• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.337-344
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• 2001

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. The continuous monitoring of respiratory function and early recognition of respiratory difficulties are essential for the successful management of sedated dental patients. The purpose of this study was to evaluate the success rate of the sedation and the hypoxia through monitoring the oxygen desaturation in the pulse oximeter in pediatric dental patients sedated with 60mg/kg chloral hydrate and 25mg hydroxyzine. The following results were obtained : 1. The success rate of the sedation was 69.6% and there was no statistically significant difference among the groups based on the ages, weight and duration of the operative time. 2. Forty two percentage of the sedated patients showed the temporary hypoxia state and there was no statistically significant difference based on the ages and weights of the patients. But there was a statistically significant difference on the duration of the operative time.

• Journal of the korean academy of Pediatric Dentistry
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• v.47 no.1
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• pp.53-61
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• 2020

Midazolam is a short-acting benzodiazepine that is widely used in pediatric dental sedation. However, its clinical effectiveness as an intravenous sedative agent in children has not been widely documented. A retrospective study was conducted to evaluate the efficacy and safety of intravenous midazolam and nitrous oxide inhalation sedation in pediatric dental treatment. The subjects were 115 patients (118 cases) who received dental treatment under intravenous midazolam and nitrous oxide inhalation sedation. Demographic factors, general health status, sedation time, midazolam and nitrous oxide dosage, and success rate of sedation were evaluated from electronic medical records. Behavioral management was the main reason of choosing sedation. Mean duration of sedation was 56.7 minutes for surgical treatment, and 74.4 minutes for restorative treatment. The initial dosage of intravenous midazolam was 0.051 ± 0.019 mg/kg. In 34 cases (28.8%), additional midazolam of 0.036 ± 0.057 mg/kg was delivered during the treatment. The concentration of nitrous oxide was maintained between 40% and 50%. The success rate of sedation was 99% (n = 117). In 1 case, laryngospasm occurred and the patient was reversed with benzodiazepine antagonist, flumazenil. Intravenous midazolam sedation with nitrous oxide was shown to be clinically effective for the dental treatment in children, if administered by trained personnel and patients are carefully selected in accordance with guidelines.

• Journal of the korean academy of Pediatric Dentistry
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• v.41 no.4
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• pp.283-291
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• 2014

Patients with extreme anxiety who are unable to cope with dental treatment under non-pharmacological behavioral management method may require sedation, or other forms pharmacological behavioral management method. The aim of this retrospective study was to investigate the effect of concomitant administration of 0.1 mg/kg intramuscular midazolam with or without sevoflurane insufflation sedation on sedation depth and cardiopulmonary function in pediatric patients. We analysed the records of anesthesia on patients who received dental treatment under deep sedation using sevoflurane insufflation from January 2013 to March 2014. Thirty-six children, aged 3 to 6 years, undergoing dental treatment were sedated using either sevoflurane insufflation alone (Group S, n = 18) or a combination of intramuscular injection of 0.1 mg/kg midazolam plus sevoflurane insufflation (Group SM, n = 18). Upon comparison, the average entropy value of group SM was lower than that of group S, but there were no statistically significant difference between the two groups (p > 0.05). The average heart rate and mean arterial pressure of group SM were higher than those of group S (p < 0.05). Concomitant intramuscular injection of 0.1 mg/kg midazolam with sevoflurane insufflation sedation is not sufficient to enhance the quality of sedation.

• Journal of The Korean Dental Society of Anesthesiology
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• v.5 no.1 s.8
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• pp.6-14
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• 2005

Chronic periodontitis is one of the most common diseases in clinical dentistry, which requires various surgical interventions to treat the moderately to severely destructed supporting periodontium. Most patients have anxiety and fear to these surgical procedures and dentists often have problems dealing with these patients. By applying the conscious sedation technique in outpatient units, periodontists have become able to manage their patients successfully with less anxiety or fear. Also, we have experienced the increased level of patients' satisfaction. Generally, periodontal treatments are time consuming procedures and patients are usually reluctant to the periodontal instruments. This study is focused on the sedation procedure with intravenous midazolam infusion performed in Department of Periodontology of Ewha Womans University Hospital. Using questionnaires, we evaluated 80 randomly selected patients for the anxiolytic effect of intravenous midazolam. Anxiety control using IV sedation was very helpful in performing various periodontal reconstructive and advanced surgical procedures in implant dentistry.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.1
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• pp.9-12
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• 2013

General anesthesia has been developed in dentistry as a type of management technique to sedate patients who may be uncontrollable or require medical consideration. However, emergency treatment for controlling pain before general anesthesia could be required due to the time for medical evaluation for general anesthesia. There is a greater possibility of developing complications under extended waiting period. A disabled patient who needs dental treatment under general anesthesia underwent pretreatment with intramuscular injection of midazolam and $N_2O-O_2$ inhalation sedation in these cases report.

• Journal of dental hygiene science
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• v.14 no.3
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• pp.411-416
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• 2014

The purpose of this study was to examine the effects of conscious sedation on pain and anxiety of patients in implant surgery. A total of 95 patients who underwent implant surgery were included in the study. In this study, the patient's anxiety and pain to evaluate the pre-operative Visual Analogue Scale (VAS), during-operative Pain Question (PQ), post-operative (Short-form McGill Pain Questionnaire [SF-MPQ], VAS) was used for tools such as questionnaires. The data were analyzed using the chi-squire, independent-samples t-test, multiple linear regression analysis. As a result, the pain reduction was significantly different between the sedative dental treatment and non-sedative dental treatment (p<0.05). The finding of the study multiple linear regression analysis showed that operation time, implant surgery experience, gender, age, operation form and Pain Catastrophizing Scale (PCS) with factors that affect the pain and anxiety (p<0.05). According to the results of the study, considered to be necessary to develop intervention strategies effective using the PCS when managing pain and anxiety of behavior management of this implant patient. Thus, it is advised to provide necessary practical guidelines and dental utilization behaviors on patients with conscious 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.42 no.4
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• pp.331-339
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• 2015

The first priority of sedation for incorporative children in pediatric dentistry is a safety. Therefore, evidence-based practices in health care are needed for preventing medical accidents. In accordance with the rise of the evidence based medicine, the interest in Evidence-Based Dentistry is increasing in the field of dentistry. However, systematic research about Evidence-Based sedation in Korea has rarely been done. As such, the purpose of this systematic review is to critically analyze the available scientific literature regarding dental sedation and to seek the next developmental strategies about evidence based pediatric dental sedation. A broad search of the 5 databases of the systematic reviews manual of the National Evidence-based Healthcare Collaborating Agency in Korea were referenced: 1) Core search database- KMbase, KISS; 2) Academic information and portal; 3) the National Assembly Library; 4) DBpia, and 5) RISS. Of a total 470 themes limited to the search term of "dental sedation", in accordance with the PRISMA statement for reporting systematic reviews of health sciences interventions, a literature selection process, which includes the removal of overlapping down the flow chart, was performed. Of the remaining 31 articles, two authors read through articles independently and added or removed articles using the exclusion criteria. Finally, twenty published papers of acceptable quality were identified and reviewed. This systemic review of Korean pediatric dental sedation practices for the last twenty-five years was based on the objective criteria defined in the GRADE process and identified consistent evidence. The results were evidence of moderate quality. Therefore, more systemically well-designed clinical studies are needed about the safe use of a sedative medicines (drugs).

• Journal of the korean academy of Pediatric Dentistry
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• v.45 no.2
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• pp.154-161
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• 2018

Sedation is a useful behavior management technique for dental patients who may be uncontrollable or have medical problems. The aim of this study is to investigate the changes in patterns of sedative treatments in pediatric dentistry by analyzing the distribution of patients and used sedative agents. Patients and sedative agents were reviewed based on the electronic medical records (EMR) of the department of pediatric dentistry in Yonsei University Dental Hospital from 2011 to 2016. The number of patients who were treated under sedation generally increased. Male received more sedation treatment than female by 2014, and they became similar from 2015. The treatment percentage of patients with systemic disease decreased in 2013, remained constantly afterwards. The ratio of sedative treatment for the age 4 - 5 and age 6 - 10 generally increased, while that of the age 0 - 2 and older than age 11 decreased. The ratio of the age 3 remained steady. Nitrous oxide was the most frequently used sedative agent. The use of benzodiazepine increased while the use of chloral hydrate decreased. Although the use of sedation has expanded, multidimensional approaches for ensuring safety have been less focused. Therefore, it is necessary to explore further studies for the safety and efficacy of the use of sedation.

• Journal of the korean academy of Pediatric Dentistry
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• v.37 no.3
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• pp.338-344
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• 2010

The purpose of this study was to evaluate the effect of children's tonsil size on the behavior during pediatric dental sedation. The sedation records of thirty five children were examined in this study. All the sedations had been performed using chloral hydrate/hydroxyzine, nitrous oxide/oxygen or/and submucosal midazolam, and the subjects were divided into 4 groups according to their tonsil size using Brodsky's tonsil classification. The results were as follows: 1. The patients with enlarged tonsils showed negative behaviors in all behavior rating aspects(sleep, movement, crying, overall behavior) during sedation than those with normal tonsils(p<0.05). 2. Enlarged tonsils were correlated with mouth breathing(p<0.05) but not with snoring and coughing(p>0.05) during sedation. 3. For the patients with enlarged tonsils, significantly higher doses of midazolam were administered during sedation than for those with normal tonsils(p<0.05).