Wednesday, February 21, 2018

The physiological effects of supplemental oxygen versus nitrous oxide/oxygen during conscious sedation of pediatric dental patients

Article Title: The physiological effects of supplemental oxygen versus nitrous oxide/oxygen during conscious sedation of pediatric dental patients
Author(s): Leelataweewud P, et al
Journal: Pediatric Dentistry
Date: 2000; 22: 125-133
Major Topic: Sedation regimen
Type of Article: randomized double-blind crossover study
Main Purpose:  This study aimed to compare the 2 different sedation regimens.
Key Points:  Nitrous oxide supplementation for sedations increases the depth of sedation and thus increased risk of desaturation, but it also improves the outcome of sedations.
·      Supplemental oxygen elevates arterial oxygen tension (PaO2) to levels as high as 400-600 mmHg compared to 100 mmHg with breathing normal room air
o   Higher PaO2 increases O2 available in functional residual capacity, which is reduced in children compared to adults.
o   Higher O2 in FRC delays desaturation
·      It can be argued that a child receiving 40% nitrous and thus being supplemented with 60% O2 has the potential to increase SpO2 to the same levels as 100% O2
·      Other studies supplementing sedations with nitrous have found better patient effects
·      There are studies that indicate nitrous added to sedations does not significantly deepen sedation while others do find that nitrous deepens the sedation.
·      Sedation regimen used for 22 children who needed 2 sedation appointments
o   1.5mg/kg meperidine
o   50 mg/kg chloral hydrate
o   25 mg hydroxyzine
o   1 groups had 50% nitrous and the other had 100% oxygen
·      Although not statistically significant, the nitrous group had desaturation in more visits and had higher frequency of desaturation than the 100% O2 group.
·      No statistically significant difference between the groups on heart rate or SpO2 but the nitrous group had a slightly higher respiratory rate.  
·      Nitrous group received more local anesthesia (58mg vs. 47 mg) – likely because the operator was taking advantage of the better sedated patient to complete more treatment
·      Although not statistically significant, the 100% O2 group had higher SpO2 values than the nitrous group
·      The nitrous group was more sedated at each procedural point throughout appointments
·      The nitrous group required more airway repositioning after desaturation episodes than the 100% oxygen group
·      Desaturations are not uncommon in pediatric conscious sedation
·      This study demonstrated that deeper sedation was associated with increased risk of desaturation
·      Nitrous did not seem to increase the risk of desaturation but did increase the frequency of desaturation events
·      Nitrous deepened the level of sedation with this regimen and improved sedation outcomes

Remarks:
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Assessment of Article:  Level of Evidence/Comments: II-1

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