Resident: J. Hencler
Date: 04/02/2010

Article title: A retrospective study of chloral hydrate, meperidine, hydroxyzine, and midazolam regimens used to sedate children for dental care
Author(s): Wilson
Journal: Pediatric dentristry-22:2, 2000
Major topic: Oral Sedation
Type of Article: Retrospective study

Main Purpose:
Examine the behavior and physiology of pre-school children each sedated with 1 of 3 drug regimens based on age, dental needs, and pre-operative clinical impressions and to determine the association between pre-operative behaviors to the behavior and physiology of the sedated children.

Overview of method of research:
Sedation sheets of 300 children were randomly selected from a pool of 600. Selection included preschoolers who had received one of the three drug regimens; chloral hydrate and hydroxyzine (CH-H), chloral hydrate, meperidine, and hydroxyzine (CH-D-H), or midazolam (M).

Key points in the article discussion:
M seemed to be consistent with quiet behaviors until the LA was administered at which time crying and struggling behaviors were observed. Heart rate was notably elevated during and after LA administration. Contrastingly, CH-D-M resulted in quiet and sleeping behavior after these procedures. CH-H was noted to be somewhere in between the other two regimens. The M regimen produced the least good behaviors compared to CH-D-H and CH-H. The M regimen has a short duration and occasionally causes “angry “child syndrome. M is ideally suited for short procedures, it has rapid onset when administered orally and causes minimal crying or struggling until 10-15 mins following LA injection. M has no analgesic properties. CH-D-H, contrastingly takes about 45 mins for onset and lasts 40 mins. It is often associated with a mellow affect during which interactive states and some analgesia are notable. It is a good combo of agents to use when 1 or more quads are required on a child who has potential reasonable coping skills. CH-H produced mild depressive effect consistent with settling of an anxious child. CH-H was not significantly different from the other 2 drug regimens.

Summary of conclusions:
• CH-D-H appears to maximize quiet and sleeping behaviors while producing more interactive and cooperative children.
• Children who pre-op follow instructions are minimally predictive of intra-op quiet and sleeping behaviors. Children who pre-op refuse to follow instructions were also minimally predictive of intra-op crying and struggling.
• Heart rate was consistent with age for all 3 regimens, however heart rate increased significantly following local anesthesia, reflecting disruptive and crying behavior in the M grp.
• Post-op heart rate, in addition to patient age, seems consistent with the degree of child cooperation and interaction with dental personnel. Uncooperative children had higher heart rates and BP pre- and intr-op.

Assessment of article:
Very interesting article. Some important stuff and would love to get some experience with oral sedation.