• Journal of the korean academy of Pediatric Dentistry
• /
• v.29 no.3
• /
• pp.304-312
• /
• 2002

The purpose of this study was to assess the sedative effects of four kinds of medication for management in the uncooperative 64 children aged from 18 to 92 months(ASA class I) and weighting between 10 and 32 kg. They were given randomly a dose of chloral hydrate 75mg/kg and hydroxyzine 25mg orally(group 1), midazolam 0.1mg/kg intramuscularly and $N_2O$(group 2), group 1 with additional $N_2O$(group 3) and group 1 with additional midazolam 0.5cc intranasally(group 4), respectively. According to rating scale, sleep, crying, movement and overall behavior were checked for evaluation of the clinical sedative effects. They were restraind with Pediwrap and were monitored by pulse oximeter for safety during treatment period. The results were as follows : 1. In the evaluation of sleep, rating scale of chloral hydrate and hydroyzine combination group was superior to midazolam and $N_2O$ combination group(p<0.001), but there was no significant difference between chloral hydrate, hydroxyzine and $N_2O$ combination group and chloral hydrate, hydroxyzine and midazolam combination group. 2. In the evaluation of crying, movement and overall behavior, there were significant differences between chloral hydrate and hydroxyzine combination group and midazolam and $N_2O$ combination group(p<0.05), but no significant difference between chloral hydrate, hydroxyzine and $N_2O$ combination group and chloral hydrate, hydroxyzine and midazolam combination group. 3. In the evaluation of overall behavior, the mean score of chloral hydrate and hydroyzine combination group was 2.94, midazolam and $N_2O$ combination group 2.07, chloral hydrate, hydroxyzine and $N_2O$ combination group 2.47 and chloral hydrate, hydroxyzine and midazolam combination group 2.24, respectively. 4. Evidence of adverse effect was not detected or reported during and/or after dental treatment.

• The Journal of Korea Assosiation for Disability and Oral Health
• /
• v.9 no.1
• /
• pp.46-50
• /
• 2013

Developmental disorders are a group of psychiatric conditions originating in childhood that involve serious impairments in different areas. These disorders comprise language disorders, learning disorders, motor disorders and autism spectrum disorders. Midazolam is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic, amnestic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties. The anterograde amnesia property of midazolam is useful for premedication before surgery to inhibit unpleasant memories. This article presents a case report including caries treatment of a 8-year-old male patient with developmental disorders using oral midazolam premedication as an alternative method of behavior management prior to general anesthesia.

• The Korean Journal of Pain
• /
• v.11 no.2
• /
• pp.241-246
• /
• 1998

Background: Opioids and local anesthetics have been administered epidurally for the purpose of the postoperative analgesia. However opioids have a serious risk of respiratory depression and local anesthetics have the risks of hypotension, sensory block, or motor one. In recent years, reports of spinal administration of midazolam for acute postoperative pain control have appeared in the literature. This study was performed to observe the effect of epidural midazolam in patient-controlled analgesia (PCA) device. Methods: Forty-five patients scheduled for the elective total hysterectomy were randomly selected; epidurally take morphine only (group I, n=15), morphine plus 0.1% bupivacaine (group II, n=15), or morphine plus midazolam (group III, n=15). The visual analogue scale (VAS) at rest and with movement, the sedation score, the degree of the satisfaction, the total amounts of a morphine usage, and the incidence of the side effects were observed. Rusults: The VAS at rest of group II and III were decreased significantly than that of group I. The VAS with movement of group III was significantly decreased than that of group I and II. The sadation score and the cumulative dose of a morphine were statistically insignificant within groups. Conclusion: Epidural morphine plus midazolam was proven to be clinically effective in the post-operative pain control especially for the pain with movement, compared with epidural morphine only and morphine plus 0.1% bupivacaine.

• Journal of Veterinary Clinics
• /
• v.28 no.2
• /
• pp.211-218
• /
• 2011

The aims of this study were to investigate the anesthetic effects of medetomidine-midazolam-ketamine (MMK) combination and to compare antagonistic effects of atipamezole and yohimbine in dogs anesthetized with MMK. Eighteen adult male healthy beagles were used in this study. All dogs were anesthetized with intramuscular (IM) administration of medetomidine (0.04 mg/kg), midazolam (0.2 mg/kg) and ketamine (5 mg/kg) in one syringe. Intravenous (IV) administration of atipamezole (0.24 mg/kg, MMKA), yohimbine (0.2 mg/kg, MMKY) or saline solution (0.1 ml/kg, MMK) was administered 20 minutes after MMK combination anesthesia. Induction and recovery times, scores of sedation and analgesia, heart rate, blood pressure, rectal temperature, respiratory rate and blood gases were determined and recorded for each dog. Mean anesthesia times, sternal recumbency times, standing times and walking times in the MMKA and MMKY groups were significantly shorter than those in the MMK group. But there were not significantly different between MMKA and MMKY groups. In all groups, MMK administration produced a satisfactory sedation and analgesia for all dogs. However, after administration of atipamezole or yohimbine the scores for posture and response to noxious stimuli were significantly lower in the MMKA or MMKY group than those in the MMK group. MMK produced good sedation and anesthesia effects, and atipamezole or yohimbine can be used as a safe and effective agent for antagonizing the MMK anesthesia in dogs.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.39 no.1
• /
• pp.11-16
• /
• 2012

Effect of supplementary intranasal midazolam on oral sedation of children The purpose of this study was to compare the cardiopulmonary parameters of two sedation regimens during dental treatment: (1) Oral chloral hydrate(CH) and hydroxyzine(HZ) with nitrous oxide-oxygen($N_2O/O_2$) inhalation(CH-HZ group); (2) Oral chloral hydrate(CH) and hydroxyzine(HZ) with nitrous oxide-oxygen($N_2O/O_2$) inhalation and supplementary intranasal(IN) midazolam administration(MIDA group). Among the patients of OO hospital who received dental treatment under sedation over the past 5 years, 44 patients were selected for each group of CH-HZ and MIDA according to their age, gender and weight. Following parameters that were recorded every 5 minutes were compared: 1) Heart rate(HR) 2) $O_2$ saturation 3) End tidal carbon dioxide concentration($EtCO_2$) 4) Respiratory rate(RR) 33 patients of Group MIDA who have complete data of 15 minutes before and after supplementary IN midazolam administration were selected. And measurements 15 minutes before and after midazolam administration in same patient were evaluated. The results were as follows: 1. Heart rate was significantly higher in MIDA group than in CH-HZ group, but it was within normal range. 2. Comparing HR, $O_2$ saturation, EtCO2, RR between before and after of supplementary IN midazolam administration in the same patient, the differences were not statistically significant.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.6 no.2 s.11
• /
• pp.103-112
• /
• 2006

Background: The purpose of this study was to compare the clinical safety and effect with and without additional submucosal midazolam to oral chloral hydrate and hydroxyzine when used for pediatric conscious sedation in a clinical dental environment. Methods: Thirty one cases of pediatric conscious sedations were performed in this study. Selection criteria included good health (ASA I), under 6 years old, 20 kg of body weight, uncooperative behavior and the need for sedation to receive dental treatment including anesthesia and restorative or surgical procedure for at least two teeth. In each visit, patients were randomly assigned into one of two groups; CH group: chloral hydrate (60 mg/kg), hydroxyzine (1 mg/kg), CH-M group: chloral hydrate (60 mg/kg). hydroxyzine (1 mg/kg) and submucoal midazolam (0.1 mg/kg). 50% nitrous oxide-oxygen was maintained during the sedation period Sedations were monitored using a pulse oximeter for estimating pulse rate (PR) and percutaneous oxygen saturation ($SpO_2$). Behavior response rated using Houpt's scale and need of restraint was assessed every 2 minutes through 30 minutes of operative procedure reviewing the videotape recording. Evaluation of overall behavior success was performed using modified overall behavior rate of Houpt's scale. Data was analyzed using t-test. Results: PR and $SpO_2$ for both groups remained within the normal values. The mean scores for sleep and movement of CH-M group were higher than those of CH group (P < 0.05). There were no significant difference in mean score for crying between two groups. The mean scores of overall behavior of CH-M group was higher than those of CH group (P < 0.01). Reinstraint of CH-M group was less required than that of CH group (P < 0.05). Conclusions: Oral chloral hydrate (60 mg/kg) and hydroxyzine (1 mg/kg) combined with submucosal injection of midazolam was safer and showed more improved sedation effect than oral chloral hydrate (60 mg/kg) and hydroxyzine (1 mg/kg) without midazolam for sedation of pediatric dental patients.

• Journal of The Korean Dental Society of Anesthesiology
• /
• v.12 no.1
• /
• pp.11-16
• /
• 2012

Background: The purpose of this study was to evaluate the safety and effectiveness of intravenous ketamine-midazolam sedation in uncooperative children and disabled people undergoing dental procedures. Methods: From September 2009 to January 2012, total 114 intravenous deep sedation were carried out using midazolam and ketamine at pediatric dentistry in Wonkwang University Daejeon Dental Hospital. Patients' dental charts and sedation records were retrospectively reviewed. Results: 103 cases were enrolled, divided into four groups. There were 22 children under five in group 1, 14 children over six years with severe anxiety in group 2, 34 disabled person in group 3 and 33 children over six years with surgical procedure in group 4. Carries treatment (56 cases) was the most common dental treatment. The highest ketamine usage was 4.15 mg/kg, the longest duration of dental treatment was 41.6 minutes in children under five group. Nausea and vomiting (16 cases) was the most common side effect. Conclusions: Intravenous ketamine-midazolam sedation appears safe and effective for uncooperative children and disabled person undergoing dental procedures. But, emesis is a common side effect of ketamine occurring with increasing age.

• The Korean Journal of Pain
• /
• v.7 no.2
• /
• pp.199-204
• /
• 1994

The purpose of this study is to evaluate the feasibility, advantages/disadvantages of patient-controlled sedation (PCS) compared to anesthesiologist-controlled sedation (ACS) during neurolytic pain block and regional anesthesia. Forty patients were divided randomly into two groups of 20 patients each. Group 1(ACS) received 0.01 $mg{\cdot}kg^{-1}$ intravenous midazolam and 0.5 ${\mu}g{\cdot}kg^{-1}$ fentanyl intravenously by anesthesiologist just before, 30, and 60 minutes after the procedure to acheive sedation; Group 2 (PCS) patients self-administered a mixture of midazolam (0.4 mg) and fentanyl ($20{\mu}g$) using a syringe type infusion pump (Terumo, Japan) to acheive sedation. Considering the dermographics of patients, the types and durations of procedure performed, the level of average sedation the comfort level were similar in both groups. But the doses of midazolam and fentanyl administerd in group 2 were smaller than those in group 1 (p<0.01). Patients in PCS group showed their level of sedation more proper than did those in ACS group. However, patients in ACS group rated their level of comfort higher than did those in PCS group. The findings of this study indicate that PCS using a combination of midazolam and fentanyl is a fafe and effective technique. More studies are, however, needed to determinc the best choice of drug(s), doses, lock-out intervals, and possible use of continuous infusion with patient-controlled sedation.

• The Journal of Korea Assosiation for Disability and Oral Health
• /
• v.5 no.2
• /
• pp.100-103
• /
• 2009

Dental treatment of mentally challenged patients under general anesthesia is a series of challenging procedures not only for dental operators but also for dental anesthesiologists. Patients presenting with uncooperative behavior often resist the perioperative management for adesthestic administration. This case report suggests oral premedication as a conjuctive method for anestheitic induction. A 26-year-old male dental patient with autism was referred to dental treatment under general anesthesia. The patient refused to enter dental clinic office and was not able to receive preoperative assessment. In the day of operation, 15 mg of midazolam was given to the patient for oral premedication prior to anesthetic induction. Ater 20 minutes, the patient presented with drowziness and was transferred to the office. Anesthestic staff were able to achieve appropriate intravenous access and mask inhalation. The patient recieved 8 hrs long dental treatment and recovered in a noncomplicated way. Oral midazolam is commonly used to reduce anxiety for combative and irritated pateints. In this case, oral midazolam sedation was used as a preanesthetic management of a highly uncoopearive patient.

• Journal of the korean academy of Pediatric Dentistry
• /
• v.33 no.4
• /
• pp.710-716
• /
• 2006

The purpose of this study is to evaluate the intravenous (IV) sedation technique with midazolam and ketamine for uncooperative dental child patients. Three child patients between the ages of 4.4 years and 5.6 years who required sedation for dental treatment were given midazolam and ketamine. Initial dosage was combined of $0.03{\sim}0.06mg/kg$ midazolam and 1.0mg/kg ketamine. Additional dosages of ketamine (0.33mg/kg) were given as needed to maintain deep sedation. Pulse rate, respiratory rate, blood pressure, oxygen saturation, adverse reactions, postoperative recovery and behavior were monitored with saturation pulse oximetry, ECG, NIBP and Cardiocap. In conclusion, the combination of midazolam and ketamine is efficacious in deep sedation for painful dental treatment. However, a significant drop in oxygen saturation was observed as a common adverse side effect. Therefore advanced airway management proficiency is required in order to achieve a successful IV sedation.