• 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.

• 대한치과마취과학회지
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• 제1권1호
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• pp.21-25
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• 2001

연구배경: 임상적으로 진정법을 시행할 경우 뇌의 상태에 대한 접근은 매우 중요하다. 환자의 뇌에 대한 마취제의 영향을 측정하기 위해 개발된 Bispectral Index (BIS)는 환자의 진정을 방해하지 않고 객관적인 진정정도를 평가할 수 있다. 그러나 이는 항상 진정 깊이의 임상적인 척도와는 일치하지 않는다. 이번 연구에서는 진정법 시행시 환자의 진정 정도를 측정하기 위한 BIS의 유용성을 검증하기 위하여 BIS, 진정점수, 그리고 midazolam의 혈중 농도와의 관계를 연구하였다. 방법: 25명의 건강한 성인 지원자들을 대상으로 무의식을 유도하기 위하여 midazolam 0.08 mg/kg을 정맥으로 주입하였으며 환자의 의식 상태를 진정 회복 시까지 관하였다. BIS와 진정점수는 진정 전과, midazolam 투여 후 10, 20, 30분 간격으로 측정하였다. Midazolam의 혈중 농도는 주입 후 10분 경과 후에 정맥혈 채취 후 HPLC를 이용하여 측정하였다. BIS는 BISTM monitor (Aspect Medical Systems, USA)으로 측정하였으며 또한 진정 정도는 진정 점수로도 평가하였다. 결과: BIS 수치는 진정점수와 유의한 상관관계를 보였다(r = 0.676, p < 0.05). 혈중 midazolam 농도가 감소함에 따라 혈중 농도는 진정점수와 유의한 상관관계를 보였다(r = -0.656). Midazolam 투여 후 10분에서 BIS 수치와 midazolam의 혈중 농도는 유의한 상관관계를 보이지 않았지만(r =0.467) 진정 후 수치는 진정 전 수치와 명확히 구분되었다. 결론: BIS는 환자의 수면상태의 효과적인 척도로 알려져 있으며 진정점수와도 높은 상관관계를 보였다. 그러나 항상 진정 깊이를 나타내는 임상적인 척도와는 일치하지 않았다. 그러므로 진정법 시행동안 BIS 만을 사용하는 것은 더욱 많은 주의가 필요하며 매 주어진 시간마다 다양한 진정 점수 측정방법으로 환자의 의식을 감시하는 것이 추천된다.

• 대한치과마취과학회지
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• 제12권1호
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• pp.11-16
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• 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.

• Environmental Analysis Health and Toxicology
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• 제31권
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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.

• 대한소아치과학회지
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• 제25권4호
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• pp.782-787
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• 1998

Midazolam의 비강내 분무를 이용한 소아치과 환자의 의식진정하 치과치료 결과, 아래와 같은 특징들이 발견되었으며, 기존의 비강내 점적의 대표적인 단점인 posterior dripping이 대부분 제거되었음에도 불구하고, 상기도감염 등의 경우 보이는 비강내 충혈, 잦은 비루등의 경우에서는 이의 사용이 제한됨을 알 수 있었다. 1. 투여시 불편감의 감소 2. 점적의 경우보다 빠른 약효의 발현 및 회복 3. 점적시 보였던 rhinorrhea등 부작용의 감소 4. 점적시보다 개선된 행동양상의 표현

• 대한소아치과학회지
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• 제24권1호
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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.

• 대한치과마취과학회지
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• 제10권1호
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• pp.27-33
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• 2010

The gag reflex is a physiologic reaction which safeguards the airway from foreign bodies. But, an exaggerated gag reflex can be a severe limitation to a patient's ability to accept dental care and for a clinician's ability to provide it. The overactive gag reflex can be due to psychological factors or physiological factors, or both. Psychological factors can include fear of loss of control and past traumatic experiences. A 58-year-old man, scheduled for extraction of left upper second molar, left lower second and third molar and implantation of left upper second molar, and left lower second molar had no specific underlying medical problems. He had exaggerated gag reflex. Dental treatment was successfully performed using intravenous sedation. Intravenous sedation with midazolam and propofol was a useful management technique for reflex control during dental treatment extended to the posterior regions in the oral cavity.

• 대한장애인치과학회지
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• 제9권1호
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• pp.46-50
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• 2013

저자는 본 증례를 통하여 발달장애 환자의 치과치료 시 다음과 같은 지견을 얻었다. 1. 발달장애 환자의 경우 불량한 구강위생 등으로 인하여 치과적 치료가 필요한 경우가 많다. 2. 발달장애 환자의 경우 비약물적 행동조절만으로 치과적 치료를 위한 충분한 협조도를 얻기가 어렵다. 3. 발달장애 환자에 있어서 midazolam 구강 전투약을 이용한 전신마취 하 치과치료가 매우 유용하게 적용될 수 있다. 4. 숙련된 의료진의 철저한 감시하에 정맥주사용 midazolam 제재를 설탕시럽에 혼합하여 투약한다면 전투약을 통해 기대하는 효과를 얻을 수 있다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권2호
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• pp.47-52
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• 2015

Sedation allows patients to maintain their airway independently and respond appropriately to physical stimulation and verbal command while maintaining a minimum depressed level of consciousness. Drugs commonly used for sedation of pediatric dental patients include a combination of chloral hydrate, hydroxyzine, and nitrous oxide-oxygen. Midazolam is a benzodiazepine and currently one of the most commonly used intravenous sedative agents. It can be easily titrated to provide a wide range of sedation, from conscious sedation to deep sedation, and exhibits a wide safety margin without severe respiratory and circulatory depression. At an appropriate dose, it also decreases patient anxiety and induces amnesia. We found that the submucosal administration of midazolam combined with chloral hydrate provided increased sedative effects and decreased the postoperative vomiting response compared with conventional chloral hydrate administration, with no significant difference in physiological responses. The depth of sedation can be titrated using this technique.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제37권3호
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• pp.241-244
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• 2011

Introduction: Intravenous sedation is performed to ensure smooth and safe surgery. Dental anxiety is a reaction to an unknown danger. The Spielberger's state-trait anxiety inventory (STAI) can be used to simultaneously evaluate the levels of state and trait anxiety. State anxiety is defined as subjective feelings of nervousness. This study assessed the presurgical anxiety using STAI and performed intravenous sedation for patients whose level of state anxiety was > stage IV. Based on our clinical experience, it is believed that higher doses of sedatives are needed to induce the desired levels of sedation in patients with a high level of state anxiety. Objectives: This study examined whether the sedative consumption of the patient with a high anxiety level increased. Patients and Methods: Patients with state anxiety scores of ${\geq}$51 were included in Group V, and those with state anxiety scores ranging from 42 to 50 were placed in Group IV. To induce sedation, intravenous access was established, and a bolus dose of 3.0 mg midazolam was administered intravenously. Sedation was maintained by administering a continuous infusion of propofol, which was aimed at achieving an Observer's Assessment of Alertness/Sedation scale of 10-12/20. In this study, midazolam was initially administered when the body movements appeared to occur or the blood pressure increased. This was followed by the administration of higher doses of propofol if low sedation was observed. Results: There were no significant differences in the patient demographics, duration of sedation, and doses of local anaesthetic agents between Groups IV and V. The midazolam dose and mean propofol dose needed to maintain comparable levels of sedation were significantly higher in Group V than in Group IV. Conclusion: In female patients, whose level of preoperative state anxiety is more than Stage V of STAI, a large quantity of sedatives is needed for intravenous sedation.