Resident: Roberts
Date: 4/2/10
Article title: Adverse events and outcomes of conscious sedation for pediatric patients; study of an oral sedation regimen
Author: Leelataweedwud, pattarawadee, et al.
Journal: Jada
Volume: 132 month: November
Year: 2001
Method and Materials:
In a five year retrospective study, the authors examined 195 records of conscious sedation performed in 111 healthy children aged 24 months to 48 months. The author analyzed age, sex, weight, methods of drug delivery, waiting time after administration, adverse events, and sedation outcomes. The sedation regimen used was a cocktail of chloral hydrate (50mg/kg), meperidine (1.5mg/kg), hydroxizine pamoate (25mg) and supplemental oxygen.

Results: All of the following categories were compared in a table to satisfactory sedations, unsatisfactory sedations, and aborted cases to find any correlations if possible. Satisfactory defined as treatment completed without difficulty. Unsatisfactory defined as completed with difficulty or treatment not completed – due to disruptive behavior. Aborted – not attempted.

Age S: 24-80 months ( avg. 48mo w/sd of 13), U: 27 - 66 months (avg. 44 +-11),
A: 33-84 months (avg. 46+- 15)

Sex S: (M -77 F - 64), U: (M-21 F-23), A: (M-2 F-8)

Weight in kg S: 11-34 (avg. 17 +-3), U: 10 – 20 (avg16+-2), A: 10-23 (avg16+-3)

methods of drug delivery according to pt compliance
- all meds drunk 174/195 S: 131 (75%), U: 36 (21%), A: 7 (4%)
- meds delivered by syringe 21/195 S: 10 (48%), U: 8 (38%), A: 3 (14%)

waiting time after administration in min. S: 30 – 115 (avg. 61+-11), U: 30-75 (avg. 58+-11),
A: 35-65 (avg. 49+-12)

treatment time duration in min. S: 65+-22, U: 64+-24, A: N/A

adverse events S: 6 (100%), U: 0 (0%), A: 0 (0%)

apnea - defined as no visual signs of breathing, no audible signs from a precordial stethoscope Out of the 195 cases reviewed, only one case was recorded.

vomiting – defined as vomiting after the administration of the drug and before discharge requirements are met. Only 1 case incident was recorded in the study

desaturation – defined as an Spo2 reading from a pulse oximeter that fell below below95% while the patient was quiet and still. Only one incident was recorded.

prolonged sedation – defined as prolonged sedation time after all dental treatment is finished in which more than 30 minutes or more of recovery time is necessary to achieve discharge criteria recommended by the AAPD’s guidelines. A total of 3 incidents were found.

Conclusions
The described regimen of Chloral hydrate, meperidine, hydroxizine, and supplemental oxygen yielded a 72% overall success rate, while 23 percent of cases were unsuccessful, and 5 percent were aborted. Compliance with taking the full amount of oral sedation and waiting time prior to treatment (of around 60 min) were the most important factors for predicting success. Age, sex, and duration of treatment seamed to be less reliable predictors for success. Only 3% of cases resulted in adverse events occurring.

Assessment: I thought the author did a great job of reviewing the history of OCS cases performed. Though the conclusion was simple and precise he also had a lot of good information covered throughout his article pertaining to these drugs and this regimen. So for those of you that are interested in reading more, I would say go for it.