Variables Influencing the Depth of Conscious Sedation in Plastic Surgery: A Prospective Study

여현정,김원우,박효천,김훈남 대한성형외과학회 2017 Archives of Plastic Surgery Vol.44 No.1

Background Conscious sedation has been widely utilized in plastic surgery. However, inadequate research has been published evaluating adequate drug dosage and depth of sedation. In clinical practice, sedation is often inadequate or accompanied by complications when sedatives are administered according to body weight alone. The purpose of this study was to identify variables influencing the depth of sedation during conscious sedation for plastic surgery. Methods This prospective study evaluated 97 patients who underwent plastic surgical procedures under conscious sedation. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and glucose levels were measured. Midazolam and ketamine were administered intravenously according to a preset protocol. Bispectral index (BIS) recordings were obtained to evaluate the depth of sedation 4, 10, 15, and 20 minutes after midazolam administration. Associations between variables and the BIS were assessed using multiple regression analysis. Results Alcohol intake and female sex were positively associated with the mean BIS (P<0.01). Age was negatively associated with the mean BIS (P<0.01). Body mass index (P=0.263), creatinine clearance (P=0.832), smoking history (P=0.398), glucose (P=0.718), AST (P=0.729), and ALT (P=0.423) were not associated with the BIS. Conclusions Older patients tended to have a greater depth of sedation, whereas females and patients with greater alcohol intake had a shallower depth of sedation. Thus, precise dose adjustments of sedatives, accounting for not only weight but also age, sex, and alcohol consumption, are required to achieve safe, effective, and predictable conscious sedation.

Variables Influencing the Depth of Conscious Sedation in Plastic Surgery: A Prospective Study

Yeo, Hyeonjung,Kim, Wonwoo,Park, Hyochun,Kim, Hoonnam Korean Society of Plastic and Reconstructive Surge 2017 Archives of Plastic Surgery Vol.44 No.1

Background Conscious sedation has been widely utilized in plastic surgery. However, inadequate research has been published evaluating adequate drug dosage and depth of sedation. In clinical practice, sedation is often inadequate or accompanied by complications when sedatives are administered according to body weight alone. The purpose of this study was to identify variables influencing the depth of sedation during conscious sedation for plastic surgery. Methods This prospective study evaluated 97 patients who underwent plastic surgical procedures under conscious sedation. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and glucose levels were measured. Midazolam and ketamine were administered intravenously according to a preset protocol. Bispectral index (BIS) recordings were obtained to evaluate the depth of sedation 4, 10, 15, and 20 minutes after midazolam administration. Associations between variables and the BIS were assessed using multiple regression analysis. Results Alcohol intake and female sex were positively associated with the mean BIS (P<0.01). Age was negatively associated with the mean BIS (P<0.01). Body mass index (P=0.263), creatinine clearance (P=0.832), smoking history (P=0.398), glucose (P=0.718), AST (P=0.729), and ALT (P=0.423) were not associated with the BIS. Conclusions Older patients tended to have a greater depth of sedation, whereas females and patients with greater alcohol intake had a shallower depth of sedation. Thus, precise dose adjustments of sedatives, accounting for not only weight but also age, sex, and alcohol consumption, are required to achieve safe, effective, and predictable conscious sedation.

소아 진정 요법에 대한 간호사의 지식과 수행

김나연 ( Na Yeon Kim ),주현옥 ( Hyeon Ok Ju ),박소연 ( So Yeon Park ) 한국모자보건학회 2021 한국모자보건학회지 Vol.25 No.4

Purpose: This study aimed to examine the pediatric sedation knowledge and performance of nurses in tertiary hospitals. Methods: Altogether 120 nurses working in the Pediatric Departments of 4 tertiary hospitals in Busan and Kyungnam participated in this descriptive survey. The questionnaire was developed based on domestic and international guidelines and consisted of 40 questions including 18 questions on knowledge and 22 on the performance level of sedation nursing. Results: The mean score regarding the knowledge of pediatric sedation care was 3.14 points and the mean performance level score was 3.44 points. Questions that received low scores in terms of pediatric sedation care knowledge included items regarding the latest policies, level of sedation, and fasting before sedation. Questions that received low scores in the performance level included items regarding psychological preparation before sedation, sedation education considering developmental level and disease, and items related to blood pressure measurement. Pediatric sedation knowledge scores were higher in the groups with higher age, longer clinical experience, higher educational experience, and awareness of sedation guidelines. Performance scores were significantly higher in the groups having educational experience in pediatric sedation and in those exhibiting awareness of sedation guidelines. Conclusion: Sedation education was significantly associated with both knowledge and performance of sedation nursing, conducting educational programs on pediatric sedation nursing.

The influence of obesity on pediatric conscious sedation

Park, Ki-Tae,Kim, Ji-Yeon,Park, Sung-Dong 大韓小兒齒科學會 2006 大韓小兒齒科學會誌 Vol.33 No.1

Objective: This study was conducted to investigate as to whether obesity have any effects on conscious sedation outcomes. Methods: Forty children (mean age 30.5 months, mean height and weight were 91.3 cm, 14.3 kg respectively) were sedated with chloral hydrate (60 mg/kg) and hydroxyzine (25 mg). The relative obesity rate of the patients was obtained by the proportion of height to weight and the tonsil size of the patients was classified by Brodsky's scale. The overall sedation outcomes were evaluated by Houpt's scale. The pulse and respiratory rates during sedation were also evaluated. Results: The obesity of the patients had no statistically significant effects on movement, crying during sedation. However, an increase in obesity had negative effects on the overall conscious sedation outcomes. Conclusion: This investigation demonstrated that increased obesity may cause detrimental effects on pediatric conscious sedation outcomes. 본 연구의 목적은 소아의 비만도가 진정요법의 효과에 미치는 영향을 알아보는 것이다. 삼성서울병원 소아치과에 내원한 환자 중 ASA Ⅰ또는Ⅱ에 해당하는 40명의 환아 (평균연령 30.5개월, 평균신장 91.3cm, 평균체중 14.3kg)를 대상으로 chloral hydrate(60mg/kg) 및 hydroxyzine(25mg)을 사용하여 진정요법을 시행하였다. 환아의 체중과 신장을 이용하여 환아 각각의 비만도를 계산하였고 Broadsky's scale을 이용하여 편도선의 크기를 측정하였다. 진정요법에 대한 결과는 Houpt's scale(수면, 움직임, 울음, 전반적인 행동지수)을 이용하여 평가하였다. 환아의 비만도는 진정효과중 움직임과 울음에 대하여는 통계학적으로 유의한 차이를 만들지 않았으나 비만도가 증가 할수록 전반적인 행동지수가 유의하게 나빠지는 결과를 보였다.

소아치과 진정법에 사용되는 약제

김지연,정태성,양연미,유승훈,최성철,신터전 大韓小兒齒科學會 2016 大韓小兒齒科學會誌 Vol.43 No.1

Sedation is an indispensable part of contemporary pediatric dentistry. The Korean Academy of Pediatric Dentistry (KAPD) organized the dental sedation committee to help members perform safer and more effective sedation. The committee surveyed 111 members who practice dental sedation to figure out the present state of sedation in 2014. According to the survey, 86% of the respondents indicated that they were interested in continuing education of sedation. The most interesting topic was sedation related emergency management, followed by safe dosages of sedative drugs. However, it is not realistic to establish the recommended dosages as a guideline since the selection of agents and dosages depend on various factors. In order to provide successful sedation, pediatric dentist should make an individual sedation plan for each procedure. It is important to understand not only the properties of each sedative, but also interactions with other drugs. This article reviews useful information of commonly used agents for dental sedation and summarizes the recommended dosages from the Physicians’Desk Reference (PDR) and some famous pediatric dentistry textbooks. 오늘날 소아치과 진료에 있어서 진정법은 필수 불가결한 요소로 받아들여지고 있다. 이에 대한소아치과학회는 학회원들의보다 안전하고 효율적인 진정법 시행을 돕기 위해 진정법 위원회를 결성하고 2014년 소아치과 개원의들의 진정법 사용에 대한 실태조사를 실시 한 바 있다. 이 설문조사 결과, 진정법을 시행하는 교육 코스가 만들어 진다면 참여할 의사가 있는지에대한 질문에 응답자의 86%가 참여의사를 밝혔으며 진정법 교육과정에서 배우고 싶은 내용으로 안전한 약물용량과 가이드라인이 2위를 차지하여 1위인 응급상황 시 대처법 다음으로 교육받고 싶은 내용으로 나타났다. 그러나 약물을 선택하고 용량을결정하기 위해서는 여러 가지 요소를 고려해야 하므로 용량을 일률적으로 정하여 지침을 제정하는 것은 현실적으로 어려운일이고 실제적으로도 그 어떤 진정법 지침에도 약물의 용량을 제시해 놓지는 않았다. 성공적인 진정법을 위해 소아치과의사는 각 과정마다 개별적인 치료 계획을 수립해야 하며, 각 진정제의 고유의 약효뿐 만 아니라 다른 약제들 간의 상호 작용에대하여 충분히 숙지하는 것이 중요하다. 이 종설에서는 문헌 고찰을 통해 소아치과 임상에서 자주 사용되는 진정제들에 대한 정보를 되새기고 의사용 처방편람(Physicians’Desk Reference: PDR) 및 소아치과 분야의 다양한 교과서의 추천용량을 정리하여 소개하고자 한다.

진단검사 전 처치로 실시하는 의식하 진정요법에 대한 환아 보호자의 인식도와 간호요구도, 간호만족도

서미희,박순주 한국융합학회 2021 한국융합학회논문지 Vol.12 No.12

This study aims to investigate the awareness, nursing needs, and nursing satisfaction of conscious sedation, and their relationships in the guardians of hospitalized children receiving conscious sedation. Data were collected from 120 guardians of children who were admitted to the pediatric ward of University Hospital C in D city from July 6 to October 6, 2016 and received conscious sedation as a pretreatment for diagnostic tests. The result showed that the guardians' awareness was relatively low (2.49±0.83) and nursing needs (4.53±0.40) was found to be significantly higher than nursing satisfaction (3.81±0.56)(p<.001). Awareness showed a significant positive correlation with nursing satisfaction (r=.18, p=.048) and there was a significant positive correlation between nursing needs and satisfaction (r=.20, p=.033). This result suggested that in order to improve the nursing satisfaction of the guardians, it is necessary to understand the awareness and nursing needs of the guardians on conscious sedation. In addition, the development of customized nursing intervention should be carried out based on the awareness and nursing needs. 본 연구는 환아 보호자를 대상으로 진단검사 전 처치로 실시하는 의식하 진정요법에 대한 인식도와 간호요구도, 간호만족도를 확인하고 변수들 간의 관계를 파악하기 위한 서술적 조사연구이다. 연구대상자는 D시에 있는 C대학병원 소아청소년과 병동에 입원하여 진단검사 전 처치로 의식하 진정요법을 받는 환아의 보호자 120명이다. 연구결과 대상자의 의식하 진정요법에 대한 인식도는 비교적 낮은 편이었고(2.49±0.83), 간호요구도(4.53±0.40)가 간호만족도(3.81±0.56)보다 유의하게 높게 나타났다(p<.001). 의식하 진정요법에 대한 인식도는 간호만족도와 유의한 양의 상관관계가 있었고(r=.18, p=.048), 간호요구도와 간호만족도도 유의한 양의 상관관계가 있었다(r=.20, p=.033). 의식하 진정요법에 대한 대상자의 간호만족도를 높이기 위해서는 의식하 진정요법에 대한 인식 정도와 간호요구 영역들을 먼저 확인하여 대상자의 요구를 기반으로 하는 맞춤형 간호중재가 제공되어야 할 것이다.

한양대의료원 치과 진정요법 클리닉의 진정요법(I)

빙정호,전재윤,박창주,황경균,심광섭,Bing, Jung-Ho,Chun, Jae-Yoon,Park, Chang-Joo,Hwang, Kyung-Gyun,Shim, Kwang-Sup 대한치과마취과학회 2006 Journal of Dental Anesthesia and Pain Medicine Vol.6 No.2

Recently, sedation in dentistry is gaining more and more interests of dental practitioners. Moreover. 'dental sedation', 'sleep dentistry', or 'pain-free dental treatment' become everyday words familiar to ordinary persons. Sedation clinic in Hanyang University Medical Center was open on Mar 2006 as specialty clinic at department of dentistry. Our aim is performing comfortable and safe dental treatments for patients who have problems for routine dental treatments because of extreme fear and anxiety or for patients who are supposed to have stressful and painful time-consuming treatment, such as sinus elevation and bone graft for implant placement. Our sedation was focused on conscious sedation, especially intravenous sedation using midazolam alone in technique. In two series, the sedation protocol at our Sedation Clinic will be described in details and then, analysis of our cases will be presented to help beginners for sedation in dentistry.

Considerations for submucosal midazolam administration in combination with oral and inhaled medications for sedation of pediatric dental patients

Baek, Kwanwoo The Korean Dental Society of Anesthsiology 2015 Journal of Dental Anesthesia and Pain Medicine Vol.15 No.2

Sedation allows patients to maintain their airway independently and respond appropriately to physical stimulation and verbal command while maintaining a minimum depressed level of consciousness. Drugs commonly used for sedation of pediatric dental patients include a combination of chloral hydrate, hydroxyzine, and nitrous oxide-oxygen. Midazolam is a benzodiazepine and currently one of the most commonly used intravenous sedative agents. It can be easily titrated to provide a wide range of sedation, from conscious sedation to deep sedation, and exhibits a wide safety margin without severe respiratory and circulatory depression. At an appropriate dose, it also decreases patient anxiety and induces amnesia. We found that the submucosal administration of midazolam combined with chloral hydrate provided increased sedative effects and decreased the postoperative vomiting response compared with conventional chloral hydrate administration, with no significant difference in physiological responses. The depth of sedation can be titrated using this technique.

구강 내 소수술에 있어 Midazolam을 이용한 의식하진정 치료원칙

김성민,김지혁,박영욱,장재현,권광준,김세정,남대우,권기열,Kim, Soung-Min,Kim, Ji-Hyuck,Park, Young-Wook,Jang, Jae-Hyun,Kwon, Kwang-Jun,Kim, Se-Jung,Nam, Dae-Woo,Kwon, Ki-Yeul 대한치과마취과학회 2003 Journal of Dental Anesthesia and Pain Medicine Vol.3 No.1

Background: Conscious sedation is a minimally depressed level of consciousness that retains the patient's ability to maintain the airway continuously and to respond appropriately to physical stimulation and verbal command at any time, produced by a pharmacologic or nonpharmacologic method or a combination thereof. In dental anesthesia, a state of sedation in which the conscious patient is rendered free of fear, apprehension, and anxiety through the use of pharmacologic agents. Midazolam is a useful drug of benzodiazepine on minor operation of dentistry. The purpose of this study is to estimate the appropriate dosage protocol of midazolam to the patient receiving intravenous sedation at the department of oral and maxillofacial surgery. Methods: Total subject was fifty-one patients and fifteen patients of this subject were decided to control group (Group I) that they were not received intravenous sedation. The experimental group was randomly subdivided into two groups and each of those groups was administrated to 0.05 mg/kg (Group II) and 0.08 mg/kg (Group III) each other. All patients of the subject were surveyed with postoperative one day questionaire to evaluate the level of sedation. Results: In view of antegrade amnesia, 1. Group II and III were statistically different compared to Group 1, respectively. 2. Group II and III were not statistically different. Conclusions: Apparent antegrade amnesia was found in both groups 0.05 mg/kg and 0.08 mg/kg intravenously administered. So we present the protocol of the department of oval and maxillofacial surgery, Kangnung National University Dental Hospital. But further studies concerning patient's age, body weight, and general condition will be carried out.

의식하 진정 내시경검사: Midazolam vs Propofol

구자설,최재현 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.2

Endoscopy is increasingly performed with the patient under conscious sedation in many countries. The majority of patients can be adequately and safely sedated during routine upper endoscopy and colonoscopy with a combination of a benzodiazepine and opioid. Midazolam is a water-soluble benzodiazepine that is characterized by a rapid onset of action and a shorter duration compared with that of the other drugs of the same class. The major side effect of midazolam is respiratory depression, which can be reversed by flumazenil, a benzodiazepine-specific antagonist. Propofol is a lipid-soluble agent that has the advantages of a more rapid onset of action and a shorter recovery time compared to that of midazolam. However, it should be used with caution since it can lead to hypotension and respiratory depression. Propofol can be safely and effectively administered by nonanesthesiology physicians and nurses provided that they have received adequate training. Two models have been proposed for the administration of propofol by endoscopists: nurse-administered propofol sedation (NAPS) and combination propofol (propofol plus other agents) sedation. In order to modify the pharmacological disadvantages of propofol, fospropofol sodium, a water-soluble prodrug of propofol, has recently been developed. In addition, new delivery systems have been devised: patient-controlled sedation and computer-assisted personalized sedation, in which the computer continuously monitors the patient’s condition and adjusts the dose of propofol accordingly. Endoscopists must have a thorough understanding of the medications used for endoscopic sedation and they must acquire the skills necessary for the treatment of cardiopulmonary complications. Therefore, it is necessary to develop a practice guideline pertaining to endoscopic sedation and also training programs for physicians and nurses in Korea. 내시경검사에 진정제를 사용하는 의식하 진정 내시경검사는 점차 증가하고 있으며 벤조다이아제핀과 아편유사제가 흔히 사용되었다. Midazolam은 다른 벤조다이아제핀계 약물보다 효과가 빠르게 나타나고 지속시간이 짧은 장점이 있으나 부작용으로 호흡억제가 발생할 수 있다. 그러나, 벤조다이아제핀 길항제인 flumazenil을 사용하여 midazolam의 호흡억제 효과를 감소시킬 수 있다. Midazolam과 아편유사제의 병합은 효과적이며 안전한 진정방법으로 일반적인 상부위장관 내시경과 대장내시경 검사에 적합하다. Propofol은 지용성으로 midazolam보다 진정 유도와 회복이 빠른 장점이 있으나 저혈압과 일시적 무호흡이 보고되어 주의가 필요하다. 내시경 의사의 감독 하에 적절하게 훈련받은 의료인에 의한 propofol 투여는 효과적이고 안전하며, propofol 투여 방법으로는 간호사가 환자를 감시하면서 propofol을 투약하는 nurse-administered propofol sedation (NAPS)과 propofol과 다른 약물을 병용하는 propofol 병합요법이 있다. 새로운 진정제로 propofol 전구 물질인 fospropofol이 개발되었으며 새로운 약물 투여 방법으로 propofol 주입을 환자 스스로 조절하는 patient-controlled sedation과 환자 상태에 따라 자동으로 약물을 조절하는 computer-assisted personalized sedation이 연구 중에 있다. 안전하고 효과적인 의식하 진정 내시경검사를 위하여 내시경 의사는 사용 약물에 대한 충분한 지식을 갖춰야 하고 발생할 수 있는 부작용에 대처할 수 있어야 한다. 이를 위해 국내 실정에 적합한 내시경검사 지침과 의사 및 간호사를 위한 교육 훈련 프로그램이 개발되어야 할 것이다.