• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.1
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• pp.53-61
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• 2006

When routine behavior control is impossible, midazolam is often used for sedation, because it has wide margin of safety, relatively few side-effects and multiple route of administration. Although intramuscular administration of all administration route is frequently used, it is a major source of anxiety, discomfort, and trauma in children. To the contrary, oral administration of midazolam is easily administered and accepted by children. But, it's therapeutic drug concentration has not been established. The purpose of this study was to compare sedation effect and physiologic parameter of oral midazolam which palliate demerits of intramuscular administration in sedating young pediatric patients with intramuscular midazolam Twelve negative children, mean age 62.5 months, who needed at least two separate restorative visits, requiring local anesthesia participated in this study On every visit, one of the following 2 different sedative regimen was given : (1) 0.30mg/kg midazolam by intramuscular administration (2) 0.75mg/kg by oral administration. Physiologic parameter(oxygen saturation, heart rate) was recorded by ten procedure and behavior was videotaped and rated using Ohio State University Behavior Rating Scale and Automated Counting System by one investigator, blind to administration route The analyzed sedative effect of oral midazolam resulted in good sedative effect, comparing to intramuscular route, And there is no statistically difference between oral and intramuscular administration of midazolam (p>0.05).

• Journal of The Korean Dental Society of Anesthesiology
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• v.11 no.1
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• pp.27-31
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• 2011

We report two cases of accidental overdoses of intramuscular midazolam used for a conscious sedation. A 4-year-old boy with dental caries was scheduled for treatment under conscious sedation. The pedodontist prescribed midazolam ($dormicum^{(R)}$ 5 mg / 5 ml) 2 ml (2 mg) by verbal order to hygienist. The hygienist instead of the pedodontist wrote a prescription for midazolam ($dormicum^{(R)}$ 15 mg / 3 ml) 2 ml (10 mg). The inexperienced nurse gave an injection to his buttock as prescription. The child fell into a deep sedation. A 4-year-old boy with dental caries was scheduled for treatment under conscious sedation. The inexperienced pedodontist gave an injection to his buttock midazolam ($dormicum^{(R)}$ 15 mg / 3 ml) 3 ml (15 mg) instead of midazolam ($dormicum^{(R)}$ 5 mg / 5 ml) 3 ml (3 mg). The child fell into a deep sedation. Both cases had no complications, but the accidents happened as a result of the inexperienced dental staffs. The five times midazoalm instead of the intended doses was inadvertently given intramuscularly, fortunately caused no harm in our cases. However, the situations suggest that we should carefully check the dosage and review the correct procedures, even when using a drug that is considered to be familiar with most practitioners.

• Journal of Veterinary Clinics
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• v.30 no.6
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• pp.415-420
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• 2013

This study was performed to examine the anesthetic and cardiopulmonary effects of medetomidine, midazolam and ketamine (MMK) combination in ten beagle dogs. Dogs were randomly allocated to two groups. Treatment group MMK-L received 0.015 mg/kg medetomidine followed by 0.3 mg/kg midazolam and 5 mg/kg ketamine by intramuscular injection. Treatment group MMK-H received 0.02 mg/kg medetomidine followed by 0.3 mg/kg midazolam and 5 mg/kg ketamine by intramuscular injection. Induction, anesthesia, sternal recumbency, standing, walking time, heart rate, arterial blood pressure, rectal temperature, respiratory rate and arterial blood gases were measured. Mean anesthesia time was significantly different between MMK-L group ($52.4{\pm}11.08$ minutes) and MMK-H group ($78.2{\pm}20.72$ minutes). Sedative scores and noxious stimuli were raised to the maximum value at 5 minutes after administration of the test dose and maintained until 40 minutes in both groups. In both groups, the heart rate significantly decreased after MMK administration. The blood pressures (MAP, SAP and DAP) increased after MMK administration but there were no significant differences in blood pressures between two groups. In conclusion, intramuscular administration of medetomidine followed by intramuscular injection of midazolam and ketamine in beagle dogs, leads immediate and sufficient anesthesia and proper doses of medetomidine for minimal adverse effects in intramuscular MMK combination will be 0.015 mg/kg in dogs.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.2
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• pp.111-114
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• 2012

Attention deficit hyperactivity disorder (ADHD) is characterized by inattention, impulsivity, and hyperactivity. Given high incidence of ADHD, many children with ADHD is likely to present for anesthesia. This case report suggests intramuscular premedication as an alternative method for anesthetic induction. A 9-year-old male patient with ADHD was transferred for dental treatment under general anesthesia. The patient refused to go into dental clinic office. Oral midazolam was given to the patient, however, he was resistant to take midazolam via oral route. Instead, we administer midazolam and ketamine via intramuscular route. After less than 10 miniutes, the patient became drowsy and was transferred to dental chair. Intravenous access and mask inhalation was possible. The patient received dental treatment under general anesthesia and recovered in a non-complicated way. In this case, intramuscular sedation with midazolam and ketamine was used as a premedication in highly uncoopearive patient refused to take oral sedative medication.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.726-731
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• 2006

Purpose : We reported previously that intramuscular ketamine with adjunctive midazolam is more effective than ketamine alone in pediatric procedural sedation, but with limited satisfactory sedation by suboptimal ketamine dose. The optimal dose of intramuscular ketamine in children has never been studied in Korea. In this study, we investigated the effectiveness and adverse events of ketamine 4mg/kg with adjunctive midazolam in pediatric laceration repair. Methods : From Jan. 2005 to July 2005, we enrolled 60 children, aged 3 months-7 years, who needed laceration repair under sedation. After verbal consent from parents, patients were randomly assigned to KMA group(IM ketamine 4 mg/kg＋atropine 0.01 mg/kg＋intramuscular midazolam 0.05 mg/kg) or KA group(without midazolam). We compared both groups with the induction time, recovery time, total sedation time, efficacy of sedation, adverse effects, and the satisfaction score of treating physicians. Results : Potentially confounding variables, age, weight, injury site and anxiety score, were similar between groups. The induction time, recovery time and total sedation time were not different statistically. In KMA group, 90.9 percent of patients showed satisfactory sedation compared to 66.7 percent of KA group(P=0.02) and the occurrence rate of significant adverse effect was 0.0 percent and 37.0 percent respectively. Conclusion : We found adjunctive midazolam with ketamine doses of 4 mg/kg IM produced more effective, satisfactory sedation and less adverse effect than without midazolam in pediatric laceration repair. The emergence phenomenon(agitation during recovery) only occurred in 9 KA group patients. In spite of adverse effect, all patients recovered, were discharged and there were no reported delayed events.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.11 no.1
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• pp.17-20
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• 2015

Autism is a life-long neurodevelopmental disorder characterized by qualitative abnormalities in reciprocal social interactions and patterns of communication. Patients with autism are difficult to manage during dental treatment. Thus they need special consideration like physical restraint, conscious sedation or general anesthesia. A 5-year-old male dental patient with autism was reffered to dental treatment under conscious sedation using intramuscular midazolam that creats anterograde amnesia. Dental procedure using midazolm which cause anterograde amnesia can be effective treatment strategy in autism patient.

• Journal of The Korean Dental Society of Anesthesiology
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• v.12 no.4
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• pp.223-227
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• 2012

Autism patients in general have bad oral hygiene. It is hard for autism patients to get dental treatment as poor communication. Therefore, they may have to be treated by deep sedation or general anesthesia in numerous cases. However, this process requires induction with mask, so it is not easy to do for disobliging autism patient. Midazolam is a water-soluble benzodiazepine, has been used in pediatric dentistry or dentistry for the handicapped because of rapid onset. Midazolam can be administered through oral, rectal, intramuscular,intravenous, and intranasal (IN) routes. IN route of midazolam may be considered as effective way to allay for uncooperative autism patients before general anesthesia. In this case report, two autism patients required dental treatment. Intranasal spray of midazolam before general anesthesia was safe and effective procedure of behavioral management.

• 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 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 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).