부산대학교 도서관

We describe our experience with intravenous sedation in a patient with a history of panic disorder who exhibited a restless state postoperatively. The patient was an 18-year-old girl who had panic disorder associated with hyperventilation attacks and was receiving oral medication. We decided to perform tooth extraction and dental treatment with the patient under intravenous sedation. The first time that intravenous sedation was used, extraction of an impacted right lower wisdom tooth was scheduled. Optimal sedation was achieved with midazlam 5.0mg, and treatment was completed in 15min. A hyperventilation attack occurred after the patient returned to her room, but her condition improved when a vinyl bag was used to breathe exhaled air. The second time that intravenous sedation was used, extraction of an impacted left lower wisdom tooth was scheduled. Because the patient complained of pain and showed hyperventilation despite optimal sedation with midazolam 5.0mg, she was additionally given a local anesthetic and midazolam, and the procedure was completed in 30min. A hyperventilation attack occurred after the completion of treatment, and the patient was given midazolam 3.0mg. We waited until the patient's condition improved before allowing her to return to her room, but a restless state and hyperventilation attacks recurred after she returned to her room. The stress of changes in the environment, pain, and other factors can trigger panic attacks in patients with panic disorder. This case made us keenly aware of the need for exercising caution with regard to anxiety, pain, and other symptoms throughout the perioperative period.