• Journal of Dental Anesthesia and Pain Medicine
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• 제23권1호
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• pp.1-8
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• 2023

Backgrounds: Pain management is one of the most important factors affecting the success of pediatric dentistry. Therefore, new needle- and pain-free local anesthesia techniques have been developed in parallel with technological advancements. The purpose of this study is to compare the pain perception and dental anxiety levels associated with a needle-free injection system (Comfort-in^TM) and the classic needle method during treatment-required infiltration anesthesia in children. Methods: This randomized controlled crossover split-mouth clinical study included 94 children who required dental treatment with local anesthesia using a dental needle or needle-free injection system for the bilateral primary molars. The Wong-Baker Scale (WBS) was used to measure pain perception at different times, and the Modified Child Dental Anxiety Scale (MCDAS) was used to measure the anxiety level of the child. A statistical software package was used to process the data. Statistical significance was set at P < 0.05. Results: There was no significant difference between the needle-free injection system and dental needle method during the induction stage for filling and pulpotomy (P > 0.05). "Pain on postoperative 1st day" was similar in both types of anesthesia (P = 0.750). Conclusions: The needle-free injection system was as effective as the dental needle method. The Comfort-in^TM system was an acceptable alternative for patients during the postoperative period. Understanding how pain management may be provided during local anesthesia administration and a child's fear and anxiety regarding the dentist may lead to better dental compliance.

• 대한치과마취과학회지
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• 제8권1호
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• pp.22-28
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• 2008

Background: Cerebral palsy (CP) is non-progressive disorder of motion and posture. In CP patient, there are difficulties in dental treatment because of uncontrolled movement of limb and head, and conjoined disabilities such as cognitive impairment, sensory loss, seizures, communication and behavioral disturbances. It is reported that CP patients have high incidence in caries and a higher prevalence of periodontal disease. But, despite the need for oro-dental care, these patients often are unlikely to receive adequate treatment without sedation or general anesthesia because of uncontrolled movements of the trunk or head. Methods: We reviewed the 58 cases of 56 patients with CP who underwent outpatient general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results: The mean age was 19 (2-54) years. The number of male patient was 40 and that of female was 18. They all had severe spastic cerebral palsy and 22 had sever mental retardation, 15 epilepsy, 8 organic brain disorder, 1 blindness, 2 deafness and cleft palate. For anesthesia induction, 14 cases was needed physical restriction who had sever mental retardation and cooperation difficulty, but 44 cases showed good or moderate cooperation. Drugs used for anesthesia induction were thiopental (37 cases), sevoflurane (14 cases), ketamine (3 cases ) and propofol (4 cases). All patients except one were done nasotracheal intubation for airway management and 4 cases were needed difficult airway management and 1 patient already had tracheostomy tube. Mean total anesthetic time was $174{\pm}56$ min and staying time at PACU was $88{\pm}39$ min. There was no death or long term hospitalization because of severe complications. Conclusion: If general anesthesia is needed, pertinent diagnostic tests and workup about anomaly, and appropriate anesthetic planning are essential for safety.

• 대한치과마취과학회지
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• 제12권4호
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• pp.223-227
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• 2012

Autism patients in general have bad oral hygiene. It is hard for autism patients to get dental treatment as poor communication. Therefore, they may have to be treated by deep sedation or general anesthesia in numerous cases. However, this process requires induction with mask, so it is not easy to do for disobliging autism patient. Midazolam is a water-soluble benzodiazepine, has been used in pediatric dentistry or dentistry for the handicapped because of rapid onset. Midazolam can be administered through oral, rectal, intramuscular,intravenous, and intranasal (IN) routes. IN route of midazolam may be considered as effective way to allay for uncooperative autism patients before general anesthesia. In this case report, two autism patients required dental treatment. Intranasal spray of midazolam before general anesthesia was safe and effective procedure of behavioral management.

• Journal of Yeungnam Medical Science
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• 제3권1호
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• pp.63-66
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• 1986

영남대학교 의과대학 부속병원에서 1983 년 5월부터 1986년 8월까지 여러 마취하에서 시행된 423예의 제왕절개술 환자를 임상적으로 고찰하여서 다음과 같은 결론을 얻었다. 1) 제왕절개술의 빈도는 총분만예의 13.9%였다. 2) 제왕절개술 환자의 63.2%가 응급수술을 시행하였다. 3) 산모의 상태와 태아의 Apgar지수와의 관계는 산모의 상태가 좋을수록 태아의 Apgar지수가 좋았다. 4) 마취 유도에서 신생아 분만시까지 시간이 짧을수록 신생아의 상태가 좋았다.

• 대한정형외과학회지
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• 제53권6호
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• pp.513-521
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• 2018

목적: 본 연구는 상지 수술에서 정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술의 유용성 및 합병증을 조사하기 위해 시행하였다. 대상 및 방법: 2017년 3월부터 2017년 5월까지 총 103건에서 초음파 유도 액와 상완 신경총 차단술을 시행하였다. 초음파 및 프로브는 Siemens Acuson X300의 VF13-5 transducer를 사용했다. 수술 부위가 차단한 신경의 해부학적 감각 분포 범위에 포함되는 경우 대상에 포함하였으며, 다발성 손상으로 2시간 이상의 수술 시간이 예상되는 경우와 상완부의 수술은 제외했다. 술기는 lidocaine HCl 2% 20 ml, ropivacaine 0.75% 20 ml, 0.9% normal saline 10 ml로 조성된 50 ml의 혼합액으로, 2명의 정형외과 의사에 의해 동일한 방법으로 시행되었으며, 술기의 성공률(수술 시 마취 유도 상태 여부), 마취 유도 시간(천자침 제거 후 근력과 감각이 모두 소실될 때까지의 시간), 가능한 상지 수술 범위, 수술 후 무통 지속 시간(완전 마취 유도와 수술 후 수술 부위 통증 발생까지의 시간) 및 합병증을 조사하였다. 결과: 술기를 시행한 2명의 의사 간 결과값의 차이는 없었다. 초음파 유도 액와 상완 신경총 차단술에 소요된 needling time은 평균 5.5분(2.5-13.2분), 완전 마취 유도에 걸린 시간은 평균 18.4분(5-40분)이었으며 103명의 환자 중 100명에서 마취가 성공하여 97.1%의 성공률을 보였다. 무통 지속 시간은 평균 402.8분(141-540분)이었다. 마취 후 1예에서 어지러움, 4예에서 구역, 구토 증상을 보였고, 2예에서 입 주변이 얼얼한 증상을 보였으나 7예 모두 당일 완전히 호전되었으며, 총 103예 중 3예에서는 마취 실패로 수술실에서 2예에서 국소 마취제를 추가 투여하였고, 1예에서 전신 마취로 전환하여 수술을 하였다(3예/103예, 2.9%). 결론: 일부 주관절을 포함한 상지 수술에서 정형외과 의사가 시행한 초음파 유도 액와 상완 신경총 차단술은 빠르고 쉽게 마취를 가능하게 하여 수술 대기 시간을 줄일 수 있으며 높은 마취 성공률을 얻을 수 있게 하고 용량 선택적 마취가 가능하게 하는 안전한 술기로 판단된다.

• 한국산학기술학회논문지
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• 제10권9호
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• pp.2460-2470
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• 2009

본 연구에서는 마취 단계에서 마취 심도 평가를 위한 파라미터 추출을 수행하였다. 연구대상은 평균 나이 $42{\pm}9.13$세, 신체등급 분류상 1 또는 2 등급에 속하는 산부인과 수술 환자를 선택하였다. 투약제로는 Enflurane으로 전신 마취를 시행하였다. HRV 신호는 ECG 신호로부터 R 피크치 검출 알고리즘에 의해 획득 되었다. HRV 데이터는 전처리 단계를 거쳤고, 마취 단계별 마취심도 평가 파라미터를 개발하기 위하여 마취단계를 마취 전, 마취유도, 수술중, 각성, 마취 후 등으로 구분하여 시행하였다. 본 연구에서는 마취단계에서 웨이브렛 변환을 이용한 HRV신호 분석 알고리듬이 제안되었다. 세 종류의 웨이브렛 함수를 적용한 PSD 분석 결과 마취 단계에 따라 모두 비슷한 양상을 나타내었으나, 이들 중 Daubeches 10의 실험 결과가 보다 양호하게 관측되어 마취 단계별 마취심도를 평가할 수 있는 특징 파라미터로서 가장 적절하다는 판단하였다.

• 한국정보통신학회논문지
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• 제14권9호
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• pp.2099-2104
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• 2010

본 연구에서는 마취 중 리턴맵 분석 방법을 적용하여 ECG 신호에서 R-R 간격의 변화로 표시될 수 있는 HRV 신호를 분석하였다. HRV신호는 자율신경계(autonomic nervous system : ANS)의 상태변이에 따른 심혈관계(cardio vascular system : CVS)의 변화 양상에 대한 객관적인 정보를 구할 수 있으므로 수술중 자율신경계의 변화를 관찰하여 마취심도를 평가할 수 있다. 리턴맵 분석 방법은 일련의 시계열 HRV 신호를 위상공간으로 사상하기 위해 지연시간과 매립차원을 구한 후 2차원의 위상공간에 신호를 재구성하였다. 위상공간에 재구성된 신호 분포를 타원형으로 근사화 한 후 장축과 단축의 길이를 구하여 마취심도를 구별하는데 이용하였다. 마취 단계별 마취심도를 평가하기 위하여 마취 단계를 7단계로 구분하여 분석하였다. 외부자극이 아주 강한 마취유도단계에서 장축과 단축 모두 통계적으로 유의하게 큰값을 나타내었으며, 외부 자극이 가해지지 않은 수술중 단계에서는 장축과 단축의 길이 모두 작은 값을 나타내었다. 따라서 2차원의 위상공간에 매립된 수술중의 HRV 신호를 이용하여 자율신경계의 영향을 판단하여 마취심도를 구분 할 수 있었다.

• 대한치과마취과학회지
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• 제2권2호
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• pp.101-106
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• 2002

Background: The management of the behavior of handicapped children when providing required dental care is often a problem, whether in the dental office or in a hospital setting. Because of the high incidence of poor cooperation, many of these patients are scheduled for dental care under general anesthesia with preoperative medical assessment. The purpose of this study was to carry out a clinico-statistical survey on dental treatment for handicapped children under general anesthesia. Methods: After approval from the institutional review board, the medical records of 64 handicapped children between 1997 and 2002 were reviewed to determine the patient profiles, anesthesia management, and complications. The charts of these patients, who underwent dental examination, scaling and prophylaxis, and restoration and extraction of teeth under general anesthesia, were reviewed. Results: The mean age was 12.8 years old, and males (53%) predominated females (47%). Twenty-four patients had mental retardation, twelve had autism, six had cerebral palsy, 4 had behavior disorder, others had heart disease, convulsive disorder, etc. Sixty-two had intravenous thiopental with neuromuscular blocker, 2 had intravenous ketamine induction. Nasotracheal intubation was uneventful in 55 patients, nine had orotracheal intubation because of difficult visualization of the larynx. Twenty-one patients experienced postoperative complications in the recovery room, including epistaxis, nasal obstruction, vomiting, airway obstruction, respiratory depression. Conclusions: General anesthesia is a very effective way of completing the dental treatments for disabled children. We emphasize the need to train anesthesiologists in the care of disabled patients.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권3호
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• pp.193-197
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• 2016

Background: Some patients with special needs exhibit intellectual disability, including deficits in cognitive skills and decreased quality of life. The purpose of this study was to retrospectively compare changes in body composition and hemodynamics during general anesthesia in patients with and without special needs. Methods: The backgrounds of patients who underwent oral maxillofacial surgery under general anesthesia were recorded from medical records. Intracellular water (ICW), extracellular water (ECW), stroke volume variation (SVV), and heart rate (HR) were recorded for 3 h after the start of anesthesia. Categorical data were compared using an unpaired t-test, and a P-value of less than 0.05 was regarded as significant. Numerical data were compared using the Bonferroni correction, and a P-value of less than 0.0125 was regarded as significant. Results: A total of 21 patients were included in the study: 10 patients without special needs (non-S-group) and 11 patients with special needs (S-group). There were no significant differences in patients' backgrounds, except with regard to height (P = 0.03). In both groups, ICW and ECW were maintained, although they were lower in the S-group compared to the non-S-group. SVV was maintained in both groups, although it was higher in the S-group than the non-S-group. HR was significantly lower in the S-group 1 h after induction of anesthesia (P < 0.003). Conclusions: Changes in hemodynamics due to body fluid imbalance should be monitored during general anesthesia, especially for patients with special needs.

• Journal of Dental Anesthesia and Pain Medicine
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• 제23권2호
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• pp.111-116
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• 2023

We provided general anesthesia management to a patient with advanced atrioventricular block, which was discovered in the remote period after open-heart surgery. A 21-year-old man with Noonan syndrome was scheduled to undergo excision of a median intramandibular tumor. At 2 months of age, the patient underwent endocardial repair for congenital heart disease. During our preoperative examination, an atrioventricular block was detected, which had not been previously noted. Emergency drugs were administered, and a transcutaneous pacemaker was placed. During anesthesia induction, mask ventilation was easy, and intubation was performed smoothly using a video laryngoscope. The transcutaneous pacemaker was activated in demand mode at a pacing rate of 50 cycles/min approximately throughout the anesthesia time, and the hemodynamic status remained stable. The effect of intraoperatively administered atropine was brief, lasting only a few seconds. Although body movements due to thoracoabdominal muscle spasm were observed during pacemaker activation, they did not interfere with surgery. In postoperative patients with congenital heart disease, an atrioventricular block may be identified in the remote period, and preoperative evaluation should be based on this possibility. In addition, during anesthesia management, it is important to prepare multiple measures to maintain hemodynamic status.