• Journal of the korean academy of Pediatric Dentistry
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• v.23 no.4
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• pp.937-945
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• 1996

Nitrous oxide has acquired widespread use as a tool for management of anxious and comprehensive pediatric dental patients. Clinical impressions have suggested that inhalation sedation with $N_2O/O_2$ reinforces the effect of other sedatives. Fifteen uncooperative children, mean age of 37months, who were regarded as fail in the first treatment using chloral hydrate-hydroxyzine orally, midazolam orally or intranasally, were sedated with the same sedatives in conjunction with $N_2O/O_2$. All the children were restrained in a pediwrap and were monitored with pulse oximeter for their heart rate and oxygen saturation. Degree of sleep, crying and movement were evaluated. The clinical results indicated that a satisfactory level of sedation was achieved in approximately two thirds of the cases (about 66 %) under those sedation manner. Complications were rare and those of treatments were successfully completed without difficulty.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.2
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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.

• Clinical and Experimental Pediatrics
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• v.62 no.2
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• pp.75-78
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• 2019

Although rare, antihistamines can cause adverse effects, including drug-induced eruptions or anaphylaxis. A 4-year-old child visited the pediatric department of a hospital for skin eruptions after administration of antihistamines, (e.g., ucerax [hydroxyzine] or leptizine [levocetirizine]), for cholinergic rashes; he did not have pruritus. Skin prick, intradermal, and drug provocation tests were performed to determine the relationship between the antihistamines and eruptions. Levocetirizine induced wheals in the skin prick test and a rash in the oral drug provocation test. In contrast, ketotifen induced no reaction in the skin prick test but showed a positive reaction in the oral provocation test. Our case report highlights that children can experience the same types of adverse reactions as seen in adults, and cross-reactivity between various antihistamines can occur.

• 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).

• Korean Journal of Clinical Pharmacy
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• v.22 no.2
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• pp.176-180
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• 2012

The stability of triamcinolone in three kinds of oral liquid syrups at 4 and $25^{\circ}C$ was studied for 21 days. Twenty tablets of 4 mg triamcinolone were mixed with 100 mL of each oral liquid syrup, which is Levotuss$^{(R)}$Syrup (levodropropizine 6 mg/mL), Ucerax$^{(R)}$Syrup (hydroxyzine 2 mg/mL), and Xyzal$^{(R)}$Liquid (levocetirizine 0.5 mg/mL). The chromatographic analysis after deliberate degradation showed no evidence of any breakdown product likely to interfere with the chromatographic peak of the parent substance. The relationship between triamcinolone concentrations and peak areas was linear from 50 to 1000 ${\mu}g/mL$ ($r^2$ = 0.9998). The analysis method was precise, with coefficients of variation no greater than 5.4%. Triamcinolone was stable for up to 14 and 21 days in Levotuss$^{(R)}$Syrup at 25 and $4^{\circ}C$, respectively; in Ucerax$^{(R)}$Syrup and Xyzal$^{(R)}$Syrup, it was stable for at least 21 days at both temperatures. The percentages of initial triamcinolone concentration remaining after 21 days were $72.3{\pm}3.2$ and $94.9{\pm}6.0%$ and $93.2{\pm}4.9$ and $92.4{\pm}5.7%$, and $92.6{\pm}1.2$ and $92.7{\pm}2.2%$ in Levotuss$^{(R)}$Syrup, Ucerax$^{(R)}$Syrup, and Xyzal$^{(R)}$Syrup at 25 and $4^{\circ}C$, respectively. The pH variations of all test solutions were within 0.8. Based on the results, it was concluded that triamcinolone in three oral liquid syrups which are Levotuss$^{(R)}$syrup, Ucerax$^{(R)}$syrup and Xyzal$^{(R)}$syrup was chemically and physically stable in both states of refrigeration and room temperature for at least 14 days.

• Korean Journal of Clinical Pharmacy
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• v.15 no.2
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• pp.149-159
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• 2005

Purpose: To determine the extent and rate of prescription drug therapy, especially polypharmacy and the prevalence of potentially inappropriate medication use in Korean elderly ambulatory patients based on an explicit criterion. Methods: Performed a retrospective study of 65 years or older ambulatory patients visiting a university hospital based clinic from January 2002 to April 2004. Study determined the patterns of drug prescription per Anatomical Therapeutic Chemical Classification and the potentially inappropriate medication usage based on explicit Beers criteria. Results: Of the 4,042 elderly patients the mean number of prescription was $2.2{\pm}2.0$, which was similar between genders and all age groups within the elderly. 10.7% of patients were prescribed with more than 5 medications concurrently. The most frequently prescribed medication was the drugs used for treating nervous system diseases (44.3%), followed by alimentary tract/metabolism disorders (27.6%), cardiovascular disease (10.7%), blood/blood forming disorders (4.3%), respiratory disorders (6.5%), and musculoskeletal diseases (3.2%). A total of 511 elderly (13%) was prescribed with medication that met the criteria for=1 potentially inappropriate drugs for the elderly. This proportion was similar between genders and all age groups within the elderly. Among these 511 elderly patients the mean number of potentially inappropriate drugs prescribed was $5.1{\pm}3.3$ drugs. Potentially inappropriately prescribed drugs included amitriptyline (76 cases), diazepam (69 cases), ketorolac (57 cases), short acting nifedipine (44 cases), triazolam (38 cases), and hydroxyzine (38 cases). Conclusion: Potentially inappropriate drug prescribing in Korean ambulatory elderly patients are common. Education programs and interventions aimed at optimizing the prescribing and dispensing of the most appropriate drugs are needed.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.4
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• pp.213-220
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• 2015

Background: Pediatric dentists face challenges when young patients require a mesiodens extraction. General anesthesia may be a burden to the child as well as the parent due to dental fears and costs. The aim of this study was to evaluate oral and intravenous sedation in the outpatient setting as a safe and effective means of managing patients who require a mesiodens extraction. Methods: Records were reviewed retrospectively to find patients who underwent a mesiodens removal procedure from January 2013 to September 2014 in the Department of Pediatric Dentistry at Ajou University Hospital (Suwon, Gyeonggi-do, Republic of Korea). A total of 81 patients (62 male and 19 female) between 4 and 11 years of age (mean [${\pm}SD$] $81.6{\pm}14.1$ months) were studied, with a mean weight of $22.9{\pm}3.3kg$ (16 kg to 30 kg). Vital signs, sedation drug dosage, and sedation time were studied. Results: Mean doses of $63.7{\pm}2.5mg/kg$ chloral hydrate and $1.36{\pm}0.22mg/kg$ hydroxyzine were used for oral sedation. Nitrous oxide/oxygen was administrated for $40.0{\pm}2.1$ min. The mean dose of midazolam administered intravenously was $0.14{\pm}0.06mg/kg$ ($2.38{\pm}0.97$ times). In all cases, the mesiodens was removed successfully. Conclusions: Intravenous sedation combined with oral sedation and nitrous oxide/oxygen inhalation can be an alternative to general anesthesia when administrated and monitored properly.

• Journal of the korean academy of Pediatric Dentistry
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• v.24 no.4
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• pp.823-829
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• 1997

The patients visiting pediatric dental office have been being younger than the previous, and they were often combined with systemic disease. But, we aren't able to perform the verbal communication, because of their impediment and youthfullness. And, we can't carry out the behavior control via physical restraint, as the developed social structure and the attitude of children and their parents. So, the importance and concerning of conscious sedation using sedative medicine are increased by time and time. Among the various conscious sedation, Chloral Hydrate and Nitrous Oxide inhalation are most popularly used, and barbiturates, benzodiazepine, opioids and hydroxyzine are used often. But, these medications have some side-effects and adverse reactions, may be failed to sedate the children. And limited use of medically compromised patients, especially for ASA class III, IV or more dangerous patients. We, the Department of Pediatric Dentistry, Chosun University have met some dangerous situation due to unfavorable pharmacogenic reactions, but we can control the situation and get well healed results. The below results are common situations and their solutions during conscious sedation. 1. By the intravenous administration, thrombophlebitis is the most common side-effects, but it may be healed with time without any special treatment. 2. Under the definitive guidelines about conscious-sedation, we can perform a safe conscious sedation for ASA class III patients. 3. When adversed reaction of Benzodiazepine is occured, it could be cared effectively with benzodiazepine antagonist, named Flumazenil.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.3
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• pp.525-532
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• 1998

The autism is a complex disorder, characterized language impairment, perceptual-motor difficulties, and social disturbance. The autistic children have hyperactivity, lack of communication' lack of cooperation, inappropriate patient/dentist interaction, so they require professionally recognized behavioral management technique during dental treatment such as behavior modification, phamacological agents, and general anesthesia. A behavior management technique can be chosen by factors such as the severity of autism and possible accompanying disabilities, degree of cooperation, oral and general conditions of children. A non-pharmacological behavior modification may be selected for the autistic children who are able to communicate with dentist with mild dental caries, without compromised medical history. In case of excessively hyperactive, destructive, antisocial, and/or severe communicative disorder, a sedation technic with chloral hydrate, hydroxyzine, midazolam or nitrous oxide gas might to be performed. General anesthesia is preferred for severe communicative and/or behavioral disorder, elder age, excessive dental care need, and living a remote area.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.11 no.2
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• pp.76-80
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• 2015

Mental retardation is one of the major disorders covered in special care dentistry. Patients show poor oral health and are a challenge for the dentist due to lack of cooperation. Triazolam is a short-acting benzodiazepine and has been used in the dental office for many years because of its favorable properties. In this study, five patients with mental retardation were sedated with triazolam on a dental out-patient setting. Patients were administrated with 0.25 mg or 0.5 mg of triazolam on the first dose according to the patient's cooperation. Twenty minutes after the initial dose, patients received 0.25 mg of triazolam. Triazolam was administrated sublingually to one patient and orally to four patients. Hydroxyzine was also administrated to three patients in order to prevent nausea and vomiting. All patients were inhaled with 50% nitrous oxide during the sedation. Treatment time ranged from 20 minutes to 55 minutes. Two patients showed paradoxical reactions and were administrated with intramuscular injections of flumazenil. In result, depending on the range of dental treatment and level of intellectual disability, we can assume that triazolam may be beneficial for sedation in disabled patients.