• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.1
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• pp.19-22
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• 2013

Certain oral surgery can be performed safely under monitored anesthesia care (MAC) with local anesthesia. Several drugs, such as propofol, benzodiazepine, and opioids have been used for MAC either alone or in combination. Benzodiazepine may cause excessive sedation and confusion, and propofol can also result in disorientation and excessive sedation. Low dose propofol anesthesia with the concomitant use of dexmedetomidine is an effective technique for MAC in patients who are scheduled for intraoral surgery.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.7-14
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• 2011

Purpose: Many patients have fear for surgery owing to the injection of lidocaine and the possible pain in the course of the operation. To resolve such a problem the cases to do plastic surgery with monitored anesthetic care are increasing, in which something like sedatives is injected into vein without endotracheal intubation and under voluntary respiration, but the usage is now under the controversy. Methods: There were 25 patients who had surgery with local anesthesia, and another 25 patients who had surgery with monitored anesthetic care which belongs to ASA class 1 and 2 from January to April, 2009. Their anesthesia records were collected and surveys were given before and after the surgery and the surgery staff recorded OAA/S during the surgery. The postoperative surveys included the awakening during the surgery, pain, anxiety, and the degree of patient's satisfaction through visual analogue scale to identify the difference between the two methods. Results: The OAA/S results according to time lapse show that it is possible to lead a fast effective sedation and recovery with monitored anesthetic care, and monitored anesthetic care enhances both surgeon's convenience level and patient's satisfaction level, and reduces awakening, pain, and anxiety, compared to local anesthesia. Conclusion: The current paper shows about the plastic surgery, particularly the outpatient surgery, when monitored anesthetic care method is applied, it could gain a fast sedation and recovery or an effective sedation of patients. The method also has some affirmative effects in regard with surgeon's convenience and the patients' satisfaction degree and the reduction of their awakening, pain, and anxiety. With careful and adequate watch on the measures about vital signs like electrocardiogram, the degree of oxygen saturation, and blood pressure, it could clinically be very useful.

• Journal of The Korean Dental Society of Anesthesiology
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• v.7 no.2
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• pp.120-125
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• 2007

Background: Propofol has been used extensively for short-acting intravenous sedative agent during monitored anesthesia care (MAC). This study was designed to evaluate the safety and availability of MAC using propofol in implant surgery of the one-day admission patients. Methods: In this study, subjects were divided into two groups according to ASA physical status. The heart rate, blood pressure, peripheral oxygen saturation and ECG of a patient were estimated under MAC by an anesthesiologist and the vital signs were recorded in recovery room periodically afterwards. The subjective satisfaction with regard to outpatient ambulatory surgery under MAC procedure was evaluated the next day. Results: Systolic and diastolic blood pressure were significantly decreased during MAC in ASA I group, but other remarkable changes in vital sign were not observed. There was no significant difference in pain and anxiety level between ASA I and ASA II, III group. Satisfaction rate was high in both groups. Conclusion: Monitored-Anesthesia Care using propofol during implant surgery of the one-day admission patients might be safe and available procedure because heart rate, blood pressure and oxygen saturation are stable before and during surgery, and adequate control of pain and anxiety is supported.

• 대한치과마취과학회:학술대회논문집
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• 2005.12a
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• pp.123-126
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• 2005

• Journal of Korean Neurosurgical Society
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• v.55 no.4
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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.

• Clinical Endoscopy
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• v.55 no.1
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• pp.77-85
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• 2022

Background/Aims: Endoscopic submucosal dissection (ESD) of gastric tumors in the mid-to-upper stomach is a technically challenging procedure. This study compared the therapeutic outcomes and adverse events of ESD of tumors in the mid-to-upper stomach performed under general anesthesia (GA) or monitored anesthesia care (MAC). Methods: Between 2012 and 2018, 674 patients underwent ESD for gastric tumors in the midbody, high body, fundus, or cardia (100 patients received GA; 574 received MAC). The outcomes of the propensity score (PS)-matched (1:1) patients receiving either GA or MAC were analyzed. Results: The PS matching identified 94 patients who received GA and 94 patients who received MAC. Both groups showed high rates of en bloc resection (GA, 95.7%; MAC, 97.9%; p=0.68) and complete resection (GA, 81.9%; MAC, 84.0%; p=0.14). There were no significant differences between the rates of adverse events (GA, 16.0%; MAC, 8.5%; p=0.18) in the anesthetic groups. Logistic regression analysis indicated that the method of anesthesia did not affect the rates of complete resection or adverse events. Conclusions: ESD of tumors in the mid-to-upper stomach at our high-volume center had good outcomes, regardless of the method of anesthesia. Our results demonstrate no differences between the efficacies and safety of ESD performed under MAC and GA.

• The Korean Society of Law and Medicine
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• v.18 no.1
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• pp.61-99
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• 2017

Medical practices such as surgery often need to accompany anesthesia, which frequently causes medical accidents. In order to determine whether a medical accident related to anesthesia was caused by a doctor's fault, it is necessary to understand what is the duty of care required for the medical staff such as a doctor through all stages of anesthesia. This paper analyzed Supreme Court decisions since 1990s and recent lower courts' decisions in order to understand standard of care with respect to anesthesia. While numerous medical accidents were related to inhalation anesthesia in the past, it turned out that recent medical accidents were often related to the use of intravenous or local anesthetics. In particular, legal disputes with respect to medical accidents related to propofol have considerably increased since 2007. However, because Supreme Court decisions as to anesthesia accidents are mostly related to inhalation anesthesia, they seem to be insufficient to set standard of care as to other types of anesthesia accidents. In light of the fact that medical accidents related to the use of propofol have been increasing, it is critical to establish and maintain clinical guidelines on the use of each anesthetic in the medical field. However, The Courts can present the standard of care suitable for medical reality to serve as a compass for medical practices.

• Journal of Korean Dental Science
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• v.10 no.2
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• pp.82-86
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• 2017

Oral and maxillofacial surgery (OMFS) trauma cases are commonly treated under general anesthesia. The purpose of this case report is to introduce an alternative method of anesthesia in patients who refuse general anesthesia. A combination of dexmedetomidine and ketamine for sedation anesthesia in 3 frequent fracture types in the field of OMFS-Le Fort I fracture, mandibular fracture, and alveolar bone fracture-was used. Dexmedetomidine as the single agent has not shown stable success rates for invasive procedures. To overcome some of the pitfalls with dexmedetomidine, combination sedation using ketamine was performed. Visual analogue scale scores were recorded postoperatively. Dexmedetomidine combined with ketamine administration provided safe and effective sedation and anxiolysis for surgical reduction and internal fixation of OMFS fractures. It showed advantages of decreased admission time, reduced expenses, minimal pain, and reduced anesthetic burden for the patient thus ultimately increasing overall satisfaction.

• The Korean Journal of Pain
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• v.27 no.4
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• pp.313-320
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• 2014

Dexmedetomidine, an imidazoline compound, is a highly selective ${\alpha}_2$-adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties. In order to minimize the patients' pain and anxiety during minimally invasive spine surgery (MISS) when compared to conventional surgery under general anesthesia, an adequate conscious sedation (CS) or monitored anesthetic care (MAC) should be provided. Commonly used intravenous sedatives and hypnotics, such as midazolam and propofol, are not suitable for operations in a prone position due to undesired respiratory depression. Dexmedetomidine converges on an endogenous non-rapid eye movement (NREM) sleep-promoting pathway to exert its sedative effects. The great merit of dexmedetomidine for CS or MAC is the ability of the operator to recognize nerve damage during percutaneous endoscopic lumbar discectomy, a representative MISS. However, there are 2 shortcomings for dexmedetomidine in MISS: hypotension/bradycardia and delayed emergence. Its hypotension/bradycardiac effects can be prevented by ketamine intraoperatively. Using atipamezole (an ${\alpha}_2$-adrenoceptor antagonist) might allow doctors to control the rate of recovery from procedural sedation in the future. MAC, with other analgesics such as ketorolac and opioids, creates ideal conditions for MISS. In conclusion, dexmedetomidine provides a favorable surgical condition in patients receiving MISS in a prone position due to its unique properties of conscious sedation followed by unconscious hypnosis with analgesia. However, no respiratory depression occurs based on the dexmedetomidine-related endogenous sleep pathways involves the inhibition of the locus coeruleus in the pons, which facilitates VLPO firing in the anterior hypothalamus.

• Archives of Plastic Surgery
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• v.50 no.1
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• pp.30-36
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• 2023

Background Most children with facial lacerations require sedation for primary sutures. However, sedation guidelines for invasive treatment are lacking. This study evaluated the current status of the sedation methods used for pediatric facial laceration repair in Korea. Methods We surveyed one resident in each included plastic surgery training hospital using face-to-face interviews or e-mail correspondence. The health care center types (secondary or tertiary hospitals), sedation drug types, usage, and dosage, procedure sequence, monitoring methods, drug effects, adverse events, and operator and guardian satisfaction were investigated. Results We included 45/67 hospitals (67%) that used a single drug, ketamine in 31 hospitals and chloral hydrate in 14 hospitals. All health care center used similar sedatives. The most used drug administered was 5 mg/kg intramuscular ketamine (10 hospitals; 32%). The most common chloral hydrate administration approach was oral 50 mg/kg (seven hospitals; 50%). Twenty-two hospitals (71%) using ketamine followed this sequence: administration of sedatives, local anesthesia, primary repair, and imaging work-up. The most common sequence used for chloral hydrate (eight hospitals; 57%) was local anesthesia, administration of sedatives, imaging work-up, and primary repair. All hospitals that used ketamine and seven (50%) of those using chloral hydrate monitored oxygen saturation. Median operator satisfaction differed significantly between ketamine and chloral hydrate (4.0 [interquartile range, 4.0-4.0] vs. 3.0 [interquartile range, 3.0-4.0]; p <0.001). Conclusion The hospitals used various procedural sedation methods for children with facial lacerations. Guidelines that consider the patient's condition and drug characteristics are needed for safe and effective sedation.