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심한 구역반사를 가진 성인환자에서 프로포폴 목표농도 주입법으로 시행한 깊은 진정
신순영,차민주,서광석,김현정,이정만,장주혜,Shin, Soonyoung,Cha, Min-Joo,Seo, Kwang-Suk,Kim, Hyun-Jeong,Lee, Jung-Man,Chang, Juhea 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.2
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.
치과장애인 환자의 외래마취 하 치과치료 귀가 후 전화추후 관리 분석
김미선,서광석,이정만,김혜정,한진희,한희정,이은희,신순영,신터전,김현정,장주혜,Kim, Mi-Seon,Seo, Kwang-Suk,Lee, Jung-Man,Kim, Hye-Jung,Han, Jin-Hee,Han, Hee-Jeong,Lee, Eun-Hee,Shin, Soonyoung,Shin, Teo-Jeon,Kim, Hyun-Jeong,Chang, Juhea 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.2
Background: Some disabled patients show insufficient cooperation during dental treatment, and general anesthesia in an outpatient setting can be successfully administered. To minimize post-anesthetic complications is an essential issue, and strict discharge protocols are required for the safety of the patients. Post-anesthetic follow-ups using telephone calls can be applied to improve the quality of the outpatient care system. The authors evaluated the post-operative condition of patients after dental treatment under general anesthesia. Methods: Total 143 patients and their caregivers included in this study. The patients received general anesthesia for dental treatment in Seoul National University Dental Hospital, Clinic for Persons with Disabilities from July, 2011 to April, 2012. Telephone calls were given to the patients or their caregivers to collect information about the patients' systemic condition and anesthesia-related complications. Results: Among 131 patients with responses of telephone calls, 87 patients (66.4%) reported no discomfort, while 44 patients (33.6%) presented post-anesthetic complications. A total of 20 patients reported mild fever, 10 patients had vomiting, and 7 patients had sore throat. Other complications included nausea, fatigue, nasal bleeding, skin sore, and body rash. Among the patients with the history of epilepsy, 63.6% showed post-anesthetic discomfort or complication (P = 0.027, ${\chi}^2$ test). Conclusions: One third of dental patients who received general anesthesia due to insufficientcooperation complained discomfort after discharged from outpatient anesthetic care.