• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.2
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• pp.101-110
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• 2023

Background: Dentists make various efforts to reduce patients' anxiety and fear associated with dental treatment. Dental sedation is an advanced method that dentists can perform to reduce patients' anxiety and fear and provide effective dental treatment. However, dental sedation is different from general dental treatment and requires separate learning, and if done incorrectly, can lead to serious complications. Therefore, sedation is performed by a limited number of dentists who have received specific training. This study aimed to investigate the proportion of dentists who practice sedation and the main sedatives they use in the context of the Republic of Korea. Methods: We used the customized health information data provided by the Korean National Health Insurance. We investigated the number of dental hospitals or clinics that claimed insurance for eight main sedatives commonly used in dental sedation from January, 2007 to September, 2019 at the Health Insurance Review and Assessment Service. We also identified the changes in the number of dental medical institutions by region and year and analyzed the number and proportion of dental medical institutions prescribing each sedative. Results: In 2007, 302 dental hospitals prescribed sedatives, and the number increased to 613 in 2019. In 2007, approximately 2.18% of the total 13,796 dental institutions prescribed sedatives, increasing to 3.31% in 2019. In 2007, 168 institutions (55.6%) prescribed N₂O alone, and in 2019, 510 institutions (83.1%) made claims for it. In 2007, 76 (25.1%) hospitals made claims for chloral hydrate, but the number gradually decreased, with only 29 hospitals (4.7%) prescribing it in 2019. Hospitals that prescribed a combination of N₂O, chloral hydrate, and hydroxyzine increased from 27 (8.9%) in 2007 to 51 (9%) in 2017 but decreased to 38 (6.1%) in 2019. The use of a combination of N₂O and midazolam increased from 20 hospitals (6.6%) in 2007 to 51 hospitals (8.3%) in 2019. Conclusion: While there is a critical limitation to the investigation of dental hospitals performing sedation using insurance claims data, namely exclusion of dental clinics providing non-insured treatments, we found that in 2019, approximately 3.31% of the dental clinics were practicing sedation and that N₂O was the most commonly prescribed sedative.

• Journal of Korean Clinical Nursing Research
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• v.18 no.2
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• pp.284-295
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• 2012

Purpose: This study was done to clarify effects of bispectral index monitoring sedative administration, compared to MOAA/S (Modified Observer's Assessment of Alertness and Sedation), on conscious sedation, physiological stability and recovery time for patients undergoing endoscopic submucosal dissection. Methods: Participants In this study were patients who underwent endoscopic submucosal dissection because of early gastric cancer. Participants were assigned randomly to an experimental group receiving sedatives based on bispectral index monitoring or to a control group with the MOAA/S instrument. Movements, belching, memory, pain, discomfort, physiological stability (MBP, PR, $SpO_2$), and recovery time were measured during the treatment and recovery. Data were analyzed using Spearman partial correlation coefficient analysis, Mixed model and Wilcoxon rank sum test to determine differences in the parameters. Results: There were no statistically significant differences between the two groups for conscious sedation(movement, belching, memory, pain, or discomfort), physiological stability and recovery time. Conclusion: The results of this study indicate that no differences were found between the two types of monitoring. Thus, use of a bispectral index monitor in clinical practice enabling medical staff to readily assess the conscious sedation of for these patients is expected to be increasingly used as an objective assessment tool for conscious sedation for patient safety.

• Journal of Pharmacopuncture
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• v.11 no.3
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• pp.17-31
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• 2008

Objective: To review the theoretic basis of the Sa-Ahm 5 Element acupuncture devised about 360 years ago, papers and books were researched. Methods: Total of 59 books and papers ranging from ancient Huang Di nei jing to modern Bio Medical Acupuncture for Pain Management were researched to study the basic theory of it in relation to the 5 Shu points, Results: Gao-mu in Chinese Ming dynasty, for the 1st time, had used 5 Shu points based on creation cycle as tonification and sedation treatment respectively and named it as 'tonification and sedation treatment of self meridian' but since then, this method, without special reasons, has been rarely used until Sa-Ahm's new doctrine that include the concept of destruction cycle was asserted. Conclusions: Sa-Ahm 5 Element acupuncture is a method which uses 5 Shu points from the viewpoints of simultaneous tonification and sedation methods which are based on promotion and control cycles. Though it is nowadays mostly-used method in accordance with practitioner's points, it needs to be set guidelines by which to effectively practice Sa-Ahm acupuncture.

• Journal of the korean academy of Pediatric Dentistry
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• v.46 no.3
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• pp.328-336
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• 2019

The purpose of this study is to analyze the changes in patient distribution and practice pattern resulted from changes of socioeconomic circumstances. From January 2008 to December 2017, information about patient distribution and practice pattern was collected and reviewed. Both the number of new patients and revisiting patients increased. The average age of new patients showed a declining trend. Children aged between 0 and 6 had the majority. In case of restorative treatment, the use of composite resin decreased, whereas resin modified glass ionomer increased. As to pulp treatment of primary tooth, the proportion of pulpectomy increased significantly, but decreased in pulpotomy. The results showed an increase in the treatments under sedation and general anesthesia and with the use of midazolam and nitric oxide increased after 2014.

• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.1
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• pp.29-39
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• 2014

Background: Dental phobia or anxiety of patients is the serious impediment to appropriate and effective dental treatment. Sedative technique helps to mitigate patients' fear and anxiety thus make them more cooperative and familiar to dental practices. With increasing attention to sedative dentistry in dentists, educational requirements and technical qualification also become stricter but actual survey on recent sedative dentistry has not been reported yet. Especially there is insufficient study reporting the survey of sedative dentistry subjected to Korean adults. In this paper, we conducted a survey study on the actual condition and practice related to sedation with a questionnaire to dentists in South Korea. Methods: The survey was done for members of The Korean Dental Society of Anesthesiology (KDSA), who had great interest in sedation and for whom survey-by-mail was convenient. 472 members of The KDSA having dental license and solid address and contact information were subjected to the survey by sending them survey questions about their sedative techniques and knowledge. In order to increase the response rate, small gifts were presented to those who accurately responded to the survey questions and text messages and phone calls were made to encourage their participation. We collected their responses over two months and examined the returned surveys. Statistical analysis was performed using IBM SPSS Statistics 21 for each question. Results: Out of 472 dentists, 181 responded (38.4% response rate). 63.0% (114 dentists; 77 male and 37 female) of respondents had experience on sedative technique and their average age was $39.8{\pm}7.6$ year. 74 of them were private practitioners, 17 of them were professors (14.9%), 11 of them were dentists-in-service (9.6%), 11 of them were residents (specialist training) (9.6%) and 1 of them was military doctors (0.9%). There were 89 dentists (78.1%) who were specialists or receiving trainings to be specialist, most of whom were pediatric dentists (55, 48.2%) and oral surgeon (31, 27.2%). The most popular route for drug medications was orderly oral, inhalational, intravenous medication. Combination of oral and inhalational medications or single use of intravenous medication was the most common. The most preferred sedative drug was pocral in oral sedation and midazolam in intravenous sedation. 48.2% of practitioners responded that they experienced side effects and emergency situations. Airway obstruction was the most frequent. Conclusions: Results from the survey show that the protocol and system for sedative dentistry have been improved compared to the past. Nevertheless, quality of emergency protocol, monitoring devices and preparation of sedative drugs was still insufficient to achieve safe sedative procedure. This study acquires novelty since actual survey on recent sedative dentistry for adult patients has not been reported yet.

• Clinical Endoscopy
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• v.57 no.4
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• pp.476-485
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• 2024

Background/Aims: Sedation has become a standard practice for patients undergoing gastrointestinal (GI) endoscopy. However, considering the serious cardiopulmonary adverse events associated with sedatives, it is important to identify patients at high risk. Machine learning can generate reasonable prediction for a wide range of medical conditions. This study aimed to evaluate the risk factors associated with sedation during GI endoscopy and develop a predictive model for hypoxia during endoscopy under sedation. Methods: This prospective observational study enrolled 446 patients who underwent sedative endoscopy at the Korea University Ansan Hospital. Clinical data were used as predictor variables to construct predictive models using the random forest method that is a machine learning algorithm. Results: Seventy-two of the 446 patients (16.1%) experienced life-threatening hypoxia requiring immediate medical intervention. Patients who developed hypoxia had higher body weight, body mass index (BMI), neck circumference, and Mallampati scores. Propofol alone and higher initial and total dose of propofol were significantly associated with hypoxia during sedative endoscopy. Among these variables, high BMI, neck circumference, and Mallampati score were independent risk factors for hypoxia. The area under the receiver operating characteristic curve for the random forest-based predictive model for hypoxia during sedative endoscopy was 0.82 (95% confidence interval, 0.79-0.86) and displayed a moderate discriminatory power. Conclusions: High BMI, neck circumference, and Mallampati score were independently associated with hypoxia during sedative endoscopy. We constructed a model with acceptable performance for predicting hypoxia during sedative endoscopy.

• Tuberculosis and Respiratory Diseases
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• v.69 no.2
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• pp.75-80
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• 2010

The year of 2009~2010 brought a number of concepts and new ideas were evaluated with promising results. However, some studies that challenged many beliefs. In acute respiratory distress syndrome (ARDS), recent clinical studies took into consideration of pathophysiologic changes of respiratory system compliance. Meta-analysis of positive end-expiratory pressure trials showed survival benefit of high positive end-expiratory pressure in ARDS. Until now, prone positioning did not show survival benefit in patients with ARDS. Extracorporeal membrane oxygenation (ECMO) based management improved survival in patients with severe ARDS. ECMO can be a management option in severe ARDS. Sedation is a standard practice in critically ill patients needing mechanical ventilation. However, Danish group reported less sedation of critically ill patients receiving mechanical ventilation was associated with an increase in days without ventilation. Although this single center study has some limitations, the overall results are promising. Use of maximal sterile barrier precautions (mask, sterile gown, sterile gloves, and large sterile drapes) with chlorhexidine-impregnated dressing reduced central venous catheter related infection. Selective oropharyngeal decontamination (application of topical antibiotics in the oropharynx) reduced the mortality rate of an intensive care unit (ICU) population. Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial reported intensive glucose control increased mortality among adults in the ICU. Some of the results of above papers are promising. However, some ideas may need for more frequent individual assessment and increase the workload of ICU staffs. Before implementation of new practice in ICU, we should take into consideration of individual hospital situation including human and material resources.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.1
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• pp.31-37
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• 2016

Background: The definition of evidence-based clinical practice guidelines (CPGs) is "statements that are systematically developed to assist in the doctors' and patients' decision-making in certain situations." This study aims to establish the concept of evidence-based CPGs and investigate the development status to seek measures to apply evidence-based methods to CPG development for dental sedation in Korea. Methods: The study conducted systematic searching methods based on evidence-based CPGs. Articles published between 1995 to 2015 were searched on a Korean database and the international database PubMed. The search was based on keywords related to four subjects (dentistry, clinical practice, guideline, recommendation). Two authors independently reviewed the searched articles to determine their analysis inclusion and the convergence stages, and to arrive at a conclusion through discussion. Results: A total of 65 Korean CPGs were included. There were 51 medical guidelines, of which seven were dental and seven were Oriental medicine. Conclusions: As a basic direction for the development of evidence-based CPGs, this work suggests the following: increased awareness; consensus on the need to supply evidence-based development methods; education, computerization, and systematic observation of evidence-based CPG development methods; continuous research development and distribution of CPGs; and creation of a database for Korean clinical dentistry practice outcomes

• Anxiety and mood
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• v.1 no.1
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• pp.37-42
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• 2005

Benzodiazepines are widely used for a variety of conditions in psychiatric field. In this article, the author reviewed the indications, the effects on anxiety and sleep disorders, the side effects, the drug-drug interactions, and the tapering strategies. Benzodiazepines were relatively safe and useful for the treatment of anxiety and sleep disorders. However, used clinically, benzodiazepines can induce many adverse effects (e. g. over-sedation, cognitive impairments, paradoxical effects, dependence and withdrawal symptoms, and so on). Currently available informations about their effects on the developing fetus is controversial. For this reason, pregnant women and nursing mother should be cautioned against the use of benzodiazepines. Drug-drug interactions have to be considered in combination treatments. For the tapering issues, gradual tapering was important to prevent the withdrawal symptoms. Especially, the tapering schedules have to be individualized for the each long-term benzodiapzepine users.

• Journal of Veterinary Clinics
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• v.38 no.5
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• pp.225-230
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• 2021

A 4-year-old gelding Thoroughbred racehorse, which had been undergoing antibiotic therapy at a local veterinary clinic, was referred to the KRA veterinary center with a 20-day history of continuous right nasal discharge. Patient's history, endoscopic examination, and radiographic examination revealed primary maxillary sinusitis. Under sedation, surgical intervention was performed to collect samples and remove the accumulated mucopurulent exudate in the sinus. Swab samples were collected from the sinus during surgery for cytology and antimicrobial susceptibility testing. Only one type of bacteria was cultured, and molecular analyses of 16S ribosomal RNA gene sequences identified it as Staphylococcus aureus (S. aureus). The isolate was resistant to multiple antibiotics, which are frequently used in equine practice. Trimethoprim-sulfamethoxazole was chosen based on antibiotic susceptibility test, trephination, and sinus lavage using saline were applied to treat bacterial sinusitis. The clinical signs improved after 1 month and the patient resumed training. This report describes S. aureus isolated from bacterial maxillary sinusitis in a horse and its antibiotic susceptibility.