• 대한소아치과학회지
• /
• 제25권4호
• /
• pp.710-716
• /
• 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.

• 대한치과마취과학회지
• /
• 제14권3호
• /
• pp.167-172
• /
• 2014

Background: Propofol is the most commonly used anesthetic for sedation and target-controlled infusion (TCI) is useful for dental treatment. However, it is important to assess and maintain an adequate depth of sedation in patients with severe intellectual disabilities Therefore, in this study we aimed to evaluate the adequate propofol target concentration for dental treatment in severely intellectually disabled patients. Methods: We undertook retrospective review of the sedation records of severely intellectually disabled patients who underwent dental treatment under TCI propofol sedation from September 2011 to April 2012. We evaluated the initial target concentration, stabilized concentration of propofol and monitored vital signs, including BIS score using sedation records. Results: Total 20 patients (10 male and 10 female patients) were included in the study. Every participant was severely intellectually disabled. The mean sedation duration was $70{\pm}16$ (45-100) minutes. The initial propofol target concentration infusion amount was $2.7{\pm}0.45$ (2.0-3.0) mcg/ml. The propofol effect site concentration (Ce) was $2.6{\pm}0.7$ (1.0-4.0) mcg/ml. The average value of BIS was $52.6{\pm}13$ (28-81). During the treatment period, there were no severe complications. Conclusions: The average propofol Ce for deep sedation without any complications in intellectually disabled patients was 2.6 mcg/ml.

• 대한소아치과학회지
• /
• 제33권1호
• /
• pp.62-69
• /
• 2006

본 연구의 목적은 소아의 비만도가 진정요법의 효과에 미치는 영향을 알아보는 것이다 삼성서울병원 소아치과에 내원한 환자 중 ASA I 또는 II에 해당하는 40명의 환아 (평균연령 30.5개월, 평균신장 91.3cm, 평균체중 14.3kg)를 대상으로 chloral hydrate(60mg/kg) 및 hydroxyzine(25mg)을 사용하여 진정요법을 시행하였다. 환아의 체중과 신장을 이용하여 환아 각각의 비만도를 계산하였고 Broadsky's scale을 이용하여 편도선의 크기를 측정하였다. 진정요법에 대한 결과는 Houpt's scale(수면, 움직임, 울음, 전반적인 행동지수)을 이용하여 평가하였다. 환아의 비만도는 진정효과중 움직임과 울음에 대하여는 통계학적으로 유의한 차이를 만들지 않았으나 비만도가 증가할수록 전반적인 행동지수가 유의하게 나빠지는 결과를 보였다.

• Korean Journal of Acupuncture
• /
• 제36권3호
• /
• pp.171-180
• /
• 2019

Objectives : Although the tonification and sedation method such as mountain-burning fire method and heaven-penetrating cooling method, is one of the important techniques that have been claimed to increase the effect of acupuncture, research on this has been sparse. The aim of this study is to provide an understanding of tonification and sedation methods in the "Yeongsochimgugyeong". Methods : We analyzed the similarities and differences by comparing the contents of the tonification and sedation method described in books "Yeongsochimgugyeon" and "Complete Compendium of Acupuncture and Moxibustion" Results : A total of 28 out of the 33 tonification and sedation methods described in "Yeongsochimgugyeon" were compared with those in "Complete Compendium of Acupuncture and Moxibustion". As a result, we found that many of the tonification and sedation methods recorded in "Yeongsochimgugyeon" were based on more detailed and specific clinical cases. Conclusions : The tonification and sedation methods in "Yeongsochimgugyeon" were not only descriptive and consistent in describing that methods, but also contains valuable information for clinical use. In the future, based on this research, we will be able to clinically implement these tonification and sedation methods and quantitatively evaluate them.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제22권3호
• /
• pp.217-224
• /
• 2019

Purpose: Various publications on the use of sedation and anesthesia for diagnostic procedures in children have demonstrated that no ideal agent is available. Although propofol has been widely used for sedation during esophagogastroduodenoscopy in children, adverse events including hypoxia and hypotension, are concerns in propofol-based sedation. Propofol is used in combination with other sedatives in order to reduce potential complications. We aimed to analyze whether the administration of midazolam would improve the safety and efficacy of propofol-based sedation in diagnostic esophagogastroduodenoscopies in children. Methods: We retrospectively reviewed the hospital records of children who underwent diagnostic esophagogastroduodenoscopies during a 30-month period. Demographic characteristics, vital signs, medication dosages, induction times, sedation times, recovery times, and any complications observed, were examined. Results: Baseline characteristics did not differ between the midazolam-propofol and propofol alone groups. No differences were observed between the two groups in terms of induction times, sedation times, recovery times, or the proportion of satisfactory endoscopist responses. No major procedural complications, such as cardiac arrest, apnea, or laryngospasm, occurred in any case. However, minor complications developed in 22 patients (10.7%), 17 (16.2%) in the midazolam-propofol group and five (5.0%) in the propofol alone group (p=0.010). Conclusion: The sedation protocol with propofol was safe and efficient. The administration of midazolam provided no additional benefit in propofol-based sedation.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제15권1호
• /
• pp.1-4
• /
• 2015

In pediatric dentistry, chloral hydrate is habitually selected for sedation of uncooperative children. Although chloral hydrate has been used for decades, various adverse effects are reported and necessity for new alternative drugs has increased. Dexmedetomidine was approved by FDA for sedation at intensive care units (ICU) in 1999. Compared to conventional sedative drugs, dexmedetomidine has not only analgesic and sedative effects but also it barely suppresses the respiratory system. Due to these characteristics, dexmedetomidine is known as safe sedative drug for children and elderly patients. Furthermore, approved by KFDA in 2010 in Korea, the frequency of sedation using dexmedetomidine is increasing. However, due to its intravenous administration method, it was difficult to apply in pediatric dentistry. Recently, intranasal administration method was introduced which might be a new possible alternative of oral sedation. In this study, we compare the mechanisms, pros and cons of chloral hydrate and dexmedetomidine, introducing new possibilities.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제17권2호
• /
• pp.157-161
• /
• 2017

In sedation via the submucosal route, the drug is administered through the maxillary buccal submucosa. It is time saving, effective, and safe. Patients with autism, a mental disorder, often find it hard to make relationships with other people. These patients display a strong resistance to dental treatment and sedation. This study reports a successful case of behavioral management during dental treatment, using sedation via the submucosal route. The patient was strongly resistant to sedation via the oral, intramuscular, and intravenous routes. The drug used was 9 mg (0.1 mg/kg) of midazolam. Through this case report, we reaffirm the significance of sedation via the submucosal route, and expect that it will be used more frequently for patients with autism, who display behaviors that are difficult to manage, patients with other disabilities, and children.

• 대한치과마취과학회지
• /
• 제10권2호
• /
• pp.209-213
• /
• 2010

Anxiety and fear is two main factors that keep patients from going to dental clinic. Especially, patients may feel implants operations are more traumatic. Intravenous conscious sedation for dental treatment can make patient comfortable and relaxable. Midazolam is more popular for sedation for dental treatment, but target-controlled infusion (TCI) of propofol and remifentanil is gaining wide popularity. A 54-year-old female patient who had severe dental phobia was referred to our dental hospital. She had past history of 2 times of hyperventilation and syncope during dental treatment. The patient showed a lot of dental anxiety and fear to dental treatments and stress reduction protocol was needed. We administered intravenous conscious sedation using target controlled infusion system with remifentanil and propofol. During sedation, we monitored the status of consciousness with bispectral index and vital signs. Dental treatment could be finished successfully without any problems.

• Journal of Dental Anesthesia and Pain Medicine
• /
• 제20권3호
• /
• pp.107-118
• /
• 2020

Chloral hydrate is the oldest and most common sedative drug used in moderate sedation for pediatric dental patients. Hence, the purpose of this article is to review the safety and possible adverse events of this drug when used for pediatric dental treatment. A bibliographic search in PubMed, MEDLINE, Cochrane Library and KMbase, KISS, DBpia, KoreaMed, and RISS databases was performed. Using the keywords "dental sedation," "chloral hydrate," and "children or adolescent," 512 scientific articles were found. Subsequently, 183 studies were individually assessed for their suitability for inclusion in this literature review. Altogether, 24 studies were selected. They included 12 cases of death before, during, or after chloral hydrate sedation for dental treatment, majorly due to dosing error and use of multiple sedatives. Additionally, intraoperative adverse events were mostly respiratory problems such as hypoxia and apnea, but most events were temporary. After treatment, prolonged sedation, including excessive sleep and less activity were the most common postoperative adverse events, and even death cases were reported. Despite the wide acceptance of chloral hydrate as a sedative-hypnotic agent, the risk of adverse events and adequate dose should be of great concern when using it for pediatric dental sedation.

• 대한소아치과학회지
• /
• 제43권1호
• /
• pp.85-92
• /
• 2016

대한소아치과학회는 진정법 교육연구위원회를 설립하여 학회원들이 진정법을 시행함에 있어서 안전한 술식을 시행할 수 있도록 진정법 지침서를 개정하고 평생교육프로그램을 개발하게 하였다. 이에 2015년 종합학술대회 기간에 진정법 심포지움과 BLS교육을 시행하였으며, 이에 대한 학회원들의 만족도 평가를 시행하였다. 진정법연구교육위원회는 종합학술대회에 참가한 학회원들에게 배포할 설문지를 제작하여 심포지움에 참가한 학회원 중 설문에 응한 총 143명의 학회원들의 설문지를 분석하였으며, BLS코스에 참여한 23명의 학회원을 대상으로 설문지를 배포하여 이를 분석하였다. 심포지움과 BLS코스에 참석한 학회원들은 전반적인 질문에 대하여 높은 만족도를 보였으며, 진정법 교육연구위원회는 이번 설문지를 통하여 학회원들이 원하는 교육내용과 향후 교육프로그램 개발에 관한 중요한 정보를 얻을 수 있었다. 대한소아치과학회는 앞으로도 꾸준히 학회원들의 더 낳은 교육을 위하여 힘 쓸 것이며, 체계적인 교육프로그램 개발을 위하여 노력할 것이다.