Sedation For Dental Procedures Research Articles

Amnesia after Midazolam and Ketamine Sedation in Children: A Secondary Analysis of a Randomized Controlled Trial.

The incidence of peri-procedural amnesia following procedural sedation in children is unclear and difficult to determine. This study aimed to apply quantitative and qualitative approaches to better understand amnesia following dental sedation of children. After Institutional Review Board Approval, children scheduled for sedation for dental procedures with oral midazolam (OM), oral midazolam and ketamine (OMK), or intranasal midazolam and ketamine (IMK) were recruited for examination of peri-procedural amnesia. Amnesia during the dental session was assessed using a three-stage method, using identification of pictures and an animal toy. On the day following the sedation, primary caregivers answered two questions about their children’s memory. One week later, the children received a semi-structured interview. Behavior and level of sedation during the dental session were recorded. Quantitative data were analyzed using descriptive statistics and comparison tests. Qualitative data were analyzed using content analysis. Triangulation was used. Thirty-five children (age: 36 to 76 months) participated in the quantitative analysis. Most children showed amnesia for the dental procedure (82.9%, n = 29/35) and remembered receiving the sedation (82.1%, n = 23/28 for oral administration; 59.3%, n = 16/27 for intranasal administration). The occurrence of amnesia for the dental procedure was slightly higher in the oral midazolam group compared with the other groups (44.8%, n = 13/29 for OM, 13.8%, n = 4/29 for OMK, and 41.4%, n = 12/29 for IMK). Twenty-eight children participated in the qualitative approach. The major theme identified was that some children could remember their procedures in detail. We conclude that peri-procedural amnesia of the dental procedure was common following sedation.

Nasopharyngeal Tube Effects on Breathing during Sedation for Dental Procedures: A Randomized Controlled Trial.

Dental procedures under sedation can cause hypoxic events and even death. However, the mechanism of such hypoxic events is not well understood. Apnea and hypopnea occur frequently during dental procedures under sedation. The majority of the events are not detectable with pulse oximetry. Insertion of a nasal tube with small diameter does not reduce the incidence of apnea/hypopnea. Intravenous sedation is effective in patients undergoing dental procedures, but fatal hypoxemic events have been documented. It was hypothesized that abnormal breathing events occur frequently and are underdetected by pulse oximetry during sedation for dental procedures (primary hypothesis) and that insertion of a small-diameter nasopharyngeal tube reduces the frequency of the abnormal breathing events (secondary hypothesis). In this nonblinded randomized control study, frequency of abnormal breathing episodes per hour (abnormal breathing index) of the patients under sedation for dental procedures was determined and used as a primary outcome to test the hypotheses. Abnormal breathing indexes were measured by a portable sleep monitor. Of the 46 participants, 43 were randomly allocated to the control group (n = 23, no nasopharyngeal tube) and the nasopharyngeal tube group (n = 20). In the control group, nondesaturated abnormal breathing index was higher than the desaturated abnormal breathing index (35.2 [20.6, 48.0] vs. 7.2 [4.1, 18.5] h, difference: 25.1 [95% CI, 13.8 to 36.4], P < 0.001). The obstructive abnormal breathing index was greater than central abnormal breathing index (P < 0.001), and half of abnormal breathing indexes were followed by irregular breathing. Despite the obstructive nature of abnormal breathing, the nasopharyngeal tube did not significantly reduce the abnormal breathing index (48.0 [33.8, 64.4] h vs. 50.5 [36.4, 63.9] h, difference: -2.0 [95% CI, -15.2 to 11.2], P = 0.846), not supporting the secondary hypothesis. Patients under sedation for dental procedure frequently encounter obstructive apnea/hypopnea events. The majority of the obstructive apnea/hypopnea events were not detectable by pulse oximetry. The effectiveness of a small-diameter nasopharyngeal tube to mitigate the events is limited.

Reaction times of children having nitrous oxide inhalation sedation for dental procedures.

Inhalation sedation (IHS), using nitrous oxide and oxygen, is a commonly used form of pharmacological behaviour management in paediatric dentistry. Previous studies suggest that IHS causes a delay in reaction time, which recovers to baseline within 10min. To observe the reaction times (RT) of children before and after undergoing IHS for dental treatment. Sixty children from clinics at St Thomas' Hospital (London, UK) participated in this observational study. RT was measured using an eight-point choice reaction time system (MOART computer panel, Lafayette Instruments). RT was measured twice: before (prior to patient entering clinic for treatment) and after (immediately after discharge from the clinic). A paired-samples t test was used to analyse data. Fifty-two patients completed the study. There was a statistically significant delay in RT after treatment (p = 0.022). There was no significant correlation between RT and concentration of nitrous oxide, or length of the recovery period. Children may have a small impairment in reaction times following recovery from IHS in the clinical setting, regardless of the strength of nitrous oxide given, or the length of the recovery period. The child's escort should be aware of the need to supervise the child following discharge.

Pediatric dental sedation: challenges and opportunities.

High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques.

Comparative study between novel sedative drug (dexmedetomidine) versus midazolam–propofol for conscious sedation in pediatric patients undergoing oro-dental procedures

ObjectiveA comparative study to evaluate the effect of dexmedetomidine as a sedative in pediatric dental patients in comparison to the currently used combination of midazolam and propofol.MethodsSixty ASA I children (4–10 years old) referred from the outpatient clinic of the pediatric dentistry department for sedation for dental procedures. They were randomly classified into two groups, group I (dexmedetomidine group) was given as 2 μg/kg loading dose over 5 min followed by 0.4 μg/kg/h continuous infusion. Group II (midazolam–propofol group) midazolam was given as 0.05 mg/kg and propofol was given loading dose as 1 mg/kg over 5 min followed by 5 mg/kg/h continuous infusion. Heart rate, mean arterial blood pressure, oxygen saturation, respiratory rate were recorded every 5 min till discharge. The onset of sedation, procedure time, recovery time, discharge time and the need of analgesia were recorded. The incidence of occurrence of adverse effects was observed.ResultsIn group I, the mean onset of sedation was significantly longer than in group II, but recovery time was significantly shorter in group I than group II, there are significantly hemodynamics effects in the first 15 min and more incidence of occurrence of side effects in group II than group I. There are more analgesic effects of dexmedetomidine in group I than group II postoperatively.ConclusionDexmedetomidine is safe and effective when used for sedation in pediatric patients undergoing dental procedures.

Sedation for dental procedures

Control of pain and anxiety is fundamental to the practice of dentistry. Patients who have a fear of dental treatment and those who are faced with the prospect of an unpleasant or distressing procedure, rightfully expect that the option of conscious sedation should be available. A satisfactory assessment visit is crucial to the success of subsequent treatment. The planned dentistry must be appropriate and realistically achievable under sedation. Inhaled nitrous oxide (relative analgesia), intravenous, oral and intranasal midazolam are effective for most patients and have an exemplary safety record in dentistry. For moderately anxious adults and children, titrated nitrous oxide has excellent anxiolytic, sedative and analgesic properties with little depression of myocardial function or ventilation. Induction and recovery are rapid. Midazolam is well suited to sedation for dentistry. For intravenous administration, a titration technique ensures the optimum level of sedation for each individual. Midazolam produces a period of acute detachment for 20–30 minutes followed by a state of relaxation for a further hour or so. Most patients have little or no recollection of the operative procedure. Since some degree of respiratory depression is seen in all patients, pulse oximetry is essential. Conscious sedation techniques are appropriate, safe and successful for most fit, cooperative dental patients. However, a more flexible approach may be needed for individuals presenting special medical or behavioural challenges. These patients are better managed in specialist centres with appropriate staff and facilities.

Recent Advances in Conscious Sedation

Conscious sedation for dental procedures is constantly developing. Midazolam remains the most widely used agent, although there has been encouraging research into patient-maintained sedation (PMS) with propofol. This article reviews the use of sedation in children, recent advances with propofol, and outlines current opinion on multiple drug sedation techniques. There is also a description of the current recommendations for training in the practice of conscious sedation.

Hazards during Anæsthesia or Sedation for Dental Procedures [Abridged

Hazards during Anæsthesia or Sedation for Dental Procedures [Abridged

Hazards during Anæsthesia or Sedation for Dental Procedures [Abridged

Hazards during Anæsthesia or Sedation for Dental Procedures [<i>Abridged</i>

Hazards during Anæsthesia or Sedation for Dental Procedures [Abridged

Hazards during Anæsthesia or Sedation for Dental Procedures [<i>Abridged</i>