Journal of The Korean Dental Society of Anesthesiology
/
v.12
no.2
/
pp.105-109
/
2012
The gag reflex is a physiological reaction, but, an exaggerated gag reflex can be a severe limitation not only to treat dental caries but also to do oral exam. Procedures such as surface anesthesia of the palate and pharyngeral area, sedation, or general anesthesia can be options as behavioral management. But, there are no golden rule for the sever gag reflex patients. We present a case report of propofol intravenous sedation using TCI pump for simple dental treatment. A 44-year-old man, who had past history of general anesthesia for dental treatment because of severe gag reflex, was scheduled intravenous sedation for simple dental treatment. After 8 hour fasting he entered the clinic for persons with disabilities. We explained about intravenous deep sedation and got informed consent. First, we kept intravenous catheter (22G) in the arm and started monitoring ECG, non-invasive blood pressure, pulse oximetry and end-tidal $CO_2$ through nasal cannula. We started propofol infusion with TCI pump at the target concentration of 3 mcg/ml. The patient became sedated, but he showed involuntary movement during dental treatment, so we increased the target concentration to 4 mcg/ml. We finished the dental treatment without complications during 30 min. And after 40 min recovery room stay he was discharged without any complications.
Kim, Jongbin;Kim, Seungoh;Lee, Deok-Won;Ryu, Dae-Seung
Journal of Dental Anesthesia and Pain Medicine
/
v.15
no.1
/
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.
Jo, Chan-Woo;Park, Chan-Hee;Lee, Jong-Hyug;Kim, Ji-Hun
Journal of Dental Anesthesia and Pain Medicine
/
v.17
no.2
/
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.
Journal of The Korean Dental Society of Anesthesiology
/
v.12
no.2
/
pp.75-91
/
2012
Background: Dental sedation reduces fear and phobia during dental treatment and helps patients get quality treatment by inducing adequate consciousness control. Propofol has recently grabbed the spotlight, but no meta-analysis for efficacy and safety of propofol in dentistry has yet been performed. Thus, the purpose of this study was to perform meta-analysis to verify the efficacy and safety of propofol for use in dental sedation. Methods: Articles published between 1980 and 2010 were searched in the web sites, journals and medical database including The Cochrane Library, MEDLINE and EMBASE. And a total of 22 studies were selected among the randomized controlled trials (RCTs) that compared the use of propofol with other sedatives (control group). The data was collected from these studies and meta-analysis for efficacy and safety was performed using Comprehensive Meta-Analysis 5.0 (CMA 5.0). Results: The patient recovered significantly faster and discharged significantly earlier in the propofol group (SMD = -1.442, P < 0.001). The satisfaction of patient and that of operator was higher in the propofol group (P < 0.05). The incidence of arrhythmia and apnea/ hypoventilation was significantly lower in the propofol group (OR = 0.071, P < 0.05), and there was no significant difference in the other side effects. On the level of sedation, although the sedation score was significantly lower in the propofol group (SMD = -0.430, P < 0.05). Conclusions: The present analysis showed that the use of propofol resulted in high satisfaction levels on the part of the patients and operators, a shorter recovery time, and faster hospital discharge. The incidence of complications, however, was lower in the propofol groups or not much different between the propofol and control groups. Thus, the adequate use of propofol in dentistry is believed to be helpful for the effective and safe sedation of the patients.
Purpose : On outpatient facilities, our sedation protocol focuses on the intermittent bolus injections of midazolam intravenously, according to patient's and operator's needs during the dental treatment. This multicenter retrospective study was aimed to prove the efficiency and safety of our sedation protocol. Patients and Methods : In three centers using the same outpatient sedation protocol for dental treatment (Division of Oral and Maxillofacial Surgery/Department of Dentistry in Hanyang University Medical Center, S-plant Dental Hospital. and Grand Oral and Maxillofacial Surgery), total 937 patients had various dental treatments under intravenous conscious sedations with independent patient monitoring from March 2006 to March 2009. By reviewing charts, we analyzed the results of sedation and dental treatment, retrospectively. Results : Our sedation protocol had no severe postoperative complications requiring admission. while showing good compatibility with almost all dental treatments, with acceptable satisfaction of both patients and operators. Conclusion : We assure that our sedation protocol can be used efficiently and safely on routine outpatient basis. We also hope that this study will provide the concrete concepts to common dental practitioners, who desire to perform sedation for dental treatment.
Background: Dentists make various efforts to reduce patients' anxiety and fear associated with dental treatment. Dental sedation is an advanced method that dentists can perform to reduce patients' anxiety and fear and provide effective dental treatment. However, dental sedation is different from general dental treatment and requires separate learning, and if done incorrectly, can lead to serious complications. Therefore, sedation is performed by a limited number of dentists who have received specific training. This study aimed to investigate the proportion of dentists who practice sedation and the main sedatives they use in the context of the Republic of Korea. Methods: We used the customized health information data provided by the Korean National Health Insurance. We investigated the number of dental hospitals or clinics that claimed insurance for eight main sedatives commonly used in dental sedation from January, 2007 to September, 2019 at the Health Insurance Review and Assessment Service. We also identified the changes in the number of dental medical institutions by region and year and analyzed the number and proportion of dental medical institutions prescribing each sedative. Results: In 2007, 302 dental hospitals prescribed sedatives, and the number increased to 613 in 2019. In 2007, approximately 2.18% of the total 13,796 dental institutions prescribed sedatives, increasing to 3.31% in 2019. In 2007, 168 institutions (55.6%) prescribed N2O alone, and in 2019, 510 institutions (83.1%) made claims for it. In 2007, 76 (25.1%) hospitals made claims for chloral hydrate, but the number gradually decreased, with only 29 hospitals (4.7%) prescribing it in 2019. Hospitals that prescribed a combination of N2O, chloral hydrate, and hydroxyzine increased from 27 (8.9%) in 2007 to 51 (9%) in 2017 but decreased to 38 (6.1%) in 2019. The use of a combination of N2O and midazolam increased from 20 hospitals (6.6%) in 2007 to 51 hospitals (8.3%) in 2019. Conclusion: While there is a critical limitation to the investigation of dental hospitals performing sedation using insurance claims data, namely exclusion of dental clinics providing non-insured treatments, we found that in 2019, approximately 3.31% of the dental clinics were practicing sedation and that N2O was the most commonly prescribed sedative.
Journal of the korean academy of Pediatric Dentistry
/
v.41
no.1
/
pp.18-26
/
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.
Park, Eun-Jin;Yum, Kwang-Won;Kim, Eun-Seok;Kim, Hyun-Jeong
Journal of the Korean Association of Oral and Maxillofacial Surgeons
/
v.29
no.3
/
pp.169-172
/
2003
Purpose : We examined the relationship between BIS, sedation score and plasma midazolam concentration to verify the usefulness of BIS to assess the patient's consciousness during sedation. Patients and Methods : Twenty-five young, healthy adult volunteers participated in this clinical study. Midazolam was administered intravenously up to 0.08 mg/kg to induce unconsciousness and we monitored the patient's physiological and conscious status until complete recovery from sedation. BIS and sedation score were measured before sedation, 10, 20, 30 minutes after midazolam administration. Plasma midazolam concentration was measured 10 minutes after midazolam administration. BIS was measured using A-2000 BISTM monitor (Aspect Medical Systems, USA) and the degree of sedation was evaluated with the sedation score. Results : The BIS score correlated with the sedation score (r = 0.676; P < 0.05). With the decreased plasma midazolam concentration, the correlation was better with sedation score (r = -0.656). Although BIS values did not correlate with calculated plasma concentration of midazolam (r = 0.467) at 10 minutes after midazolam administration, values after sedation were well distinguished from those before sedation. Conclusions : BIS is known for an effective predictor of patient's hypnotic state, and it is correlated with the sedation score. But, it doesn't always coincide with the clinical parameters of depth of sedation. So more attention is needed using BIS only during sedation, and it is advisable that the patient's consciousness is monitored with variable sedation score systems every several minutes.
Journal of The Korean Dental Society of Anesthesiology
/
v.13
no.3
/
pp.81-87
/
2013
This article discusses the issues of benefit and possibility of application of patient-controlled sedation (PCS) for the dental treatment. The purpose of administering PCS for patients is to diminish anxiety and to provide cooperative and effective dental treatment. But there are a lot of barriers to application of PCS such as knowledge about pharmacokinetics of sedatives, expensive high speed and patient-controllable syringe pump, and well educated sedationist. And there could be risk of deep sedation, airway obstruction and hypoxic brain damages, etc. In order to decrease incidence of complication, appropriate drug selection, selection of right bolus dose, lock-out time is much important.
Journal of The Korean Dental Society of Anesthesiology
/
v.2
no.1
s.2
/
pp.1-6
/
2002
The usage of nitrous oxide is increased for the anxious patient to dental treatment. There are two methods to induce the sedation during dental treatment. One is sedation with drugs the other no need of drugs. We discussed here about sedation with drugs. The methods of drug administration are oral, intramuscular, intravenous, inhalation. The method of oral administration of drugs are convenient to patient and doctor but poor controllability. Intramuscular method is a parenteral technique that maintains several advantages over the enteral technique. However its pales in comparison to other parenteral technique. Intravenous method represents most effective method of ensuring predictable and adequate sedation in all patients. But it has inability to reverse the action of drugs after they have been injected except some drugs (e.g., narcotics and benzodiazepine). A variety of gaseous agents may be administered by inhalation to produce sedation. In dental practice, the inhalation administration of gas means use of nitrous oxide. There are many advantages of nitrous oxide administration. First, very short latent period and rapid onset of drug action which lead to possible titration of drug concentration. With nitrous oxide, clinical effects may become noticeable as quickly as 15 to 30 seconds after inhalation. Recovery from inhalation sedation is also quite rapid. In out patient dental practice rapid recovery is very important because it permit to discharge the patient without escort and the patient return to their ordinary life without limit. To success the conscious sedation with nitrous oxide, the administrator should be keep the mind that always titration of nitrous oxide concentration during induction and treatment. Careful observation need during treatment to prevent oversedation because the adequate nitrous oxide concentration to patients changed by environmental stress. Always begins with 100% oxygen and ends with 100% oxygen to prevent diffusion hypoxia which rare in clinical practice.
본 웹사이트에 게시된 이메일 주소가 전자우편 수집 프로그램이나
그 밖의 기술적 장치를 이용하여 무단으로 수집되는 것을 거부하며,
이를 위반시 정보통신망법에 의해 형사 처벌됨을 유념하시기 바랍니다.
[게시일 2004년 10월 1일]
이용약관
제 1 장 총칙
제 1 조 (목적)
이 이용약관은 KoreaScience 홈페이지(이하 “당 사이트”)에서 제공하는 인터넷 서비스(이하 '서비스')의 가입조건 및 이용에 관한 제반 사항과 기타 필요한 사항을 구체적으로 규정함을 목적으로 합니다.
제 2 조 (용어의 정의)
① "이용자"라 함은 당 사이트에 접속하여 이 약관에 따라 당 사이트가 제공하는 서비스를 받는 회원 및 비회원을
말합니다.
② "회원"이라 함은 서비스를 이용하기 위하여 당 사이트에 개인정보를 제공하여 아이디(ID)와 비밀번호를 부여
받은 자를 말합니다.
③ "회원 아이디(ID)"라 함은 회원의 식별 및 서비스 이용을 위하여 자신이 선정한 문자 및 숫자의 조합을
말합니다.
④ "비밀번호(패스워드)"라 함은 회원이 자신의 비밀보호를 위하여 선정한 문자 및 숫자의 조합을 말합니다.
제 3 조 (이용약관의 효력 및 변경)
① 이 약관은 당 사이트에 게시하거나 기타의 방법으로 회원에게 공지함으로써 효력이 발생합니다.
② 당 사이트는 이 약관을 개정할 경우에 적용일자 및 개정사유를 명시하여 현행 약관과 함께 당 사이트의
초기화면에 그 적용일자 7일 이전부터 적용일자 전일까지 공지합니다. 다만, 회원에게 불리하게 약관내용을
변경하는 경우에는 최소한 30일 이상의 사전 유예기간을 두고 공지합니다. 이 경우 당 사이트는 개정 전
내용과 개정 후 내용을 명확하게 비교하여 이용자가 알기 쉽도록 표시합니다.
제 4 조(약관 외 준칙)
① 이 약관은 당 사이트가 제공하는 서비스에 관한 이용안내와 함께 적용됩니다.
② 이 약관에 명시되지 아니한 사항은 관계법령의 규정이 적용됩니다.
제 2 장 이용계약의 체결
제 5 조 (이용계약의 성립 등)
① 이용계약은 이용고객이 당 사이트가 정한 약관에 「동의합니다」를 선택하고, 당 사이트가 정한
온라인신청양식을 작성하여 서비스 이용을 신청한 후, 당 사이트가 이를 승낙함으로써 성립합니다.
② 제1항의 승낙은 당 사이트가 제공하는 과학기술정보검색, 맞춤정보, 서지정보 등 다른 서비스의 이용승낙을
포함합니다.
제 6 조 (회원가입)
서비스를 이용하고자 하는 고객은 당 사이트에서 정한 회원가입양식에 개인정보를 기재하여 가입을 하여야 합니다.
제 7 조 (개인정보의 보호 및 사용)
당 사이트는 관계법령이 정하는 바에 따라 회원 등록정보를 포함한 회원의 개인정보를 보호하기 위해 노력합니다. 회원 개인정보의 보호 및 사용에 대해서는 관련법령 및 당 사이트의 개인정보 보호정책이 적용됩니다.
제 8 조 (이용 신청의 승낙과 제한)
① 당 사이트는 제6조의 규정에 의한 이용신청고객에 대하여 서비스 이용을 승낙합니다.
② 당 사이트는 아래사항에 해당하는 경우에 대해서 승낙하지 아니 합니다.
- 이용계약 신청서의 내용을 허위로 기재한 경우
- 기타 규정한 제반사항을 위반하며 신청하는 경우
제 9 조 (회원 ID 부여 및 변경 등)
① 당 사이트는 이용고객에 대하여 약관에 정하는 바에 따라 자신이 선정한 회원 ID를 부여합니다.
② 회원 ID는 원칙적으로 변경이 불가하며 부득이한 사유로 인하여 변경 하고자 하는 경우에는 해당 ID를
해지하고 재가입해야 합니다.
③ 기타 회원 개인정보 관리 및 변경 등에 관한 사항은 서비스별 안내에 정하는 바에 의합니다.
제 3 장 계약 당사자의 의무
제 10 조 (KISTI의 의무)
① 당 사이트는 이용고객이 희망한 서비스 제공 개시일에 특별한 사정이 없는 한 서비스를 이용할 수 있도록
하여야 합니다.
② 당 사이트는 개인정보 보호를 위해 보안시스템을 구축하며 개인정보 보호정책을 공시하고 준수합니다.
③ 당 사이트는 회원으로부터 제기되는 의견이나 불만이 정당하다고 객관적으로 인정될 경우에는 적절한 절차를
거쳐 즉시 처리하여야 합니다. 다만, 즉시 처리가 곤란한 경우는 회원에게 그 사유와 처리일정을 통보하여야
합니다.
제 11 조 (회원의 의무)
① 이용자는 회원가입 신청 또는 회원정보 변경 시 실명으로 모든 사항을 사실에 근거하여 작성하여야 하며,
허위 또는 타인의 정보를 등록할 경우 일체의 권리를 주장할 수 없습니다.
② 당 사이트가 관계법령 및 개인정보 보호정책에 의거하여 그 책임을 지는 경우를 제외하고 회원에게 부여된
ID의 비밀번호 관리소홀, 부정사용에 의하여 발생하는 모든 결과에 대한 책임은 회원에게 있습니다.
③ 회원은 당 사이트 및 제 3자의 지적 재산권을 침해해서는 안 됩니다.
제 4 장 서비스의 이용
제 12 조 (서비스 이용 시간)
① 서비스 이용은 당 사이트의 업무상 또는 기술상 특별한 지장이 없는 한 연중무휴, 1일 24시간 운영을
원칙으로 합니다. 단, 당 사이트는 시스템 정기점검, 증설 및 교체를 위해 당 사이트가 정한 날이나 시간에
서비스를 일시 중단할 수 있으며, 예정되어 있는 작업으로 인한 서비스 일시중단은 당 사이트 홈페이지를
통해 사전에 공지합니다.
② 당 사이트는 서비스를 특정범위로 분할하여 각 범위별로 이용가능시간을 별도로 지정할 수 있습니다. 다만
이 경우 그 내용을 공지합니다.
제 13 조 (홈페이지 저작권)
① NDSL에서 제공하는 모든 저작물의 저작권은 원저작자에게 있으며, KISTI는 복제/배포/전송권을 확보하고
있습니다.
② NDSL에서 제공하는 콘텐츠를 상업적 및 기타 영리목적으로 복제/배포/전송할 경우 사전에 KISTI의 허락을
받아야 합니다.
③ NDSL에서 제공하는 콘텐츠를 보도, 비평, 교육, 연구 등을 위하여 정당한 범위 안에서 공정한 관행에
합치되게 인용할 수 있습니다.
④ NDSL에서 제공하는 콘텐츠를 무단 복제, 전송, 배포 기타 저작권법에 위반되는 방법으로 이용할 경우
저작권법 제136조에 따라 5년 이하의 징역 또는 5천만 원 이하의 벌금에 처해질 수 있습니다.
제 14 조 (유료서비스)
① 당 사이트 및 협력기관이 정한 유료서비스(원문복사 등)는 별도로 정해진 바에 따르며, 변경사항은 시행 전에
당 사이트 홈페이지를 통하여 회원에게 공지합니다.
② 유료서비스를 이용하려는 회원은 정해진 요금체계에 따라 요금을 납부해야 합니다.
제 5 장 계약 해지 및 이용 제한
제 15 조 (계약 해지)
회원이 이용계약을 해지하고자 하는 때에는 [가입해지] 메뉴를 이용해 직접 해지해야 합니다.
제 16 조 (서비스 이용제한)
① 당 사이트는 회원이 서비스 이용내용에 있어서 본 약관 제 11조 내용을 위반하거나, 다음 각 호에 해당하는
경우 서비스 이용을 제한할 수 있습니다.
- 2년 이상 서비스를 이용한 적이 없는 경우
- 기타 정상적인 서비스 운영에 방해가 될 경우
② 상기 이용제한 규정에 따라 서비스를 이용하는 회원에게 서비스 이용에 대하여 별도 공지 없이 서비스 이용의
일시정지, 이용계약 해지 할 수 있습니다.
제 17 조 (전자우편주소 수집 금지)
회원은 전자우편주소 추출기 등을 이용하여 전자우편주소를 수집 또는 제3자에게 제공할 수 없습니다.
제 6 장 손해배상 및 기타사항
제 18 조 (손해배상)
당 사이트는 무료로 제공되는 서비스와 관련하여 회원에게 어떠한 손해가 발생하더라도 당 사이트가 고의 또는 과실로 인한 손해발생을 제외하고는 이에 대하여 책임을 부담하지 아니합니다.
제 19 조 (관할 법원)
서비스 이용으로 발생한 분쟁에 대해 소송이 제기되는 경우 민사 소송법상의 관할 법원에 제기합니다.
[부 칙]
1. (시행일) 이 약관은 2016년 9월 5일부터 적용되며, 종전 약관은 본 약관으로 대체되며, 개정된 약관의 적용일 이전 가입자도 개정된 약관의 적용을 받습니다.