• The Korean Journal of Pain
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• 제19권1호
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• pp.77-80
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• 2006

Background: Painful experiences during procedures such as prolotherapy and intramuscular stimulation are stressful to patients and can affect the treatment outcome. We present a method for relieving pain and increasing the level of patient comfort during the procedure. Methods: Twenty six patients who requested sedation anesthesia during the procedure were examined. All patients were injected with 500 ml of 0.9% normal saline and were monitored by electrocardiography, blood pressure and pulse oximetry. The patients were supplied with oxygen (3 L/min) through a nasal cannula. Midazolam (0.02 mg/kg) and alfentanil ($8{\mu}g/kg$) was injected before the procedure and a bolus injection was administered during the procedure if patients felt any pain. The duration of the procedure, the total amount of drugs, the changes in the systolic blood pressure, heart rate, pulse oxygen saturation, sedation and pain level during procedure, satisfaction scale after the procedure, complications and the incidence of amnesia were evaluated. Results: Twenty one patients had a moderate level of sedation, 15 patients did not feel any pain during the procedure, 17 patients had high level of satisfaction (8-10). No patient experienced complications after the procedure, or unstable vital signs, and 6 patients could not remember the procedure. Conclusions: Sedation anesthesia is a safe method for relieving pain during the procedure, and most patients had a high level of satisfaction.

• 대한치과마취과학회지
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• 제11권1호
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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.

• 대한치과마취과학회지
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• 제2권1호
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• pp.1-6
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• 2002

The usage of nitrous oxide is increased for the anxious patient to dental treatment. There are two methods to induce the sedation during dental treatment. One is sedation with drugs the other no need of drugs. We discussed here about sedation with drugs. The methods of drug administration are oral, intramuscular, intravenous, inhalation. The method of oral administration of drugs are convenient to patient and doctor but poor controllability. Intramuscular method is a parenteral technique that maintains several advantages over the enteral technique. However its pales in comparison to other parenteral technique. Intravenous method represents most effective method of ensuring predictable and adequate sedation in all patients. But it has inability to reverse the action of drugs after they have been injected except some drugs (e.g., narcotics and benzodiazepine). A variety of gaseous agents may be administered by inhalation to produce sedation. In dental practice, the inhalation administration of gas means use of nitrous oxide. There are many advantages of nitrous oxide administration. First, very short latent period and rapid onset of drug action which lead to possible titration of drug concentration. With nitrous oxide, clinical effects may become noticeable as quickly as 15 to 30 seconds after inhalation. Recovery from inhalation sedation is also quite rapid. In out patient dental practice rapid recovery is very important because it permit to discharge the patient without escort and the patient return to their ordinary life without limit. To success the conscious sedation with nitrous oxide, the administrator should be keep the mind that always titration of nitrous oxide concentration during induction and treatment. Careful observation need during treatment to prevent oversedation because the adequate nitrous oxide concentration to patients changed by environmental stress. Always begins with 100% oxygen and ends with 100% oxygen to prevent diffusion hypoxia which rare in clinical practice.

• 대한소아치과학회지
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• 제41권4호
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• pp.283-291
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• 2014

심한 치과적 공포와 불안으로 치과적 행동조절에 문제를 일으키는 환자의 경우, 진정법과 같은 약물적 행동 조절 방법이 요구될 수 있다. 이번 연구에서는 소아 환자에서 세보플루란 흡입진정시에 추가적으로 0.1 mg/kg의 미다졸람을 근육주사하였을 때 진정 깊이와 심폐기능에 미치는 영향을 알아보기 위해 2013년 1월부터 2014년 3월 사이 본원에서 세보플루란 흡입진정 하에 치과치료를 받은 환자의 마취기록지를 후향적으로 분석하였다. 3~6세의 환자를 대상으로 하였으며, 세보플루란 단독 사용군이 18명, 미다졸람 병용 투여군이 18명이었다. 미다졸람 병용 투여군의 평균 엔트로피 값은 세보플루란 단독 사용군에 비해 10정도 낮게 측정되었으나 통계적 유의성은 없었으며(p > 0.05), 분당 심박수와 평균동맥압은 미다졸람 병용 투여군이 세보플루란 단독 사용군에 비해 높은 값을 보였다(p < 0.05). 즉, 0.1 mg/kg의 미다졸람 근육주사는 세보플루란 흡입진정시 진정의 질을 높이는데 큰 도움이 되지는 않았으며, 추후 세보플루란 흡입진정과 병용 사용하기에 적절한 미다졸람의 용량을 결정하기 위한 추가적인 연구가 필요할 것으로 사료된다.

• Clinical and Experimental Pediatrics
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• 제49권7호
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• pp.726-731
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• 2006

목 적 : 소아의 통증을 수반하는 술기의 시술시에 진통, 진정을 위해 ketamine을 사용하는데, midazolam을 병용 투여 할 필요가 있는가에 대한 논의가 활발하게 진행되고 있다. ketamine의 근육주사의 적정용량은 국내에서 연구된 바가 없으며 저자들은 이전 연구에서 ketamine 3 mg/kg가 부족하다는 결론을 얻어 용량을 4 mg/kg로 증량하여 KMA(ketamine+midazolam+atropine)와 KA(ketamine+atropine)의 진정 및 부작용 발생여부의 차이를 알아보고자 하였다. 방 법 : 2005년 1월부터 2005년 7월까지 열상처치 시 진정이 필요한 생후 3개월에서 7세까지의 60명의 소아를 대상으로 KMA군(IM ketamine 4 mg/kg+atropine 0.01 mg/kg+intramuscular midazolam 0.05 mg/kg) 혹은 KA 군(without midazolam)을 무작위로 선택하여 anxiety/tolerance scores, 합병증, 진정정도, 진정유도시간, 진정회복시간, 총 진정시간, 시술자의 만족도를 기록하였다. 결 과 : 두 군간에 성비, 체중, 연령, 상처 부위에는 통계학적으로 유의한 차이가 없었으며anxiety/tolerance score, 진정유도시간, 진정회복시간, 총 진정시간에는 두 군간에 통계적으로 유의한 차이가 없었다. 효과적 진정을 보인 경우가 KA군은 66.7%, KMA군은 90.9%로 KMA군이 진정에 보다 효과적이었으며(P=0.02), 시술자의 만족도는 KA군은 55.6%, KMA군은 90.9%로 만족, 매우 만족 이상으로 유의한 차이를 보였다. 의미 있는 부작용의 발생은 KA군은 37.0%, KMA군은 0.0%였다. 결 론 : 소아의 피부 열상 봉합 시 진정을 위해 근육주사를 통한 ketamine 4 mg/kg과 midazolam 및 atropine의 병용 투여는 ketamine과 atropine만을 투여하는 것보다 안전하고 효과적으로 진정을 유도할 뿐 아니라 시술자의 만족도를 높일 수 있다.

• 대한장애인치과학회지
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• 제11권1호
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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 Dental Anesthesia and Pain Medicine
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• 제17권2호
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• pp.157-161
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• 2017

In sedation via the submucosal route, the drug is administered through the maxillary buccal submucosa. It is time saving, effective, and safe. Patients with autism, a mental disorder, often find it hard to make relationships with other people. These patients display a strong resistance to dental treatment and sedation. This study reports a successful case of behavioral management during dental treatment, using sedation via the submucosal route. The patient was strongly resistant to sedation via the oral, intramuscular, and intravenous routes. The drug used was 9 mg (0.1 mg/kg) of midazolam. Through this case report, we reaffirm the significance of sedation via the submucosal route, and expect that it will be used more frequently for patients with autism, who display behaviors that are difficult to manage, patients with other disabilities, and children.

• 대한장애인치과학회지
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• 제2권2호
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• pp.142-146
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• 2006

환아의 연령, 과다체중, 환아의 약물 거부 등으로 인하여 chloral hydrate를 이용한 수면치료가 불가능한 경우, Midazolam을 이용한 정주진정요법이 전신마취를 대신하는 대안으로 사용될 수 있다. 본 환아의 경우, 0.3mg/kg의 midazolam을 근주하고, 70% 아산화질소 가스를 이용하여 초기 수면상태를 유도하고 정맥천자를 실시한 후, 0.2mg/kg midazolam을 정주하여 50분간 별다른 부작용 없이 성공적으로 치료할 수 있었다.

• 대한소아치과학회지
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• 제33권1호
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• pp.53-61
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• 2006

미다졸람은 소아 환자의 진정시 흔히 사용되는 약물로서 안전성이 뛰어나고 사용이 편리하며 투여 방법이 다양하다. 여러 투여 방법 중, 주로 사용되는 근육내 투여 방법은 동통을 유발하기 때문에 어린이의 치과에 대한 공포를 가중시킬 수 있다. 따라서 근육내 투여의 이런 단점을 완화할 수 있도록 용량에 따른 미다졸람 경구 투여의 진정 효과를 근육내 투여시의 진정 효과와 비교 평가하고자 하였다. 총 12명의 환자를 실험대상으로 하였으며 이중 맹검법에 의해 두 번의 내원중 임의로 한 번은 Midazolam 0.75 mg/kg을 경구 투여하고, 한 번은 미다졸람 0.3mg/kg을 근육내 투여하여 치료하였으며, 치료과정 동안 환자의 생징후(말초 동맥혈 산소 포화도, 심박수)와 행동양상을 Ohio State University Behavior rating scale과 Automated Counting System을 사용하여 평가하였다. 생징후의 경우 양 군 모두 정상범위 내에서 안정된 양상을 보였으며, 임상적으로 바람직한 행동양상(Q:Quiet)의 비율이양 군에서 대부분 높게 나타났으며 양군간에 유의 한 차이를 보이지 않았다(p>0.05). 본 연구에서 미다졸람을 근육내 투여한 군과 경구 투여한 군 모두 진정 효과가 양호한 결과를 보였으며 양군간에 유의한 차이를 보이지 않았다(pgt;0.05).

• Archives of Plastic Surgery
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• 제50권1호
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• pp.30-36
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• 2023

Background Most children with facial lacerations require sedation for primary sutures. However, sedation guidelines for invasive treatment are lacking. This study evaluated the current status of the sedation methods used for pediatric facial laceration repair in Korea. Methods We surveyed one resident in each included plastic surgery training hospital using face-to-face interviews or e-mail correspondence. The health care center types (secondary or tertiary hospitals), sedation drug types, usage, and dosage, procedure sequence, monitoring methods, drug effects, adverse events, and operator and guardian satisfaction were investigated. Results We included 45/67 hospitals (67%) that used a single drug, ketamine in 31 hospitals and chloral hydrate in 14 hospitals. All health care center used similar sedatives. The most used drug administered was 5 mg/kg intramuscular ketamine (10 hospitals; 32%). The most common chloral hydrate administration approach was oral 50 mg/kg (seven hospitals; 50%). Twenty-two hospitals (71%) using ketamine followed this sequence: administration of sedatives, local anesthesia, primary repair, and imaging work-up. The most common sequence used for chloral hydrate (eight hospitals; 57%) was local anesthesia, administration of sedatives, imaging work-up, and primary repair. All hospitals that used ketamine and seven (50%) of those using chloral hydrate monitored oxygen saturation. Median operator satisfaction differed significantly between ketamine and chloral hydrate (4.0 [interquartile range, 4.0-4.0] vs. 3.0 [interquartile range, 3.0-4.0]; p <0.001). Conclusion The hospitals used various procedural sedation methods for children with facial lacerations. Guidelines that consider the patient's condition and drug characteristics are needed for safe and effective sedation.