• Journal of The Korean Dental Society of Anesthesiology
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• v.1 no.1 s.1
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• pp.21-25
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• 2001

연구배경: 임상적으로 진정법을 시행할 경우 뇌의 상태에 대한 접근은 매우 중요하다. 환자의 뇌에 대한 마취제의 영향을 측정하기 위해 개발된 Bispectral Index (BIS)는 환자의 진정을 방해하지 않고 객관적인 진정정도를 평가할 수 있다. 그러나 이는 항상 진정 깊이의 임상적인 척도와는 일치하지 않는다. 이번 연구에서는 진정법 시행시 환자의 진정 정도를 측정하기 위한 BIS의 유용성을 검증하기 위하여 BIS, 진정점수, 그리고 midazolam의 혈중 농도와의 관계를 연구하였다. 방법: 25명의 건강한 성인 지원자들을 대상으로 무의식을 유도하기 위하여 midazolam 0.08 mg/kg을 정맥으로 주입하였으며 환자의 의식 상태를 진정 회복 시까지 관하였다. BIS와 진정점수는 진정 전과, midazolam 투여 후 10, 20, 30분 간격으로 측정하였다. Midazolam의 혈중 농도는 주입 후 10분 경과 후에 정맥혈 채취 후 HPLC를 이용하여 측정하였다. BIS는 BISTM monitor (Aspect Medical Systems, USA)으로 측정하였으며 또한 진정 정도는 진정 점수로도 평가하였다. 결과: BIS 수치는 진정점수와 유의한 상관관계를 보였다(r = 0.676, p < 0.05). 혈중 midazolam 농도가 감소함에 따라 혈중 농도는 진정점수와 유의한 상관관계를 보였다(r = -0.656). Midazolam 투여 후 10분에서 BIS 수치와 midazolam의 혈중 농도는 유의한 상관관계를 보이지 않았지만(r =0.467) 진정 후 수치는 진정 전 수치와 명확히 구분되었다. 결론: BIS는 환자의 수면상태의 효과적인 척도로 알려져 있으며 진정점수와도 높은 상관관계를 보였다. 그러나 항상 진정 깊이를 나타내는 임상적인 척도와는 일치하지 않았다. 그러므로 진정법 시행동안 BIS 만을 사용하는 것은 더욱 많은 주의가 필요하며 매 주어진 시간마다 다양한 진정 점수 측정방법으로 환자의 의식을 감시하는 것이 추천된다.

• The Journal of the Korean dental association
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• v.47 no.11
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• pp.736-749
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• 2009

근래 환자의 불안을 조절하는 것이 성공적인 치료에 매우 중요하다는 인식이 확산되면서 의과, 치과, 영상의학과, 응급실 및 외래 수술센터 등에서 진정요법에 대한 필요가 현저하게 늘어났다. 응급상황이거나 아니거나 진정요법의 필요성은 점차 증가하고 있고 대한 소아치과학회는 이러한 진정요법에 대한 지침을 출간한 바 있다. 이번 개정은 진정요법에 필요한 적절한 환자감시(monitoring)의 필요에 관한 최신지견을 반영한 것이나 그럼에도 불구하고 이 지침에 충실하였다고 해서 특정환자의 결과를 보장하지는 못한다. 그러 나 이번에 소개하는 진정요법 protocol은 널리 받아들여지는 것으로 부작용 역시 최소화한 것이다. 소아 환자의 진정요법은 원하는 수준의 진정이나 투여 방법과는 상관없이 호흡기능 저하와 환자의 방어 반응이 소실될 수도 있다는 인식하에 작성되었다. 이번 호에서는 최근 2006년에 미국소아과학회와 미국소아치과학회가 공동으로 개정된 지침(Guideline for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures developed and endorsed by AAP a and AAPD)이 어떻게 변경되는지에 중점적으로 알아보며 새로 변경된 지침에 따라 소아치과의의 진정요 법의 진료와 교육도 영향을 미칠 것이다. 이러한 영향으로 다양한 약 투여방법(Alternative routes of d drug administration)과 다양한 약물의 선택에 대해 알아 보기로 한다.

• 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 academy of Pediatric Dentistry
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• v.37 no.2
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• pp.213-217
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• 2010

The use of chloral hydrate and hydroxyzine for oral sedation is most effective in children aged less than 36 months and weighing less than 15 kg. Children who do not belong to this category may show frequent movements due to shallow sedation level, and it can lead to sedation failures. One of the solutions to such sedation failure is conversion to deeper sedation. But, it is not so much of an option, since inhalation anesthetics and devices are required. In this case, conversion from oral sedation to intravenous sedation was successfully achieved without causing injection pain while searching for an intravenous route, by using EMLA cream (Eutectic Mixture of Local Anesthesia). A patient aged 46 months and weighing 15 kg visited the Pediatric Department of Dankook University Dental Hospital. Treatment under TSD(Tell Show Do) was offered, but due to the parent's request, oral sedative measures were taken. Considering prompt converting from oral sedation to iv sedation in case the oral sedation fails, EMLA cream was apllied preemptively. Adequate sedation level could not be achieved after 90 minutes of oral administration, therefore, under the parent's consent, intravenous route was prepared after conscious sedation by $N_2O-O_2$. During treatment, $ETCO_2$, $SPO_2$ and heart rate was monitored every 5 minutes. The patient showed stable vital signs and did not show any movements. The whole procedure took two and a half hours in total, and the treatment was completed without any adverse effects.

• Journal of the korean academy of Pediatric Dentistry
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• v.36 no.2
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• pp.209-216
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• 2009

The purpose of this retrospective study was to examine twenty four hour postsedation events after discharge in children sedated for dental treatment. The sedation sheets of 355 children were selected. Selection criteria excluded no midazolam or nasal route of midazolam, no ASA class I, absent or incomplete questionnaire. Children received orally chloral hydrate and hydroxyzine, nitrous oxide was maintained during the sedation. Midazolam was injected to buccal submucosa with titration. Parents were interviewed via telephone within twenty four hours after sedation. Questionnaire included sleeping response, sleeping time, sleeping behavior, vomiting response at home. Two hundred twenty four (67.8%) children slept and twenty one(6.3%) children had abnormal sleeping behavior. One hundred four(31.0%) children had abnormal behavior after sleep and ten(3.0%) children had vomiting response. In the children took the higher dose of midazolam, there were the great tendency to sleep after discharge (p<0.05), the more negative response to sleeping behavior(p = 0.055), the longer sleeping time(p=0.054). In this study many children slept after sedation and a few children showed negative response. However there were not any considerable emergency events. Further study is required to determine the postsedation safety for the use of submucosal midazolam combination with chloral hydrate and hydroxyzine.

• Journal of the korean academy of Pediatric Dentistry
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• v.40 no.1
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• pp.28-39
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• 2013

General anesthesia or sedation is an essential for a successful dental treatment for the disabled. The aim of this study is to assess the patients who had dental management under general anesthesia or sedation at Chungnam dental clinic for the disabled, who received dental treatment under general anesthesia, sevoflurane sedation and intravenous sedation from January, 2011 to September 2012. Of the 426 patients studied, 389 patients received dental care under general anesthesia, 20 patients received dental care under sevoflurane sedation and 17 patients received dental care under intravenous sedation. The Rate of general anesthesia was higher than that of sevoflurane sedation, intravenous sedation. Sevoflurane sedation is a useful method for short time treatment such as traumatic pediatric patients. Intravenous sedation is an option for patients who had anxiety and fear such as dentally disabled patients. Sevoflurane or intravenous sedation not only gradually reduces the use of general anesthesia but also useful methods themselves for the dentally disabled.

• Journal of the korean academy of Pediatric Dentistry
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• v.47 no.2
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• pp.109-119
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• 2020

This retrospective study assessed the effectiveness and side effects of conscious sedation using chloral hydrate, hydroxyzine, and N₂O/O₂ in the sedation of 149 pediatric patients over 188 sedation sessions, and to identify associated variables. The effectiveness of the sedation was evaluated using the Houpt scale, and was considered effective for scale categories of excellent or good. Effectiveness and side effects were assessed every 15 minutes. The effectiveness decreased and side effects increased over time. The effectiveness of sedation during 60 minutes was 57.4%, and one or more side effects occurred in 18.1% of sessions. Effectiveness of sedation increased with body mass index (BMI). When patients were sedated at the beginning of the procedure, the effectiveness was greater. Side effects increased with patient age. When sedation was divided into two sessions, the number of sedation did not affect the effectiveness or side effects. It can be suggested that sedation should be performed over two separate sessions, as a single prolonged session may lead to reduced effectiveness and increased side effects. To maximize effectiveness and minimize side effects, several variables such as BMI, whether to sedate at the beginning of the procedure and age should be considered thoroughly before sedation.

• Journal of the korean academy of Pediatric Dentistry
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• v.41 no.1
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• pp.18-26
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• 2014

Deep sedation is considered for the dental treatment of pediatric or disabled patients who have severe anxiety or involuntary movement. Deep sedation using sevoflurane inhalation in emergency dental practice, therefore, is also preferred for fast induction and recovery. This survey consists of 121 people with pediatric or disabled patients who underwent dental treatment under deep sedation using sevoflurane inhalation from January 2013 to October 2013. Patients who were scheduled for deep sedation were classified into a non-emergency sevoflurane sedation group, whereas patients who underwent emergency sedation due to trauma and patients with disabled characteristics itself were classified into an emergency sevoflurane sedation group. Of 121 patients studied, 95 patients received dental care under non-emergency sedation, 26 patients received dental care under emergency sevoflurane sedation. The two groups were analyzed according to: gender; age; primary reason for sedation; duration of sedation; treatment time; induction methods; treatment information; and departments. Non-emergency sevoflurane sedation in pediatric or disabled patients was safe and effective for controlling the behavior. Emergency sevoflurane sedation was a useful method for younger pediatric patients with traumatic injury who need simple, short time emergency treatment. Deep sedation using sevoflurane inhalation not only will reduce the use of general anesthesia gradually but also will be a useful method to emergency treatment for pediatric or disabled patients.

• Journal of the korean academy of Pediatric Dentistry
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• v.26 no.4
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• pp.579-588
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• 1999

Monitoring of patients is essential in assuring the safety of sedation in the dental office. The purpose of this study was to explore the utilization and preferences of sedation, utilization of monitoring methods, and the preparation for emergencies during sedation. Members of the Korean Academy of Pediatric Dentistry were surveyed(n=245) from 1998. 10. 1 to 1998. 12. 20 to establish current trends in the use of sedation practices and monitoring methods in Korea. Findings of the survey include: 1. Twenty nine percent of pediatric dentists use sedative agents in their practices. Seventy one percent of pediatric dentists do not use any sedative agents in their practices 2. Thirty nine percent of pediatric dentists who use sedative agents do so without monitoring devices 3. Nitrous oxide inhalation sedation was the most frequently utilized sedation method by pediatric dentists and chloral hydrate was the most frequently utilized sedative by pediatric dentists. Pulse oximeter was the most frequently utilized monitoring method during sedation in dental office. 4. Only twenty eight percent of pediatric dentists obtain the informed consent of the child's legal guardian. 5. Only sixty percent of pediatric dentists prepare for emergencies during sedation.

• The Journal of the Korea Contents Association
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• v.14 no.11
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• pp.398-410
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• 2014

The purpose of this study is threefold. Firstly, what are some attributes of brands that affect perceived authenticity of brands? Secondly, how do the product characteristics such as public goods and private goods change the impacts of attributes on the perceived authenticity of brands? Thirdly, does the perceived authenticity influence consumers' brand attitude and mediate the relationship between brand attributes and the brand attitude? With regard to the role of authenticity in performance of marketing, the authors examined the relationship between the perceived authenticity and brand attitude. The study expands understanding of the relationship between brand attributes and authenticity while at the same time answering the call for further studies on the role of the perceived authenticity in improving brand attitude. The finding also demonstrates that the influence of attributes could be different depending on product categories.