A retrospective study of chloral hydrate, meperidine, hydroxyzine, and midazolam regimens used to sedate children for dental care.
OBJECTIVE
The purpose of this retrospective study was twofold: a) to examine the behavior and physiology of pre-school children each sedated with 1 of 3 drug regimens based on patient age, dental needs, and pre-operative clinical impression; and b) to determine the association between pre-operative behaviors to the behavior and physiology of the sedated children.


METHODS
Records of more than 600 patients sedated at Columbus Children's Hospital dental clinic over a two-year period were culled for patients who ranged in age from 2 to 5 years of age and had received one of three different drug regimens: a) chloral hydrate and hydroxyzine (CH-H), b) chloral hydrate, meperidine, and hydroxyzine (CH-D-H), or c) midazolam (M). A minimum of 300 patients (100/drug regimen) were randomly selected. The standard sedation sheet used in all sedations at the clinic included, among other factors, pre-operative assessments of patient behavior, interaction, and cooperation. Physiological and behavioral variables during the intraoperative sedation periods were also available. These periods included initial baseline vitals, vitals following drug administration, topical and local drug administration, rubber, dam placement, and a minimum of the first 15 minutes of restorative procedures. The three drug regimens were compared for these variables. Data were entered into SPSS for data analysis using one-way ANOVA, Chi-square, regression analysis, and descriptive statistics.


RESULTS
The results indicated significant mean differences in patient age, weight, and duration by drug regimen (F = 20.3, P < 0.001; 16.2, P < 0.001; and 48.7, P < 0.001, respectively). ANOVA indicated a significant difference among drug regimens for percent of quiet, sleeping, and struggling behaviors. Quiet behavior accounted for 26%, 41%, and 67% of all behaviors for CH-H, CH-D-H, and M, respectively. Sleep accounted for 50%, 43%, 0.4% and struggling 11%, 8%, and 19% for CH-H, CH-D-H, and M, respectively. Pre-operative behaviors were also significantly different and patient cooperation was the only variable found minimally predictable of intra-operative behaviors (R = 0.32, P < 0.001). Significant differences among drug regimens were found for heart rate (HR) and mean arterial blood pressure (MAP) during certain procedures (e.g., CH-H produced lower MAP compared to the other drug regimens); however, all physiological variables were within normal limits for the children.


CONCLUSIONS
Significant differences were found for behavioral and physiological variables among the drug regimens (e.g., CH-D-H produced significantly more quiet and sleeping behaviors than M). Prospective studies are needed to confirm these findings.
Wilson
S
S
Postgraduate Pediatric Dentistry Program, Ohio State University & Columbus Children's Hospital, Columbus, USA. wilson.42@osu.edu
Easton
J
J
Lamb
K
K
Orchardson
R
R
Casamassimo
P
P
D000704:Analysis of Variance; D000766:Anesthesia, Dental / Q000379:methods*; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D016009:Chi-Square Distribution; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D002697:Chloral Hydrate; D016292:Procedural Sedation / Q000379:methods*; D019140:Dental Care for Children / Q000379:methods*; D006801:Humans; D006919:Hydroxyzine; D008614:Meperidine; D008874:Midazolam; D010349:Patient Compliance; D012044:Regression Analysis; D012189:Retrospective Studies
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D006919:Hydroxyzine; D002697:Chloral Hydrate; D008614:Meperidine; D008874:Midazolam