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행동조절이 어려운 소아치과 환자 치료시 Halothane과 Midazolam을 사용한 Modified Deep Sedation
윤형배 大韓小兒齒科學會 1998 대한소아치과학회지 Vol.25 No.1
Manangement 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 negativebehavior 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 N₂O 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 0.2㎎/㎏ and 0.3㎎/㎏ 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 incerment or decrement. The success rate of conscious sedation were 21.2% in 0.2㎎/㎏ and 30.3% in 0.3㎎/㎏. There's many factors in proceed of conscious sedation. The most inportant factors are age of patient and experience of children for dental care.
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구호흡 소아환자에서 흡인도관을 이용한 $N_2O-O_2$ 진정
윤형배,Yoon, Hyung-Bae 대한소아치과학회 1999 대한소아치과학회지 Vol.26 No.4
There are some problems in inhalation sedation of non-cooperative pediatric patients. Usually the pediatric patients reject the nasal hood and there's no cooperation for administration of nitrous oxide gas. In mouth breathing patient, other technics of sedation such as intravenous or oral sedation or general anesthesia were recommended. Common causes of mouth breathing are common cold, allergic rhinitis, sinus problem, anatomical disorder, and habitual mouth-breathing. However in some patient not indicated the general anesthesia and high failure rate in oral and intravenous sedation. Administration of $N_2O-O_2$ with suction catheter was applied in full mouth breathing patient. Clinically effective sedation were occurred during procedure about 45 to 55 minutes. There's no any side effects by $N_2O-O_2$ inhalation sedation. The patients awoke at the end of the procedure and received 100% oxygen for 2-3 minutes. There's still some problems in use of the suction catheter such as air pollution of operation theater and elevate arterial carbon dioxide tension.
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윤형배,Yoon, Byung-Bae 대한치과마취과학회 2002 Journal of Dental Anesthesia and Pain Medicine Vol.2 No.1
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.
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행동조절이 어려운 소아환자의 Deep sedation을 이용한 치과치료
엄혜숙,윤형배 大韓小兒齒科學會 1998 대한소아치과학회지 Vol.25 No.4
It is one of difficulties to control children who show defintely negative behavior in dental clinic. In such a case, the pharmacologic management has been used to provide quality care, minimize the extremes of disruptive behavior, promote a positive psychologic response to treatment and patient welfare and safety. Deep sedation can be defined as a controlled, pharmacologically-induced state of depressed consciousness from which the patient is not easily aroused which may be accompanied by a partial loss of protective reflexes. In this retrospective report, the sedation records of 200 pediatric dental patients of ASA Class Ⅰ&Ⅱ Who were not successfully treated under conscious sedation were used for analysis. Most frequently used regimen of deep sedation was the co-medication of midazolam(0.3mg/kg), enflurane(1.0-2.0 vol%) and 50-70% N₂O-O₂. The average age and weight of the patients was 4.6 yr (S,D:2.72) and 18.7kg(S.D:6.35)respectively. The average operative time was 52 minutes and midazolam (0.1-0.2㏄) was additionally administered intranasally to prolong the operative time as needed. The episodes of untoward side effects were reported during and/or after the procedure in 58 patients. Serious adverse reactions such as cyanisis or laryngospasm were even reported in 7 patients but without mortality. deep sedation is a very effective way of completing the dental treatments for those who failed to respond well to the conscious sedation. This technique has many practical advantages over general anesthesia case but the demands for the rigid monitoring criteria limit its use in general practice setting. The continuous efforts to improve the safety of the medication and the technique are required for the benefits of the patients and parent.
RISS
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