• 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.

• The Korean Journal of Pain
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• v.11 no.1
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• pp.69-73
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• 1998

Background: The postoperative pain in children and adolescents is most commonly managed by intramuscular injections of NSAIDs or opioids. This approach may result in fluctuating plasma drug levels and cycles of pain, comfort, and sedation. Patient-controlled analgesia(PCA) is a method of analgesia administration that consists of a computer-driven pump with a button that the patient may press to administer a small dose of analgesic drug. Materials & Methods: Forty ASA physical status 1 or 2 children and adolescents were divided into two groups. In the PRN group, patients received intramuscularly diclofenac(Valentac$^{(R)}$) on a p.r.n. basis. The PCA group patients received a mixture of nalbuphine and ketorolac by WalkMed$^{(R)}$PCA infusor. Analgesic efficacy was evaluated with NRS(numerical rating scale) and Faces Pain Rating Scale. The side effects were evaluated. Results: The patients of PCA group had less pain than those of PRN group. Complications were similar in both group. Conclusions: PCA with nalbuphine and ketorolac is a safe and effective methods of pain relief in children and adolescents after surgery, and is better accepted than intramuscular injections.

• Journal of the korean academy of Pediatric Dentistry
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• v.41 no.3
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• pp.257-265
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• 2014

The aim of this study was to establish the appropriate guidelines in the sedation techniques and to organize the continuing education programs for the sedation in future under the direction of Committee on Sedation, Education and Research under the Korean Academy of Pediatric Dentistry(KAPD). The surveys on the sedation technique were performed on 111 organizations which practices the sedation and responded to the survey via online and e-mail by February 2014. The collected survey were analyzed. The purpose of sedation was mainly to manage the children's behavior and its uses were primarily on 3~4 years old children. The most frequent duration of treatment was 1~2 hours to treat both maxillary and mandible. The preferred dosages of sedative drugs were chloral hydrate(CH) 50~70 mg/kg, hydorxyzine(Hx) 1~2 mg/kg, and intramuscular midazolam(Mida IM) 0.1~0.2 mg/kg. The preferred combination of the sedative drugs were CH + Hx + $N_2O/O_2$(67.6%), CH + Hx + Mida submucosal administration (SM) + $N_2O/O_2$(29.7%), and Mida IM + $N_2O/O_2$(23.4%). The administration of additional sedatives was carried out at 48%, mainly using Midazolam. 87.5% of the respondents experienced the adverse effects of the sedation such as vomiting/retching, agitation during recovery, subclinical respiratory depression, staggering, and etc. Among them, only 20% periodically retrain the emergency management protocol. About the discharge criteria for patients after the sedation, the respondents either showed a lack of clear criteria or did not follow the recommended discharge criteria. 86% of the respondents expressed the interests in taking a course on the sedation and they wanted to learn mostly about the sedation-related emergency management, the safe dosage of the sedative drugs, and etc. The use of sedation in pediatric dentistry must be consider a patient's safety as top priority and each dentist must show the evidence of sound practices for the prevention of any possible medical errors. Therefore, KAPD must establish the proper sedation guidelines and it needs to provide the systematic technical training program of sedation-related emergency management for pediatric dentists.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.2
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• pp.207-212
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• 2016

Irritation fibroma is a common hyperplastic lesion of the oral mucosa that can occur in response to chronic irritation or trauma. This report presents an unusual case of irritation fibroma associated with ectopic eruption of the maxillary left central incisor in a patient with Angelman syndrome. Considering the patient's medical history and cooperative ability, excisional biopsy under intramuscular sedation using midazolam was performed. The patient exhibited successful healing without lesion recurrence. It is important to perform histopathological examination followed by excisional biopsy, because other benign or malignant tumors may mimic the clinical appearance of an irritation fibroma.

• 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.

• The Korean Journal of Pain
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• v.7 no.2
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• pp.205-210
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• 1994

The effects of either clonidine or epinephrine into local anesthetics administered into brachial plexus sheath were evaluated in 42 patients who underwent surgery of the upper limb. All patient received 0.5 ml/kg of 2:1 mixture of bupivacaine and lidocaine injected into the brachial plexus sheath, using the subclavian perivascular technique. The patients were randomly allocated into two groups; Group I(n=25) received $150{\mu}g$ of clonidine hydrochloride, and Group II(n=27) received $200{\mu}g$ of epinephrine. The duration of analgesia and the degree of sedation reflecting the systemic effect of clonidine were assessed. The block produced by the addition of clonidine was longer($100.3{\pm}469.8$ vs $648.8{\pm}192.1$ min) and superior to that by epinephrine(p < 0.05). The highest degree of sedation was achieved about 20 minutes after block, which roughly equals the time required for intramuscular clonidine to show the similar effect. The author concludes that the injection of clonidine mixed to local anesthetics into the brachial plexus sheath prolongs analgesia than that of epinephrine, but this prolongation may be due to the systemic effect of clonidine.

• 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.

• Korean Journal of Veterinary Research
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• v.21 no.2
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• pp.145-150
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• 1981

This study was performed to evaluate the sedative effect of xylazine for restraint of deers such as sika deer (19 cases), red deer (19 cases), elk (19 cases), pere david deer (13 cases) and reindeer (8 cases), raised in the area of surburb of Seoul, Chungcheongnam-do and Gyungsangbug-do. provinces The results were as follows : 1. The more the dose of xylazine, the earlier the onset of sedation, and the s1ower the recovery time to normal state. 2. The optimal intramuscular dose of xylazine was found to be 0.8~1.4mg per Kg of body weight for sika deer, 0.6~1.0mg for red deer, 1.0~1.4mg for elk, 0.2~0.4mg for pere david deer, and 0.6~1.0mg for reindeer.

• 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.

• Journal of the korean academy of Pediatric Dentistry
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• v.32 no.3
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• pp.416-426
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• 2005

Intravenous sedation have many advantages of rapid onset and recovery, ability of control sedation levels and duration through titration. Midazolam is most commonly used intravenous medication for sedation in pediatrics, endoscopy, oncologic procedures and so on. But in dentistry, midazolam intravenous sedation is usually for adult, and there are few reports for children. Todays, children who need sedation become more and older, intravenous sedation technique is going a matter of concern in pediatric dentistry. The purpose of this paper is to evaluate the efficacy of sedation and clinical success for different initial dosage of midazolam in intravenous sedation for pediatric dental patients. 16 healthy children (male 10, female 6), mean age $54.7{\pm}10.7$ months, who needed at least two separate treatment visits requiring local anesthesia were chosen for this study. Every children were taken 0.3mg/kg, maximum 5mg of midazolam by intramuscular route, and then 30~50% $N_2O-O_2$ for 10 minutes was given. On every visits, one of the following 2 different initial dosage was given by intravenous route : (1) Group I : 0.1mg/kg Midazolam (2) Group II : 0.2mg/kg Midazolam. Additional dosage was half of the first dose. Physiologic parameters (oxygen saturation, heart rate, respiratory rate, end-tidal carbon dioxide pressure) was recorded by ten procedure steps. Behavior was videotaped and rated using Ohio State University Behavioral Rating Scale and Automated Counting System by one investigator, blind to administered dosage. After the treatment, operator evaluated the clinical success. Physiologic parameters were stable and within normal range during treatment in both groups. The analyzed sedative effect, in behavioral evaluation, ratio of favorable Quiet was higher in group II, and clinical success rate of group II was better than group I. Induction time was rapid in group II, and recovery time was rapid in group I. And there was no statistically difference between two groups in every results.