임상가를 위한 특집 3 - 치과시술을 위한 정주진정

Intravenous Sedation for Dental Procedure

  • 김철홍 (부산대학교 치의학전문대학원 치과마취통증학교실) ;
  • 윤지영 (부산대학교 치의학전문대학원 치과마취통증학교실)
  • Kim, Cheul Hong (Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University) ;
  • Yoon, Ji Young (Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University)
  • 투고 : 2013.06.13
  • 심사 : 2013.06.26
  • 발행 : 2013.07.01

초록

Apprehension and phobia regarding dental procedures are represent the most common deterrents in patients seeking dental care and very common. For these individuals, and others who cannot cooperate during care, procedural sedation may permit completion of intraoral procedures. In most cases, the level of sedation may be kept at minimal to moderate levels permitting patient maintenance of their airway patency and ventilation. Unlike many medical procedures, the majority of dental procedures, no matter the depth of sedation, are performed in the presence of complete analgesia provided by local anesthesia. Therefore, the goal of procedural sedation is to primarily suppress patient fear and apprehension and gain cooperation. Any issues regarding actual pain are usually limited to that produced by the local anesthetic injections or, rarely, the extent of the procedure. For the extremely phobic patient, however, allaying apprehension may be very challenging. Intravenous titration of sedative drugs is the most effective route of administration to achieve this goal but requires advanced training beyond that provided in undergraduate training.

키워드

참고문헌

  1. Coolidge T, Irwin SP, Leyster KA, Milgrom P: Determinants of receiving intravenous sedation in a sample of dentally-fearful patients in the USA. SAAD Dig 2012; 28: 52-60.
  2. Jackson DL, Johnson BS: Inhalational and enteral conscious sedation for the adult dental patient. Dent Clin North Am 2002; 46: 781-802. https://doi.org/10.1016/S0011-8532(02)00029-0
  3. Montagnese TA: Why intravenous moderate sedation should be taught in graduate endodontic programs. J Dent Educ 2012; 76: 288-90.
  4. Jackson DL, Johnson BS: Conscious sedation for dentistry: Risk management and patient selection. Dent Clin North Am 2002; 46: 767-80. https://doi.org/10.1016/S0011-8532(02)00034-4
  5. Tiernan J: Consent in general anaesthesia and sedation. A legal or conduct issue? SAAD Dig 1995; 12: 3-6.
  6. Boynes SG, Lewis CL, Moore PA, Zovko J, Close J: Complications associated with anesthesia administered for dental treatment. Gen Dent 2010; 58: e20-5.
  7. McKenna G, Manton S, Neilson A: A study of patient attitudes towards fasting prior to intravenous sedation for dental treatment in a dental hospital department. Prim Dent Care 2010; 17: 5-11. https://doi.org/10.1308/135576110790307681
  8. Coulthard P: Conscious sedation. Br Dent J 2008; 204: 52.
  9. Becker DE, Casabianca AB: Respiratory monitoring: Physiological and technical considerations. Anesth Prog 2009; 56: 14,20; quiz 21-2.
  10. Braidy HF, Singh P, Ziccardi VB: Safety of deep sedation in an urban oral and maxillofacial surgery training program. J Oral Maxillofac Surg 2011; 69: 2112-9. https://doi.org/10.1016/j.joms.2011.04.017
  11. Mizuno J: Flumazenil. Masui 2013; 62: 10-8.
  12. Lewis D: Summary of: The use of flumazenil after midazolam-induced conscious sedation. Br Dent J 2010; 209: 568-9. https://doi.org/10.1038/sj.bdj.2010.1107
  13. Ogawa S, Seino H, Ito H, Yamazaki S, Ganzberg S, Kawaai H: Intravenous sedation with low-dose dexmedetomidine: Its potential for use in dentistry. Anesth Prog 2008; 55: 82-8. https://doi.org/10.2344/0003-3006-55.3.82
  14. McNeir DA, Mainous EG, Trieger N: Propofol as an intravenous agent in general anesthesia and conscious sedation. Anesth Prog 1988; 35: 147-51.
  15. Pang WW, Huang PY, Chang DP, Huang MH: The peripheral analgesic effect of tramadol in reducing propofol injection pain: A comparison with lidocaine. Reg Anesth Pain Med 1999; 24: 246-9.