title: Conscious sedation of pediatric dental patients using chloral hydrate, hydroxyzine, and nitrous oxide--a retrospective study of 382 sedations.
abstract: This retrospective study assessed the effectiveness and safety of chloral hydrate (55 mg/kg), hydroxyzine (1 mg/kg), and nitrous oxide in the sedation of 336 uncooperative pediatric dental patients over 382 sedation sessions, and identified variables associated with effectiveness including: sex, weight, age, and preoperative behavior of the patient; route and combinations of the sedative drugs; and sex of the operating and monitoring dentists. The operating and monitoring dentists rated the sedation session as either effective or ineffective and also as either heavy, moderate, light or poor. The mean age of the children was 2.6 years and mean weight was 14.1 kg. Seventy-four percent of the sedation sessions were deemed effective. Boys had more effective sessions (80.6%) than girls (65.1%) (P = 0.001). Also, the percentage of sedations rated as effective increased as the preoperative behavior was more positively rated (P = 0.001). Oral regimen of chloral hydrate alone or in combination with oral hydroxyzine was more effective (75.5%) than rectal administration of chloral hydrate alone (65.7%) (P = 0.09). There was no significant difference in effectiveness when chloral hydrate was administered orally alone or in combination with oral hydroxyzine. Sedation sessions rated effective had longer operative times, included more sextants of treatment, were more likely to include restorative treatment, and were less likely to include extractions than the ineffective sedations. Vomiting was the only complication reported, occurring in 8.1% of the sedations. Vomiting did not vary significantly with either route of administration or inclusion of hydroxyzine in the oral regimen. Pulse rates were significantly higher for children in the ineffective sedation sessions. This sedative drug regimen was deemed safe and effective for treating young and uncooperative pediatric dental patients.
authors.affiliation: Harvard School of Dental Medicine, Boston, Massachusetts, USA.
authors.forename: H L
authors.initials: HL
authors.lastname: Needleman
authors.forename: A
authors.initials: A
authors.lastname: Joshi
authors.forename: D G
authors.initials: DG
authors.lastname: Griffith
mesh_terms: D000284:Administration, Oral; D000285:Administration, Rectal; D000766:Anesthesia, Dental / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000009:adverse effects; D001291:Attitude of Health Personnel; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D002697:Chloral Hydrate / Q000008:administration & dosage* / Q000009:adverse effects; D016292:Procedural Sedation / Q000379:methods; D003812:Dentist-Patient Relations; D005260:Female; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage* / Q000009:adverse effects; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D008297:Male; D009609:Nitrous Oxide / Q000008:administration & dosage* / Q000009:adverse effects; D011674:Pulse / Q000187:drug effects; D012189:Retrospective Studies; D012449:Safety; D012737:Sex Factors; D014839:Vomiting / Q000139:chemically induced
chemical_list: D018685:Anesthetics, Inhalation; D006993:Hypnotics and Sedatives; D006919:Hydroxyzine; D002697:Chloral Hydrate; D009609:Nitrous Oxide