• Journal of Dental Anesthesia and Pain Medicine
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• 제17권4호
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• pp.271-280
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• 2017

Background: The number of patients with Alzheimer's disease is growing worldwide, and the proportion of patients requiring dental treatment under general anesthesia increases with increasing severity of the disease. However, outpatient anesthesia management for these patients involves great risks, as most patients with Alzheimer's disease are old and may show reduced cardiopulmonary functions and have cognitive disorders. Methods: This study retrospectively investigated 43 patients with Alzheimer's disease who received outpatient anesthesia for dental treatment between 2012-2017. Pre-anesthesia patient evaluation, dental treatment details, anesthetics dose, blood pressure, duration and procedure of anesthesia, and post-recovery management were analyzed and compared between patients who underwent general anesthesia or intravenous sedation. Results: Mean age of patients was about 70 years; mean duration of Alzheimer's disease since diagnosis was 6.3 years. Severity was assessed using the global deterioration scale; 62.8% of patients were in level ${\geq}6$. Mean duration of anesthesia was 178 minutes for general anesthesia and 85 minutes for intravenous sedation. Mean recovery time was 65 minutes. Eleven patients underwent intravenous sedation using propofol, and 22/32 cases involved total intravenous anesthesia using propofol and remifentanil. Anesthesia was maintained with desflurane for other patients. While maintaining anesthesia, inotropic and atropine were used for eight and four patients, respectively. No patient developed postoperative delirium. All patients were discharged without complications. Conclusion: With appropriate anesthetic management, outpatient anesthesia was successfully performed without complications for dental treatment for patients with severe Alzheimer's disease.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권3호
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• pp.187-193
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• 2024

Background: Patients with autism spectrum disorder (ASD) present challenges in dental treatment cooperation owing to deficits in communication skills and social interaction. Behavioral guidance, sedation, and general anesthesia may be employed to ensure the quality of dental care for individuals with ASD. This study aimed to examine the trends in dental treatment for patients with ASD who visited the Department of Pediatric Dentistry at Dankook University Jukjeon Dental Hospital, an oral health center for the disabled in the Gyeonggi region, over the past 10 years. Methods: This study utilized the order communication system to gather data on sex, age, cooperation level, number of quadrants treated, and administration of sedation or general anesthesia for patients with ASD who visited the Department of Pediatric Dentistry at Dankook University Jukjeon Dental Hospital between January 2013 and December 2022. Results: The total number of patients with ASD increased annually, possibly due to an increase in ASD prevalence and the hospital's designation as a center for disabled oral health. General anesthesia was predominant before 2017, with a shift towards N₂O-O₂ sedation. The most common age group for sedation or general anesthesia was 6-9 years, with a higher prevalence in males than in females. Notably, N₂O-O₂ and midazolam sedation resulted in better cooperation and fewer treated teeth than general anesthesia. Conclusion: This study highlights the evolving trends in dental treatment for individuals with ASD, indicating a shift towards outpatient methods, particularly N₂O-O₂ sedation. The sex distribution aligns with national statistics, emphasizing a higher prevalence of ASD in males than in females. These findings underscore the need for further research to establish evidence-based guidelines for optimal dental care strategies tailored to the unique needs of individuals with ASD.

• 성인간호학회지
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• 제28권5호
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• pp.525-535
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• 2016

Purpose: This study was conducted to examine the effects of music therapy on anxiety, sedation, and stress responses of patients during surgery with spinal anesthesia. Methods: A quasi-experimental design with a non-equivalent control group pre-post test was used. There were 55 adults over 19 years of age scheduled for a lower leg surgery with spinal anesthesia: 27 in the treatment group and 28 in the comparison group. Each subject in the treatment group identified their music preference which was used during the period of surgery which usually lasted, 61 minutes. Data were analyzed using chi-square, Fisher's exact test, independent t-test and repeated measured ANOVA. Results: There were significant reported differences in levels of anxiety, sedation, and stress responses which were measured by plasma cortisol levels, heart rate, and respiratory rate. The findings of all the variables were effectively decreased among those in the treatment group than the comparison group. Conclusion: The preference based music therapy may be useful as a non-pharmacological intervention.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권1호
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• pp.75-80
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• 2024

Dental sedation plays a pivotal role in alleviating patient anxiety during various procedures. Remimazolam, a benzodiazepine derivative, stands out for its distinctive attributes, particularly its rapid onset of sedation coupled with a brief duration, making it an invaluable option for dental applications. The patient was admitted for the extraction of impacted third molars via patient-controlled sedation and not only demonstrated stable vital signs but also expressed a high level of satisfaction with the procedure. An in-depth analysis of plasma remimazolam concentrations and changes in the Patient State Index revealed negative correlation patterns, highlighting the inherent potential of remimazolam in achieving effective sedation. This expanded research scope aims to provide a more nuanced understanding of the pharmacological responses to remimazolam in dental sedation scenarios. This case report offers valuable insights into the evolving landscape of dental sedation methodologies and paves the way for a more informed and evidence-based approach to the use of remimazolam in patient-controlled sedation.

• 한국임상수의학회지
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• 제40권4호
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• pp.260-267
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• 2023

Specialized hearing tests for pets are currently in demand. A brainstem auditory evoked response (BAER) test is an objective, non-invasive, and practical electrophysiological method that records electric signals from the peripheral auditory system to the brainstem when an auditory stimulation is provided. In veterinary medicine, sedation or anesthesia is essential for a successful examination. In human medicine, research has established the indications for various sedatives, anesthetics, and drugs according to the depth of anesthesia required. However, in veterinary medicine, there are very few comparative studies on propofol or isoflurane, which are the most common anesthetics used. Therefore, the present study aimed to analyze the difference in BAER test results between sedation with medetomidine, anesthesia using propofol, and inhalation anesthesia with isoflurane after propofol administration. The test was conducted on four healthy adult dogs. There was no statistically significant difference in latency, interpeak latency, or amplitude between the various drugs. The results suggest that a sedative or anesthetic for the administration of a BAER test can be selected according to the patient's needs.

• Journal of Dental Anesthesia and Pain Medicine
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• 제24권3호
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• pp.143-144
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• 2024

• Archives of Plastic Surgery
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• 제41권4호
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• pp.312-316
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• 2014

This is a review article of the wide-awake approach to hand surgery. More than 95% of all hand surgery can now be performed without a tourniquet. Epinephrine is injected with lidocaine for hemostasis and anesthesia instead of a tourniquet and sedation. This is sedation-free surgery, much like a visit to a dental office. The myth of danger of using epinephrine in the finger is reviewed. The wide awake technique is greatly improving results in tendon repair, tenolysis, and tendon transfer. Here, we will explain its advantages.

• Journal of Korean Neurosurgical Society
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• 제55권4호
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• pp.185-189
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• 2014

Objective : General anesthesia is often preferred for endovascular coiling of intracranial aneurysm at most centers. But in the authors' hospital, it is performed under monitored anesthesia care (MAC) using dexmedetomidine. To determine the feasibility and safety of this approach, the authors reviewed our initial experience. Methods : Retrospective data was analyzed from July 2012 to November 2012. We performed coil embolization in 28 cases using this method. Among them, for statistical significance, we analyzed 12 cases in which the procedure time exceeded an hour. Vital signs were analyzed every 10 minutes. Depth of sedation was measured according to the Ramsay sedation scale and frequency of the repeated roadmap image(s) caused by movement of the patient's head during the procedure. Results : All procedures were completed without occurrence of procedure related complications. Under MAC using dexmedetomidine, vital signs of the patients were stable, no statistical significance regarding hemodynamic and respiratory parameters was observed between time points (p>0.05). Adequate sedation was achieved. Mean Ramsay sedation scale was $3.67{\pm}1.61$ (2 to 6). Repeated roadmap image(s) due to patient's factor occurred in only one case. The mean dosage of drug for adequate sedation for the procedure was $0.65{\pm}0.12mcg/kg/hr$ without loading doses. Conclusion : To the best of my knowledge, this is the first report published in English using the method of monitored anesthesia with dexmedetomidine for intracranial aneurysm coiling. Monitored anesthesia care using dexmedetomidine without loading dose for embolization of intracranial aneurysms appeared to be a safe and effective alternative to general anesthesia.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권5호
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• pp.349-356
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• 2022

Background: Awake fiberoptic intubation (AFOI) is the procedure of choice for securing the airway in patients with a difficult airway when undergoing surgeries under general anesthesia. An ideal drug would not only provide conscious sedation but also maintain spontaneous ventilation, smooth intubation conditions, and stable hemodynamics. We compared the effects of dexmedetomidine alone and dexmedetomidine in combination with fentanyl at a dose lower than the standard dose for achieving conscious sedation during AFOI in difficult airway patients undergoing oral cancer and dental surgeries. Methods: We included 68 adult patients undergoing AFOI. The patients were randomized in two groups, wherein Group D received intravenous dexmedetomidine 1 ㎍/kg and Group DF received dexmedetomidine 0.5 ㎍/kg and fentanyl 1 ㎍/kg. The outcomes measured were airway obstruction score, intubation scores, fiberoptic intubation comfort score, sedation score, and hemodynamic variables. Results: Low-dose dexmedetomidine with fentanyl showed similar results as those with the standard dose of dexmedetomidine in terms of airway obstruction, vocal cord movement, degree of cough, degree of limb movements, and intubation comfort. However, the sedation achieved and incidence of hypotension and bradycardia were higher in Group D than in Group DF. Conclusions: A low dose of dexmedetomidine-fentanyl provides satisfactory intubation conditions as those with a standard dose of dexmedetomidine in AFOI, thereby avoiding bradycardia, hypotension, and sedation.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권4호
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• pp.213-220
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• 2015

Background: Pediatric dentists face challenges when young patients require a mesiodens extraction. General anesthesia may be a burden to the child as well as the parent due to dental fears and costs. The aim of this study was to evaluate oral and intravenous sedation in the outpatient setting as a safe and effective means of managing patients who require a mesiodens extraction. Methods: Records were reviewed retrospectively to find patients who underwent a mesiodens removal procedure from January 2013 to September 2014 in the Department of Pediatric Dentistry at Ajou University Hospital (Suwon, Gyeonggi-do, Republic of Korea). A total of 81 patients (62 male and 19 female) between 4 and 11 years of age (mean [${\pm}SD$] $81.6{\pm}14.1$ months) were studied, with a mean weight of $22.9{\pm}3.3kg$ (16 kg to 30 kg). Vital signs, sedation drug dosage, and sedation time were studied. Results: Mean doses of $63.7{\pm}2.5mg/kg$ chloral hydrate and $1.36{\pm}0.22mg/kg$ hydroxyzine were used for oral sedation. Nitrous oxide/oxygen was administrated for $40.0{\pm}2.1$ min. The mean dose of midazolam administered intravenously was $0.14{\pm}0.06mg/kg$ ($2.38{\pm}0.97$ times). In all cases, the mesiodens was removed successfully. Conclusions: Intravenous sedation combined with oral sedation and nitrous oxide/oxygen inhalation can be an alternative to general anesthesia when administrated and monitored properly.