• 대한소아치과학회지
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• 제23권4호
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• pp.937-945
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• 1996

Nitrous oxide has acquired widespread use as a tool for management of anxious and comprehensive pediatric dental patients. Clinical impressions have suggested that inhalation sedation with $N_2O/O_2$ reinforces the effect of other sedatives. Fifteen uncooperative children, mean age of 37months, who were regarded as fail in the first treatment using chloral hydrate-hydroxyzine orally, midazolam orally or intranasally, were sedated with the same sedatives in conjunction with $N_2O/O_2$. All the children were restrained in a pediwrap and were monitored with pulse oximeter for their heart rate and oxygen saturation. Degree of sleep, crying and movement were evaluated. The clinical results indicated that a satisfactory level of sedation was achieved in approximately two thirds of the cases (about 66 %) under those sedation manner. Complications were rare and those of treatments were successfully completed without difficulty.

• 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.

• Clinical and Experimental Pediatrics
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• 제62권2호
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• pp.75-78
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• 2019

Although rare, antihistamines can cause adverse effects, including drug-induced eruptions or anaphylaxis. A 4-year-old child visited the pediatric department of a hospital for skin eruptions after administration of antihistamines, (e.g., ucerax [hydroxyzine] or leptizine [levocetirizine]), for cholinergic rashes; he did not have pruritus. Skin prick, intradermal, and drug provocation tests were performed to determine the relationship between the antihistamines and eruptions. Levocetirizine induced wheals in the skin prick test and a rash in the oral drug provocation test. In contrast, ketotifen induced no reaction in the skin prick test but showed a positive reaction in the oral provocation test. Our case report highlights that children can experience the same types of adverse reactions as seen in adults, and cross-reactivity between various antihistamines can occur.

• 대한소아치과학회지
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• 제37권3호
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• pp.338-344
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• 2010

본 연구에서는 진정법을 이용한 치과치료에서 소아환자의 편도선 크기가 진정법 중 환자의 행동에 미치는 영향을 평가하기 위해 진정법으로 치과치료를 받은 소아환자 35명의 진정기록지를 분석하였다. 진정법은 chloral hydrate 50 mg/kg, hydroxyzine 1 mg/kg를 경구투여하고, 치료 중 50% 아산화질소-산소 흡입 진정 및 필요에 따라 midazolam의 점막하투여(0~0.3 mg/kg)를 병행하는 방법으로 시행되었으며, 편도선의 크기는 Brodsky 분류법을 이용하여 4그룹으로 분류하였다. 환자의 진정 기록지를 분석하여 다음과 같은 결과를 얻었다. 1. 진정법 중 행동 반응은 수면, 움직임, 울음, 전반적 행동 모두에서 편도선 크기가 클수록 낮은 지수(negative behavior) 를 보였다(p<0.05). 2. 편도선의 크기는 진정법 중 구호흡과 유의한 연관성을 보였으나(p<0.05), 진정법 중 코골이, 기침과는 유의한 연관성을 보이지 않았다(p>0.05). 3. 편도선의 크기가 큰 환자일수록 midazolam의 점막하투여량이 유의하게 증가하였다(p<0.05).

• 한국임상약학회지
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• 제22권2호
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• pp.176-180
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• 2012

The stability of triamcinolone in three kinds of oral liquid syrups at 4 and $25^{\circ}C$ was studied for 21 days. Twenty tablets of 4 mg triamcinolone were mixed with 100 mL of each oral liquid syrup, which is Levotuss$^{(R)}$Syrup (levodropropizine 6 mg/mL), Ucerax$^{(R)}$Syrup (hydroxyzine 2 mg/mL), and Xyzal$^{(R)}$Liquid (levocetirizine 0.5 mg/mL). The chromatographic analysis after deliberate degradation showed no evidence of any breakdown product likely to interfere with the chromatographic peak of the parent substance. The relationship between triamcinolone concentrations and peak areas was linear from 50 to 1000 ${\mu}g/mL$ ($r^2$ = 0.9998). The analysis method was precise, with coefficients of variation no greater than 5.4%. Triamcinolone was stable for up to 14 and 21 days in Levotuss$^{(R)}$Syrup at 25 and $4^{\circ}C$, respectively; in Ucerax$^{(R)}$Syrup and Xyzal$^{(R)}$Syrup, it was stable for at least 21 days at both temperatures. The percentages of initial triamcinolone concentration remaining after 21 days were $72.3{\pm}3.2$ and $94.9{\pm}6.0%$ and $93.2{\pm}4.9$ and $92.4{\pm}5.7%$, and $92.6{\pm}1.2$ and $92.7{\pm}2.2%$ in Levotuss$^{(R)}$Syrup, Ucerax$^{(R)}$Syrup, and Xyzal$^{(R)}$Syrup at 25 and $4^{\circ}C$, respectively. The pH variations of all test solutions were within 0.8. Based on the results, it was concluded that triamcinolone in three oral liquid syrups which are Levotuss$^{(R)}$syrup, Ucerax$^{(R)}$syrup and Xyzal$^{(R)}$syrup was chemically and physically stable in both states of refrigeration and room temperature for at least 14 days.

• 한국임상약학회지
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• 제15권2호
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• pp.149-159
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• 2005

Purpose: To determine the extent and rate of prescription drug therapy, especially polypharmacy and the prevalence of potentially inappropriate medication use in Korean elderly ambulatory patients based on an explicit criterion. Methods: Performed a retrospective study of 65 years or older ambulatory patients visiting a university hospital based clinic from January 2002 to April 2004. Study determined the patterns of drug prescription per Anatomical Therapeutic Chemical Classification and the potentially inappropriate medication usage based on explicit Beers criteria. Results: Of the 4,042 elderly patients the mean number of prescription was $2.2{\pm}2.0$, which was similar between genders and all age groups within the elderly. 10.7% of patients were prescribed with more than 5 medications concurrently. The most frequently prescribed medication was the drugs used for treating nervous system diseases (44.3%), followed by alimentary tract/metabolism disorders (27.6%), cardiovascular disease (10.7%), blood/blood forming disorders (4.3%), respiratory disorders (6.5%), and musculoskeletal diseases (3.2%). A total of 511 elderly (13%) was prescribed with medication that met the criteria for=1 potentially inappropriate drugs for the elderly. This proportion was similar between genders and all age groups within the elderly. Among these 511 elderly patients the mean number of potentially inappropriate drugs prescribed was $5.1{\pm}3.3$ drugs. Potentially inappropriately prescribed drugs included amitriptyline (76 cases), diazepam (69 cases), ketorolac (57 cases), short acting nifedipine (44 cases), triazolam (38 cases), and hydroxyzine (38 cases). Conclusion: Potentially inappropriate drug prescribing in Korean ambulatory elderly patients are common. Education programs and interventions aimed at optimizing the prescribing and dispensing of the most appropriate drugs are needed.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권4호
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• pp.213-220
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• 2015

Background: Pediatric dentists face challenges when young patients require a mesiodens extraction. General anesthesia may be a burden to the child as well as the parent due to dental fears and costs. The aim of this study was to evaluate oral and intravenous sedation in the outpatient setting as a safe and effective means of managing patients who require a mesiodens extraction. Methods: Records were reviewed retrospectively to find patients who underwent a mesiodens removal procedure from January 2013 to September 2014 in the Department of Pediatric Dentistry at Ajou University Hospital (Suwon, Gyeonggi-do, Republic of Korea). A total of 81 patients (62 male and 19 female) between 4 and 11 years of age (mean [${\pm}SD$] $81.6{\pm}14.1$ months) were studied, with a mean weight of $22.9{\pm}3.3kg$ (16 kg to 30 kg). Vital signs, sedation drug dosage, and sedation time were studied. Results: Mean doses of $63.7{\pm}2.5mg/kg$ chloral hydrate and $1.36{\pm}0.22mg/kg$ hydroxyzine were used for oral sedation. Nitrous oxide/oxygen was administrated for $40.0{\pm}2.1$ min. The mean dose of midazolam administered intravenously was $0.14{\pm}0.06mg/kg$ ($2.38{\pm}0.97$ times). In all cases, the mesiodens was removed successfully. Conclusions: Intravenous sedation combined with oral sedation and nitrous oxide/oxygen inhalation can be an alternative to general anesthesia when administrated and monitored properly.

• 대한소아치과학회지
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• 제24권4호
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• pp.823-829
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• 1997

The patients visiting pediatric dental office have been being younger than the previous, and they were often combined with systemic disease. But, we aren't able to perform the verbal communication, because of their impediment and youthfullness. And, we can't carry out the behavior control via physical restraint, as the developed social structure and the attitude of children and their parents. So, the importance and concerning of conscious sedation using sedative medicine are increased by time and time. Among the various conscious sedation, Chloral Hydrate and Nitrous Oxide inhalation are most popularly used, and barbiturates, benzodiazepine, opioids and hydroxyzine are used often. But, these medications have some side-effects and adverse reactions, may be failed to sedate the children. And limited use of medically compromised patients, especially for ASA class III, IV or more dangerous patients. We, the Department of Pediatric Dentistry, Chosun University have met some dangerous situation due to unfavorable pharmacogenic reactions, but we can control the situation and get well healed results. The below results are common situations and their solutions during conscious sedation. 1. By the intravenous administration, thrombophlebitis is the most common side-effects, but it may be healed with time without any special treatment. 2. Under the definitive guidelines about conscious-sedation, we can perform a safe conscious sedation for ASA class III patients. 3. When adversed reaction of Benzodiazepine is occured, it could be cared effectively with benzodiazepine antagonist, named Flumazenil.

• 대한소아치과학회지
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• 제25권3호
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• pp.525-532
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• 1998

치과의사는 자폐인의 치료시 자폐증의 정도와 의학적 관리가 필수적인 질환, 내과적 병력, 현재 환자가 복용하고 있는 약물등을 고려하여 이에 따라 적절한 행동조절 방법을 선택하여야 한다. 행동조절 방법의 선택시 술자가 선호하는 방법을 우선하기 보다는 환자의 상태와 치과치료시 환자와 보호자가 받는 스트레스를 최우선으로 고려하는 것이 필요하다. 환자의 현증에 대한 적절한 행동조절하의 치과치료도 중요하지만, 그보다 더 중요한 것은 환자가 거부감을 느끼지 않고 치과에 내원할수 있도록 훈련시키는 것과 지속적인 구강위생 관리이므로 보호자를 위한 구강위생 관리교육 및 주기적인 내원에 의한 관리가 필요하다고 생각된다.

• 대한장애인치과학회지
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• 제11권2호
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• pp.76-80
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• 2015

장애인의 보건 수준이 높아지면서 치료보다는 예방의 관점에서의 구강 관리가 중요해지고 있다. 본 증례에서 소개된 다섯 명의 지적 장애를 지닌 환자들을 triazolam을 이용하여 경구 투여하여 치료하였다. Triazolam을 이용한 진정법은 장애인의 정기적인 구강 관리의 한 대안으로 고려해볼 수 있겠다.