• 대한치과마취과학회지
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• 제6권2호
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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 Dental Anesthesia and Pain Medicine
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• 제15권1호
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• pp.1-4
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• 2015

In pediatric dentistry, chloral hydrate is habitually selected for sedation of uncooperative children. Although chloral hydrate has been used for decades, various adverse effects are reported and necessity for new alternative drugs has increased. Dexmedetomidine was approved by FDA for sedation at intensive care units (ICU) in 1999. Compared to conventional sedative drugs, dexmedetomidine has not only analgesic and sedative effects but also it barely suppresses the respiratory system. Due to these characteristics, dexmedetomidine is known as safe sedative drug for children and elderly patients. Furthermore, approved by KFDA in 2010 in Korea, the frequency of sedation using dexmedetomidine is increasing. However, due to its intravenous administration method, it was difficult to apply in pediatric dentistry. Recently, intranasal administration method was introduced which might be a new possible alternative of oral sedation. In this study, we compare the mechanisms, pros and cons of chloral hydrate and dexmedetomidine, introducing new possibilities.

• 대한화학회지
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• 제10권4호
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• pp.149-152
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• 1966

鹽素置換 anisol과 chloral hydrate를 縮合하면 D.D.T 類의 合成에서와 같이 bis compound의 化合物이 生成될 것이고 D.D.T 系統의 化合物처럼 殺蟲能이 있으리라고 豫測되므로 4-chloro anisol 과 chloral hydrate를 縮合하여 生成物의 構造를 檢討하였던 바 2,2 bis(2-methoxy-5-chlorophenyl) 1.1.1-trichloroethane임을 確認하였으며 反應條件과 「국화꼬마수염진딧물」 및 「귤응애」에 대한 殺충能을 檢討한 結果 前報文$^{(67)}$에서 發表한 바 있는 化合物들의 殺蟲能에 比하여 5培나 强한 殺蟲能을 가졌다는 事實을 알았다.

• 대한치과마취과학회지
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• 제8권1호
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• pp.16-21
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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 sublingual 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 sublingual midazolam increased the success rate in sedation and the vital signs were stable during sedation.

• 대한소아치과학회지
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• 제24권3호
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• pp.537-542
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• 1997

Chloral hydrate is one of the most widely used sedative agents to control the difficult-to-treat young age group in the dental clinic. The normal onset time of oral Chloral hydrate is 30-45 minute with some variations. We are often frustrated see the patient still awake and cry with agitation even after far more than the normal onset time. 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 case report presents a sedative regimen that can possibly help the clinician complete scheduled treatment without postponement. We have tried additional administration of Midazolam intranasally to 22 patients of those who failed to respond properly to the initial dose(50-75mg/kg) of oral Chloral hydrate. The average age and weight of the patients was 34.2 months(22-61 mos.) and 15.2 kg(10-17 kg) respectively. Half of the regular dose of Midazolam(0.1mg/kg) was administered intranasally. using needless syringe in 42 cases without notable resistance of the patient. The onset was very rapid in most cases and colud proceed the treatment under the constant monitoring by Pulse oximeter. All the planned procedures could be completed in 93.2 % (69.4% of 'Good' plus 23.8% of 'Fair' rating)with only 6.8 %('Poor' rating) of failure rate. Evidence of adverse effect was not detected or reported during and/or after the procedures.

• 대한소아치과학회지
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• 제32권3호
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• pp.517-524
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• 2005

Chloral hydrate는 소아환자 진정요법 시 hydroxyzine과 함께 가장 일반적으로 사용되는 약물임에도 불구하고 협조도가 불량한 어린 환아들의 행동조절을 위한 적절한 용량에 대한 의견이 분분한 실정이며, 또한 chloral hydrate를 제조사의 추천 용량으로 사용 시 적절한 진정수준을 제공하는데 있어 잦은 실패를 초래하는 경우를 볼 수 있었다. 지금까지도, chloral hydrate를 사용함에 있어 약물의 용량에 따른 진정의 효과와 안전성 측면에서 많은 의견들이 존재한다. 본 연구는 소아환자 진정요법에서 chloral hydrate의 용량에 따른 진정의 효과와 안전성 측면에서 적절한 용량을 제시하고자, 소아환자 진정요법 시 제조사의 추천용량인 chloral hydrate 50mg/kg와 더 높은 용량인 70mg/kg을 hydroxyzine 2mg/kg와 50% $N_2O$와 함께 투여하고, 진정의 효과와 안전성을 비교, 평가하여 다음과 같은 결론을 얻었다. 1. 수면, 울음, 움직임, 전체적인 행동양상에 대한 두 군 간의 비교, 평가에서 II군(70mg/kg)이 I군(50mg/kg)에 비해 네 가지 항목 모두에서 유의하게 더 높은 평균값을 나타내었다(p<0.05). 2. 진정요법의 성공률에 대한 두 군 간의 평가에서 I군은 38.7%, II군은 71.0%의 성공률을 나타내었으며, 통계적으로 유의한 차이를 나타내었다(p<0.05). 3. 저산소증의 발생률에 대한 두 군 간의 평가에서 I군은 22.6%, II군은 19.4%의 발생률을 나타내었으며, 통계적으로 유의한 차이가 없었다(p>0.05).

• 대한치과마취과학회지
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• 제8권2호
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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 Dental Anesthesia and Pain Medicine
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• 제15권2호
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• pp.47-52
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• 2015

Sedation allows patients to maintain their airway independently and respond appropriately to physical stimulation and verbal command while maintaining a minimum depressed level of consciousness. Drugs commonly used for sedation of pediatric dental patients include a combination of chloral hydrate, hydroxyzine, and nitrous oxide-oxygen. Midazolam is a benzodiazepine and currently one of the most commonly used intravenous sedative agents. It can be easily titrated to provide a wide range of sedation, from conscious sedation to deep sedation, and exhibits a wide safety margin without severe respiratory and circulatory depression. At an appropriate dose, it also decreases patient anxiety and induces amnesia. We found that the submucosal administration of midazolam combined with chloral hydrate provided increased sedative effects and decreased the postoperative vomiting response compared with conventional chloral hydrate administration, with no significant difference in physiological responses. The depth of sedation can be titrated using this technique.

• 대한소아치과학회지
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• 제32권1호
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• pp.40-48
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• 2005

전신상태가 양호하며 2회 이상의 치료가 필요한 남아 10명, 여아 12명 총 22명의 환아를 대상으로 chloral hydrate($Pocral^{(R)}$ syrup, 한림제약) 60mg/kg와 hydroxyzine($Ucerax^{(R)}$정, 한국 유씨비제약) 25mg을 병용투여한 군과 midazolam($Dormicum^{(R)}$, 주, 한국로슈) 0.5mg/kg과 hydroxyzine($Ucerax^{(R)}$ syrup, 한국 유씨비제약) 25mg을 병용투여한 군을 각각 I군과 II군으로 구분하였다. 약물 투여 30분 후 치과 치료를 시행하였으며 치료과정을 6단계로 구분하여 각 단계별로 수면지수와 울음지수, 움직임지수, 전반적인 행동지수를 측정, 비교하여 다음과 같은 결과를 얻었다. 1. 전반적인 행동지수를 기준으로 성공률을 평가한 결과 I 군은 59.2%, II군은 77.3%의 성공률을 보였다(p<0.05). 2. 수면지수는 I 군에서 평균 $1.81{\pm}0.93$으로 II 군의 $1.44{\pm}0.69$에 비해 유의하게 깊은 수면상태를 보였다(p<0.05). 3. 울음치수, 움직임지수, 전반적인 행동지수는 군 간에 유의한 차이가 없었다(p>0.05). 4. 성별에 따른, 연령에 따른 군 간에 유의한 차이가 없었다(p>0.05). 위와 같은 결과를 종합하여 볼 때 midazolam의 경구투여는 적절한 진정효과를 가지는 방법으로 어린환자의 치과치료시 유용하게 사용될 수 있을 것으로 사료된다.

• 대한치과마취과학회지
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• 제6권2호
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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.