• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.3
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• pp.199-204
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• 2017

Background: Anxiety control remains an important concern in dental practice. We evaluated the incidence, nature, and sequelae of complications during and after minor oral surgeries performed under intravenous midazolam and fentanyl sedation using the titration technique. Method: The medical records of patients who had undergone minor oral surgeries under moderate intravenous midazolam and fentanyl sedation at our institution between January 1, 2015 and December 31, 2015 were retrospectively evaluated. Age, sex, body mass index, medical history, American Society of Anesthesiologists (ASA) classification, indications for sedation, amount of sedative used, surgical duration, and recovery time were evaluated for all patients. Results: In total, 107 patients aged 9-84 years were included. ASA class I and class II were observed for 56.1% and 43.9% patients, respectively. Complications associated with sedation occurred in 11 (10.2%) patients. There were no serious adverse events. Oxygen saturation reached 95% during the procedure in six patients; this was successfully managed by stimulating the patients to take a deep breath. Two patients exhibited deep sedation and one exhibited paradoxical excitement. After the procedure, one patient experienced nausea without vomiting and one exhibited a prolonged recovery time. The surgical procedures were completed in all patients. Obesity was found to be significantly associated with sedation-related complications. Conclusion: Our results suggest that complications associated with intravenous midazolam and fentanyl sedation using the titration technique for minor oral surgeries are mostly minor and can be successfully managed with no prolonged sequelae.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.34 no.6
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• pp.449-454
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• 2012

Purpose: Intravenous sedation with midazolam is common in contemporary dentistry. That is effective for anxious patients, but additional analgesic agent needs to be used, because midazolam alone doesn't have an analgesic effect. This study was performed to select an analgesic agent between an opioid agent, and nonsteroidal anti-inflammatory drugs as adjunctives in intravenous sedation with midazolam. Methods: The subjects were 60 patients who visited the Department of Oral and Maxillofacial Surgery, Sacred Heart Hospital, Hallym University, between August 2009 and February 2010. Conscious sedation was performed on 20 patients of 3 groups (control group, ketorolac group, and fentanyl group), who were divided randomly. The analgesic agent was administrated preoperatively. For sedation, vital signs were recorded. After sedation and operation, subjective questionnaires of the patient and operator were implemented. Results: All of the $SPO_2$, blood pressure, and heart rates stayed within the normal range for sedation. The sedation depth and analgesic effect of the ketorolac group and fentanyl group were similar. In the case of sedation depth, 12 patients in the ketorolac group and 14 patients in the fentanyl group had no memory of surgery. In the case of analgesic effect, the visual analogue scale of pain scored 2~3 in 13 patients in the ketorolac group, and 0~2 in 12 patients in the fentanyl group. The satisfaction of patients and doctors was also similar. Conclusion: Considering the management and complication of an opioid agent, non-steroidal anti-inflammatory drugs is more effective than an opioid agent.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.1
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• pp.38-46
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• 1998

Management of children who show negative response to treatment was difficult. Usually the dentist used the restraintor sedatives for these children. Especially it is very difficult to management of definitely negative behavior patients who resist to ordinary sedative technics including psychosedation and various sedatives. These patients were managed with general anesthesia. Midazolam was used for sedation of non-cooperative pediatric patients and halothane for induce initial sleepness, If the patient shows negative response to management after 15 minutes of midazolam administration, used the halothane in 30 to 120 seconds for calm down the patient. After induce sleepness, cut off the halothane administration and maintain the sedation with $N_2O$ in 50-70 vol.% concentration. This technic reduce the toxity and untoward effects of major anesthetics. To compare the difference of sedation effect by dosage, dose of 0.2mg/kg and 0.3mg/kg were injected respectively. Though there's no statistical difference in duration and results between two dosage but show the increment of score with age, If the patients show positive response to management after midazolam administered. try to conscious sedation with nitrous oxide in 30 to 70 vo.% concentration. Nitrous oxide concentration was administered slowly according to their consciousness and response to treatment by increment or decrement. The success rate of conscious sedation were 21.2% in 0.2mg/kg and 30.3% in 0.3mg/kg. There's many factors in proceed of conscious sedation. The most important factors are age of patient and experience of children for dental care.

• Journal of Dental Anesthesia and Pain Medicine
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• v.23 no.2
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• pp.69-81
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• 2023

Background: In order to assess the effectiveness of various analgesio-sedative combinations for pain relief and sedation in pediatric dental patients, a thorough evaluation of clinical studies and patient outcomes is necessary. Methods: A total of 128 healthy, uncooperative pediatric dental patients were randomly allocated to receive one of the four combinations of drugs via the intranasal (IN) route: Group I received midazolam-ketamine (MK), Group II received dexmedetomidine-ketamine (DK), Group III received midazolam-fentanyl (MF), and Group IV received dexmedetomidine-fentanyl (DF) in a parallel-arm study design. The efficacy and safety of the combinations were evaluated using different parameters. Results: The onset of sedation was significantly faster in the DF group than in the DK, MF, and MK groups (P < 0.001). The depth of sedation was significantly higher in the DK and DF groups than in the MK and MF groups (P < 0.01). DK and DF produced significant intra- and postoperative analgesia when compared with combinations of MK and MF. No significant adverse events were observed for any of the combinations. Conclusions: The DK and DF groups showed potential as analgesio-sedatives in view of their anxiolytic and analgesic effects.

• Journal of Veterinary Clinics
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• v.26 no.4
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• pp.317-323
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• 2009

This study was performed to evaluate the effect of intravenous administration of glycopyrrolate on cardiovascular and respiratory system in dogs given intravenous medetomidine (20 ${\mu}g$/kg) and intramuscular midazolam (0.3 mg/kg) (MM). Prior to administration of MM, glycopyrrolate was administered intravenously at doses of 5 ${\mu}g$/kg (Gly-5), 10 ${\mu}g$/kg (Gly-10) or 20 ${\mu}g$/kg (Gly-20), respectively. For the control group saline was administered intravenously. In the cardiovascular system, HR, BP, RAP, PAWP, CI, SI, SVR, and PVR were measured. RR, $V_T$, $P_{ETCO2}$, and arterial blood gas analysis were measured for respiratory system. Although rapid and satisfied depth of sedation was obtained by MM, life-threatening bradycardia, the outstanding side-effect on cardiovascular system in dogs were observed. This combination also decreased CO and increased SVR, RAP, and PAWP significantly. The bradycardia could be prevented in all the glycopyrrolate treated groups, but tachycardia was observed in Gly-10 and Gly-20 groups. Significant increases in blood pressure were shown in glycopyrrolate treated groups. Also, tachycardia depends on dose of glycopyrrolate, compensating the CO. However, these were not fully reserved. In conclusion, MM combination could induce rapid and satisfied depth of sedation but was not the suitable method for the deep sedation of dogs with cardiovascular or circulatory problems.

• 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.

• Korean Journal of Veterinary Research
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• v.39 no.3
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• pp.616-627
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• 1999

This study was performed to evaluate anesthetic and cardiovascular effects of xylazine/fentanyl/azaperone and medetomidine/midazolam as preanesthetics and their combinations with antagonists in halothane-anesthetized dogs. Eight clinically healthy dogs($4.54{\pm}2.16kg$) were used at the interval of more than 14 days between experiments in turn for propionyl promazine(PP 0.3mg/kg, IM), xylazine/fentanyl/azaperone(XFA 2mg/kg, 0.0137mg/kg, 0.11mg/kg, IM), medetomidine/midazolam(MM 0.02mg/kg, 0.3mg/kg, IM), combination of XFA and their antagonists (yohimbine 0.05mg/kg, naloxon 0.0005mg/kg, IV) and combination of MM and their antagonist(atipamezole 0.08mg/kg IM). The sedation induction times in XFA($2.56{\pm}1.01min$) and MM($5.44{\pm}2.07min$) groups were significantly better than that of PP group($10.75{\pm}2.38min$)(p < 0.05). The thiopental sodium dose required for tracheal intubation in XFA($2.38{\pm}3.38mg/kg$) and MM($3.91{\pm}3.47mg/kg$) groups were significantly less than that of PP group($12.57{\pm}2.13mg/kg$)(p < 0.05). All time indices expressing the recovery(pedal reflex recurrence time, extubation time, arousal time, standing time and walking time) were significantly shorter in the combination groups of XFA or MM with their antagonists than in PP, XFA and MM groups(p < 0.05). The suppressions of cardiovascular function of XFA and MM were more than that of PP. Heart rate and cardiac output were recovered by the antagonists of XFA and MM, but mean arterial pressure were not recovered by the antagonists. PP induced apnea in 4 out of 8 dogs, but XFA in none and MM in one. The present study suggested that for rapid sedation, prevention of apnea after intubation and rapid recovery after halothane cessation, combinations of xylazine/fentanyl/azaperone or medetomidine/midazolam with their antagonists are recommendable as preanesthetic method in gas anesthetised dogs with normal cardiovascular function.

• Environmental Analysis Health and Toxicology
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• v.31
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• pp.16.1-16.9
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• 2016

Objectives Banha-sasim-tang (BST), which consists of seven different herbs, is one of the most popular herbal formulae for treating gastrointestinal disorders in Eastern Asia. The commonly used herbal medicine is often co-administered with other therapeutic drugs, which raises the possibility of herb-drug interactions and may modify the clinical safety profile of therapeutic drugs. Methods We investigated the potential herb-drug interactions between BST extract and midazolam (MDZ) in mice. The area under the plasma concentration-time curve (AUC) of MDZ and 1'-hydroxymidazolam (1'-OH-MDZ) was evaluated for both oral and intraperitoneal administration of MDZ, following oral administration of BST (0.5 and 1 g/kg). Results It was found that the AUC of MDZ and 1'-OH-MDZ was lower in case of oral administration of MDZ. Administration of BST extract was not associated with hepatic cytochrome P450 activity. BST extract induced a strong reduction in pH and it has been reported that oral mucosal absorption of MDZ is lower at low pH. The decreased absorption rate of MDZ might be caused by the ingredients of BST and may not be related to other factors such as increased excretion of MDZ by P-glycoprotein. Conclusions The altered pharmacokinetics of midazolam caused by co-administration with BST in vivo could be attributed to a decrease in pH and subsequent reduction of MDZ absorption rate.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.4
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• pp.782-787
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• 1998

The treatment for pediatric dental patient has become more complex than the previous, because patients of pediatric dentistry, younger than the previous, and they were often combined with systemic disease. And, the importnace of conscious sedation has been increased by this time for this reason. In a variety of CNS depressants, newly developed imidazobenzodiazepine (midazolam) is well known as a safe and effective medicament. It has a rapid onset, minimized cardiovascular depression and various possible administering, route, so it is commonly used for the conscious sedation of pediatric dental patients. Recently, "intranasal drop-in method" draws attention for its safety, but discomfort during administration and posterior dripping through pharynx diminish its popularity. Now more advanced method for intranasal administration is introduced for conscious sedation for pediatric dental patients, it is "intranasal spray" with aerosol form of medicament. With this method, we can achieve some benefits as belows : 1. Diminished discomfort during intranasal spray than nitranasal drop-in. 2. Rapid osnet and reduction than intranasal drop-in. 3. Eliminatin of adverse reaction, such as rhinorrhea. 4. More improved behavior rating scale.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.4
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• pp.811-824
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• 1998

The purpose of this study was to compare the clinical sedation effect of chloral hydrate and hydroxyzine combination, midazolam, triazolam when young children were sedated for dental treatment. The uncooperative 22 children aged, 25 to 52 months of age(ASA class I) and weighting between 11 and 17kg, participated in the study. Each patient was assigned randomly to receive chloral hydrate(50mg/kg) and hydroxyzine HCl(25mg), midazolam(0.5mg/kg), and triazolam(0.25mg) oral administration : alternative regimens were administered at next appointment. According to rating scale, sleep, crying, movement, and overall behavior response were checked for evaluation of the clinical sedation effect. Pulse rate and oxygen saturation were also measured for monitoring the patients during treatment period by pulse oximeter. The results were as follows: 1. In the evaluation of sedation effect, 90.9% in chloral hydrate and hydroxyzine combination and midazolam, and 77.3% in triazolam were rated "good" or "very good". 2. Sleep was demonstrated to be statistically significant increase in chloral hydrate and hydroxyzine combination group. Despite the fact that chloral hydrate and hydroxyzine group was in a deeper state of sleep, all the children were easily aroused. 3. There were no statistically significance among the three regimens with regard to cry ing, movement, overall behavior. 4. The adverse side effect was vomiting in one patient of chloral hydrate and hydroxyzine combination. There were no clinical sign of respiratory depression.