Children Sedated for Dental Care: A Pilot Study of the 24-Hour

Department of Pediatric Dentistry
Resident’s Name:Murphy Program: Lutheran Medical Center - Providence
Article title: Children Sedated for Dental Care: A Pilot Study of the 24-Hour Postsedation Period
Author(s): David Martinez, DDS Stephen Wilson, DMD, PhD
Journal: Pediatric Dentistry
Year. Volume (number). Page #’s: 2006. vol 28 No 3 260-264
Major topic: Evaluating children 24 hours post sedation
Minor topic(s): Difference in sedation between chloral hydrate/meperidine/hydroxyzine and midazolam
Main Purpose: Investigate postseadtion events during the first 24 hours after discharge from the treatment facility.

Overview of method of research:
Prospective pilot study. 30 healthy ASA 1 children ranging in age from 2-5 were selected and scheduled for dental sedation. The children were worked up pre operatively with a thorough eval of med/social.dental hx, review of systems, vitals, dental needs, behavior, tonsil size, and sedative regime. 14 Children received a triple combo of chloral hydrate/meperidine/hydroxyzine ranging in dose from 20 to 30 mg/kg, 1 to 2 mg/kg, 1 to 2 mg.kg, respectively. 16 children received midazolam with does ranging from .05 to .75 mg. After the dental procedure was completed and the child was discharged, an investigated called the parents of the patients at the 24 mark. A 20 item questionnaire , including questions about amount of napping, discomfort, food intake, changes in diurnal rhythms, etc was asked to the parents. Responses were entered into an excel spreadsheet and analyzed using SPSS Statistical Package, version 13.

Findings:
It has been suggested that children are often discharge early from treatment facilities following sedations. This may result in an adverse event that may not be detected by non-medical caregivers. This pilot study aimed to quantify any issues arising 24 hours post sedation.
All of the 30 case questionnaires were used in the study. Differences were noted between the triple group compared to the midazolam group with respect to sleeping on the way home, or shortly after getting home. This may be significant because of the parents inability to monitor a sleeping child in car seat while driving, the child may be in a car seat with their head flexed, airway may become compromised.
No difference was found between the groups with regards to eating habits, bathroom habits, vomiting, or post op pain.

Key points/Summary:
There is a chance that an adverse reaction could occur after the child is discharged from the treatment facility. The proper discharge criteria must be met or exceeded to decrease these chances.

Assessment of Article: Good, insightful article that is relevant for us. Limitations include small number of cases, no notes about depth of sedation, pre/post op behavior, age, weight, or what was completed. Overall very well done. More research needed.