우리나라 노인의 수면제 복용과 골절 발생의 상관성 분석

장윤욱,한은아,최재우,강혜영 한국보건사회약료경영학회 2022 한국보건사회약료경영학회지 Vol.10 No.1

OBJECTIVE To investigate association between the use of sedative-hypnotics and fractures in the Korean elderly population. METHODS We used 2016 Health Insurance Review and Assessment Service-the Adult Patient Sample (HIRA-APS) data, which was extracted from 20% of the elderly patients over 65 years old. We excluded individuals diagnosed with fractures, osteoporosis, or car accidents during a wash-out period (i.e., January - March). Then, patients with at least one claim record with prescribed sedative-hypnotics from April through December were defined as those treated with sedative-hypnotics. If there was at least one claim record with a diagnosis of fracture during the same time period, then we defined a fracture incidence. RESULTS A multivariate logistic regression analysis result showed that the elderly prescribed with sedative-hypnotics had a significantly higher risk of fractures by 1.337 times (adjusted odds ratio (aOR)=1.337, 95% confidence interval (CI): 1.316-1.358). Also, the risk of fractures significantly increased as the number of sedative-hypnotics prescribed increased (aOR of taking one sedative-hypnotics vs. none: 1.255 (95% CI: 1.233-1.278), aOR of two sedativehypnotics: 1.464 (95% CI: 1.425-1.504), and aOR of three or more sedative-hypnotics: 1.720 (95% CI: 1.652-1.790). CONCLUSION A significant association between the use of sedative-hypnotics and the risk of fractures and its dose-response relationship among Korean elderly population were confirmed based on a nationally representative data of HIRA-APS. Our results suggest careful use of sedative-hypnotics to treat elderly population. Especially, when it is necessary to prescribe multiple sedative- hypnotics for the elderly, a close monitoring should be accompanied to prevent fractures.

소아 중환자실에서의 진정제 사용 현황과 금단현상과의 상관관계 분석

양미희,배혜정,박지언,정애희,정선회,한현주,조윤희,조윤숙,최유현,박준동 한국병원약사회 2020 병원약사회지 Vol.37 No.1

Background : Although sedatives are commonly used in intensive care units, they may cause side effects such as delayed weaning of mechanical ventilation and withdrawal syndrome. There is no adequate assessment tool for evaluating the level of sedation in children and there is a lack of studies related to the use of sedatives in children. The purpose of this study was to investigate the use of sedatives in the pediatric intensive care unit (PICU) and to analyze the frequency and related factors of withdrawal syndrome. Methods : From January 1 through June 30, 2016, we retrospectively reviewed the electronic medical records of pediatric patients admitted to the PICU at the Seoul National University Children’s Hospital. The use of sedatives, tapering status, and frequency of withdrawal syndrome was investigated. Results : Ninety-three patients were treated with sedatives in the PICU at the Seoul National Children’s Hospital. Sixty-six were surgical patients, and 27 were medical patients. A combination of midazolam and fentanyl were the most commonly used sedative and analgesic (n=78, 83.9%). The median period of sedation was 60.1 hours (interquartile range (IQR) 75.8) in the surgical patients and 117.5 hours (IQR 121.2) in the medical patients. Compared to the surgical patients, long-term sedation was applied in medical patients. Tapering off of sedatives was performed in 40 patients (43.0%). The median total duration of tapering of sedatives was 16.0 hours (IQR 26.5) in the surgical patients and 30.2 hours (IQR 62.0) in the medical patients. The withdrawal syndrome occurred in 33 patients (37.1%) among 89 patients using midazolam as the main sedative. The duration of midazolam infusion was significantly associated with the frequency of withdrawal syndrome (Spearman’s rho 0.345, p=0.049). Conclusion : The withdrawal syndrome of sedatives was associated with the duration of sedation. Thus, more attention should be focused on tapering and monitoring the occurrence of withdrawal syndrome in patients requiring prolonged sedation.

The Effect of a Sleep Education and Hypnotics Reduction Program on Hypnotics Prescription Rate for the Hospitalized Patients with Cancer at a General Hospital

Soyoung Youn,Su-yeon Lee,Changnam Kim,Seockhoon Chung 대한정신약물학회 2019 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.17 No.4

Objective: We aimed to investigate whether the sleep education and hypnotics reduction program (the i-sleep program), developed for all hospitalized patients and medical personnel, help reducing the hypnotics prescriptions rate among hospitalized cancer patients in a general hospital. Methods: Patient data such as hypnotics prescribed at the time of admission and discharge during prior to (year of 2014) and after (year of 2015) initiation of the i-sleep program were collected and compared. Also, hypnotics prescription rate at the first day of each month of 2014 and 2015 were estimated and compared. Results: All of 12,382 patients in 2014 and 12,313 patients in 2015 were admitted to the Department of Oncology of the hospital. In 2014, 782 (6.3%) of 12,382 inpatients were already taking hypnotics at the time of admission, and 594 (76.0%) of the 782 patients were still taking sleeping pills at the time of discharge. Following initiation of the i-sleep program (2015), 792 (6.4%) of 12,313 inpatients were already taking hypnotics at the time of admission, and 553 (69.8%) of the 792 inpatients were still taking them at the time of discharge (relative risk, 0.92; 95% confidence interval, 0.87−0.98). On the first day of each month of 2014, 7.3% to 12.6% (mean, 10.0%) of inpatients had prescriptions for hypnotics. Following initiation of the program, the rate of hypnotic prescription was significantly reduced (3.2−10.8%; mean, 8.0%; p = 0.03). Conclusion: Our date showed that the i-sleep program may help to reduce the hypnotic prescription rate in hospitalized cancer patients.

수면진정제 중독 환자에서 흡인성 폐렴 발생의 예측 인자 분석

강민진 ( Min Jin Kang ),임지용 ( Jee Yong Lim ),오상훈 ( Sang Hoon Oh ),김한준 ( Han Joon Kim ),김영민 ( Young-min Kim ) 대한임상독성학회 2015 대한임상독성학회지 Vol.13 No.2

Purpose: Drug overdose is easily found in the emergency department (ED). Sedative-hypnotics overdose causes the aspiration pneumonia in patients with decreased mental status. The purpose of this study was to investigate the risk factors of aspiration pneumonia in patients poisoned with sedative-hypnotics. Methods: One hundred seventy eight patients who were poisoned with sedative-hypnotics and who visited ED between 2009 and 2015 were included. This study was conducted retrospectively, with collection of data by review of medical records. We collected the data concerning the characteristics of patients and classified them into two groups based on the development of aspiration pneumonia. Logistic regression analysis was performed to investigate the factors for the development of aspiration pneumonia. Results: Thirty five patients had an aspiration pneumonia during their hospital stay in 178 patients. The age, amount of ingestion, Glasgow Coma Scale (GCS) score at admission, a history of hypertension and diabetes mellitus, and the hypotension at admission were significantly different between two groups in univariate analysis. The age, amount of ingestion and GCS score at admission were associated with the development of aspiration pneumonia in the multivariate logistic regression analysis (OR 1.028 (95%CI, 1.002-1.056, p=0.037), 1.026 (95%CI, 1.004-1.043, p=0.001), 0.737 (95%CI, 0.683-0.915, p=0.002)). All patients with aspiration pneumonia were discharged without a sequelae. Conclusion: The development of aspiration pneumonia in the patients of sedative-hypnotics overdose is associated with old age, amount of drug ingestion, and GCS score at admission.

Detection of phenobarbital adulteration in dietary supplements: simultaneous analysis of 16 sedative-hypnotics and sleep-inducers by ultra-high-performance liquid chromatography with UV detection (UPLC-UV) and quadruple Orbitrap mass spectrometry (Q-Orbi

Lee, Ji Hyun,Choi, Ji Yeon,Park, Hanna,Min, Ah Young,Kim, Nam Sook,Park, Seong Soo,Park, Sung-Kwan,Kang, Ho-il The Korean Society of Analytical Sciences 2019 분석과학 Vol.32 No.1

The safety of food is occasionally questionable, as there have been some reports of products contaminated with illegal adulterants. In this study, the presence of 16 sedative-hypnotics and sleep inducers in dietary supplements was determined by ultra-high-performance liquid chromatography with UV detection (UPLC-UV) and quadruple Orbitrap mass spectrometry (Q-Orbitrap-MS). The UPLC method was validated, providing a linearity (R2) of more than 0.999, and LODs and LOQs that ranged from 0.2 to 0.5 and 0.6 to $1.5{\mu}g\;mL^{-1}$, respectively. The repeatabilities were 0.2-8.4 % (intra-day) and 0.3-4.5 % (inter-day), and the accuracies were 89.0-117.0 % (intra-day) and 87.8-111.9 % (inter-day). The mean recoveries of the spiked samples ranged from 98.7 to 107.3 %. The relative standard deviation (%RSD) of the stability was less than 2.4 %. Using the developed method, one sedative-hypnotic compound, phenobarbital, was detected in one of the nineteen samples tested. In addition, the major characteristic fragment ions of each target compound were confirmed using Q-Orbitrap-MS for higher accuracy. Monitoring the presence of these 16 sedative-hypnotics and sleep inducers in dietary supplements should be pursued in the interest of human health, and the results of this study confirmed that the developed method has value for this application.

급성 진정제 중독 추정 환자에서 플루마제닐의 투여: 위험도/이익 재평가

허재홍 ( Jae Hong Huh ),최상천 ( Sang Chun Choi ),임용균 ( Yong Gyun Lim ),샘슨램포탕 ( Samsun Lampotang ),박은정 ( Eung Jung Park ) 대한임상독성학회 2016 대한임상독성학회지 Vol.14 No.2

Purpose: The use of flumazenil administration in the emergency department is still controversial because of concerns about adverse effects. The present study was conducted to re-evaluate the risk-benefit ratio associated with flumazenil administration to patients suspected of having acute hypnotics and sedatives poisoning in the emergency department. Methods: A retrospective chart review study was conducted for patients whose final diagnoses were “poisoning” and “benzodiazepine” or “sedatives-hypnotics” from Mar. 2006 to Feb. 2015. The basal characteristics of the patients, including past medical history, ingredients and dose of ingested drug and co-ingested drugs were investigated. For patients administered flumazenil, responsiveness and time from admission to flumazenil administration were investigated with supplement. All collected data were analyzed in aspect terms of risk/benefit. Results: A total of 678 patients were included in our study. Benzodiazepine was the most common sedative/hypnotic drug prescribed, and the frequency of prescription continuously increased. The proportion of TCA as co-ingestion decreased from 13.1% to 3.9% in patients with acute sedative/hypnotic poisoning. Flumazenil was administered to 55 patients (8.1%), of which 29 patients (52.7%) were applied to contraindications. Fifty-three patients (96.4%) showed positive responsiveness, including partial responsiveness after flumazenil administration. No severe adverse events were identified. Conclusion: Based on the current trends in prescription patterns for sedative/hypnotic drugs, increased use of non- TCA antidepressants, and responsiveness to administration of flumazenil, benefit seemed weighted more in this study, although the observed benefits were based on limited results. Further prospective multicenter studies will be needed to optimize benefit-risk ratio.

Deep Sedation in Traumatic Brain Injury Patients

Yoon-Hee Choo,Young Beom Seo,Hyuk Jin Oh 대한신경손상학회 2023 Korean Journal of Neurotrauma Vol.19 No.2

Traumatic brain injury (TBI) is one of the leading causes of mortality and disability in adults. In cases of severe TBI, preventing secondary brain injury by managing intracranial hypertension during the acute phase is a critical treatment challenge. Among surgical and medical interventions to control intracranial pressure (ICP), deep sedation can provide comfort to patients and directly control ICP by regulating cerebral metabolism. However, insufficient sedation does not achieve the intended treatment goals, and excessive sedation can lead to fatal sedative-related complications. Therefore, it is important to continuously monitor and titrate sedatives by measuring the appropriate depth of sedation. In this review, we discuss the effectiveness of deep sedation, techniques to monitor the depth of sedation, and the clinical use of recommended sedatives, barbiturates, and propofol in TBI.

진정수면제 중독 환자의 처방과에 따른 처방 및 임상양상 비교

김도민 ( Do Min Kim ),박원빈 ( Won Bin Park ),임용수 ( Yong Su Lim ),김진주 ( Jin Joo Kim ),장재호 ( Jae Ho Jang ),장지용 ( Jee Yong Jang ),양혁준 ( Hyuk Jun Yang ),이근 ( Geun Lee ) 대한임상독성학회 2014 대한임상독성학회지 Vol.12 No.2

Purpose: The purpose of this study was to compare prescription patterns and clinical features according to clinical departments in sedative-hypnotic intoxication. Methods: This was a retrospective study of histories, substances of poisoning, acquisition routes, clinical courses, and outcomes of patients treated for acute intoxication in a single emergency medical center from January, 2011 to December, 2013. Results: A total of 769 patients were treated for acute intoxication, 281 patients ingested sedative hypnotics during the study period. Among 281 patients, 155 patients were prescribed by psychiatric department and 80 patients were prescribed by non-psychiatric department. Benzodiazepines were more likely to be prescribed by psychiatrists, and zolpidem was preferred by non-psychiatrists (p<0.001). Non-psychiatrists were more likely to prescribe short acting benzodiazepines than psychiatrists (p<0.001). However, there was no statistically significant difference in the clinical outcomes, including prevalence of admission to ICU, ventilator care, and length of stay in ICU. In patients prescribed by non-psychiatrists, there were more patients prescribed without psychiatric diagnosis and diagnosed as major depression disorder after hospitalization. Conclusion: To promote rational prescribing of sedative hypnotics, proper psychiatric evaluation should be performed before prescribing, and educational programs including the contents of interactions and side effects of sedative hypnotics are needed.

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.

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.