소아환자에서 치료 전 수면 시간이 chloral hydrate 진정 효과에 미치는 영향 = AN EFFECT OF SLEEPING HOURS PRIOR TO PROCEDURE ON CHLORAL HYDRATE SEDATION FOR PEDIATRIC DENTAL PATIENT

국문 초록 (Abstract)

소아치과 분야에서 chloral hydrate와 hydroxyzine를 이용한 진정 요법은 가장 보편화된 방법이지만 진정 효과는 약물의 용량, 연령, 체중, 술 전 환아의 수면 시간, 술 전 공복유지 유무, 환아의 건강 상태에 따라 좌우 될 수 있다. 본 연구는 경험적 으로 chloral hydrate 진정 요법 시행 전날 수면 시간이 짧을수록 진정 효과가 더 크다는 점에 착안하여 협조전 단계 환아에 서 chloral hydrate/hydroxyzine을 이용한 진정 치료 시 치료 전 수면 시간과 진정 효과의 관계에 대해 알아보고자 시행 하 였다. 한림대 소아치과에 내원한 환자 중 사전 조사에서 1일 평균 수면 시간이 비슷한 만 2-5세 아이들 37명을 대상으로 chloral hydrate/hydroxyzine 진정 요법 하 치료를 시행하였다. 치수 치료를 포함하여 수복치료를 요하는 아이들을 대상으로 하였 으며 치수치료를 한 환자는 총 11명이었다. 진정 효과는 동일한 평가자에 의해 Houpt 등의 rating scal에 따라 점수를 산정 하여 단순회귀 분석법으로 평가하였고 치수 치료 유무에 따라 진정 효과가 달라지는지 여부를 t-test로 평가하여 다음과 같은 결과를 얻었다. 1. Houpt 등의 rating scale 중 sleep, crying 항목은 전날 수면 시간에 따라 유의하지는 않지만 반비례 상관관계를 지닌 다(p>0.05). 2. Movement, overall behavior는 전날 수면 시간에 따라 유의하게 반비례하는 상관관계를 나타냈다(p<0.05). 3. 치료 내용에 따른 진정 요법 효과의 차이는 보이지 않았다(p>0.05). 실험 결과 진정 전 수면 시간이 짧을수록 진정 효과가 높은 것으로 나타났다.

다국어 초록 (Multilingual Abstract)

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).

참고문헌 (Reference)

1 김경희, "소아환자의 진정요법 효과와 그와 연관된 변수에 대한 연구" 대한소아치과학회 34 (34): 234-246, 2007

2 대한소아치과학회, "소아청소년치과학 4판" 신흥인터내셔날 171-187, 2007

3 대한소아치과학회, "소아청소년치과학 4판" 신흥인터내셔날 195-202, 2007

4 Leelataweedwud P, "The physiologic effects of supplemental oxygen versus nitrous oxide/oxygen during conscious sedation of pediatric dental patients" 22 : 125-133, 2000

5 Sanders BJ, "The effect of sleep on conscious sedation : a follow-up study" 21 : 131-134, 1997

6 Webb MD, "Sedation for pediatric dental patients" 46 : 803-814, 2002

7 Stewart JG, "Routine preoperative medication in dentistry for children" 28 : 209-212, 1961

8 Feber R, "Principles and practice of sleep medicine in the child" W. B. Saunders company, Phliadelphia 91-98, 1995

9 Braham RL, "Phamacologic patient management in pediatric dentistry : An update" 270-282, 1993

10 Barr ES, "Oral medication for the problem child : placebo and chloral hydrate" 1 : 272-280, 1977

11 Nathan JE, "Management of the refractory young child with chloral hydrate : dosage selection" 54 : 22-29, 1987

12 American Academy of Pediatric Dentistry, "Guideline on the elective use of minimal, moderate, and deep sedation and anesthesia for pediatric dental patients" 27 : 110-118, 2005

13 Baygin O, "Effectiveness of premedication agents administered prior to nitrous oxide/oxygen" 27 : 341-346, 2010

14 Carno MA, "Developmental stage of sleep from birth to adolescence, common childhood sleep disorders : overview and nursing implications" 18 : 274-283, 2003

15 Needleman HL, "Conscious sedation of pediatric dental patient using chloral hydrate, hydroxyzine, and nitrous oxide-a retrospective study of 382 sedation" 17 : 424-431, 1995

16 Houpt MI, "Comparison of chloral hydrate with and without promethazine in the sedation of young children" 7 : 41-46, 1985

17 Saarnivaara L, "Comparison of chloral hydrate and midazolam by mouth as premedicants in children undergoing otolaryngological surgery" 61 : 390-396, 1988

18 정지혜, "Chloral hydrate와 hydroxyzine을 사용한 진정 요법의 성공률과 저산소증의 발생에 관한 연구" 대한소아치과학회 28 (28): 337-344, 2001

19 Duncan WK, "Chloral hydrate sedation: A simple technique" 15 : 884-893, 1994

20 Litman RS, "Chloral hydrate sedation - The additive sedative and respiratory depressant effects of nitrous oxide" 86 : 724-728, 1998

21 Carr KR, "Behavior management techniques among pediatric dentists practicing in the southeastern United States" 21 : 347-353, 1999

22 Houpt MI, "Assessing chloral hydrate dosage for young children" 52 : 364-369, 1985

23 Leelataweedwud P, "Adverse events and outcomes of conscious sedation for pediatric patient" 132 : 1531-1539, 2001

24 "AAPD Reference Manual : Guideline for the elective use of pharmacologic conscious sedation and deep sedation in pediatric dental patient" Appendix I 1997-1998,

25 Tobias MG, "A Study of three preoperative sedative combinations" 42 : 453-459, 1975