• Journal of Dental Anesthesia and Pain Medicine
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• 제21권5호
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• pp.461-469
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• 2021

Background: The global population is aging rapidly, and accordingly, the number of patients with dementia is increasing every year. Although the need for dental treatment increases for various reasons in patients with dementia, they cannot cooperate during dental treatment. Therefore, behavioral management, including sedation (SED) or general anesthesia (GA), is required for patients with dementia. Thus, this study aimed to investigate the trends and effects of SED or GA in patients with dementia undergoing dental treatment in South Korea based on the Korean National Health Insurance claims data. Methods: This study utilized customized health information data provided by the Health Insurance Review and Assessment Service. Among patients with records of using sedative drugs during dental treatment from January 2007 to September 2019, patients with the International Classification of Diseases-10 code for dementia (F00, F01, F02, F03, and G30) were selected. We then analyzed the full insurance claims data for dental care. Age, sex, sedative use, and dental treatment of patients were analyzed yearly. In addition, the number of cases of GA or SED per year was analyzed, and changes in behavioral management methods with increasing age were investigated. Results: Between January 2007 and September 2019, a total of 4,383 (male, 1,454; female, 2,929) patients with dementia received dental treatment under SED or GA. The total number of SED and GA cases were 1,515 (male, 528 ; female, 987 ) and 3,396 (male, 1,119 ; female, 2,277) cases, respectively. The total number of cases of dental treatment for 4,383 patients with dementia was 153,051 cases, of which 2.22% were under GA and 0.98% were under SED. Midazolam was the most commonly used drug for SED. Conclusion: Although gingivitis and pulpitis were the most common reasons for patients with dementia to visit the dentist, GA or SED for patients with dementia was frequently used in oral and maxillofacial or periodontal surgery.

• Journal of Korean Academy of Oral Health
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• 제42권4호
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• pp.238-241
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• 2018

Williams syndrome is a rare congenital disorder with various physical abnormalities and characterized by facial, oral, and dental features. Individuals with Williams syndrome typically have eating disorders in the early childhood, which lead to prolonged night feeding. Prolonged night feeding is a risk factor for rampant dental caries. Williams syndrome is caused by the microdeletion of chromosome 7, resulting in elastin deficiency. Elastin is integral to cardiovascular health. Many patients with Williams syndrome have complex cardiovascular abnormalities that must be considered a part of dental management. Complications related to cardiovascular diseases may induce adverse effects such as dangerously elevated blood pressure. This may occur in patients during stressful dental treatment. In addition, characteristics of auditory hyperalgesia and anxiety disorders among patients with William syndrome, complicate receiving routine dental management. Therefore, dental treatment under sedation or general anesthesia may be preferable for patients with Williams syndrome; in particular, patients who are very uncooperative and/or needs extensive dental treatment. A thorough evaluation of each patient's physical condition is required before making decisions regarding dental treatment. Careful monitoring and preparation for emergencies are very important during and shortly after dental treatment under general anesthesia or sedation. Monitoring is critical until vital signs have stabilized and return to normal. A 28-month-old man diagnosed as having Williams syndrome, visited the Dental Hospital of ${\bigcirc}{\bigcirc}$ University for the management of rampant dental caries. We reported on the management of this patient who had peripheral pulmonic stenosis, and received dental treatment under general anesthesia. We also reviewed the characteristics of Williams syndrome and discussed considerations for dental treatment under general anesthesia.

• 대한소아치과학회지
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• 제42권3호
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• pp.226-232
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• 2015

소아 청소년치과에서 장애아동 및 청소년을 안전하고 효율적으로 치료하기 위해서는 여러 사람의 다양한 협조가 필요하다. 이 연구는 장애아동의 치과치료 시 자주 이용되는 의식하진정치료의 진료용 표준지침을 시범적으로 개발, 적용하고, 진료과정에 참여한 사람들의 만족도를 평가하기 위해 시행되었다. 의무기록 분석을 통하여 표준진료지침을 개발하고 치료과정에 적용한 후 환자, 보호자, 의료진 및 스탭의 만족도를 설문을 통하여 평가한 결과, 표준진료지침의 적용은 환자, 보호자 및 의료진과 보조자가 전반적으로 만족한 것으로 나타나 임상적 유용성이 높을 가능성을 암시하였다. 결론적으로 표준진료지침의 개발과 적용은 임상진료과정의 표준화를 통하여 진료에 대한 예측가능성을 높이고, 환자 안전에 대한 불안을 감소시켜 환자와 의료진의 만족도 향상과 진료의 질적 향상을 기대 할 수 있을 것이다.

• 대한치과마취과학회지
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• 제8권2호
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• pp.113-117
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• 2008

Background: The purpose of this study was to compare the use of midazolam only with midazolam with fentanyl or propofol in IV sedation. Methods: 24 cases were divided to midazolam group (M group), midazolam + fentanyl group (MF group), midazolam + propofol group (MP group) and midazolam + fentanyl + propofol group (MFP group). In M group, 2 ml midazolam was injected at first, than at 2 minutes interval 1-2 ml injected continuously depending on the level of sedation. In MP, MFP groups, propofol was injected at the speed of 15-20 ml/hr by infusion pump. In this study, the sedation level was evaluated by using OAA/S scale. In each groups, the recovery time was measured until OAA/S scale score level was 5, and pre and postoperative blood pressure change was measured. Each group's data was statistically analyzed using one-way ANOVA. If significant statistical difference were observed, Dunnet test was performed, and control group was M group. Results: Pre and postoperative blood pressure change were not represent significant statistical difference in 4 groups (P value = 0.679 [systolic], P value = 0.206 [diastolic]). But recovery time were represent significant statistical difference (M group: 35.6, MF group: 32.5, MP group: 17.9, MFP group: 19.6 [P value = 0.002]). The result of Dunnet test on recovery time showed significant statistical difference on MF, MFP group when M group was control group. In MFP group, sedation was increased by using supplemental fentanyl, and postoperative pain control was dominant. Conclusion: To achieve the effect of anxiolysis, analgesia, amnesia effectively, and short recovery time, MFP group is mostly recommended.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제34권6호
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• pp.449-454
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• 2012

Purpose: Intravenous sedation with midazolam is common in contemporary dentistry. That is effective for anxious patients, but additional analgesic agent needs to be used, because midazolam alone doesn't have an analgesic effect. This study was performed to select an analgesic agent between an opioid agent, and nonsteroidal anti-inflammatory drugs as adjunctives in intravenous sedation with midazolam. Methods: The subjects were 60 patients who visited the Department of Oral and Maxillofacial Surgery, Sacred Heart Hospital, Hallym University, between August 2009 and February 2010. Conscious sedation was performed on 20 patients of 3 groups (control group, ketorolac group, and fentanyl group), who were divided randomly. The analgesic agent was administrated preoperatively. For sedation, vital signs were recorded. After sedation and operation, subjective questionnaires of the patient and operator were implemented. Results: All of the $SPO_2$, blood pressure, and heart rates stayed within the normal range for sedation. The sedation depth and analgesic effect of the ketorolac group and fentanyl group were similar. In the case of sedation depth, 12 patients in the ketorolac group and 14 patients in the fentanyl group had no memory of surgery. In the case of analgesic effect, the visual analogue scale of pain scored 2~3 in 13 patients in the ketorolac group, and 0~2 in 12 patients in the fentanyl group. The satisfaction of patients and doctors was also similar. Conclusion: Considering the management and complication of an opioid agent, non-steroidal anti-inflammatory drugs is more effective than an opioid agent.

• 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.

• 대한소아치과학회지
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• 제47권2호
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• pp.228-234
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• 2020

Chloral hydrate(CH)는 100년이상 동안 진정용 약물로 이용되어 왔다. CH는 1832년 처음 합성되었고, 1861년에는 진정제의 특성이 소개되었으며, 1869년 이후부터는 합성기술의 발달로 이용 빈도가 증가되었다. 1894년 소아에게 CH를 사용하기 시작한 기록이 있다. CH는 최근까지도 안정성에 관한 많은 논란들이 있었음에도 저렴한 가격과 비교적 안전하다는 경험적 이유로 어린이의 치과 진정법에 여전히 사용되고 있다. 그러나, 2006년 미국 FDA의 권고 이후, 2012년부터 미국내 제약회사는 CH를 더 이상 생산하지 않고 있다. 그럼에도 여전히 미국 내 여러 지역에서는 CH 원재료를 이용하여 조제한 현탁액 형태로 진정법에 사용하고 있으며, 2012년 이후에도 사망과 관련한 부작용의 보고는 계속되고 있다. CH는 현재까지 한국에서 소아 진정법에 가장 많이 이용되고 있는 약제이며, 최근 한국에서도 다수의 부작용에 관련한 보고들이 있었다. 최근 진정법을 이용한 소아의 치과치료에, CH를 대신하여 dexmedetomidine, propofol 등 여러 약물들이 소개되었다. 다만 이들을 소아치과 영역에서 사용하는데 있어서는 여러 가지 제한점이 있으며 고려해 볼 사항들도 많다. 이에 CH와 관련된 합병증들과 한국에서의 사용 실태, 그리고 CH를 대체할 수 있는 약물에 대해 알아보고자 한다.

• 대한치과마취과학회지
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• 제5권2호
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• pp.101-106
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• 2005

Purpose: This retrospective study assessed the effectiveness of submucosal (SM) midazolam (M), oral chloral hydrate (CH), hydroxyzine (H), and nitrous oxide (N) 99 uncooperative pediatric dental patients over 182 sedation sessions. Methods: Selection criteria included good medical health (ASA I), from 2 to 6 years of age, uncooperative behavior, and the need for restorations and dental surgery. The children who was administerated with CH H, N was Group 1 (48 case). The children who was administerated with CH, H, N, M was Group 2 (51 case). All the patients received oral CH (50-70 mg/Kg), H (1 mg/Kg) and N (less than 50%). Additionally the Group 2 received SM midazolam (0.1-0.2 mg/kg). Behavior response was rated as quiet (Q), crying (C), movement (M), or struggling (S) every 5 minutes through operative procedures. Behavior response rating was assigned to Houpt scale of Overall behavior. Data was analyzed using Chi-Square Test. Results: The Group 2 had more effective (88.2%) than the Group 1 (68.8%)(P = 0.05). Also, vomiting response decreased in the Group 2 (94.4%) than those with oral administration of chloral hydrate alone without SM midazolam (77.1%)(P = 0.05). Conclusions: SM midazolam improved the quality of sedation and vomiting response.

• 대한치과마취과학회지
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• 제10권1호
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• pp.34-44
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• 2010

The causes for airway obstruction include foreign body aspiration, congenital structural abnormalities of the airway, infection, etc. And the potential causes of acute respiratory distress contain many situations, like hyperventilation, vasodepressor syncope, asthma, etc. A major factor that leads to the exacerbation of respiratory disorders is undue stress, either physiologic or psychologic. Psychologic stress in dentistry is the primary factor in the exacerbation of preexisting medical problems. Adequate pretreatment medical and dental evaluation of the prospective patient can often prevent respiratory problems from developing. The dentist can modify patient management to minimize the risk of exacerbating these conditions. When dental anxiety is a major factor, the use of psychosedative procedures and other stress-reduction techniques should also be considered. This is the report of a children case of airway obstruction and respiratory distress owing to sedation complication by use of Chloral hydrate and Ketamine before extraction of the mesiodens in a patient with bronchial asthma and tonsillar hyperplasia. After these situations, the patient was consulted & referred to the department of Pediatrics and Otorhinolaryngology.

• 대한장애인치과학회지
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• 제11권2호
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• pp.76-80
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• 2015

장애인의 보건 수준이 높아지면서 치료보다는 예방의 관점에서의 구강 관리가 중요해지고 있다. 본 증례에서 소개된 다섯 명의 지적 장애를 지닌 환자들을 triazolam을 이용하여 경구 투여하여 치료하였다. Triazolam을 이용한 진정법은 장애인의 정기적인 구강 관리의 한 대안으로 고려해볼 수 있겠다.