• Journal of Korean Biological Nursing Science
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• v.8 no.1
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• pp.49-59
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• 2006

Purpose: The purpose of this study was to investigate the recovery time and its related factors after sedative gastroscopy. Method: The subjects of this study consisted of 103 clients. The data were collected from clients who visited a health care system at S national university hospital in Seoul. The sedative gastroscopy was performed by gastrointestinal endoscopists. Patients' demographics and medical characteristics were assessed by reviewing the patients' charts. Degree of sedation and recovery were assessed by the Ramsay's sedation scale and the Aldrete score, respectively. Result: The mean recovery time was $37.8{\pm}16.9$ minutes(range, 5 to 90 minutes). Hypoxia was resent in four clients during recovery. Alcohol intake(p=0.02) and pulmonary function(p=0.003) were significant factors affecting recovery time, whereas midazolam dose and sedation level were not. Conclusion: Current alcohol intake, pulmonary function were predicting factors on recovery time.

• Journal of The Korean Dental Society of Anesthesiology
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• v.10 no.1
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• pp.27-33
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• 2010

The gag reflex is a physiologic reaction which safeguards the airway from foreign bodies. But, an exaggerated gag reflex can be a severe limitation to a patient's ability to accept dental care and for a clinician's ability to provide it. The overactive gag reflex can be due to psychological factors or physiological factors, or both. Psychological factors can include fear of loss of control and past traumatic experiences. A 58-year-old man, scheduled for extraction of left upper second molar, left lower second and third molar and implantation of left upper second molar, and left lower second molar had no specific underlying medical problems. He had exaggerated gag reflex. Dental treatment was successfully performed using intravenous sedation. Intravenous sedation with midazolam and propofol was a useful management technique for reflex control during dental treatment extended to the posterior regions in the oral cavity.

• Journal of The Korean Dental Society of Anesthesiology
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• v.9 no.2
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• pp.104-107
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• 2009

Midazolam, one of the most common benzodiazepine derivatives, is widely used in intravenous sedation for dental treatment without severe complications. However, paradoxical reactions to midazolam, including patient's unanticipated restlessness, agitation, hostility, and rage, have been frequently reported since the introduction of benzodiazepine. During outpatient intravenous sedation using midazolam for dental treatment, we experienced a paradoxical reaction to midazolam in a 28-year-old female patient. With a thorough review of the literature, the management of this complication and its various etiologies were discussed.

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.27-31
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• 2011

We report two cases of accidental overdoses of intramuscular midazolam used for a conscious sedation. A 4-year-old boy with dental caries was scheduled for treatment under conscious sedation. The pedodontist prescribed midazolam ($dormicum^{(R)}$ 5 mg / 5 ml) 2 ml (2 mg) by verbal order to hygienist. The hygienist instead of the pedodontist wrote a prescription for midazolam ($dormicum^{(R)}$ 15 mg / 3 ml) 2 ml (10 mg). The inexperienced nurse gave an injection to his buttock as prescription. The child fell into a deep sedation. A 4-year-old boy with dental caries was scheduled for treatment under conscious sedation. The inexperienced pedodontist gave an injection to his buttock midazolam ($dormicum^{(R)}$ 15 mg / 3 ml) 3 ml (15 mg) instead of midazolam ($dormicum^{(R)}$ 5 mg / 5 ml) 3 ml (3 mg). The child fell into a deep sedation. Both cases had no complications, but the accidents happened as a result of the inexperienced dental staffs. The five times midazoalm instead of the intended doses was inadvertently given intramuscularly, fortunately caused no harm in our cases. However, the situations suggest that we should carefully check the dosage and review the correct procedures, even when using a drug that is considered to be familiar with most practitioners.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.5 no.2
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• pp.100-103
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• 2009

Dental treatment of mentally challenged patients under general anesthesia is a series of challenging procedures not only for dental operators but also for dental anesthesiologists. Patients presenting with uncooperative behavior often resist the perioperative management for adesthestic administration. This case report suggests oral premedication as a conjuctive method for anestheitic induction. A 26-year-old male dental patient with autism was referred to dental treatment under general anesthesia. The patient refused to enter dental clinic office and was not able to receive preoperative assessment. In the day of operation, 15 mg of midazolam was given to the patient for oral premedication prior to anesthetic induction. Ater 20 minutes, the patient presented with drowziness and was transferred to the office. Anesthestic staff were able to achieve appropriate intravenous access and mask inhalation. The patient recieved 8 hrs long dental treatment and recovered in a noncomplicated way. Oral midazolam is commonly used to reduce anxiety for combative and irritated pateints. In this case, oral midazolam sedation was used as a preanesthetic management of a highly uncoopearive patient.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.87-90
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• 2006

Background: There are many ways to provide superior analgesia for postoperative pain after abdominal surgery of which epidural analgesics with opioids and local analgesics are the most useful. In an effort to maximize the level of analgesia and to minimize the side effects, ketamine, midazolam, clonidine, and adrenalin can be co-administrated as an adjuvant. This study examined the analgesic effect and side effects of midazolam compared with those given an epidural injection of bupivacaine, fentanyl and ketamine. Methods: In a double blind randomized controlled trial, 50 patients received either fentanyl $0.3{\mu}g/kg/h$ and ketamine 0.1 mg/kg/h (Group FK) or fentanyl $0.3{\mu}g/kg/h$, ketamine 0.1 mg/kg/h and midazolam 0.4 mg/h (Group FKM), added to 0.125% of bupivacaine at a rate of as much as 2 ml/h, for patient controlled epidural analgesia (PCEA) after low abdominal surgery. Ten minutes before surgery, the patients received either 10 ml of 0.125% bupivacaine with 0.5 mg/kg of ketamine or 10 ml of 0.125% bupivacaine with the same amount of normal saline, added to fentanyl $50{\mu}g$. The pain score and the side effects were recorded at 1, 3, 6, and 24 hours after surgery. Results: There was no difference in the pain score except for the VAS on coughing 1 hour after surgery. FKM group had fewer side effects. Conclusions: There was a better analgesic effect and fewer side effects with the addition of epidural midazolam to bupivacaine and fentanyl with ketamine formula. However, more study on the dose and route of administration will be needed.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.4
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• pp.782-787
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• 1998

The treatment for pediatric dental patient has become more complex than the previous, because patients of pediatric dentistry, younger than the previous, and they were often combined with systemic disease. And, the importnace of conscious sedation has been increased by this time for this reason. In a variety of CNS depressants, newly developed imidazobenzodiazepine (midazolam) is well known as a safe and effective medicament. It has a rapid onset, minimized cardiovascular depression and various possible administering, route, so it is commonly used for the conscious sedation of pediatric dental patients. Recently, "intranasal drop-in method" draws attention for its safety, but discomfort during administration and posterior dripping through pharynx diminish its popularity. Now more advanced method for intranasal administration is introduced for conscious sedation for pediatric dental patients, it is "intranasal spray" with aerosol form of medicament. With this method, we can achieve some benefits as belows : 1. Diminished discomfort during intranasal spray than nitranasal drop-in. 2. Rapid osnet and reduction than intranasal drop-in. 3. Eliminatin of adverse reaction, such as rhinorrhea. 4. More improved behavior rating scale.

• Korean Journal of Clinical Pharmacy
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• v.26 no.4
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• pp.312-317
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• 2016

Objective: Midazolam is mainly metabolized by cytochrome P450 (CYP) 3A. Inhibition or induction of CYP3A can affect the pharmacological activity of midazolam. The aims of this study were to develop a population pharmacokinetic (PK) model and evaluate the effect of CYP3A-mediated interactions among ketoconazole, rifampicin, and midazolam. Methods: Three-treatment, three-period, crossover study was conducted in 24 healthy male subjects. Each subject received 1 mg midazolam (control), 1 mg midazolam after pretreatment with 400 mg ketoconazole once daily for 4 days (CYP3A inhibition phase), and 2.5 mg midazolam after pretreatment with 600 mg rifampicin once daily for 10 days (CYP3A induction phase). The population PK analysis was performed using a nonlinear mixed effect model ($NONMEM^{(R)}$ 7.2) based on plasma midazolam concentrations. The PK model was developed, and the first-order conditional estimation with interaction was applied for the model run. A three-compartment model with first-order elimination described the PK. The influence of ketoconazole and rifampicin, CYP3A5 genotype, and demographic characteristics on PK parameters was examined. Goodness-of-fit (GOF) diagnostics and visual predictive checks, as well as bootstrap were used to evaluate the adequacy of the model fit and predictions. Results: Twenty-four subjects contributed to 900 midazolam concentrations. The final parameter estimates (% relative standard error, RSE) were as follows; clearance (CL), 31.8 L/h (6.0%); inter-compartmental clearance (Q) 2, 36.4 L/h (9.7%); Q3, 7.37 L/h (12.0%), volume of distribution (V) 1, 70.7 L (3.6%), V2, 32.9 L (8.8%); and V3, 44.4 L (6.7%). The midazolam CL decreased and increased to 32.5 and 199.9% in the inhibition and induction phases, respectively, compared to that in control phase. Conclusion: A PK model for midazolam co-treatment with ketoconazole and rifampicin was developed using data of healthy volunteers, and the subject's CYP3A status influenced the midazolam PK parameters. Therefore, a population PK model with enzyme-mediated drug interactions may be useful for quantitatively predicting PK alterations.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.2
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• pp.111-114
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• 2012

Attention deficit hyperactivity disorder (ADHD) is characterized by inattention, impulsivity, and hyperactivity. Given high incidence of ADHD, many children with ADHD is likely to present for anesthesia. This case report suggests intramuscular premedication as an alternative method for anesthetic induction. A 9-year-old male patient with ADHD was transferred for dental treatment under general anesthesia. The patient refused to go into dental clinic office. Oral midazolam was given to the patient, however, he was resistant to take midazolam via oral route. Instead, we administer midazolam and ketamine via intramuscular route. After less than 10 miniutes, the patient became drowsy and was transferred to dental chair. Intravenous access and mask inhalation was possible. The patient received dental treatment under general anesthesia and recovered in a non-complicated way. In this case, intramuscular sedation with midazolam and ketamine was used as a premedication in highly uncoopearive patient refused to take oral sedative medication.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.13 no.1
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• pp.43-46
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• 2017

Patients with cerebral palsy have higher risk of traumatic dental injuries because of clinical characteristics, such as, ataxia, large overjet and lip incompetency. Especially, intrusive luxation has rare occurrence but higher incidence of complications. It can be treated by expecting re-eruption, orthodontic reposition, and surgical reposition. Clinicians should be aware of management and follow-up in dealing with cerebral palsy patients who are exposed by intrusive luxation, due to their involuntary movement. This case report describes a 9-year-old male patient with cerebral palsy and epilepsy who experienced intrusion of maxillary permanent central incisor. After one-month follow-up, waiting for spontaneous eruption, pulp necrosis on maxillary permanent central incisor had proceeded. Therefore, surgical reposition with resin wire splint and apexification was performed under conscious sedation with midazolam. After two months, removal of resin wire splint was done. Gutta percha filling and composite resin restoration were performed after sixteen months. During five-year follow-up ankylosis and partial root resorption were observed. But there was no significant complications.