Abstract
The purpose of this study was to assess the sedative effects of four kinds of medication for management in the uncooperative 64 children aged from 18 to 92 months(ASA class I) and weighting between 10 and 32 kg. They were given randomly a dose of chloral hydrate 75mg/kg and hydroxyzine 25mg orally(group 1), midazolam 0.1mg/kg intramuscularly and $N_2O$(group 2), group 1 with additional $N_2O$(group 3) and group 1 with additional midazolam 0.5cc intranasally(group 4), respectively. According to rating scale, sleep, crying, movement and overall behavior were checked for evaluation of the clinical sedative effects. They were restraind with Pediwrap and were monitored by pulse oximeter for safety during treatment period. The results were as follows : 1. In the evaluation of sleep, rating scale of chloral hydrate and hydroyzine combination group was superior to midazolam and $N_2O$ combination group(p<0.001), but there was no significant difference between chloral hydrate, hydroxyzine and $N_2O$ combination group and chloral hydrate, hydroxyzine and midazolam combination group. 2. In the evaluation of crying, movement and overall behavior, there were significant differences between chloral hydrate and hydroxyzine combination group and midazolam and $N_2O$ combination group(p<0.05), but no significant difference between chloral hydrate, hydroxyzine and $N_2O$ combination group and chloral hydrate, hydroxyzine and midazolam combination group. 3. In the evaluation of overall behavior, the mean score of chloral hydrate and hydroyzine combination group was 2.94, midazolam and $N_2O$ combination group 2.07, chloral hydrate, hydroxyzine and $N_2O$ combination group 2.47 and chloral hydrate, hydroxyzine and midazolam combination group 2.24, respectively. 4. Evidence of adverse effect was not detected or reported during and/or after dental treatment.
Chloral hydrate, hydroxyzine, 아산화질소($N_2O$), midazolam은 치과치료에 비협조적인 소아환자의 진정시 흔히 사용하는 약물이다. 이러한 진정약물을 두 가지 이상 병용투여 하게 되면 더 적은 용량으로도 진정이 되며 전신적인 부작용도 감소시킬 수 있다. 따라서 병용투여시 나타나는 진정효과를 비교해 본다면 행동조절이 어려운 아이들에게 사용할 수 있는 보다 나은 약물 진정방법을 얻을 수 있으리라 사료된다. 본 연구에서는 전남대학교 병원 소아치과에 내원한 환아중 첫 내원시에 간단한 구강검사에도 행동조절이 어려운 Frankl 1과 2에 해당되는 아동으로서 전신적으로 건강이 양호하고 위장장애가 없는 나이 $18{\sim}92$개월, 체중 $10{\sim}32kg$의 아동 64명(남자 42명, 여자 22명)을 대상으로 약물 병용에 따른 진정효과를 비교하여 다음과 같은 결과를 얻었다. 1. 수면효과는 chloral hydrate와 hydroxyzine의 복합투여군이 midazolam IM과 아산화질소를 병용한 군보다 모든 치료단계에서 매우 좋았으나(p<0.001), 3군과 4군간에는 유의한 차이가 없었다. 2. 울음, 움직임, 전반적 행동에 있어서 제 1군과 제 2군간에는 통계적으로 유의한 차이를 보였으나(p<0.05), 제 3군과 제 4군간에는 유의한 차이를 나타내지 않았다. 3. 전반적인 행동평가항목에 있어서 평균 score가 제 1군은 2.94, 제 2군은 2.07, 제 3군은 2.47, 제 4군은 2.24였다.