• Journal of Dental Anesthesia and Pain Medicine
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• v.22 no.1
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• pp.49-60
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• 2022

Background: Although dental sedation helps control anxiety and pain, side effects and serious complications related to sedation are gradually increasing. Due to the introduction of new drugs and sedation methods, insurance rates, legal regulations, drugs, and methods used for dental sedation are inevitably changed. In the Republic of Korea, National Health Insurance is applied to all citizens, and this study investigated changes in the use of sedatives using this big data. Methods: This study used customized health information data provided by the Healthcare Insurance Review & Assessment Service of Korea. Among patients with a record of use of at least one of eight types of sedatives for dental sedation between January 2007 and September 2019 were selected; the data of their overall insurance claims for dental treatment were then analyzed. Results: The number of patients who received dental sedation was 786,003, and the number of dental sedation cases was 1,649,688. Inhalational sedation using nitrous oxide (N₂O) accounted for 86.8% of all sedatives that could be claimed for drugs and treatment. In particular, it was confirmed that the number of requests for sedation using N₂O sharply increased each year. Midazolam showed an increasing trend, and in the case of chloral hydrate, it gradually decreased. Conclusion: According to our analysis, the use of N₂O and midazolam gradually increased, while the use of chloral hydrate gradually decreased.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.6
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• pp.348-355
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• 2022

Objectives: To compare the vital sign stability and cost of two commonly used sedatives, midazolam (MDZ) and dexmedetomidine (DEX). Patients and Methods: This retrospective study targeted patients who underwent mandibular third molar extractions under intravenous sedation using MDZ or DEX. The predictor variable was the type of sedative used. The primary outcome variables were vital signs (heart rate and blood pressure), vital sign outliers, and cost of the sedatives. A vital sign outlier was defined as a 30% or more change in vital signs during sedation; the fewer changes, the higher the vital sign stability. The secondary outcome variables included the observer's assessment of alertness/sedation scale, level of amnesia, patient satisfaction, and bispectral index score. Covariates were sex, age, body mass index, sleeping time, dental anxiety score, and Pederson scale. Descriptive statistics were computed including propensity score matching (PSM). The P-value was set at 0.05. Results: The study enrolled 185 patients, 103 in the MDZ group and 82 in the DEX group. Based on the data after PSM, the two samples had similar baseline covariates. The sedative effect of both agents was satisfactory. Heart rate outliers were more common with MDZ than with DEX (49.3% vs 22.7%, P=0.001). Heart rate was higher with MDZ (P=0.000). The cost was higher for DEX than for MDZ (29.27±0.00 USD vs 0.37±0.04 USD, P=0.000). Conclusion: DEX showed more vital sign stability, while MDZ was more economical. These results could be used as a reference to guide clinicians during sedative selection.

• Clinical Endoscopy
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• v.56 no.5
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• pp.594-603
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• 2023

Background/Aims: The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimed to compare the observation ability with and without pharyngeal anesthesia under midazolam sedation. Methods: This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinal endoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA- groups (250 patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA- group in terms of the pharyngeal observation success rate. Results: The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA-) groups were 84.0% and 72.0%, respectively. The PA- group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0-10 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA- group. Subgroup analysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate between the groups. Conclusions: Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improve pharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.441-446
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• 2001

Flumazenil is a competitive antagonist of benzodiazepines. It is usually administered intravenously. However, if the intravenous route is not available then other routes of drug administration should be considered. This study was designed to evaluate the reversal effects of flumazenil after nasal administration. Twenty-five young, healthy adult volunteers participated in this clinical trial. The dosage of 0.08mg/kg midazolam was administered intravenously to induce deep sedation. Ten minutes after midazolam administration, 0.5mg of flumazenil was dropped nasally, over a period of one minute. Blood samples were taken to measure the concentration of midazolam and flumazenil at 0, 5, 10, and 20min after nasal administration of flumazenil, using High Performance Liquid Chromatography. The degree of sedation was evaluated with sedation score and bispectral index (BIS), Statistical analysis was performed by multivariate ANOVA and correlation analysis (P<0.05). Peak serum flumazenil concentration was reached in 10min. Sedation score decreased after midazolam administration and showed a significant increase after flumazenil administration. However, BIS decreased during the first 10min after midazolam administration and then no significant changes after flumazenil administration. There were two instances representing rapid and complete reversal of midazolam after intranasal administration of flumazenil. In conclusion, intranasal flumazenil administration may be effective in some patients when intravenous route is not available in condition of benzodiazepine overdose.

• The Transactions of the Korean Institute of Electrical Engineers D
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• v.49 no.6
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• pp.334-338
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• 2000

Even though it is not practical, yet there is a trend of the researches related to the anesthesia on the determination of depth of anesthesia and level of consciousness in the view point of neurophysiological aspects. That is, quantification of physiological signals which represent human brain function and pharmacological response could be used to find the level of consciousness based on the changes in physiological signals. This research was performed to analyze the relationship between parameters extracted from LAEP(long latency auditory evoked potential) and the amount of sedatives injected to the patients. Seventeen patients were participated for the experiment. Two different sedatives, midazolam and diazepam, were injected intramuscularly, and LAEPs caused by 1KHz and 2KHz auditory tone bust were obtained. It was found that amplitude of extracted parameters from LAEP, N100 and P300, were reduced as dose of sedatives were increased. Results of this study could be used for extracting more meaningful index and establishing algorithm for predicting changes of level of consciousness induced by sedatives.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.5
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• pp.301-304
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• 2018

Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. The cases of 2 patients (1 male, 1 female) who underwent oral maxillofacial surgery are reported. They received $50{\mu}g$ of fentanyl 2-3 times (total $2.2-2.3{\mu}g/kg$) at intervals of approximately 2 min. Oxygen was administered via a mask at 6 L/min, and 0.5 mg of midazolam was administered 1-4 times (total 0.02-0.05 mg/kg) at intervals of approximately 2 min. A tracheal tube was inserted through the nasal cavity after topical anesthesia was applied to the epiglottis, vocal cords, and into the trachea through the fiberscope channel. All patients were successfully intubated. This is a useful and safe method for awake fiberoptic nasotracheal intubation.

• Journal of Hospice and Palliative Care
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• v.11 no.2
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• pp.106-110
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• 2008

Palliative sedation has been used in patients who undergo intractable suffering at the end of life. Its implementation, however, may be complicated due to resistance of clinicians and barrier of bioethical issues. Here, we present 50-year-old man with stomach cancer and multiple bone metastasis who was treated with palliative chemotherapy and radiotherapy. He suffered from refractory pain on the whole body even after standard analgesics and multidisplinary effort to relieve. Upon shared decision for sedation, he was given midazolam until discharge. Literature reviews reveal cases similar to the present case.

• Journal of The Korean Dental Society of Anesthesiology
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• v.6 no.2 s.11
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• pp.113-120
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• 2006

Recently, sedation in dentistry is gaining more and more interests of dental practitioners. Moreover. 'dental sedation', 'sleep dentistry', or 'pain-free dental treatment' become everyday words familiar to ordinary persons. Sedation clinic in Hanyang University Medical Center was open on Mar 2006 as specialty clinic at department of dentistry. Our aim is performing comfortable and safe dental treatments for patients who have problems for routine dental treatments because of extreme fear and anxiety or for patients who are supposed to have stressful and painful time-consuming treatment, such as sinus elevation and bone graft for implant placement. Our sedation was focused on conscious sedation, especially intravenous sedation using midazolam alone in technique. In two series, the sedation protocol at our Sedation Clinic will be described in details and then, analysis of our cases will be presented to help beginners for sedation in dentistry.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.43 no.4
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• pp.229-238
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• 2017

Objectives: The primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intravenous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction. Materials and Methods: Clinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer's assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05. Results: Most patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; however, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction. Conclusion: The preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral surgery under IVS. The amnesia about the procedure affects patient satisfaction positively.

• Journal of The Korean Dental Society of Anesthesiology
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• v.7 no.2
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• pp.114-119
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• 2007

Background: Dental disabilities mean the poor cooperation for dental treatment because of patient's inherent disability, severe fear and anxiety, and communication problem. Sedation and general anesthesia are usually used for behavioral control in dentally disabled patients. In particular, sedation (conscious and deep) can help them to tolerate the proper dental treatment effectively and safely. Methods: From March 2002 to September 2007, total 35 sedation were carried out in 33 patients (male : female = 20 : 13) with dental disabilities at Seoul National University Dental Hospital and Hanyang University Medical Center. Patients' dental charts and sedation records were retrospectively reviewed. Results: Tooth extraction (19 cases) was the most common dental treatment performed under intravenous sedation (30 cases). Occasionally, inhalation sedation using Sevoflurane 1-2% was adapted (5 cases). Deep sedation (28 cases) was carried out using midazolam 2-3 mg bolus injection and propofol infusion via TCI (4.2 ${\pm}$ 0.9 mg/kg/h), and conscious sedation (7 cases) was carried out using midazolam bolus onlywithout severe complications. The duration of dental treatment was 25.5 ${\pm}$ 12.3 min and that of sedation was 43.2 ${\pm}$ 9.7 min. Conclusion: Sedation for dentally disabledpatients should be selected for effective behavioral control in conjunction with general anesthesia, considering the duration and pain-evoking potentials of dental treatment, the type and severity of patients' disabilities, and the experience of dental anesthesiologists altogether.