행동조절이 어려운 소아환자의 Deep sedation을 이용한 치과치료
THE USE OF DEEP SEDATION FOR THE DENIAL MANAGEMENT OF PEDIATRIC PATIENTS WITH DEFINITELY NEGATIVE BEHAVIOR
엄혜숙, 김종수,
소속 상세정보
엄혜숙 ( ) - 단국대학교 자연과학대학 미생물학과
김종수 ( ) - 단국대학교 치과대학 마취학교실
KMID : 0358919980250040710
Abstract
결론
Deep sedation하에서 치과치료를 시행한 200명의 소아환자에 대한 자료를 분석하여 다음
과 같은 결과를 얻었다.
1. 평균 치료시간은 52분이었으며 치료연장이 필요한 경우 midazolam(0.1-0.2cc)을 비강
내로 추가 투여하여 1회 투여 평균 15분의 치료시간 연장이 가능하였다.
2. Deep sedation후 나타난 합병증에는 기도유지 및 호흡곤란이 가장 큰 문제점으로 나타
났으며 적은 빈도지만 cyanosis, laryngospasm과 같은 응급상황도 발생하였다.
3. Deep sedation을 시행할 때에는 환자의 생징후 를 지속적으로 관찰하고 보다 엄격한
monitoring이 강조되어야 할 것이다.
#초록#
It is one of difficulties to control children who show definitely 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 (0.1-0.2cc) 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 cyanosis 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.
키워드
Deep sedation; Enflurane; Laryngospasm; Midasolam;
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