• Journal of The Korean Dental Society of Anesthesiology
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• v.6 no.2 s.11
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• pp.103-112
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• 2006

Background: The purpose of this study was to compare the clinical safety and effect with and without additional submucosal midazolam to oral chloral hydrate and hydroxyzine when used for pediatric conscious sedation in a clinical dental environment. Methods: Thirty one cases of pediatric conscious sedations were performed in this study. Selection criteria included good health (ASA I), under 6 years old, 20 kg of body weight, uncooperative behavior and the need for sedation to receive dental treatment including anesthesia and restorative or surgical procedure for at least two teeth. In each visit, patients were randomly assigned into one of two groups; CH group: chloral hydrate (60 mg/kg), hydroxyzine (1 mg/kg), CH-M group: chloral hydrate (60 mg/kg). hydroxyzine (1 mg/kg) and submucoal midazolam (0.1 mg/kg). 50% nitrous oxide-oxygen was maintained during the sedation period Sedations were monitored using a pulse oximeter for estimating pulse rate (PR) and percutaneous oxygen saturation ($SpO_2$). Behavior response rated using Houpt's scale and need of restraint was assessed every 2 minutes through 30 minutes of operative procedure reviewing the videotape recording. Evaluation of overall behavior success was performed using modified overall behavior rate of Houpt's scale. Data was analyzed using t-test. Results: PR and $SpO_2$ for both groups remained within the normal values. The mean scores for sleep and movement of CH-M group were higher than those of CH group (P < 0.05). There were no significant difference in mean score for crying between two groups. The mean scores of overall behavior of CH-M group was higher than those of CH group (P < 0.01). Reinstraint of CH-M group was less required than that of CH group (P < 0.05). Conclusions: Oral chloral hydrate (60 mg/kg) and hydroxyzine (1 mg/kg) combined with submucosal injection of midazolam was safer and showed more improved sedation effect than oral chloral hydrate (60 mg/kg) and hydroxyzine (1 mg/kg) without midazolam for sedation of pediatric dental patients.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.4
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• pp.355-361
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• 2011

Sedative method and its effect are affected by diverse variables: dosage and intake method of drug, weight, gender, patient compliance, sleeping hours prior to procedure, treatment hours, health status, type of used drugs are the factors. This study is conducted with empirical observation that shorter the sleeping hours before the day of chloral hydrate sedation, the effectiveness is larger; and therefore to actually recognize the correlation between chloral hydrate/hydroxyzine sedation and sleeping hours of child patient prior to sedation. The subjects were those children whose sleeping hours were similar to each other at the ages ranging from 2 to 5 years old totaling 37 children. Total 11 of them received pulp treatment. Sedative effect was evaluated by the same assessor with Houpt's rating scale. Sedative effect in relation with prior day's sleeping hours evaluated with simple regression analysis. Sedative effect in relation with pulp treatment was analyzed with independent t-test. Sleeping hours prior to sedation and sedation effect have negative correlation. No significant correlation is found between pulp treatment and sedation effect(p>0.05).

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.2
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• pp.127-127
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• 2008

Recently combining regimen of minimal doses of chloral hydrate, hydroxyzine and midazolam is good in sedation of children. Midazoalm, water soluble benzdiazepine, has rapid onset and relatively short duration of action. And midazolam has prospective amnesic effect. With these advantages midazolam is popular in conscious sedation for children. This study was to reveal the dose-dependency of behavior and physiologic effects of submucosal midazolam. Sedation records were surveyed retrospectively, of which the patients admitted from April, 2005 to July, 2007. we assigned three groups according the dose of midazolam, 0.1 mg/kg, 0.2 mg/kg and 0.3 mg/kg, respectively and the behavioral evaluation was analyzed with Houpt scale statistically. Combined submucosal midazolam increased the success rate in sedation and the vital signs were stable during sedation.

• Journal of The Korean Dental Society of Anesthesiology
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• v.6 no.2 s.11
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• pp.89-97
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• 2006

Background: The aim of this study was to examine the difference of $SpO_2$, PR, $EtCO_2$, RR with submucosal injection of midazolam to oral chloral hydrate and hydroxyzine for pediatric patients Methods: Thirty two sedation cases were performed in this study. Patients were randomly classified into one group taking oral CH (60 mg/kg). hydroxyzine (1 mg/kg) and submucosal injection of midazolam (0.1 mg/kg) and the other group recieving oral CH (50 mg/kg), hydroxyzine (1 mg/kg) and submucosal injection of midazolam (0.2 mg/kg). For evaluating the depth of sedation. data including saturation percentage of oxygen ($SpO_2$), pulse rate (PR), end-tidal carbon dioxide ($EtCO_2$), respiratory rate (RR) and the behavior scale were checked every 2 minutes and were collected for only 40 minutes from the beginning of treatment and were analyzed using Two independent sample T-test. Results: Analysis showed no significant difference in the mean $SpO_2$, PR, $EtCO_2$, RR during sedation between two groups (P > 0.05). The values of $SpO_2$, PR, $EtCO_2$ and RR for both groups remained within the normal values. Conclusions: The results of this present study indicate that combination of oral CH, hydroxyzine, nitrous oxide gas inhalation and submucosal injection of midazolam improved the sedation quality without compromising safety.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.1
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• pp.40-48
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• 2005

The purpose of present study was to compare the sedative effect of chloral hydrate and oral midazolam treatment. The study was conducted on twenty two child patients who required at least two visits. All the patients showed a good physical status (ASA-I). The patient was randomly assigned to receive drug either chloral hydrate 60mg/kg and hydroxyzine 25mg(Group I) or midazolam 0.5mg/kg and hydroxyzine 25mg(Group II) at each visit. Treatment procedures were divided into six stages. In each stage, sleep, crying, movement and overall behavior score were evaluated. The overall results can be summarized as follows: 1. Success rate was 59.9% in group I and was 77.8% in Group II. 2. Mean sleep score was $1.81{\pm}0.93$ in group I and was $1.44{\pm}0.69$ in group II (P<0.05). 3. Through all treatment procedures, no significant difference was observed between group I and group II in terms of crying, movement and overall behavior score(P>0.05). 4. There was no significant difference between the sex and the age(P>0.05). In regard to above results, oral midazolam considered to be a valuable drug as sedative agent in pediatric dentistry.

• Journal of the korean academy of Pediatric Dentistry
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• v.47 no.2
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• pp.109-119
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• 2020

This retrospective study assessed the effectiveness and side effects of conscious sedation using chloral hydrate, hydroxyzine, and N₂O/O₂ in the sedation of 149 pediatric patients over 188 sedation sessions, and to identify associated variables. The effectiveness of the sedation was evaluated using the Houpt scale, and was considered effective for scale categories of excellent or good. Effectiveness and side effects were assessed every 15 minutes. The effectiveness decreased and side effects increased over time. The effectiveness of sedation during 60 minutes was 57.4%, and one or more side effects occurred in 18.1% of sessions. Effectiveness of sedation increased with body mass index (BMI). When patients were sedated at the beginning of the procedure, the effectiveness was greater. Side effects increased with patient age. When sedation was divided into two sessions, the number of sedation did not affect the effectiveness or side effects. It can be suggested that sedation should be performed over two separate sessions, as a single prolonged session may lead to reduced effectiveness and increased side effects. To maximize effectiveness and minimize side effects, several variables such as BMI, whether to sedate at the beginning of the procedure and age should be considered thoroughly before sedation.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.3
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• pp.517-524
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• 2005

Despite the widespread use of chloral hydrate with hydroxyzine in the sedation of children, there is little agreement among pediatric dentists regarding its therapeutic dosage for the management of very uncooperative young children. Also, increasing concern has been raised with respect to its frequent failure to provide adequate levels of sedation when used according to the manufacturer's recommended dosage. Therefore, there has been many suggestions with respect to sedative effectiveness and safety of varying drug dosage, and some pediatric dental articles have advocated dosages exceeding manufacturer's recommendations. This study was performed to compare the effectiveness and safety in behavior management of the manufacturer's recommended dose of chloral hydrate(50mg/kg) with those of a higher dose(70mg/kg) used together with hydroxyzine(2mg/kg) and nitrous oxide(50%) when young children were sedated for dental treatment. The following results were obtained; 1. II group(70mg/kg) displayed higher mean score compared to I group(50mg/kg) with regard to the degree of sleep, crying, movement and overall behavior. The difference was statistically significant(p<0.05). 2. In comparison of success rates for sedation between the two groups, I group and II group showed 38.7% and 71.0% success rates respectively. An analysis of variance was statistically significant(p<0.05). 3. Comparing the occurrence rate hypoxia between the two groups, there were 22.6% and 19.4% occurrence of hypoxia in I group and II group. An analysis of variance was not statistically significant(p>0.05).

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.2 no.2
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• pp.142-146
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• 2006

Oral administration of chloral hydrate with hydroxyzine, nitrous oxide inhalation and intramuscular or intranasal administration of midazolam is the most commonly used pharmacological behavior management methods for the children in pre-cooperative stage or show negative behavior in pediatric dentistry. For oral administration of chloral hydrate with hydroxyzine, it is hard to apply to the patient refused to intake and with overweighted or elderly children and the effect of the drug decrease. Nitrous oxide and midazolam is anxiolytic agents and have limitation for properly managing the behavior of the children refuse to dental treatment. These occasions, deep sedation or general anesthesia can be considered. Although intravenous sedation with midazolam has many advantages such as, rapid onset and recovery, possible to titration and few side effect, no rebound effect by metabolites, the reports for, intravenous sedation with midazolam is insufficient in pediatric dentistry. We report the case in pre-cooperative stage. He is treated successfully under intravenous sedation with midazolam.

• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.2
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• pp.234-246
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• 2007

The combination of chloral hydrate and hydroxyzine is one of the safest and most commonly used drug regimens for sedating young, uncooperative pediatric dental patients. Midazolam IM or IN and $N_2O/O_2$ inhalation is sometimes administered with chloral hydrate and hydroxyzinecombination when deeper and longer sedation is needed. The purpose of this study was to assess the outcome and safety of chloral hydrate, hydroxyzine and $N_2O/O_2$ in the sedation of a large number of uncooperative pediatric dental patients and to identify variables associated with their effectiveness. In a nine-month retrospective study, 171 records of sedation performed in 94 healthy children(male 46, female 48) with mean age of $30{\pm}8$ months were reviewed. The authors analyzed several variables such as age, sex, weight, methods of drug delivery, waiting time after drug delivery, treatment rendered, treatment time, adverse events, sedation outcome. Eighty five percent of sedation had success behavioral outcome. Sedation sessions rated success used more $N_2O/O_2$ administration and had longer treatment duration than sedation sessions rated failure. A children patient under 36 months of age had enough sleep by only oral administration and the mean waiting time of this case was significantly shorter than that of a children patient over 36 months of age. There was a clear correlation between age and $N_2O/O_2$ using tine, but no correlation between weight and $N_2O/O_2$ using time. There was no statistically significant difference among variables of treatment duration, $N_2O/O_2$ administration and adverse event.

• Journal of the korean academy of Pediatric Dentistry
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• v.27 no.4
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• pp.505-516
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• 2000

Chloral hydrate is one of the most widely used sedative agents to control the difficult-to-treat young age group in the dental clinic. We are often frustrated to see the patient still awake and cry with agitation even after far more than the normal onset time of Chloral hydrate. 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 study was designed to test the efficacy of one sedative regimen that can possibly help the clinician complete scheduled treatment without postponement. We have tried sleep induction with mixed gas of Enflurane(2vol%) and $N_2O(50%)-O_2(50%)$ for $60\sim120$ seconds to 35 patients of those who failed to respond properly to the dose(70mg/kg)of oral Chloral hydrate. The Result of this regimen was compare to those of two oral regimen of Chloral hydrate/Hydroxyzine and Chloral hydrate only Analyses of result on vital signs and behavior pattern were performed. The outcome of the study suggest that sleep induction by a short inhalation of low dose of $Enflurane/N_2O-O_2$ provide dentist with suitable condition for the completion of scheduled treatment in the patient who failed to oral Chloral hydrate. Evidence of adverse effect was not detected or reported during and/or after the procedures.