• Journal of The Korean Dental Society of Anesthesiology
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• v.6 no.1 s.10
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• pp.6-12
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• 2006

IV Deep sedation is useful for Waardenburg syndrome Child undergoing extensive dental treatment. We experienced a case of dental treatment under W deep sedation in a 3 years old boy with Waardenburg syndrome. He was treated on an outpateint basis. He was diagnosed hypothyroidism and received thyroid hormone. Premedication was done using ketamine and atropine IM. Induction using $N_2O$-enflurane mask ventilation was uneventful and intravenous cathetering was carried out. IV deep sedation was maintained with midazolam-$N_2O$ combination. After monitoring the patient for 2 hours and confirming his recovery, he was discharged from the day care unit. In summary, we report this successful IV Deep sedation management of Waardenburg syndrome child during dental treatment in as out patient.

• Journal of Dental Anesthesia and Pain Medicine
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• v.16 no.3
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• pp.217-222
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• 2016

Dental treatment is often performed under general anesthesia or sedation when an intellectually disabled patient has a heightened fear of treatment or has difficulty cooperating. When it is impossible to control the patient due to the severity of intellectual disability, conscious sedation is not a viable option, and only deep sedation should be performed. Deep sedation is usually achieved by propofol infusion using the target controlled infusion (TCI) system, with deep sedation being achieved at a slightly lower concentration of propofol in disabled patients. In such cases, anesthesia depth monitoring using EEG, as with a Bispectral Index (BIS) monitor, can enable dental treatment under appropriate sedation depth. In the present case, we performed deep sedation for dental treatment on a 27-year-old female patient with mental retardation and severe dental phobia. During sedation, we used BIS and a newly developed Anesthetic Depth Monitor for Sedation (ADMS$^{TM}$), in addition to electrocardiography, pulse oximetry, blood pressure monitoring, and capnometry for patient safety. Oxygen was administered via nasal prong to prevent hypoxemia during sedation. The BIS and ADMS$^{TM}$ values were maintained at approximately 70, and dental treatment was successfully performed in approximately 30 min.

• Journal of the korean academy of Pediatric Dentistry
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• v.41 no.1
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• pp.18-26
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• 2014

Deep sedation is considered for the dental treatment of pediatric or disabled patients who have severe anxiety or involuntary movement. Deep sedation using sevoflurane inhalation in emergency dental practice, therefore, is also preferred for fast induction and recovery. This survey consists of 121 people with pediatric or disabled patients who underwent dental treatment under deep sedation using sevoflurane inhalation from January 2013 to October 2013. Patients who were scheduled for deep sedation were classified into a non-emergency sevoflurane sedation group, whereas patients who underwent emergency sedation due to trauma and patients with disabled characteristics itself were classified into an emergency sevoflurane sedation group. Of 121 patients studied, 95 patients received dental care under non-emergency sedation, 26 patients received dental care under emergency sevoflurane sedation. The two groups were analyzed according to: gender; age; primary reason for sedation; duration of sedation; treatment time; induction methods; treatment information; and departments. Non-emergency sevoflurane sedation in pediatric or disabled patients was safe and effective for controlling the behavior. Emergency sevoflurane sedation was a useful method for younger pediatric patients with traumatic injury who need simple, short time emergency treatment. Deep sedation using sevoflurane inhalation not only will reduce the use of general anesthesia gradually but also will be a useful method to emergency treatment for pediatric or disabled patients.

• Journal of The Korean Dental Society of Anesthesiology
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• v.4 no.2 s.7
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• pp.90-95
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• 2004

Background: Sevoflurane, a rotatively new inhalational anesthetic. has non-pungent odor and is less reluctant to pediatric patients. The purpose of this study is to examine the feasibility of sevoflurane in inhalational sedation instead of the nitrous oxide for short and simple dental treatments in pediatric patients. Patients and Methods: Fifteen healthy children, whose dental treatment was abandoned due to their little or no cooperation, were selected with their caregivers' written permission. Deep sedation was induced and maintained with oxygen and 1-5% sevoflufane via specially designed nasal mask. Blood pressure, heart rate, oxygen saturation, and electrocardiogram were monitored at 3-nin interval. A dental anesthesiologist, who was independent of dental treatments, was wholly responsible for the sedation procedure. Post-sedation complications and operator's and caregiver's acceptability of this type of inhalational sedation were also investigated. Results: The systolic and diastolic blood pressure, heart rate, and oxygen saturation was significantly depressed during the deep sedation using sevoflurane (P < 0.05). No severe post-sedation complications were found, however, bradycardia was reported in 3 patients. Almost all the operators and caregivers answered that they would adapt this sedation procedure again if possible. Conclusion: In this study, inhalational deep sedation using sevoflurane for dental treatments was found to be very useful. Furthermore, the application of sevoflurane to conscious sedation for pediatric and adult dental patients should be added.

• 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.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.1
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• pp.11-15
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• 2015

Background: Emergency room doctors run into difficulties in treating injured pediatric patients because usually they fell into panic after trauma. In these situation, deep sedation with sevoflurane is fully recommendable method. The conventional way can interrupt common dental treatment procedure. Methods: In the present study, nasal cannula was used for sevoflurane deep sedation in 11 dental emergency treatment. Age ranged from 0 to 3 years old (average of 1.8 years). Results: Treatment duration was from 10 to 35 minutes (average of 16.7 minutes). Average duration of sedation was 25.5 minutes ranging from 15 to 45 minutes. Conclusions: It has advantages to use nasal cannula for sevoflurane deep sedation rather than conventional intubation; saves time and secures good operation field.

• Journal of Digestive Cancer Research
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• v.11 no.3
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• pp.125-129
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• 2023

Appropriate sedation and analgesia are crucial for successful endoscopic procedures, patient safety, and satisfaction. Endoscopic resection for upper gastrointestinal tumors requires a deep sedation level because the procedure is lengthy and induces moderate to severe pain. Continuous patient consciousness assessment and vigilant vital signs monitoring are required for deep sedation. General anesthesia may unintentionally occur even during deep sedation for endoscopic tumor resection, which may cause unexpected complications, especially in high-risk patients. Previous studies have revealed that general anesthesia increases the en bloc resection rate and decreases the procedure time. Complications, such as perforation, aspiration pneumonia, and cardiopulmonary instability, including hypoxemia, hypotension, and arrhythmia, occurred more frequently in patients with sedation compared to those with general anesthesia. Therefore, general anesthesia demonstrated potential benefits in endoscopic treatment results and patient safety. General anesthesia should be considered a useful alternative for sedation in patients undergoing endoscopic gastrointestinal tumor resection. However, more high-quality prospective studies are required to determine the safety and effectiveness of general anesthesia in endoscopic upper gastrointestinal tumor resection because most studies comparing general anesthesia and sedation in these procedures have been retrospectively conducted and the results were inconsistent.

• The Journal of the Korean dental association
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• v.51 no.7
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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 Yeungnam Medical Science
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• v.37 no.3
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• pp.159-168
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• 2020

The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infants or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.27-31
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• 2011

We report two cases of accidental overdoses of intramuscular midazolam used for a conscious sedation. A 4-year-old boy with dental caries was scheduled for treatment under conscious sedation. The pedodontist prescribed midazolam ($dormicum^{(R)}$ 5 mg / 5 ml) 2 ml (2 mg) by verbal order to hygienist. The hygienist instead of the pedodontist wrote a prescription for midazolam ($dormicum^{(R)}$ 15 mg / 3 ml) 2 ml (10 mg). The inexperienced nurse gave an injection to his buttock as prescription. The child fell into a deep sedation. A 4-year-old boy with dental caries was scheduled for treatment under conscious sedation. The inexperienced pedodontist gave an injection to his buttock midazolam ($dormicum^{(R)}$ 15 mg / 3 ml) 3 ml (15 mg) instead of midazolam ($dormicum^{(R)}$ 5 mg / 5 ml) 3 ml (3 mg). The child fell into a deep sedation. Both cases had no complications, but the accidents happened as a result of the inexperienced dental staffs. The five times midazoalm instead of the intended doses was inadvertently given intramuscularly, fortunately caused no harm in our cases. However, the situations suggest that we should carefully check the dosage and review the correct procedures, even when using a drug that is considered to be familiar with most practitioners.