagonist, blocks these actions. The aim of this study was to examine the effects of BDZs on cortical electroencephalogram (EEG) in rats. The recording electrodes were implanted over the frontal and parietal cortices bilaterally, and the reference and ground electrodes over cerebellum under ketamine anesthesia. To assess the effects of diazepam and flumazenil, rats were injected with diazepam (1 mgHg, i.p.) and/or flumazenil ( 1 mg/kg, i.p.), and the EEG was recorded before and after drugs. Normal awake had theta peak in the spectrum and low amplitude waves, while normal sleep showed large amplitude of slow waves. The powers of delta, theta and alpha bands were increased during sleep compared with during awake. Diazepam reduced the mobility of the rat and induced sleep with intermittent fast spindles and large amplitude of slow activity, and it produced broad peak over betaL band and increased the power of gamma band, which were different from EEG patterns in normal sleep. Saline injection awakened rats and abolished fast spindles for a short period about 2-5 min from EEG pattern during diazepam-induced sleep. Flumazenil blocked both diazepam-induced sleep and decreased the slow activities of delta, theta, alpha and betaL, but not of gamma activity for about 10 min or more. This study may indicate that decrease in power of betaL and betaH bands can be used as the measure of central action of benzodiazepines, and that the EEG parameters of benzodiazepines have to be measured without control over the behavioral state by experimenter.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.2 no.2
• /
• pp.245-249
• /
• 1999

Childhood intestinal tuberculosis is difficult to diagnose for its protean clinical manifestations, especially in cases without pulmonary involvement. Differential diagnosis with Crohn's disease, inflammatory bowel disease and other malignancy is also important. Surgery has often been required for pathologic confirmation or therapy. Colonoscopy may be performed safely under consciousness sedation in children for bacteriologic and histopathologic confirmation of the biopsy specimen in addition to gross appearance of the lesion. We have experienced a case of intestinal tuberculosis presenting with chronic abdominal pain, diarrhea, weight loss and anemia in a 9 year old girl who was diagnosed by a colonoscopic examination and culture of the biopsy specimen from the ascending colon. The patient was managed with antituberculous drugs and recovered uneventfully.

• Journal of Korean Critical Care Nursing
• /
• v.12 no.1
• /
• pp.22-35
• /
• 2019

Purpose : This study was to determine the levels of environmental stressor, posttraumatic stress disorder, and quality of life in intensive care units (ICU) survivors after intensive care, and to explore the factors affecting posttraumatic stress disorder and quality of life. Methods: With a longitudinal survey design, data were collected from 116 patients who were discharged from the ICU of a university hospital. The environmental stressor, posttraumatic stress disorder, and quality of life were measured immediately following and 1 month after the ICU discharge. Results: Of all the subjects, 16.4% experienced posttraumatic stress disorder after discharge. Multiple regression analysis revealed that ICU environmental stressors, experience of ICU readmission, using psychotropic drugs and narcotic analgesics, and ICU admission after surgery or cardiac intervention accounted for 22.2% of posttraumatic stress disorder. Posttraumatic stress disorder and sedation status when entering ICU accounted for 28.3% of the quality of life 1 month after ICU discharge. Conclusion: Nursing interventions focused on ICU environmental stressors would not only reduce environmental stress but also contribute to the reduction of posttraumatic stress disorder and later improvement of quality of life.