The sedative effect of intranasal Midazolam additionally administered to children who fail to respond properly to oral Chloral Hydrate

Chloral hydrate 경구투여의 진정효과가 나타나지 않는 소아환자에 대한 Midazolam의 비강내 추가 투여

Chloral hydrate is one of the most widely used sedative agents to control the difficult-to-treat young age group in the dental clinic. The normal onset time of oral Chloral hydrate is 30-45 minute with some variations. We are often frustrated see the patient still awake and cry with agitation even after far more than the normal onset time. In such a case, the patient has to be rescheduled for another sedation visit with different agents and/or routes which greatly disappoints the guardians. This case report presents a sedative regimen that can possibly help the clinician complete scheduled treatment without postponement. We have tried additional administration of Midazolam intranasally to 22 patients of those who failed to respond properly to the initial dose(50-75mg/kg) of oral Chloral hydrate. The average age and weight of the patients was 34.2 months(22-61 mos.) and 15.2 kg(10-17 kg) respectively. Half of the regular dose of Midazolam(0.1mg/kg) was administered intranasally. using needless syringe in 42 cases without notable resistance of the patient. The onset was very rapid in most cases and colud proceed the treatment under the constant monitoring by Pulse oximeter. All the planned procedures could be completed in 93.2 % (69.4% of 'Good' plus 23.8% of 'Fair' rating)with only 6.8 %('Poor' rating) of failure rate. Evidence of adverse effect was not detected or reported during and/or after the procedures.