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The effect of stellate ganglion block on the atypical facial pain.

Journal of Dental Anesthesia and Pain Medicine.2015;15(1):35-37. doi:10.17245/jdapm.2015.15.1.35

Atypical facial pain (AFP) is a type of facial pain which does not fulfill any other diagnosis. It has several features such as no objective signs, no obvious explanation of the cause and poor response to treatments. We report a case of a female patient with AFP on the left maxillary area. The pain was increased by cold innocuous stimulation and thermography showed that the temperature on the painful area was significantly decreased. The pain was successfully alleviated by stellate ganglion block (SGB). Therefore, SGB can be effectively used to treat AFP.
Diagnosis ; Facial Pain* ; Female ; Humans ; Stellate Ganglion* ; Thermography

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Acute mediastinitis secondary to delayed vascular injury by a central venous catheter and total parenteral nutrition.

Gyeong Jo BYEON ; Eun Jung KIM ; Ji Young YOON ; Seok Hyun YOON ; Mi Na WOO ; Cheul Hong KIM

Journal of Dental Anesthesia and Pain Medicine.2015;15(1):31-34. doi:10.17245/jdapm.2015.15.1.31

Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.
Central Venous Catheters* ; Drainage ; Dyspnea ; Female ; Humans ; Intensive Care Units ; Mediastinitis* ; Mediastinum ; Middle Aged ; Ovarian Neoplasms ; Parenteral Nutrition ; Parenteral Nutrition, Total* ; Patients' Rooms ; Pleural Effusion ; Subclavian Vein ; Thoracentesis ; Vascular System Injuries*

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Factor XI deficiency and orthognathic surgery: a case report on anesthesia management.

Soo Eon LEE ; Yoon Ji CHOI ; Seong In CHI ; Hyun Jeong KIM ; Kwang Suk SEO

Journal of Dental Anesthesia and Pain Medicine.2015;15(1):25-29. doi:10.17245/jdapm.2015.15.1.25

Factor XI deficiency (Hemophilia C) is a very rare autosomal recessive bleeding disorder. Patients with factor XI deficiency do not typically show any spontaneous bleeding or specific symptoms. Sometimes those who have this disorder are identified during special situations such as trauma or surgery. Orthognathic surgery is particularly associated with a high bleeding risk. Therefore, great care must be taken when treating patients with bleeding disorders such as factor XI deficiency. There are a few reports that address the management of patients with bleeding disorders during orthognathic surgery. The current report describes a patient with factor XI deficiency who underwent Le Fort I osteotomy together with bilateral sagittal split osteotomy. The patient's condition was assessed using both rotation thromboelastometry (ROTEM™) and noninvasive measurements of total hemoglobin (SpHb) using Masimo Radical 7 (Masimo Co. CA, USA).
Anesthesia* ; Factor XI Deficiency* ; Factor XI* ; Hemorrhage ; Humans ; Orthognathic Surgery* ; Osteotomy ; Thrombelastography

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Protective dental splint for oroendotracheal intubation: experience of 202 cases.

Kang Hee LEE ; Tae Min YOU ; Wonse PARK ; Sun Hwa LEE ; Bock Young JUNG ; Nan Sim PANG ; Kee Deog KIM

Journal of Dental Anesthesia and Pain Medicine.2015;15(1):17-23. doi:10.17245/jdapm.2015.15.1.17

BACKGROUND: Dental injury as a result of oroendotracheal intubation during general anesthesia is very common. We report our experiences of using mouthguard to prevent dental injury during intubation based on our protocol. METHODS: This retrospective study enrolled patients referred for preanesthetic evaluation, those patients with a history of any of the dental treatments to their anterior teeth listed on our fabrication protocol from January 1, 2009 to June 30, 2010. RESULTS: No cases of dental trauma during oroendotracheal intubation were reported among the 202 patients who used a protective device. 66% of the patients had risk factors for hard tissue damage aged 10-40 years. At the ages of 40-70 years, the incidence of risk group for periodontal damage was higher. CONCLUSIONS: Preanesthetic consultation was effective for preventing dental injury, so preanesthetic questionnaire and proper dental consultation would be helpful.
Anesthesia, General ; Humans ; Incidence ; Intubation* ; Protective Devices ; Retrospective Studies ; Risk Factors ; Splints* ; Tooth

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Using nasal cannula for sevoflurane deep sedation in emergency dental treatment.

Jongbin KIM ; Seunghoon YOO ; Jongsoo KIM ; Seungoh KIM

Journal of Dental Anesthesia and Pain Medicine.2015;15(1):11-15. doi:10.17245/jdapm.2015.15.1.11

BACKGROUND: Emergency room doctors run into difficulties in treating injured pediatric patients because usually they fell into panic after trauma. In these situation, deep sedation with sevoflurane is fully recommendable method. The conventional way can interrupt common dental treatment procedure. METHODS: In the present study, nasal cannula was used for sevoflurane deep sedation in 11 dental emergency treatment. Age ranged from 0 to 3 years old (average of 1.8 years). RESULTS: Treatment duration was from 10 to 35 minutes (average of 16.7 minutes). Average duration of sedation was 25.5 minutes ranging from 15 to 45 minutes. CONCLUSIONS: It has advantages to use nasal cannula for sevoflurane deep sedation rather than conventional intubation; saves time and secures good operation field.
Catheters* ; Deep Sedation* ; Emergencies* ; Emergency Service, Hospital ; Emergency Treatment ; Humans ; Intubation ; Methods ; Panic

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Telephone follow-up care for disabled patients discharged after receiving dental treatment under outpatient general anesthesia.

Seong In CHI ; Soo Eon LEE ; Kwang Suk SEO ; Yoon Ji CHOI ; Hyun Jeong KIM ; Hye Jung KIM ; Jin Hee HAN ; Hee Jeong HAN ; Eun Hee LEE ; Aram OH ; Suk Jin KWON

Journal of Dental Anesthesia and Pain Medicine.2015;15(1):5-10. doi:10.17245/jdapm.2015.15.1.5

BACKGROUND: Patients were subjected to post-discharge follow-up (by telephone) in order to investigate the potential complications of outpatient general anesthesia or deep sedation that could develop in disabled dental patients discharged from the hospital. The ultimate aim of this study was to establish an appropriate response measure for such complications. METHODS: The caregivers of 79 disabled patients who underwent dental procedures under general anesthesia at our outpatient clinic were interviewed over telephone. Necessary care instructions were provided during the phone calls when required. The patient satisfaction level regarding the telephonic follow-up care was surveyed by additional telephone calls. RESULTS: Most of the patients did not suffer any serious complications; however, some reported fever and bleeding. The data obtained in this study can be utilized towards the development of caregiver education pertaining to the ambulatory general anesthesia of dental patients with disabilities. CONCLUSIONS: Additionally, we hope that the findings of this study will help minimize the effects of complications experienced by disabled dental patients undergoing ambulatory general anesthesia, as well as increase the overall patient satisfaction level.
Ambulatory Care Facilities ; Anesthesia, General* ; Caregivers ; Deep Sedation ; Education ; Fever ; Follow-Up Studies* ; Hemorrhage ; Hope ; Humans ; Outpatients* ; Patient Satisfaction ; Telephone*

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The alternative of oral sedation for pediatric dental care.

Jongbin KIM ; Seungoh KIM ; Deok Won LEE ; Dae Seung RYU

Journal of Dental Anesthesia and Pain Medicine.2015;15(1):1-4. doi:10.17245/jdapm.2015.15.1.1

In pediatric dentistry, chloral hydrate is habitually selected for sedation of uncooperative children. Although chloral hydrate has been used for decades, various adverse effects are reported and necessity for new alternative drugs has increased. Dexmedetomidine was approved by FDA for sedation at intensive care units (ICU) in 1999. Compared to conventional sedative drugs, dexmedetomidine has not only analgesic and sedative effects but also it barely suppresses the respiratory system. Due to these characteristics, dexmedetomidine is known as safe sedative drug for children and elderly patients. Furthermore, approved by KFDA in 2010 in Korea, the frequency of sedation using dexmedetomidine is increasing. However, due to its intravenous administration method, it was difficult to apply in pediatric dentistry. Recently, intranasal administration method was introduced which might be a new possible alternative of oral sedation. In this study, we compare the mechanisms, pros and cons of chloral hydrate and dexmedetomidine, introducing new possibilities.
Administration, Intranasal ; Administration, Intravenous ; Aged ; Child ; Chloral Hydrate ; Dental Care* ; Dexmedetomidine ; Humans ; Hypnotics and Sedatives ; Intensive Care Units ; Korea ; Methods ; Pediatric Dentistry ; Respiratory System

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Deep sedation for dental treatment in a Down syndrome patient with Eisenmenger syndrome: A case report.

Seong In CHI ; Hyun Jeong KIM ; Kwang Suk SEO

Journal of Dental Anesthesia and Pain Medicine.2016;16(1):67-71. doi:10.17245/jdapm.2016.16.1.67

Eisenmenger syndrome (ES) is characterized by pulmonary arterial hypertension and right-to-left shunting. The signs and symptoms of ES include cyanosis, shortness of breath, fatigue, hemoptysis, and sudden death. In patients with ES, it is important that the systemic and pulmonary circulations be properly distributed and maintained. General dental treatment is not known to be particularly dangerous. To control pain and anxiety, local anesthetics without epinephrine are usually recommended. However, in cases of difficulty of cooperation, general anesthesia for dental treatment makes the condition worse. In the present case, intravenous deep sedation with propofol and remifentanil was administered for behavioral management during dental treatment successfully.
Anesthesia, General ; Anesthetics, Local ; Anxiety ; Cyanosis ; Death, Sudden ; Deep Sedation* ; Down Syndrome* ; Dyspnea ; Eisenmenger Complex* ; Epinephrine ; Fatigue ; Hemoptysis ; Humans ; Hypertension ; Propofol

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Displacement of deciduous tooth into hypopharynx due to endotracheal intubation.

Sang Hoon KANG ; Jung Hyun CHANG

Journal of Dental Anesthesia and Pain Medicine.2016;16(1):61-65. doi:10.17245/jdapm.2016.16.1.61

Intubation may lead to several dental complications. Furthermore, a tooth damaged during intubation may be subsequently dislocated. In the present case, the upper primary incisor was avulsed during intubation and, unbeknownst to the anesthesiologist, displaced to the larynx. We report here on the findings and indicate appropriate treatment. Intubation for general anesthesia in children can result in tooth damage and/or dislocation of primary teeth with subsequent root resorption. Prevention is key, and thus it is critical to evaluate the patient's dental status before and after intubation. Furthermore, anesthesiologists and dentists should pay close attention to this risk to prevent any avulsed, dislocated, or otherwise displaced teeth from remaining undetected and subsequently causing serious complications.
Anesthesia ; Anesthesia, General ; Child ; Dentists ; Dislocations ; Humans ; Hypopharynx* ; Incisor ; Intubation ; Intubation, Intratracheal* ; Larynx ; Root Resorption ; Tooth ; Tooth Injuries ; Tooth, Deciduous*

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Dexmedetomidine intravenous sedation using a patient-controlled sedation infusion pump: a case report.

Seong In CHI ; Hyun Jeong KIM ; Kwang Suk SEO

Journal of Dental Anesthesia and Pain Medicine.2016;16(1):55-59. doi:10.17245/jdapm.2016.16.1.55

Dental treatment under sedation requires various sedation depths depending on the invasiveness of the procedure and patient drug sensitivity. Inappropriate sedation depth may cause patient discomfort or endangerment. For these reasons, patient-controlled sedation (PCS) pumps are commonly used. Patients are able to control the sedation depths themselves by pushing the demand button after the practitioner sets up the bolus dose and lock-out time. Dexmedetomidine is an α-2 adrenoreceptor agonist with sedative, analgesic, and anxiolytic properties. It has been widely used for sedation for its minimal respiratory depression; however, there are few studies on PCS using dexmedetomidine. This study assessed the applicability of dexmedetomidine to PCS.
Conscious Sedation ; Dexmedetomidine* ; Humans ; Infusion Pumps* ; Respiratory Insufficiency

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