• Journal of the korean academy of Pediatric Dentistry
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• v.37 no.2
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• pp.213-217
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• 2010

The use of chloral hydrate and hydroxyzine for oral sedation is most effective in children aged less than 36 months and weighing less than 15 kg. Children who do not belong to this category may show frequent movements due to shallow sedation level, and it can lead to sedation failures. One of the solutions to such sedation failure is conversion to deeper sedation. But, it is not so much of an option, since inhalation anesthetics and devices are required. In this case, conversion from oral sedation to intravenous sedation was successfully achieved without causing injection pain while searching for an intravenous route, by using EMLA cream (Eutectic Mixture of Local Anesthesia). A patient aged 46 months and weighing 15 kg visited the Pediatric Department of Dankook University Dental Hospital. Treatment under TSD(Tell Show Do) was offered, but due to the parent's request, oral sedative measures were taken. Considering prompt converting from oral sedation to iv sedation in case the oral sedation fails, EMLA cream was apllied preemptively. Adequate sedation level could not be achieved after 90 minutes of oral administration, therefore, under the parent's consent, intravenous route was prepared after conscious sedation by $N_2O-O_2$. During treatment, $ETCO_2$, $SPO_2$ and heart rate was monitored every 5 minutes. The patient showed stable vital signs and did not show any movements. The whole procedure took two and a half hours in total, and the treatment was completed without any adverse effects.

• Journal of the korean academy of Pediatric Dentistry
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• v.28 no.3
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• pp.337-344
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• 2001

The combination of chloral hydrate and hydroxyzine is one of the safest and most commonly used drug regimens for sedating young, uncooperative pediatric dental patients. The continuous monitoring of respiratory function and early recognition of respiratory difficulties are essential for the successful management of sedated dental patients. The purpose of this study was to evaluate the success rate of the sedation and the hypoxia through monitoring the oxygen desaturation in the pulse oximeter in pediatric dental patients sedated with 60mg/kg chloral hydrate and 25mg hydroxyzine. The following results were obtained : 1. The success rate of the sedation was 69.6% and there was no statistically significant difference among the groups based on the ages, weight and duration of the operative time. 2. Forty two percentage of the sedated patients showed the temporary hypoxia state and there was no statistically significant difference based on the ages and weights of the patients. But there was a statistically significant difference on the duration of the operative time.

• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.2
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• pp.234-246
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• 2007

The combination of chloral hydrate and hydroxyzine is one of the safest and most commonly used drug regimens for sedating young, uncooperative pediatric dental patients. Midazolam IM or IN and $N_2O/O_2$ inhalation is sometimes administered with chloral hydrate and hydroxyzinecombination when deeper and longer sedation is needed. The purpose of this study was to assess the outcome and safety of chloral hydrate, hydroxyzine and $N_2O/O_2$ in the sedation of a large number of uncooperative pediatric dental patients and to identify variables associated with their effectiveness. In a nine-month retrospective study, 171 records of sedation performed in 94 healthy children(male 46, female 48) with mean age of $30{\pm}8$ months were reviewed. The authors analyzed several variables such as age, sex, weight, methods of drug delivery, waiting time after drug delivery, treatment rendered, treatment time, adverse events, sedation outcome. Eighty five percent of sedation had success behavioral outcome. Sedation sessions rated success used more $N_2O/O_2$ administration and had longer treatment duration than sedation sessions rated failure. A children patient under 36 months of age had enough sleep by only oral administration and the mean waiting time of this case was significantly shorter than that of a children patient over 36 months of age. There was a clear correlation between age and $N_2O/O_2$ using tine, but no correlation between weight and $N_2O/O_2$ using time. There was no statistically significant difference among variables of treatment duration, $N_2O/O_2$ administration and adverse event.

• Journal of Hospice and Palliative Care
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• v.11 no.3
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• pp.140-146
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• 2008

Purpose: Sooner of later, end-of-life care decision-making will unfold and be settled during the professional lives of medical students. However, there is prevalent ambiguity and uncertainty between the palliative treatment and euthanasia. We conducted this survey to investigate attitudes of medical students towards end-of-life making decisions, and to find out which factors primarily influenced the attitudes. Methods: A study was conducted among medical students at one university, the Republic of Korea. A written questionnaire was sent to all the 1st, 2nd, and 3rd-year medical students. It presented 5 statements on end-of-life decision-making. Students were asked whether they agreed or disagreed with each statement. Results: The response rate was 74.4%, and 267 questionnaires were analyzed. Percentages of agreement with each statements on Voluntary active euthanasia (VAE), Physician assisted suicide (PAS), Withholding life-sustaining management, Withdrawing life-sustaining management, and Terminal sedation (TS) was 37.1%, 21.7%, 58.4%, 60.3%, and 41.6%, respectively. The grade of students, religious activity, and educational experience were determinant factors. Agreement on each statements was higher in the low religious activity group than in the high religious activity group. Agreement on TS was higher among 3rd year students during their clerkship than among 1st and 2nd year students. Age of students and the experience of dying-people care had no significant influence. Conclusion: In end-of-life decision-making, religious and educational factors influenced medical students' attitudes. Especially, the experience of education during clerkship had significant influence on the attitude. Proper teaching on end-of-life decisions should further be considered during medical students' clerkship.

• Journal of the korean academy of Pediatric Dentistry
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• v.43 no.1
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• pp.27-35
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• 2016

The present study aimed to assess the perception of a child's primary caregiver on the oral health-related quality of life (OHRQoL) of dental treatment under general anesthesia (GA) or intravenous sedation (IV-SED) in pediatric dental patients. Self-administered questionnaires were completed before dental treatment under GA or IV-SED by 52 primary caregivers of healthy pediatric patients (10 years old or younger), and 43 (84%) of these caregivers completed the same questionnaires within 6 months after treatment. The Korean version of Child Oral Health Impact Profile (COHIP) and the Family Impact Scale (FIS) were used to assess OHRQoL in the questionnaires. The scores of COHIP and FIS improved after dental treatment. Demographic variables such as gender did not affect the improvement of COHIP and FIS, and age did not affect that of COHIP. However, baseline FIS score of younger patients was better than that of older patients before dental treatment. Regardless of the treatment variables, all COHIP and FIS scores were improved after dental treatment. COHIP score improved more in cases with pulp treatments compared to those without the treatments. On the other hand, FIS score improved less in cases with posterior stainless steel crown restorations compared to those without them. Anterior esthetic restorations and anterior teeth extractions did not affect the degree of improvement. Based on the primary caregiver's perceptions, the OHRQoL of healthy pediatric patients was improved by dental treatment under GA or IV-SED.

• Journal of the korean academy of Pediatric Dentistry
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• v.35 no.3
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• pp.427-436
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• 2008

Purpose. The objective of this study was to evaluate the behavioral response and assess the effectiveness of additional intranasal (IN) and submucosal (SM) administration of midazolam during pediatric sedation for dental procedure. Material and methods. Thirty-three cases of healthy (ASAⅠ), uncooperative children aged from 24 to 72 month old at pediatric dental clinic of Ewha Womans University Hospital were selected for this study. Children received oral chloral hydrate 50 mg/kg with hydroxyzine 1.0 mg/kg. After waiting for 45 minutes, midazolam 0.2 mg/kg was administrated via IN route and via SM route randomly maintaining 50% of $N_2O$. A pulse oximeter and a capnograph were used for measuring vital signs ($SpO_2$, PR, RR, $EtCO_2$) throughout the sedation. Behavioral response was evaluated as Quiet (Q), Crying (C), Movement (M) or Struggling (S) in every 2 minutes for 40 minutes. Results. There were also no statistically significant differences in vital signs of the two groups. The behavioral response for the first ten minutes during sedation was a statistically significant difference (P < 0.05) between the two groups. After the first ten minutes, it was revealed that there was no significant difference. Conclusion. This study demonstrated that the addition of IN midazolam to the combination of oral chloral hydrate with hydroxyzine and nitrous oxide/oxygen inhalation is as safe and effective as that of SM midazolam in pediatric sedation for dental procedure.

• Journal of the korean academy of Pediatric Dentistry
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• v.34 no.2
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• pp.341-348
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• 2007

We dentists perform many of routine dental procedures and must deal with much of the population's dental anxiety and fear. Dentists have used many non-pharmacological modalities initially to overcome anxiety and fear, including distraction, empathy, desensitization, and so on. However, certain patients need pharmacological backup of anxiety and fear to conquer dental treatment. This article presents four cases to introduce the methods from nitrous oxide and oxygen inhalation to general anesthesia for difficult adult dental phobic patients to deal with.

• Journal of Korean society of Dental Hygiene
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• v.24 no.4
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• pp.353-360
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• 2024

Objectives: This study aimed to investigate the effects of conscious sedation on patient satisfaction with dental treatment. Methods: The survey included questions on the patients' general characteristics, dental treatment fear, anxiety, and satisfaction, and patient evaluation by an observer. Statistical analyses were performed using SPSS 20.0 ver. and data were analyzed using frequency analysis, independent t-test, Pearson's correlation coefficient, and multilinear regression analysis. Results: Patients who received conscious sedation therapy showed significantly lower levels of dental fear and anxiety, whereas their dental treatment satisfaction was significantly higher than that of patients who received regular dental treatment (p<0.05). Dental treatment fear, anxiety, satisfaction, and conscious sedation depth were significantly correlated in patients who received conscious sedation therapy (p<0.05). Factors influencing dental treatment satisfaction included age, weight, use of medication, smoking habits, use of conscious sedation therapy, dental treatment fear and anxiety, and conscious sedation depth (p<0.05). Conclusions: Conscious sedation therapy can be an effective method to reduce dental treatment fear and anxiety and improve patient satisfaction.

• Journal of The Korean Dental Society of Anesthesiology
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• v.7 no.1
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• pp.6-12
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• 2007

배경: 소아 진정 치료 시 서로 다른 용량의 chloral hydrate와 hydroxyzine을 복용 후 midazolam을 구강 점막 하 주사했을 때 행동 반응을 비교하였다. 방법: 총 32회 진정법을 통해 치과치료를 받은 30명의 나이 24-72개월, 체중 20 kg 미만의 미국 마취과학회 신체등급 I의 건강하지만 겁이 많고 협조가 안 되는 소아 환자를 대상으로 2개 치아이상의 보존 치료 및 발치를 필요로 하는 환자를 대상으로 하였다. 호흡기 질환이 있는 아이들은 이 연구에서 제외되었다. 연구 계획은 이대 목동 병원의 임상 실험 심사 위원회에 제출되었다. 1군은 chloral hydrate 50 mg/kg와 hydroxyzine 1 mg/kg 복용 후 점막 하 midazolam 0.2 mg/kg을 추가 투여했고 2군은 chloral hydrate 60 mg/kg와 hydroxyzine 1 mg/kg 복용 후 점막 하 midazolam 0.1 mg/kg을 주사 받았다. 50% nitrous oxide는 치료 중 두 군 모두 유지되었다. 전날 수면 시간과 약물 복용 태도를 기록하였으며 모든 치료 과정은 비디오로 촬영되었다. 맥박 산소 계측기를 이용하여 경피적 산소 포화도와 맥박수를 기록하였고 행동 반응은 Houpt scale을 이용하여 매 2분마다 40분 동안 기록되었다. 전반적인 행동 반응은 Houpt scale를 이용하여 평가되었다. 모든 자료는 SPSS 통계 프로그램을 이용하여 two sample independent t-test를 사용하였다. P 값은 0.05 미만인 경우를 통계학적으로 유의하다고 보았다. 결과: 두 군 간의 경피적 산소 포화도와 맥박수는 모두 정상 범위이며 유의한 차이가 없었다. 행동 반응 비교에서는 치료 처음 10분 동안 2군이 1군에 비해 점수가 높게 나왔으며(P < 0.05), 그 외에는 유의한 차이가 없었다. 전날 총 수면 시간과 약물을 복용하는 태도는 수면 치료 중의 행동 반응에 영향을 주지 않았다. 결론: Chloral hydrate 50 mg/kg 복용과 점막 하 midazolam 0.2 mg/kg은 chloral hydrate 60 mg/kg 복용과 점막 하 midazolam 0.1 mg/kg과 비교할 때 두 약물의 조합은 모두 소아 환자 수면 치료시 안전하고 효과적인 용량이다. Overall behavior와 Q (quiet)의 분포를 비교해 볼 때 두 군 모두 성공적인 진정효과를 기대할 수 있다.

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