• Journal of The Korean Dental Society of Anesthesiology
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• v.6 no.2 s.11
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• pp.103-112
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• 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 academy of Pediatric Dentistry
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• v.38 no.4
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• pp.355-361
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• 2011

Sedative method and its effect are affected by diverse variables: dosage and intake method of drug, weight, gender, patient compliance, sleeping hours prior to procedure, treatment hours, health status, type of used drugs are the factors. This study is conducted with empirical observation that shorter the sleeping hours before the day of chloral hydrate sedation, the effectiveness is larger; and therefore to actually recognize the correlation between chloral hydrate/hydroxyzine sedation and sleeping hours of child patient prior to sedation. The subjects were those children whose sleeping hours were similar to each other at the ages ranging from 2 to 5 years old totaling 37 children. Total 11 of them received pulp treatment. Sedative effect was evaluated by the same assessor with Houpt's rating scale. Sedative effect in relation with prior day's sleeping hours evaluated with simple regression analysis. Sedative effect in relation with pulp treatment was analyzed with independent t-test. Sleeping hours prior to sedation and sedation effect have negative correlation. No significant correlation is found between pulp treatment and sedation effect(p>0.05).

• Journal of the korean academy of Pediatric Dentistry
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• v.33 no.1
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• pp.62-69
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• 2006

Objective : This study was conducted to investigate as to whether obesity have any effects on conscious sedation outcomes. Methods : Forty children (mean age 30.5 months, mean height and weight were 91.3cm, 14.3kg respectively) were sedated with chloral hydrate (60 mg/kg) and hydroxyzine (25mg). The relative obesity rate of the patients was obtained by the proportion of height to weight and the tonsil size of the patients was classified by Brodsky's scale. The overall sedation outcomes were evaluated by Houpt's scale. The pulse and respiratory rates during sedation were also evaluated. Results: The obesity of the patients had no statistically significant effects on movement, crying during sedation. However, an increase in obesity had negative effects on the overall conscious sedation outcomes. Conclusion: This investigation demonstrated that increased obesity may cause detrimental effects on pediatric conscious sedation outcomes.

• Journal of the korean academy of Pediatric Dentistry
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• v.29 no.4
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• pp.489-497
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• 2002

The purpose of this study was to compare the clinical sedation effect of chloral hydrate and hydroxyzine combination with and without nitrous oxide/oxygen inhalation when young children were sedated for dental treatment. The uncooperative 20 children aged, 21 to 47 months of age(ASA Class I), participated in the study. The author examined 20 children(male 12, female 8). Each patient was assigned to receive chloral hydrate(50mg/kg) and hydroxyzine(25mg). Next appointment, each patient was assigned to receive $N_2O-O_2$, choral hydrate and hydroxyzine. Sleep, crying, movement, and overall behavior response were evaluated, and the sedative effects were evaluated by Houpt's rating scale. Pulse rate and peripheral oxygen saturation were also measured for monitoring the sedated patients during treatment period by pulse oximeter. The result were as follows : 1. In the evaluation of sleep scores, crying scores, and movement scores, chloral $hydrate/hydroxyzine/N_2O-O_2$ combination group was significantly rated high(p<0.05). 2. In the evaluation of overall behavior scores, chloral hydrate/hydroxyzine/$N_2O-O_2$ combination group was significantly rated high(p<0.05). 3. In the evaluation of overall behavior evaluation scores(by Houpt), 93.3% in chloral $hydrate/hydroxyzine/N_2O-O_2$ combination group and 63.3% in chloral hydrate/hydroxyzine combination group were rated "good" or "very good". 4. There was no adverse side effect(i.e. respiratory depression) in both group.

• Journal of The Korean Dental Society of Anesthesiology
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• v.8 no.2
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• pp.127-127
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• 2008

Recently combining regimen of minimal doses of chloral hydrate, hydroxyzine and midazolam is good in sedation of children. Midazoalm, water soluble benzdiazepine, has rapid onset and relatively short duration of action. And midazolam has prospective amnesic effect. With these advantages midazolam is popular in conscious sedation for children. This study was to reveal the dose-dependency of behavior and physiologic effects of submucosal midazolam. Sedation records were surveyed retrospectively, of which the patients admitted from April, 2005 to July, 2007. we assigned three groups according the dose of midazolam, 0.1 mg/kg, 0.2 mg/kg and 0.3 mg/kg, respectively and the behavioral evaluation was analyzed with Houpt scale statistically. Combined submucosal midazolam increased the success rate in sedation and the vital signs were stable during sedation.

• 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.32 no.2
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• pp.262-269
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• 2005

The purpose of this study was to compare the efficacy and complications of two oral sedative regimens, chloral hydrate (60mg/kg)/hydroxyzine(25mg) versus midazolam(1mg/kg)/meperidine(1mg/kg) for the sedation of pediatric dental patients. Fifteen patients(mean age 36.2months, range 24-47months), ASA Class I or II, who needed at least two restorative dental procedures were selected in this double-blind, randomized study. All subjects were randomly assigned to receive either chloral hydrate/hydroxyzine or midazolam/meperidine and 50% $N_2O/O_2$ was administered at each appointment. Behavior assessment(sleep, movement, crying, overall behavior) was made using Houpt Sedation Rating Scale and physiologic parameters(pulse rate, oxygen saturation) were monitored using pulse oximeter. The incidence of hypoxia($SpO_2$ 90% or less, at least 10s duration) and vomiting was recorded. Patients sedated with chloral hydrate/hydroxyzine showed significantly better overall behavior score than patients sedated with midazolam/meperidine. There was no clinically significant difference in the incidence of hypoxia and vomiting. It was concluded that oral administration of chloral hydrate/hydroxyzine is more effective than midazolam/meperidine for the sedation of pediatric dental patients.

• Journal of The Korean Dental Society of Anesthesiology
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• v.5 no.2 s.9
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• pp.101-106
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• 2005

Purpose: This retrospective study assessed the effectiveness of submucosal (SM) midazolam (M), oral chloral hydrate (CH), hydroxyzine (H), and nitrous oxide (N) 99 uncooperative pediatric dental patients over 182 sedation sessions. Methods: Selection criteria included good medical health (ASA I), from 2 to 6 years of age, uncooperative behavior, and the need for restorations and dental surgery. The children who was administerated with CH H, N was Group 1 (48 case). The children who was administerated with CH, H, N, M was Group 2 (51 case). All the patients received oral CH (50-70 mg/Kg), H (1 mg/Kg) and N (less than 50%). Additionally the Group 2 received SM midazolam (0.1-0.2 mg/kg). Behavior response was rated as quiet (Q), crying (C), movement (M), or struggling (S) every 5 minutes through operative procedures. Behavior response rating was assigned to Houpt scale of Overall behavior. Data was analyzed using Chi-Square Test. Results: The Group 2 had more effective (88.2%) than the Group 1 (68.8%)(P = 0.05). Also, vomiting response decreased in the Group 2 (94.4%) than those with oral administration of chloral hydrate alone without SM midazolam (77.1%)(P = 0.05). Conclusions: SM midazolam improved the quality of sedation and vomiting response.

• Journal of the korean academy of Pediatric Dentistry
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• v.27 no.2
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• pp.283-291
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• 2000

The purpose of this study was to compare the sedative effect of three routes of administration - intramuscular, intranasal drop-in, intranasal spray - with midazolam. The twenty two uncooperative children from 23 months to 76 months who required at least three dental appointment. Each patient was assigned randomly to receive intramuscular(Group I, 0.15mg/kg), intranasal drop-in(Group II, 0.20mg/kg), intranasal spray(Group III, 0.20mg/kg) administration at each visit. Sleep, crying, movement, and overall behavior response were evaluated, and the sedative effects were evaluated by Houpt's rating scale In order to monitor the sedated patients, pulse rate and peripheral oxygen saturation were measured by pulse oximeter during treatment procedures. The results were as follows 1. Pulse rate and peripheral oxygen saturation were stable through all the treatment procedures, and there were no statistically significant differences among three routes of administration(P>0.05). 2. The effect on sleep was, III, II, I, in order, III group was the most effective through all the treatment procedures, except rubber-dam placement and filling phase (P<0.0001). 3. The effects on crying, movement, overall behavior were II, III, I, in order, II group was the most effective through all treatment procedures(P<0.0001).