Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
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Is it Impossible to Replace Chloral Hydrate in Dental Sedation of Pediatric Dentistry in Korea?

진정법에서 클로랄 하이드레이트의 대안은 무엇일까?

  • Han, Miran (Department of Pediatric Dentistry, Jukjeon Dental Hospital, College of Dentistry, Dankook University) ;
  • Kim, Jongbin (Department of Pediatric Dentistry, College of Dentistry, Dankook University)
  • 한미란 (단국대학교 치과대학 죽전치과병원 소아치과) ;
  • 김종빈 (단국대학교 치과대학 소아치과학교실)
  • Received : 2020.01.21
  • Accepted : 2020.02.15
  • Published : 2020.05.31
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Abstract

Chloral hydrate (CH) has been used in sedation for over 100 years. CH was first synthesized in 1832, the sedative properties were observed in 1861. Because of its easy synthesis, its use was widespread since 1869. There is a record of the use of CH in children as early as 1894. Recently there have been many controversies about safety of CH. Because of the low cost and relatively safe experience CH has still been used for dental sedation in children. After the US FDA recommendation in 2006, US pharmaceutical companies no longer produce commercial CH. However, CH has been used in the form of suspensions prepared from raw materials in many areas of the United States, and reports of adverse events related to death have continued. CH is the most commonly used drug for sedation in Korea, and there have been some reports of side effects. Dexmedetomidine, propofol and midazolam were introduced as an alternative for CH. There are various limitations in using them in the pediatric dentistry area and there are many things to consider. The purpose of this review is to analyze the complications of CH and status of use in Korea, and to introduce alternatives to CH.

Chloral hydrate(CH)는 100년이상 동안 진정용 약물로 이용되어 왔다. CH는 1832년 처음 합성되었고, 1861년에는 진정제의 특성이 소개되었으며, 1869년 이후부터는 합성기술의 발달로 이용 빈도가 증가되었다. 1894년 소아에게 CH를 사용하기 시작한 기록이 있다. CH는 최근까지도 안정성에 관한 많은 논란들이 있었음에도 저렴한 가격과 비교적 안전하다는 경험적 이유로 어린이의 치과 진정법에 여전히 사용되고 있다. 그러나, 2006년 미국 FDA의 권고 이후, 2012년부터 미국내 제약회사는 CH를 더 이상 생산하지 않고 있다. 그럼에도 여전히 미국 내 여러 지역에서는 CH 원재료를 이용하여 조제한 현탁액 형태로 진정법에 사용하고 있으며, 2012년 이후에도 사망과 관련한 부작용의 보고는 계속되고 있다. CH는 현재까지 한국에서 소아 진정법에 가장 많이 이용되고 있는 약제이며, 최근 한국에서도 다수의 부작용에 관련한 보고들이 있었다. 최근 진정법을 이용한 소아의 치과치료에, CH를 대신하여 dexmedetomidine, propofol 등 여러 약물들이 소개되었다. 다만 이들을 소아치과 영역에서 사용하는데 있어서는 여러 가지 제한점이 있으며 고려해 볼 사항들도 많다. 이에 CH와 관련된 합병증들과 한국에서의 사용 실태, 그리고 CH를 대체할 수 있는 약물에 대해 알아보고자 한다.

Keywords

References

  1. Liebig J : Ueber die Zersetzung des Alkohols durch Chlor. Annalen der Pharmacie, 1:31-32, 1832. https://doi.org/10.1002/jlac.18320010109
  2. Liebreich O. Das Chloralhydrat : Ein neue Hypnoticum und Anaestheticum. Arch Deutsch Ges Psychiat, 16:237, 1869.
  3. Reimche L, Sankaran K, Hindmarsh K, et al. : Chloral hydrate sedation in neonates and infants-clinical and pharmacologic considerations. Dev Pharmacol Ther, 12:57-64, 1989. https://doi.org/10.1159/000480965
  4. Chowdhury J, Vargas KG : Comparison of chloral hydrate, meperidine, and hydroxyzine to midazolam regimens for oral sedation of pediatric dental patients. Pediatr Dent, 27:191-197, 2005.
  5. Meadows M : The FDA takes action against unapproved drugs. FDA Consum, 41:34-35, 2007.
  6. Sing K, Erickson T, Amitai Y, et al. : Chloral hydrate toxicity from oral and intravenous administration. J Toxicol Clin Toxicol, 34:101-106, 1996. https://doi.org/10.3109/15563659609020242
  7. Hirsch IA, Zauder HL. Chloral hydrate : a potential cause of arrhythmias. Anesth Analg, 65:691-692, 1986.
  8. Rokicki W : Cardiac arrhythmia in a child after the usual dose of chloral hydrate. Pediatr Cardiol, 17:419-420, 1996. https://doi.org/10.1007/s002469900094
  9. Nordt SP, Rangan C, Hardmaslani M, et al. : Pediatric chloral hydrate poisonings and death following outpatient procedural sedation. J Med Toxicol, 10:219-222, 2014. https://doi.org/10.1007/s13181-013-0358-z
  10. Cote CJ, Karl HW, McCloskey C, et al. : Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics, 106:633-644, 2000. https://doi.org/10.1542/peds.106.4.633
  11. Park BS, Yoo YM, Lee JH, et al. : Adverse events and risk factors associated with chloral hydrate sedation for brain magnetic resonance imaging in the neonatal intensive care unit. Neonatal Med, 26:85-90, 2019. https://doi.org/10.5385/nm.2019.26.2.85
  12. Grissinger M. Chloral Hydrate: Is It Still Being Used? Are There Safer Alternatives? P T, 44:444-459, 2019.
  13. Cote CJ, Wilson S : Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatr Dent, 38:13E-39E, 2016.
  14. Roh WS, Kim DK, Lee GH, et al. : Analysis of anesthesiarelated medical disputes in the 2009-2014 period using the Korean Society of Anesthesiologists database. J Korean Med Sci, 30:207-213, 2015. https://doi.org/10.3346/jkms.2015.30.2.207
  15. Wilson S, Houpt M : Project USAP 2010: use of sedative agents in pediatric dentistry-a 25-year follow-up survey. Pediatr Dent, 38:127-133, 2016.
  16. Yang Y, Shin T, Jeong T, et al. : Survey of sedation practices by pediatric dentists. J Korean Acad Pediatr Dent, 41:257-265, 2014.
  17. Andrew Byrne SM, Stephen Curran : Side Effects of Drugs Annual 2009.
  18. Howlett P : Guidance for commissioning NHS England dental conscious sedation services: a framework tool. SAAD Dig, 30:37-39, 2014.
  19. An S, Lee J, Kim S, Kim J : A review of the systemic analysis method on dental sedation for children. J Korean Acad Pediatr Dent, 42:331-339, 2015.
  20. Wilson S : Oral Sedation for Dental Procedures in Children. Springer, 2015.
  21. Yoon JY, Kim CH : Dexmedetomidine: clinical use. J Dent Anesth Pain Med, 13:161-166, 2013.
  22. Lee Y, Kim J, Kim S, Kim J : Intranasal administration of dexmedetomidine (DEX) as a premedication for pediatric patients undergoing general anesthesia for dental treatment. J Dent Anesth Pain Med, 16:25-29, 2016. https://doi.org/10.17245/jdapm.2016.16.1.25
  23. Behrle N, Birisci E, Dalabih A, et al. : Intranasal dexmedetomidine as a sedative for pediatric procedural sedation. J Pediatr Pharmacol Ther, 22:4-8, 2017. https://doi.org/10.5863/1551-6776-22.1.4
  24. Chidambaran V, Costandi A, D'Mello A : Propofol: a review of its role in pediatric anesthesia and sedation. CNS drugs, 29:543-563, 2015. https://doi.org/10.1007/s40263-015-0259-6
  25. Cravero JP, Beach ML, Blike GT, et al. : The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg, 108:795-804, 2009. https://doi.org/10.1213/ane.0b013e31818fc334
  26. Lee K, Song JS, Kim SO, et al. : The changes of sedation in the department of pediatric dentistry, Yonsei University Dental Hospital. J Korean Acad Pediatr Dent, 45:154-161, 2018.
  27. Kim H, Kim J : A trend of treatment in department of pediatric dentistry for 10 years. J Korean Acad Pediatr Dent, 46:328-336, 2019.
  28. Tool AF : Guidance for Commissioning NHS England Dental Conscious Sedation Services. 2013.
  29. Kim HJ : Is chloral hydrate syrup ($Pocral^{(R)}$ Syrup) a safe oral sedative? J Korean Acad Adv Gene Dent, 1:27-32, 2012.