• Journal of the korean academy of Pediatric Dentistry
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• v.31 no.3
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• pp.412-420
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• 2004

The purpose of this study was to assess the anterograde amnesic effect of Midazolam administrated by intranasal and oral route. Fifteen healthy volunteers(ASA I) were administrated with placebo, oral Midazolam(15mg), intranasal Midazolam(0.25mg/kg) every 2 weeks. First picture cards were shown to volunteers before medication. At 15, 30, 45 minutes, other picture cards were shown to volunteers. BP, $SpO_2$ and sedation scores were measured. After 24 hours, the volunteers were questioned about their memory of pictures. To assess amnesic effect, recall and recognition test were performed using a series of picture cards designed for this purpose. The obtained results were as follows; 1. Compared to placebo, Midazolam group(oral and intranasal) experienced a significant anterograde amnesic effect(P<0.01) 2. There was no difference between oral and intranasal Midazolam(P>0.01). 3. Anterograde amnesic effect of oral and intranasal Midazolam group began at 15minutes. It became increasingly, oral Midazolam group experienced extremely amnesic effect at 45minutes, intranasal Midazolam group was at 30minutes. 4. After 30minutes of Midazolam administration, anterograde amnesia of oral Midazolam group is more effective than intranasal Midazolam group.

• Journal of the korean academy of Pediatric Dentistry
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• v.27 no.2
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• pp.283-291
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• 2000

The purpose of this study was to compare the sedative effect of three routes of administration - intramuscular, intranasal drop-in, intranasal spray - with midazolam. The twenty two uncooperative children from 23 months to 76 months who required at least three dental appointment. Each patient was assigned randomly to receive intramuscular(Group I, 0.15mg/kg), intranasal drop-in(Group II, 0.20mg/kg), intranasal spray(Group III, 0.20mg/kg) administration at each visit. Sleep, crying, movement, and overall behavior response were evaluated, and the sedative effects were evaluated by Houpt's rating scale In order to monitor the sedated patients, pulse rate and peripheral oxygen saturation were measured by pulse oximeter during treatment procedures. The results were as follows 1. Pulse rate and peripheral oxygen saturation were stable through all the treatment procedures, and there were no statistically significant differences among three routes of administration(P>0.05). 2. The effect on sleep was, III, II, I, in order, III group was the most effective through all the treatment procedures, except rubber-dam placement and filling phase (P<0.0001). 3. The effects on crying, movement, overall behavior were II, III, I, in order, II group was the most effective through all treatment procedures(P<0.0001).

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.3
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• pp.499-508
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• 2005

The purpose of this study were to evaluate the effect on the reversion of sedation induced by midazolam with flumazenil and to determine the plasma concentration of flumazenil according to the method of administration. Intranasal and intravenous flumazenil were administered to sedated health volunteers aged from 23 to 25 years, in doses typical of those used clinically to induce sedation with midazolam and for reversal with flumazenil. Objective assessment for degree of sedation and vital signs, plasma concentration were made for 2 hours period. 1. Systolic and diastolic blood pressure, $SpO_2$ were not changed by adminstration of flumazenil in sedated subject with midazolam, but pulse rate was increased temporarily. 2. Flumazenil showed the reversal of the sedative effect induced by midazolam regardless of administration methods. But intravenous administration showed more effect on the degree and the duration of reversion than intranasal administration with the exception of on set time. 3. Peak plasma concentration of flumazenil administered by intranasal route reached after 2 min and that of flumazenil administered by intravenous route was 4 min. Thus uptake of flumazenil did not showed any difference in accordance with the adminstration route. 4. Administration of flumazenil resulted in the temporary increase of midazolam plasma concentration.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.2
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• pp.159-167
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• 2002

The purpose of this study was to evaluate the efficacy and safety depending on the route of flumazenil, as an antagonist against midazolam. The subjects of this study were 15 volunteers of $22{\sim}24$ years old. They were sedated with midazolam 0.2mg/Kg intranasal spray, and then 40 minutes after midazolam administration, they were given flumazenil 0.2mg intranasal spray for their reversal. For evaluation of the efficacy and safety of intranasal spray for flumazenil, they were monitored with pulse-oxymeter(Nellcor symphony N-3000, Nellcor Puritan CO. USA) and electric sphygmomanometer (Heartcare 200, National CO. Japan), and were assessed themselves using visual analogue scale(VAS) for tranquilization, sleep, fatigue and attitude. All of these subjects were reduced completely without any undesired situations. The results from this study can be summarized as follows ; 1. Nasaly administered flumazenil using spray device produced much more rapid reduction than intravenously administered flumazenil, but soon after fell in more deep sedated state than intravenously administered flumazenil. 2. There were no considerable side effects or bad influence on vital signs of both nasaly administered flumazenil and intravenously administered flumazenil. These results suggested that the flumazenil administered nasaly using spray device for reversal, we could treat patients safely and effectively under conscious sedation using midazolam administration. But, We will have to research about its optimal dosages for flumazenil, used as intranasal spray for reversal agents against the midazolam by evaluating the blood plasma concentration of midazolam and flumazenil.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.3
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• pp.427-436
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• 2008

Purpose. The objective of this study was to evaluate the behavioral response and assess the effectiveness of additional intranasal (IN) and submucosal (SM) administration of midazolam during pediatric sedation for dental procedure. Material and methods. Thirty-three cases of healthy (ASAⅠ), uncooperative children aged from 24 to 72 month old at pediatric dental clinic of Ewha Womans University Hospital were selected for this study. Children received oral chloral hydrate 50 mg/kg with hydroxyzine 1.0 mg/kg. After waiting for 45 minutes, midazolam 0.2 mg/kg was administrated via IN route and via SM route randomly maintaining 50% of $N_2O$. A pulse oximeter and a capnograph were used for measuring vital signs ($SpO_2$, PR, RR, $EtCO_2$) throughout the sedation. Behavioral response was evaluated as Quiet (Q), Crying (C), Movement (M) or Struggling (S) in every 2 minutes for 40 minutes. Results. There were also no statistically significant differences in vital signs of the two groups. The behavioral response for the first ten minutes during sedation was a statistically significant difference (P < 0.05) between the two groups. After the first ten minutes, it was revealed that there was no significant difference. Conclusion. This study demonstrated that the addition of IN midazolam to the combination of oral chloral hydrate with hydroxyzine and nitrous oxide/oxygen inhalation is as safe and effective as that of SM midazolam in pediatric sedation for dental procedure.

• Journal of the korean academy of Pediatric Dentistry
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• v.39 no.1
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• pp.11-16
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• 2012

Effect of supplementary intranasal midazolam on oral sedation of children The purpose of this study was to compare the cardiopulmonary parameters of two sedation regimens during dental treatment: (1) Oral chloral hydrate(CH) and hydroxyzine(HZ) with nitrous oxide-oxygen($N_2O/O_2$) inhalation(CH-HZ group); (2) Oral chloral hydrate(CH) and hydroxyzine(HZ) with nitrous oxide-oxygen($N_2O/O_2$) inhalation and supplementary intranasal(IN) midazolam administration(MIDA group). Among the patients of OO hospital who received dental treatment under sedation over the past 5 years, 44 patients were selected for each group of CH-HZ and MIDA according to their age, gender and weight. Following parameters that were recorded every 5 minutes were compared: 1) Heart rate(HR) 2) $O_2$ saturation 3) End tidal carbon dioxide concentration($EtCO_2$) 4) Respiratory rate(RR) 33 patients of Group MIDA who have complete data of 15 minutes before and after supplementary IN midazolam administration were selected. And measurements 15 minutes before and after midazolam administration in same patient were evaluated. The results were as follows: 1. Heart rate was significantly higher in MIDA group than in CH-HZ group, but it was within normal range. 2. Comparing HR, $O_2$ saturation, EtCO2, RR between before and after of supplementary IN midazolam administration in the same patient, the differences were not statistically significant.

• Tuberculosis and Respiratory Diseases
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• v.65 no.2
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• pp.121-124
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• 2008

We experienced a rare case of sinonasal sarcoidosis initially presenting as nasal cavitary mass. When the clinical course was different from that of typical tuberculosis, physician should think the possibility of sarcoidosis, and re-biopsy or retrospective review of pathological findings might be helpful.

• Clinical and Experimental Pediatrics
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• v.45 no.7
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• pp.875-883
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• 2002

Purpose : Airways eosinophilia and increased IgE, characteristic features of asthma, result from a predominant Th2 response. In this study, we investigated the effect of CpG oligodeoxynucleotides (ODNs) on the inhibition of airways eosinophilia in mice with established airway inflammation. We also investigated the immunological mechanisms involved. Methods : Groups of BALB/c mice were sensitized intradermally with ovalbumin(OVA). At week 10, airway inflammation was induced by intranasal challenge of the mice with OVA. At week 14, the mice were challenged intranasally again with OVA in the presence and without the presence of CpG ODNs. Mice with saline administration served as negative controls. Bronchoalveolar lavage fluids(BALF) were obtained and eosinophils were counted. Th1 and Th2 cytokines in the spleen cell cultures were measured by ELISA. Serum OVA-specific IgE and IgG2a antibodies were also measured by ELISA. Results : BALF eosinophils were significantly inhibited in the CpG ODNs-treated mice(P<0.01). IgE and IgG2a levels increased significantly in both CpG ODNs-treated and untreated groups as compared to the negative control group; there was, however, no significant difference between the two groups four days after intranasal administration of CpG ODNs. Cytokine analysis revealed decreased production of IL-4, IL-5, and IL-13 and increased production of IL-12 in the CpG ODNs-treated group as compared to the untreated group. Interestingly, $IFN-{\gamma}$ levels were not upregulated in the CpG ODNs-treated group. Conclusion : CpG ODNs vaccination is a potentially useful approach for reversing airways eosinophilia in mice with established airways inflammation.

• 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.

• Clinical and Experimental Pediatrics
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• v.46 no.12
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• pp.1200-1206
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• 2003

Purpose : This study was conducted for the use of nasal continuous positive airway pressure (CPAP), by comparing the early use of non-invasive nasal CPAP with low intermittent mandatory ventilation(low IMV) and endotracheal CPAP in weaning a mechanical ventilator from infants with moderate respiratory distress syndrome(RDS). Methods : Thirty infants in the study group, with moderate RDS from November 2001 to June 2002, were administered surfactants and treated with the mechanical ventilator, and applied the nasal CPAP in weaning. Thirty infants of the control group, from January 1999 to September 2001, were applied low IMV and endoctracheal CPAP in weaning. Results : There were no significant differences in the characteristics, the severity of clinical symptoms, the initial laboratory findings and settings of the mechanical ventilator. After weaning, the study group showed no significant changes in $PaCO_2$. However, the control group showed a slight $CO_2$ retension after one and 12 hours. Twenty eight infants(93.3%) of the study group and 24 infants(80%) of the control group were successfully extubated. The primary cause of failure was apnea. There were no significant differences in the duration of weaning and the mechanical ventilator treatment between the groups. Complications in weaning were related to the fixation of nasal CPAP and the mechanical problems caused by endotracheal tube. Conclusion : Aggressive weaning is possible for moderate RDS, in which the nasal CPAP was used without the low IMV and the endotracheal CPAP process. It had no difficulties. In conclusion, the nasal CPAP is an adequate weaning method for moderate RDS.