Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Michael Hatton Date: 2/22/2018
Article Title: Sedation in pediatric dentistry: a practical assessment procedure
Author(s): Paul Moore, Eugene Mickey, J.A. Hargreaves, Howard Needleman
Date: October 1984
Major Topic: Sedation
Type of Article: Assessment presentation and RCT study
Main Purpose: Describe an assessment developed for sedation in pediatric dentistry and use in a RCT study
Key Points/Summary: The purpose of this article was to describe an assessment model for evaluating sedation in pediatric dental patients.
Purpose: Evaluate the safety and efficacy of a particular agent and develop an assessment tool that could be used by clinicians to assess their own sedation regimens
Methods: Assessment is limited to the preoperative period in which procedures are most uniform rating the behaviors as satisfactory or unsatisfactory. 60 pts (healthy pats age 2-5 needing tx requiring LA) who were considered uncooperative for routine dental care and who were to receive outpatient premed were recruited for study. Pts assigned to random grps A-D. Each child was monitored by a single research assistant and rated 6 times b/f operative tx: (A)sedation behavior in quiet room, (B) sedation behavior on arrival to operatory, (C)airway patency b/f N2O, (D) sedation behavior in operatory after 3 min N2O, (E) airway patency after 3 mins N2O, (F) response to LA injection. The dentist who performed the operative provided behavior Frankl rating.
-Sedation behaviors of 20mg/kg group were nearly identical to placebo. 40mg/kg grp tended to have more negative behaviors. 60mg/kg group was statistically superior to the placebo.
-The risks involved in sedated children are related to a variety of factors.
-Toxic reactions are related to dose and must be considered when considered when selecting premedication treatment.
-Loss of consciousness can be seen at lower does than those that produce respiratory and cardio depression. -Monitoring of consciousness, by checking response to command and protective reflexes, is an important requirement for the sedation of children.
-The practitioner should be prepared to control any adverse drug effects. It is essential that the respiratory and cardio functions be continuously monitored at all times and if need be maintained in the case of emergency.
Conclusions: Children receiving the placebo tx behaved favorably for at least 46% of the ratings; the 20 mg/kg and 40 mg/kg chloral hydrate groups showed little or no improvement when compared with the placebo group; the group receiving 60 mg/kg chloral hydrate had as much as a 33% improvement in behavior as compared with placebo and with the addition of 40% N2O/60% O2 to 60 mg/kg chloral hydrate premedication, four of 15 children (27%) were unable to maintain a patent airway when intentionally obstructed.