04/09/2010 Sedation in pediatric dentistry: a practical a practical assessment procedure

Resident: J. Hencler
Date: 04/09/2010
Article title: Sedation in pediatric dentistry: a practical a practical assessment procedure
Author(s): Moore Et Al
Journal: JADA, Vol. 109, October 1984

Major topic: Sedation techniques and assessment
Type of Article: Clinical Observational

Main 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

Overview of method of research:
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. (grpA20-grpB40-grpC60mg/kg chloral hydrate and grpD placebo). 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.

Findings:
Sedation behaviors of 20mg/kg grp were nearly identical to placebo. 40mg/kg grp tended to have more negative behaviors. 60mg/kg grp was statistically superior to the placebo.

Key points in the article discussion:
The risks involved in sedated children are related to a variety of factors. Toxic rxns 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 resp and cardio depression. Monitoring of consciousness, by checking response to command and protective reflexes, is an important requirement for the sedation of children. The practicioner should be prepared to control any adverse drug effects. It is essential that the resp and cardio functions be continuously monitored at all times and if need be maintained in the case of emergency.

Summary of 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 grps showed little or no improvement when compared with the placebo grp; the grp 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 unalble to maintain a patent airway when intentionally obstructed.

Assessment of article:
Good article, Important info and good study that could apply to OCS.