• Journal of The Korean Dental Society of Anesthesiology
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• v.14 no.1
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• pp.29-39
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• 2014

Background: Dental phobia or anxiety of patients is the serious impediment to appropriate and effective dental treatment. Sedative technique helps to mitigate patients' fear and anxiety thus make them more cooperative and familiar to dental practices. With increasing attention to sedative dentistry in dentists, educational requirements and technical qualification also become stricter but actual survey on recent sedative dentistry has not been reported yet. Especially there is insufficient study reporting the survey of sedative dentistry subjected to Korean adults. In this paper, we conducted a survey study on the actual condition and practice related to sedation with a questionnaire to dentists in South Korea. Methods: The survey was done for members of The Korean Dental Society of Anesthesiology (KDSA), who had great interest in sedation and for whom survey-by-mail was convenient. 472 members of The KDSA having dental license and solid address and contact information were subjected to the survey by sending them survey questions about their sedative techniques and knowledge. In order to increase the response rate, small gifts were presented to those who accurately responded to the survey questions and text messages and phone calls were made to encourage their participation. We collected their responses over two months and examined the returned surveys. Statistical analysis was performed using IBM SPSS Statistics 21 for each question. Results: Out of 472 dentists, 181 responded (38.4% response rate). 63.0% (114 dentists; 77 male and 37 female) of respondents had experience on sedative technique and their average age was $39.8{\pm}7.6$ year. 74 of them were private practitioners, 17 of them were professors (14.9%), 11 of them were dentists-in-service (9.6%), 11 of them were residents (specialist training) (9.6%) and 1 of them was military doctors (0.9%). There were 89 dentists (78.1%) who were specialists or receiving trainings to be specialist, most of whom were pediatric dentists (55, 48.2%) and oral surgeon (31, 27.2%). The most popular route for drug medications was orderly oral, inhalational, intravenous medication. Combination of oral and inhalational medications or single use of intravenous medication was the most common. The most preferred sedative drug was pocral in oral sedation and midazolam in intravenous sedation. 48.2% of practitioners responded that they experienced side effects and emergency situations. Airway obstruction was the most frequent. Conclusions: Results from the survey show that the protocol and system for sedative dentistry have been improved compared to the past. Nevertheless, quality of emergency protocol, monitoring devices and preparation of sedative drugs was still insufficient to achieve safe sedative procedure. This study acquires novelty since actual survey on recent sedative dentistry for adult patients has not been reported yet.

• Journal of Dental Anesthesia and Pain Medicine
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• v.15 no.1
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• pp.1-4
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• 2015

In pediatric dentistry, chloral hydrate is habitually selected for sedation of uncooperative children. Although chloral hydrate has been used for decades, various adverse effects are reported and necessity for new alternative drugs has increased. Dexmedetomidine was approved by FDA for sedation at intensive care units (ICU) in 1999. Compared to conventional sedative drugs, dexmedetomidine has not only analgesic and sedative effects but also it barely suppresses the respiratory system. Due to these characteristics, dexmedetomidine is known as safe sedative drug for children and elderly patients. Furthermore, approved by KFDA in 2010 in Korea, the frequency of sedation using dexmedetomidine is increasing. However, due to its intravenous administration method, it was difficult to apply in pediatric dentistry. Recently, intranasal administration method was introduced which might be a new possible alternative of oral sedation. In this study, we compare the mechanisms, pros and cons of chloral hydrate and dexmedetomidine, introducing new possibilities.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.48 no.6
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• pp.348-355
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• 2022

Objectives: To compare the vital sign stability and cost of two commonly used sedatives, midazolam (MDZ) and dexmedetomidine (DEX). Patients and Methods: This retrospective study targeted patients who underwent mandibular third molar extractions under intravenous sedation using MDZ or DEX. The predictor variable was the type of sedative used. The primary outcome variables were vital signs (heart rate and blood pressure), vital sign outliers, and cost of the sedatives. A vital sign outlier was defined as a 30% or more change in vital signs during sedation; the fewer changes, the higher the vital sign stability. The secondary outcome variables included the observer's assessment of alertness/sedation scale, level of amnesia, patient satisfaction, and bispectral index score. Covariates were sex, age, body mass index, sleeping time, dental anxiety score, and Pederson scale. Descriptive statistics were computed including propensity score matching (PSM). The P-value was set at 0.05. Results: The study enrolled 185 patients, 103 in the MDZ group and 82 in the DEX group. Based on the data after PSM, the two samples had similar baseline covariates. The sedative effect of both agents was satisfactory. Heart rate outliers were more common with MDZ than with DEX (49.3% vs 22.7%, P=0.001). Heart rate was higher with MDZ (P=0.000). The cost was higher for DEX than for MDZ (29.27±0.00 USD vs 0.37±0.04 USD, P=0.000). Conclusion: DEX showed more vital sign stability, while MDZ was more economical. These results could be used as a reference to guide clinicians during sedative selection.

• Korean Journal of Veterinary Research
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• v.32 no.3
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• pp.341-345
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• 1992

The tuber of Pinellia ternata Breitenbach(Araceae), which is distributed in Korea, China, and Japan, has been used in traditional Chinese medicine. The prescription containing Pinellia tuber shows anti-emetic, sedative, and anti-tussive effects. The purpose of this study was to investigate the effects of Pinellia ternata tuber on the xylazine-induced emetic and sedative responses in cats. The results were as follows ; 1. Intramuscular injection of xylazine hydrochloride(1.0mg/kg) reliably evoked vomiting with an incidence of 100% and sedated with a mean sedation time of 34.22 min. 2. The xylazine-induced emetic and sedative responses were not prevented by oral administration of powder (0.5g/head), decoction ($1.0m{\ell}/100g$), and methanol extract ($0.1m{\ell}/100g$) of the Pinellia ternata tuber. 3. The xylazine-induced emetic and sedative responses were inhibited by intravenous injection of decoction($0.3m{\ell}/100g$) of the Pinellia ternata tuber. 4. The xylazine-induced emetic and sedative responses were inhibited by intravenous injection of a combined mixture of yohimbine hydrochloride(0.125mg/kg) and 4-aminopyride(0.3mg/kg).

• 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).

• The Journal of Pediatrics of Korean Medicine
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• v.11 no.1
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• pp.205-226
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• 1997

Sanpoongdan(SPD) has been known effective on infantile convulsive disorders in clinical field of oriental medicine. The purpose of this study was to investigate the anti-convulsive, sedation and analgesic effects of SPD in mouse. The anticonvulsive effect was evaluated In mice treated with pentylenetetrazol, stychnine, and picrotoxin. For the sedative effect, observations were made on the sleeping time induced by thiopental sodium and pentobarbital sodium following oral administration of SPD. Furthermore, reduction of spontaneous movements and ataxia using rota rod method were evaluated. Analgesic effects on the writhing syndrome induced by acetic acid and on hindlimb pain induced by pressure were also observed. The findings were as follows : 1. The solid extracts of SPD revealed no effect on convulsions induced by pentylenetetrazol, strychnine, and picrotoxin. 2. Thiopental sodium-induced sleeping time was prolonged by the administration of the solid extracts of SPD, but this result was devoid of statistical significance. 3. The oral administration of SPD enhanced the sleeping induced by pentobarbital sodium. 4. Spontaneous movements were significantly depressed following the oral administration of the solid extracts of SPD. 5. Ataxia was not shown in rota rod method following the oral administration of the solid extracts of SPD. 6. The solid extracts of SPD showed positive analgesic effects on the acetic acid-induced writhing syndrome. 7. The solid extracts of SPD raised the threshold of the hindlimb pressure pain, but the result was not statistically significant. From the results, it can be concluded that SPD has sedative and analgesic effects.

• The Journal of Pediatrics of Korean Medicine
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• v.10 no.1
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• pp.245-263
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• 1996

In order to investigate the effects of Yangsymtang on the activities of central nervous system, we observed the effects on convulsions induced by pentylenetetrazole, strychnine and picrotoxin. The sedative those on spontaneous motor activity and by rota rod method, the those on sleeping time induced by barbiturate and the alleviative those on pain induced by acetic acid and hind limb pressure also were analyzed. The results were as follows: 1. The solid extracts of Yangsymtang showed no anticonvulsive effects on convulsions induced by pentylenetetrazole, strychnine and picrotoxin. 2. As to the sedative effects by rota rod method, th solid extracts of Yangsymtang were recognized as significance(P<0.01). 3. The sleeping time induced by thiopental sodium was not prolonged by the oral administration of the solid extracts of Yangsymtang. 4. The oral administration of Yangsymtang did not influenced the sleeping induced by pentobarbital sodium significantly. 5. As to the effects on spontaneous motor activity, the oral administration of Yangsymtang made spontaneous motor activity decrease significantly(P<0.05). 6. The oral administration of Yangsymtang was significant on pain induced by acetic acid(P<0.001). 7. As to alleviative effects on pain induced by hind limb pressure. The solid extracts of Yangsymtang were not significant.

• Journal of the korean academy of Pediatric Dentistry
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• v.24 no.1
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• pp.280-292
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• 1997

The purpose of this study was to assess the sedative effect of three kinds of medication for management of the uncooperative 60 children aged from 16 months to 87 months required extensive treatment. The patients were given randomly a dose of 75mg/kg of chloral hydrate and hydroxyzine 25mg orally or 0.5mg/kg of midazolam orally or 0.3mg/kg of midazolam intranasally. All the children were restrained in a Pediwrap and were monitored with Pulse oximeter for assessing the safety of patients. According to rating scale, sleep, crying, movement, and overall behavior were checked for evaluation of the clinical sedative effect. The results were as follows: 1. In the evaluation of sleep, rating scale of chloral hydrate/hydroxyzine was superior to the other group(p<0.05). 2. In the evaluation of crying and movement at beginning of treatment, rating scale of chloral hydrate/hydroxyzine was superior to the other group(p<0.05), but during the treatment, rating scale of each group was not significantly different (p>0.05). 3. In the evaluation of overall behavior, 80% children of chloral hydrate/hydroxyzine were rated good or very good. With the oral and intranasal midazolam, 60% children were rated good or very good respectively. 4. There were no clinical signs of significant cyanosis and respiratory depression. Clinically, chloral hydrate/hydroxyzine was proved to be more effective sedation than any other sedative method. Oral and intranasal midazolam were also safe and effective sedation in young children undergoing pediatric dental procedures.

• Korean Journal of Oriental Medicine
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• v.2 no.1
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• pp.205-225
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• 1996

This study has been carried out to investigate the effects of Youngyanggaksan (YGS) extract on the anticonvulsive, antipyretic, anlgesic, sedative and GABAergic system of experimental animals. The results of this study were as follows : 1. YGS extract prolonged significantly the beginning time to convulsion and time to death induced by strychnine. 2. YGS extract prolonged significantly the time to death induced by electrical shock of ECT unit (3sec, 200F, 25mA). 3. On the experiment of hypothermic effects of YGS extract on the rectal temperature of rats, YGS extract decreased significantly the rectal temperature of rats. 4. On the experiment of antipyretic effects of YGS extract on the febrile induced by the subcutaneous injection of $150{\mu}g/kg$ endotoxin in rats, YGS extract decreased significantly the rectal temperature of rats. 5. On the experiment of analgesic effects of YGS extract on the writhing syndrome induced by intraperitoneal injection 0.7% acetic acid 1ml/100g in rats, the writhing syndrome was reduced significantly by administration of YGS extract. 6. On the experiment of sedative effects of YGS extract on spontaneous motor activity measured by wheel cage method in mice, the spontaneous motor activity was reduced significantly by administration of YGS extract. 7. On the experiment of effects of YGS extract on the activity of GABA-transaminase(GABA-T) in rat brains after 21 days of oral administration of YGS extract, the activity of GABA-T was reduced significantly by administration of YGS extract. 8. On the experiment of effects of YGS extract on the activity concentration of GABA in rat brains after 21 days of oral administration of YGS extract the activity concentration of GABA was reduced significantly by administration of YGS extract. 9. On the experiment of effects of YGS extract on the activity of GAD in rat brains after 21 days of oral adminstration of YGS extract, the activity of GAD was reduced significantly by administration of YGS extract. According to the those results, Youngyanggaksan extract reveals the effects on the anticonvulsive, antipyretic, anlgesic, sedative and GABAergic system.

• Journal of the korean academy of Pediatric Dentistry
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• v.24 no.3
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• pp.537-542
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• 1997

Chloral hydrate is one of the most widely used sedative agents to control the difficult-to-treat young age group in the dental clinic. The normal onset time of oral Chloral hydrate is 30-45 minute with some variations. We are often frustrated see the patient still awake and cry with agitation even after far more than the normal onset time. In such a case, the patient has to be rescheduled for another sedation visit with different agents and/or routes which greatly disappoints the guardians. This case report presents a sedative regimen that can possibly help the clinician complete scheduled treatment without postponement. We have tried additional administration of Midazolam intranasally to 22 patients of those who failed to respond properly to the initial dose(50-75mg/kg) of oral Chloral hydrate. The average age and weight of the patients was 34.2 months(22-61 mos.) and 15.2 kg(10-17 kg) respectively. Half of the regular dose of Midazolam(0.1mg/kg) was administered intranasally. using needless syringe in 42 cases without notable resistance of the patient. The onset was very rapid in most cases and colud proceed the treatment under the constant monitoring by Pulse oximeter. All the planned procedures could be completed in 93.2 % (69.4% of 'Good' plus 23.8% of 'Fair' rating)with only 6.8 %('Poor' rating) of failure rate. Evidence of adverse effect was not detected or reported during and/or after the procedures.