• Journal of Dental Anesthesia and Pain Medicine
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• 제23권4호
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• pp.179-192
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• 2023

Obstructive sleep apnea (OSA) is a common sleep-breathing disorder associated with significant comorbidities and perioperative complications. This narrative review is aimed at comprehensively overviewing preoperative risk evaluation and perioperative management strategies for patients with OSA. OSA is characterized by recurrent episodes of upper airway obstruction during sleep leading to hypoxemia and arousal. Anatomical features, such as upper airway narrowing and obesity, contribute to the development of OSA. OSA can be diagnosed based on polysomnography findings, and positive airway pressure therapy is the mainstay of treatment. However, alternative therapies, such as oral appliances or upper airway surgery, can be considered for patients with intolerance. Patients with OSA face perioperative challenges due to difficult airway management, comorbidities, and effects of sedatives and analgesics. Anatomical changes, reduced upper airway muscle tone, and obesity increase the risks of airway obstruction, and difficulties in intubation and mask ventilation. OSA-related comorbidities, such as cardiovascular and respiratory disorders, further increase perioperative risks. Sedatives and opioids can exacerbate respiratory depression and compromise airway patency. Therefore, careful consideration of alternative pain management options is necessary. Although the association between OSA and postoperative mortality remains controversial, concerns exist regarding adverse outcomes in patients with OSA. Understanding the pathophysiology of OSA, implementing appropriate preoperative evaluations, and tailoring perioperative management strategies are vital to ensure patient safety and optimize surgical outcomes.

• 대한간호학회지
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• 제2권1호
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• pp.49-61
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• 1971

The purpose of this study is to observe the administering of analgesics and sedatives to cases of surgery, the influence of the patients'situational variables on the use of these drugs, and the required number of recovery days in relation to the patients'situational variables and general conditions. Fifty patients in the age range of 15 through 65 who had undergone general surgery at Seoul national University Hospital. Woo Sok University Hospital and Koryo Hospital between May and August of 1971 were chosen for this study. They were observed with regard to the frequency of postoperative uses of analgesics and sedatives age, the required period of recovery in comparison with the situational variables of patients such as sex, age, marital status, the type and duration of anesthesia, experience of previous operation, history of other diseases, preoperative period of hospitalizations and the general conditions of patients such as sleep, stomach condition, bowel condition, urination, interest in surroundings, strength and energy, self-assistance and appetite. The study results were reviewed in a statistical method to obtain the following findings: 1. There was a significant decrease in the frequency of analgesic uses according to the number of days passed after operation. 2. The mean postoperative recovery days were 5.31 days and mote than half of the patients have never used analgesics until recovery. 3. There was a significant decrease in the frequency of sedative uses according to the number of days passed after operation. 4. The rank-order correlation between the frequency of analgesic use and that of sedative use following surgery observes in relation to the number of postoperative days was a low and negative one. 5. All of the patients except one hate used sedatives only once a day for the whole recovery period. 6. The longer they stayed in the hospital before surgery, the less have they used analgesics after surgery. 7. There were significant differences in use of analgesics after surgery by age groups; the 25-44 age group used more analgesics than the 15-24 and 45-65 age groups. 8. There were no significant differences in use of analgesics after surgery by all situational variables except the number of days of hospitalization and age. 9. The longer they stayed in the hospital before surgery, the earlier have they recovered from the surgery. 10. There were no significant differences in the number of required recovery days by all situational variables except the length of preoperative hospitalization. 11. There were no significant differences in the number of required postoperative recordedly days by the general conditions of patients.

• 한국임상약학회지
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• 제22권4호
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• pp.304-315
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• 2012

Today, suicide by self-poisoning of prescribed or non-prescribed drugs on purpose has been increasing and is a major cause of mortality. It is very important to treat promptly and properly for saving the lives from those suicides. There is neither an organization such as poison control center nor measurement in S. Korea, though. The object of this study was to evaluate information of frequently used substances for suicide attempt in S. Korea. Our results also can provide healthcare provider including pharmacists and doctors, etc and contribute to increasing health and welfare for Korean. From June $1^{st}$ 2006 to April $30^{th}$ 2012, we retrospectively studied patients visiting emergency room due to suicide attempt. We collected information of underlying disease, history of past medical condition and suicide attempt, ingredient and getting route of ingesting substances, emergency treatment, and outcome by reviewing electronic medical record. We also evaluated actual treatment of self-poisoning and made guide information about antidote medication for S. Korean healthcare provider. Among total 242 cases of suicidal attempts, cases ingesting substances including prescription, non-prescription drugs and agricultural chemicals were 86.4%. The most frequently used drugs for suicide attempt were sedatives-hypnotics (53.6%), followed by analgesics (16.7%) and antidepressants (12.4%). Analgesics including acetaminophen and aspirin were most in teenagers but sedatives-hypnotics including benzodiazepines, non-benzodiazepine (zolpidem) and antihistamine were most in other ages including elderly people. Most frequently used antidote was activated charcoal (62.7%) and specific antidotes for some substances (acetaminophen, aspirin, agricultural chemicals) were also treated properly, accompanying with medication for supportive care. In conclusion, the most used substances for suicide attempt were sedatives-hypnotics and treatments for self-poisoning in emergency room were appropriate based on existing references. Therefore, information of frequently used substances and antidote reflecting these results will be useful for South Korean healthcare provider.

• 대한치과의사협회지
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• 제51권7호
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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

• 대한약학회:학술대회논문집
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• 대한약학회 2002년도 Proceedings of the Convention of the Pharmaceutical Society of Korea Vol.2
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• pp.387.2-387.2
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• 2002

The rhizomes of Cnidium ollicinale Makino (Umbelliferae) has been used as sedatives and analgesics in the Traditional Medicine in Korea. The essential oil of this rhizomes has been reported to possess CNS depressant activity. however, its analgesic activity has not yet been investigated. (omitted)

• 대한임상독성학회지
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• 제14권1호
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• pp.47-53
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• 2016

Purpose: Intentional poisoning is a major public health issue in many parts of the world. This study was conducted to provide details regarding the epidemiology of intentional poisoning in a metropolitan emergency department and to identify the changing patterns and epidemiology of poisoning. Methods: A retrospective study was conducted to evaluate intentional poisoning of patients who visited the emergency department in a tertiary teaching hospital between 2001 and 2015. All intentional poisoning-related emergency department visits over three five year periods (2001-2005 (P1), 2006-2010 (P2) and 2011-2015 (P3)) were reviewed to investigate trends in intentional poisoning patients. Information regarding patient sex, age, time from episode to admission, psychiatric history, type of intoxicants, alcohol co-ingestion, gastric lavage, charcoal administration, any previous suicide attempts, need for hospitalization and death before discharge was reviewed. Results: A total of 1269 patients were enrolled in this study. The number of patients admitted during each period was P1=515, P2=439 and P3=315. Comparison of the three groups revealed significant differences according to age (p<0.001), psychiatric history (p<0.001), alcohol co-ingestion (p=0.013), gastric lavage (p<0.001), charcoal administration (p<0.001), need for hospitalization (p=0.044), repeated attempt (p<0.001) and type of intoxicants (p<0.001). Conclusion: The average age of intentional poisoning patients has increased. While the use of sedatives and multiple drugs increased, the use of pesticides and the antihistamine decreased.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권3호
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• pp.241-244
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• 2011

Introduction: Intravenous sedation is performed to ensure smooth and safe surgery. Dental anxiety is a reaction to an unknown danger. The Spielberger's state-trait anxiety inventory (STAI) can be used to simultaneously evaluate the levels of state and trait anxiety. State anxiety is defined as subjective feelings of nervousness. This study assessed the presurgical anxiety using STAI and performed intravenous sedation for patients whose level of state anxiety was > stage IV. Based on our clinical experience, it is believed that higher doses of sedatives are needed to induce the desired levels of sedation in patients with a high level of state anxiety. Objectives: This study examined whether the sedative consumption of the patient with a high anxiety level increased. Patients and Methods: Patients with state anxiety scores of ${\geq}$51 were included in Group V, and those with state anxiety scores ranging from 42 to 50 were placed in Group IV. To induce sedation, intravenous access was established, and a bolus dose of 3.0 mg midazolam was administered intravenously. Sedation was maintained by administering a continuous infusion of propofol, which was aimed at achieving an Observer's Assessment of Alertness/Sedation scale of 10-12/20. In this study, midazolam was initially administered when the body movements appeared to occur or the blood pressure increased. This was followed by the administration of higher doses of propofol if low sedation was observed. Results: There were no significant differences in the patient demographics, duration of sedation, and doses of local anaesthetic agents between Groups IV and V. The midazolam dose and mean propofol dose needed to maintain comparable levels of sedation were significantly higher in Group V than in Group IV. Conclusion: In female patients, whose level of preoperative state anxiety is more than Stage V of STAI, a large quantity of sedatives is needed for intravenous sedation.

• 대한간호학회지
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• 제23권3호
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• pp.487-503
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• 1993

This study was designed to investigate the situation of adolescent drug use in Seoul, and to com-pare this with the 1991 survey in order to better understand the present situation. The subject for this study were 1000 students in High School and Middle School. The data were collected during the period from september 1, 1992 to December 30, 1992. The guestionnaire developed by Kim So Ya Ja (1991) to survey adolescent drug use was used. The data was analyzed using descriptive statistics, 1-test and ANOVA with the SPSS program. The results of this study can be summarized as follows 1. Prevalence of Substance use : Antihistamines were used by 0.3% of adolescent, Sedatives 0.6%, Stimulants 8.1%, Hallucinogens 0.9%, Inhalants 3.2%, Narcotics 1.7%, and Analgetics 154.3%. 2. Trend in substance use compared to the 1991 surbey : Alcohol use increased from 52.8% to 63.7% and narcotics from 0.6% to 1.7%, while Smeking, Analgetics, Antihistamines, Sedatives, and Inhalants showed a decrease. 3. Smoking and Alcohol use : Twenty five percent of school adolescent had experienced cigarette smoking and 63.7% of school adolescent had experienced alcohol use. 4. Motives for drug use : The highest was avoidence of sleep at 49.4% and the next highest was adventure seeking at 27.7%. As to feeling after drug use, 34.3％ felt apathy, 22.8% had feelings of sleepiness and unconsciousness. 5. Places were dreg were purchased : The most frequent was the drug store (78.3%) and 84.4% of the respondents answered that drug purchase was easy and 86.7% that drug use was mainly at home. 6. Related Variables : There was a statistically significent high score for drug and alcohol use by adolescents whose fathers used drugs. (PC.05) In conclusion, adolescents in Seoul showed in decrease in the tendency to use drugs compared to the 1991 survey, however drugs which are habit-forming and lead to dependency are still being abused. Therefore, counter-plans and preventive stratiges are important.

• 대한소아치과학회지
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• 제25권1호
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• pp.38-46
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• 1998

Management of children who show negative response to treatment was difficult. Usually the dentist used the restraintor sedatives for these children. Especially it is very difficult to management of definitely negative behavior patients who resist to ordinary sedative technics including psychosedation and various sedatives. These patients were managed with general anesthesia. Midazolam was used for sedation of non-cooperative pediatric patients and halothane for induce initial sleepness, If the patient shows negative response to management after 15 minutes of midazolam administration, used the halothane in 30 to 120 seconds for calm down the patient. After induce sleepness, cut off the halothane administration and maintain the sedation with $N_2O$ in 50-70 vol.% concentration. This technic reduce the toxity and untoward effects of major anesthetics. To compare the difference of sedation effect by dosage, dose of 0.2mg/kg and 0.3mg/kg were injected respectively. Though there's no statistical difference in duration and results between two dosage but show the increment of score with age, If the patients show positive response to management after midazolam administered. try to conscious sedation with nitrous oxide in 30 to 70 vo.% concentration. Nitrous oxide concentration was administered slowly according to their consciousness and response to treatment by increment or decrement. The success rate of conscious sedation were 21.2% in 0.2mg/kg and 30.3% in 0.3mg/kg. There's many factors in proceed of conscious sedation. The most important factors are age of patient and experience of children for dental care.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권6호
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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.