A comparison of conventional versus electronic monitoring of sedated pediatric dental patients.
The first purpose of this study was to compare traditional monitoring methods to electronic instruments for monitoring physiologic parameters during conscious sedation of pediatric dental patients. Traditional methods included careful visual assessment of skin color, airway patency and chest movements, and auscultation of breath and heart sounds using a precordial stethoscope; electronic instruments included the capnograph and pulse oximeter. The second purpose of the study was to examine the potential of the capnograph to provide more advanced warning than the pulse oximeter for respiratory compromise. Thirty-nine children (mean age 39 months) received an oral sedative regimen of chloral hydrate, hydroxyzine pamoate, and meperidine and all were supplemented with 100% oxygen via nasal cannula throughout their sedations. One investigator used traditional monitoring and the other used electronic--both monitored simultaneously while being shielded (blinded) from each other. Electronic monitoring yielded a false alert rate of 88% compared with 73% for traditional monitoring. Ten confirmed episodes of respiratory compromise were identified electronically and only three were identified by traditional monitoring. All of the 10 confirmed respiratory compromise episodes were detected by capnography; none were detected by oximetry. During these 39 pediatric sedations using a narcotic drug regimen and 100% oxygen supplementation, there were no true desaturations.
Croswell
R J
RJ
Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, USA.
Dilley
D C
DC
Lucas
W J
WJ
Vann
W F
WF
D000766:Anesthesia, Dental; D001944:Breath Tests / Q000295:instrumentation; D002245:Carbon Dioxide / Q000032:analysis; D002675:Child, Preschool; D016292:Procedural Sedation; D019140:Dental Care for Children / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000517:prevention & control; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D010092:Oximetry / Q000295:instrumentation* / Q000379:methods; D010100:Oxygen / Q000008:administration & dosage; D010102:Oxygen Inhalation Therapy
D002245:Carbon Dioxide; D010100:Oxygen