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Zouaidi K, Olson G, Lee HH, Kalenderian E, Walji MF. An Observational Retrospective Study of Adverse Events and Behavioral Outcomes During Pediatric Dental Sedation. Pediatr Dent 2022; 44:174-180. [PMID: 35799341 PMCID: PMC9648664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Purpose: The purpose of this study was to examine a university-based dental electronic health records (EHR) database to identify sedation-related adverse events (AEs) and assess patients' behavioral outcomes during routine pediatric dental sedations (PDSs) in a dental school clinic. Methods: A database was screened for patients younger than 18 years old who had received dental sedation in 2019. The qualifying EHRs were then accessed and sedations were reviewed for AEs, which were categorized using a 12-point classification system and the Tracking and Reporting Outcomes of Procedural Sedation Tool. Patient behaviors were assessed using provider progress notes and categorized as presence/ absence of agitation. Results: A total of 690 sedations were reviewed, yielding 28 AEs. Emesis was the most common AE observed in 1.3 percent of sedations. Respiratory and cardiovascular AEs were observed in 0.7 percent and 0.6 percent of sedations, respectively. Agitation was identified in 47.5 percent of sedations, while 34.1 percent of agitations resulted in the documented suspension of dental treatment. Agitation was mainly observed for nitrous oxide and oral sedation resulting in one failed sedation out of five sedations for each method. Conclusions: Potentially serious adverse effects were identified during pediatric dental sedations, but their incidence was low. A significant proportion of the sedated children experienced agitation, resulting in some sedation failures. Such events need to be tracked and examined for risk assessment reduction and quality-of-care improvement.
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Affiliation(s)
- Kawtar Zouaidi
- Dr. Zouaidi is a graduate research assistant in the Diagnostic and Biomedical Sciences Department, at the School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Gregory Olson
- Dr. Olson is a professor and chair of the Department of Pediatric Dentistry, at the School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Helen H Lee
- Dr. Lee is an associate professor, Department of Anesthesiology, University of Illinois at Chicago, Chicago, Ill., USA
| | - Elsbeth Kalenderian
- Dr. Kalenderian is a professor, School of Dentistry, University of California at San Francisco, San Francisco, Calif., USA, and a senior lecturer, Harvard School of Dental Medicine, Boston, Mass., USA, and an adjunct professor, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Muhammad F Walji
- Dr. Walji is a professor/associate dean for Technology Services and Informatics, Diagnostic and Biomedical Sciences Department, at the School of Dentistry, University of Texas Health Science Center at Houston, Houston, Texas, USA ;,
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Chen GY, Wu ZF, Lin YT, Cheng KI, Huang YT, Huang ST, Hargono A, Li CY. Association between General Anesthesia and Root Canal Treatment Outcomes in Patients with Mental Disability: A Retrospective Cohort Study. J Pers Med 2022; 12:jpm12020213. [PMID: 35207701 PMCID: PMC8876241 DOI: 10.3390/jpm12020213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023] Open
Abstract
In the population of individuals with a disability, mental illness patients can be uncooperative during dental treatment; thus, general anesthesia has been widely applied during dental procedures. This study aims to investigate the association between general anesthesia and the outcomes of root canal treatment in patients with disability. Teeth treatment records of patients with disability from Kaohsiung Medical University Hospital Research Database and electronic database from January 2005 to December 2018 were used in this retrospective cohort study. The authors conducted analysis comparing root canal treatment outcomes under general anesthesia and non-general anesthesia, indicated by endodontic re-treatment or post-treatment teeth extraction. Over the 9-year follow-up period, root canal treatment outcomes representing a cumulative survival rate of 87.68% and 74.51% in the general anesthesia group and non-general anesthesia group, respectively, were found. After adjustment for potential confounders, the teeth with general anesthesia showed a substantially and significantly reduced HR of root canal treatment failure at 0.24 (95% confidence interval, 0.12 to 0.49). Our study supported the notion that root canal treatment with general anesthesia may entail substantial reduction of treatment failure in patients with disability.
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Affiliation(s)
- Guan-Yu Chen
- Department and Graduate, Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Z.-F.W.); (K.-I.C.)
| | - Zhi-Fu Wu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Z.-F.W.); (K.-I.C.)
- Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yi-Ting Lin
- Department of Dentistry, Division of Special Care Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-T.L.); (S.-T.H.)
- School of Dentistry, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Kuang-I Cheng
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (Z.-F.W.); (K.-I.C.)
- Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Yu-Ting Huang
- Department of Medical Research, Division of Medical Statistics and Bioinformatics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Shun-Te Huang
- Department of Dentistry, Division of Special Care Dentistry, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan; (Y.-T.L.); (S.-T.H.)
- School of Dentistry, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Arief Hargono
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia;
| | - Chung-Yi Li
- Department and Graduate, Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya 60115, Indonesia;
- Department of Public Health, College of Public Health, China Medical University, Taichung 40402, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Correspondence:
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Alhaidari RI, AlSarheed MA. Post-Discharge Effects and Parents' Opinions of Intranasal Fentanyl with Oral Midazolam Sedation in Pediatric Dental Patients: A Cross-Sectional Study. Children (Basel) 2022; 9:142. [PMID: 35204863 DOI: 10.3390/children9020142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 11/24/2022]
Abstract
The aim of this study was to evaluate the post-discharge effects of oral midazolam with intranasal fentanyl sedation in pediatric patients who had dental treatment and to evaluate parents’ preference regarding sedation visits. Methods: A total of 32 uncooperative healthy pediatric patients aged 3–6 years old who met the inclusion criteria were included. In the first visit, one group received oral midazolam (0.7 mg/kg) with intranasal fentanyl (1 μg/kg) sedation (M/F) and the other group received oral midazolam with intranasal placebo (M), and in the second visit each group received the other type of sedation in a cross-over type. In this cross-sectional study, a post-discharge phone-call questionnaire was carried out 24 h after both sedation visits with the parents to evaluate the children’s behavior, function, balance, eating pattern, sleeping pattern, vomiting incidents, and any possible side effects, as well as parents’ satisfaction and preference. The Wilcoxon signed-rank test was used to analyze the categorical variables, and the Chi-square test was performed to analyze the parents’ preference. Result: A total of 32 parents responded to the phone-call questionnaire after 64 sedation visits. All of them were mothers. There was no statistically significant difference between the two groups with respect to recovery to normal function and balance, behavior, incidents of fever, vomiting, sleep disturbance, oversleeping, and adverse behavioral changes (p > 0.05). Children required a significantly longer amount of time until the first meal after M/F sedation (p = 0.04). No significant difference was found between parents’ preferences regarding the sedation visits (p > 0.05). Conclusion: Intranasal fentanyl added to oral midazolam sedation could have an effect on post-discharge adverse behavioral changes, prolonged sleeping, and prolonged recovery time. Children sedated with midazolam/fentanyl required a longer amount of time until the first meal. Vomiting and fever occurred similarly in both sedation regimens with a low incidence. There was no difference in parents’ preferences regarding the two sedation regimens.
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Sado-Filho J, Corrêa-Faria P, Viana KA, Mendes FM, Mason KP, Costa LR, Costa PS. Intranasal Dexmedetomidine Compared to a Combination of Intranasal Dexmedetomidine with Ketamine for Sedation of Children Requiring Dental Treatment: A Randomized Clinical Trial. J Clin Med 2021; 10:2840. [PMID: 34199001 DOI: 10.3390/jcm10132840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/19/2021] [Accepted: 06/24/2021] [Indexed: 12/15/2022] Open
Abstract
Outpatient pediatric sedation is challenging. This study aimed to test intranasal dexmedetomidine efficacy as a single drug or combined with ketamine (DK) to sedate children undergoing dental treatment. Children < 7 years were randomized into dexmedetomidine 2 mcg/kg and ketamine 1 mg/kg (DK) or dexmedetomidine 2.5 mcg/kg (D) groups. Videos from the dental sedation allowed the systematic assessment of children's behavior (primary outcome) according to the Ohio State University Behavioral Rating Scale (OSUBRS). Secondary outcomes were parental and dentist satisfaction, adverse events, and recovery time. The data were analyzed descriptively and through regression models. Participants were 88 children (44 per group; 50 boys). The duration of quiet behavior (OSUBRS) was higher than 50% (DK mean 58.4 [standard deviation 38.1]; D 55.2 [39.1]; p = 0.225). Parents (DK 78.0 [32.2]; D 72.7 [35.1]; p = 0.203) and dentists (KD 62.7 [41.0]; D 62.8 [40.1]; p = 0.339) were overall satisfied. Adverse events occurred in 16 cases (DK n = 10, 62.5%; D n= 6, 37.5%; p = 0.104) and were minor. The median recovery time in the DK group was 1.3 times greater than in group D (p < 0.05). Intranasal sedation with dexmedetomidine alone is equally efficacious and satisfactory for pediatric sedation with fewer adverse events and faster recovery than the DK combination.
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Abstract
Postoperative nausea and vomiting (PONV), postoperative vomiting (POV), post-discharge nausea and vomiting (PDNV), and opioid-induced nausea and vomiting (OINV) continue to be causes of pediatric morbidity, delay in discharge, and unplanned hospital admission. Research on the pathophysiology, risk assessment, and therapy for PDNV, OINV and pain therapy options in children has received increased attention. Multimodal pain management with the use of perioperative regional and opioid-sparing analgesia has helped decrease nausea and vomiting. Two common emetogenic surgical procedures in children are adenotonsillectomy and strabismus repair. Although PONV risk factors differ between adults and children, the approach to decrease baseline risk is similar. As PONV and POV are frequent in children, antiemetic prophylaxis should be considered for those at risk. A multimodal approach for antiemetic and pain therapy involves preoperative risk evaluation and stratification, antiemetic prophylaxis, and pain management with opioid-sparing medications and regional anesthesia. Useful antiemetics include dexamethasone and serotonin 5-hydroxytryptamine-3 (5-HT3) receptor antagonists such as ondansetron. Multimodal combination prophylactic therapy using two or three antiemetics from different drug classes and propofol total intravenous anesthesia should be considered for children at high PONV risk. "Enhanced recovery after surgery" protocols include a multimodal approach with preoperative preparation, adequate intravenous fluid hydration, opioid-sparing analgesia, and prophylactic antiemetics. PONV guidelines and management algorithms help provide effective postoperative care for pediatric patients.
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Affiliation(s)
- Anthony L Kovac
- Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 1034, Kansas City, KS, 66160, USA.
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Song S, Han M, Kim J. Safety of chloral hydrate sedation in dental practice for children: an overview. J Dent Anesth Pain Med 2020; 20:107-118. [PMID: 32617405 PMCID: PMC7321738 DOI: 10.17245/jdapm.2020.20.3.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/11/2020] [Accepted: 06/14/2020] [Indexed: 11/23/2022] Open
Abstract
Chloral hydrate is the oldest and most common sedative drug used in moderate sedation for pediatric dental patients. Hence, the purpose of this article is to review the safety and possible adverse events of this drug when used for pediatric dental treatment. A bibliographic search in PubMed, MEDLINE, Cochrane Library and KMbase, KISS, DBpia, KoreaMed, and RISS databases was performed. Using the keywords “dental sedation,” “chloral hydrate,” and “children or adolescent,” 512 scientific articles were found. Subsequently, 183 studies were individually assessed for their suitability for inclusion in this literature review. Altogether, 24 studies were selected. They included 12 cases of death before, during, or after chloral hydrate sedation for dental treatment, majorly due to dosing error and use of multiple sedatives. Additionally, intraoperative adverse events were mostly respiratory problems such as hypoxia and apnea, but most events were temporary. After treatment, prolonged sedation, including excessive sleep and less activity were the most common postoperative adverse events, and even death cases were reported. Despite the wide acceptance of chloral hydrate as a sedative-hypnotic agent, the risk of adverse events and adequate dose should be of great concern when using it for pediatric dental sedation.
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Affiliation(s)
- Sol Song
- Department of Pediatric Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
| | - Miran Han
- Department of Pediatric Dentistry, Jukjeon Dental Hospital, College of Dentistry, Dankook University, Yongin, Korea
| | - Jongbin Kim
- Department of Pediatric Dentistry, College of Dentistry, Dankook University, Cheonan, Korea
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Abstract
Dexmedetomidine is an α2 adrenoreceptor agonist that may be administered by the intranasal route as a sole sedative agent in children. It is odourless, colourless and tasteless and is formulated in a concentration of 100µg.ml-1. We performed a review of published randomised controlled trials in order to determine the efficacy of intranasal dexmedetomidine for sedation in children. Fourteen trials were eligible for inclusion in the review and contained a total of 1809 patients ranging in age from one month to 14 years. Intranasal dexmedetomidine was administered in a dose range of 1-4µg.kg-1 and was compared with various other sedatives. Dexmedetomidine was administered by either drops or a mucosal atomiser device. The procedures ranged from non-painful examinations such as magnetic resonance imaging scans and transthoracic echocardiography to painful procedures such as dentistry and venous cannulation. Administration of 2µg.kg-1 appears to be the optimal dose.
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Affiliation(s)
- J Lewis
- KCL School of Medicine, London, UK
| | - C R Bailey
- Department of Anaesthetics, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
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Poli PP, Creminelli L, Grecchi E, Pieriboni S, Menozzi G, Maiorana C. Anxiolysis in the Surgical Management of a Compound Odontoma in a Pediatric Patient. Case Rep Dent 2019; 2019:1385150. [PMID: 31065390 DOI: 10.1155/2019/1385150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/10/2019] [Indexed: 12/14/2022] Open
Abstract
Among odontogenic tumors, odontoma is the most frequent. The common treatment contemplates a conservative approach. While this procedure is generally accepted and tolerated, some difficulties may be encountered in the case of pediatric patients. Indeed, negative feelings of tension, apprehension, nervousness, and fear are likely to occur. The present report is aimed at discussing the management of a compound odontoma in a pediatric patient under anxiolysis with diazepam on an outpatient basis. The surgery was carried out without complications, and the discharge was completed safely. Oral premedication with diazepam should be considered to avoid more invasive sedation procedures in anxious pediatric patients.
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Mehran M, Ansari G, Vahid Golpayegani M, Shayeghi S, Shafiei L. Comparison of sedative effects of oral midazolam/chloral hydrate and midazolam/promethazine in pediatric dentistry. J Dent Res Dent Clin Dent Prospects 2018; 12:221-226. [PMID: 30443309 PMCID: PMC6231152 DOI: 10.15171/joddd.2018.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 06/20/2018] [Indexed: 11/09/2022] Open
Abstract
Background. The aim of this investigation was to compare the sedative effects of oral midazolam/chloral hydrate and midazolam/promethazine combinations on fearful children needing dental treatment. Methods. This crossover double-blind clinical trial was conducted on 30 children aged 2‒6 years, who had at least two similar teeth needing pulp treatment. Standard vital signs were recorded before and after premedication. Wilson sedation scale was used to judge the level of sedation. Cases were divided into two groups based on the sequence of medication received. This was to overcome the sequence effect. Group I received oral midazolam (0.4 mg/kg/chloral hydrate (50 mg/kg) at the first visit while they received midazolam (0.4 mg/kg)/promethazine (5 mg/kg) in their second visit. Group II received the premedication in the opposite sequence. The operator and child were blinded to the medication administered. Sedative efficacy of the two combinations were assessed and judged by two independent pediatric dentists based on the Wilson scale. Data were analyzed with ANOVA and paired t-test. Results. Only 10% of children who received chloral hydrate with midazolam exhibited high improvement in their behavior while 53% showed reasonable positive changes and 12% had no change or even deterioration of behavior. The difference between the effect of the two combination drugs was statistically significant (P<0.05) in favor of the chloral hydrate group. Conclusion. The results showed a significant difference in the sedation level induced between the two groups. Midazolam/chloral hydrate combination more effectively improved the co-operation for dental treatment.
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Affiliation(s)
- Majid Mehran
- Department of Pediatric, Faculty of Dentistry, Shahed University of Medical Science, Tehran, Iran
| | - Ghassem Ansari
- Department of Pediatric, Faculty of Dentistry, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mojtaba Vahid Golpayegani
- Department of Pediatric, Faculty of Dentistry, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Shahnaz Shayeghi
- Department of Anesthesiology, Faculty of Dentistry, Shahid Beheshti University of Medical Science, Tehran, Iran
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Abstract
BACKGROUND Two common methods of treating pediatric dental patients with severe early childhood caries (S-ECC) are general anesthesia (GA) and conscious sedation (CS). We sought to first evaluate the cost-effectiveness of treating S-ECC with GA versus CS and then compare the cost-effectiveness at 2 time points: 2011 and 2015. METHODS We used a decision tree model to produce 2-y estimates of costs and outcomes from the Medicaid perspective. The model cohort consisted of healthy 3-y-olds with S-ECC in need of a theoretical set of dental treatments to be performed under either a single GA visit or 3 CS visits. Outcomes were measured in caries-free months. Costs were evaluated in 2015 US dollars. Costs, probabilities, and outcomes were estimated from published data, expert opinion, and Medicaid billing at an academic health center. One-way and probabilistic sensitivity analyses were performed. RESULTS As compared with CS, GA resulted in 4 additional caries-free months per child. The cost of a caries-free month for GA versus CS rose from $596 in 2011 to $881 in 2015. These findings were sensitive to loss to follow-up for subsequent CS visits and total cost of GA. CONCLUSIONS Comprehensive S-ECC treatment had better outcomes when performed under GA versus CS. However, GA was not cost saving when compared with CS. While the cost of dental treatment increased for both GA and CS from 2011 to 2015, the cost rose faster for GA. These results have important implications due to the increasing cost to Medicaid insurance and the rising number of young children being treated for S-ECC under GA. KNOWLEDGE TRANSFER STATEMENT Medicaid policy makers can use the results of this study to evaluate the cost-effectiveness of dental treatment for young children with S-ECC at 2 time points: 2011 and 2015. Compared with CS, GA resulted in a longer amount of time during which children were free from dental caries but at a higher cost. The cost difference rose from 2011 to 2015.
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Affiliation(s)
- J M Burgette
- 1 Departments of Dental Public Health and Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,2 Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - R B Quiñonez
- 3 Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Abstract
PURPOSE OF REVIEW Anesthesia for dentistry is commonly performed outside the operating room. The combination of a shared airway between surgeon and anesthetist, the variety of open airway techniques, and the out-of-operating room setting often results in anxiety and avoidance of dental cases among anesthesia personnel. This review attempts to demystify dental treatment and facilitate the anesthesia provider in providing effective sedation of dental procedures performed in the nonoperating room setting. RECENT FINDINGS Specific indications for dental anesthesia improve the patient selection process. Airway assessment and strategies to secure the difficult airway are paramount because of the nature of the procedures and the patients on whom they are performed. Pediatric patients and those with special needs present specific preanesthetic assessment, induction, and management challenges. Emergence delirium is disruptive, possibly dangerous, prolongs recovery time, and may necessitate hospitalization. Simplified techniques and objective recovery criteria are necessary to ensure a safe and smooth discharge to home. Airway fire precautions should not be overlooked given the rare but potential risk of airway fire during dental treatment. SUMMARY This article reviews the indications, facility and equipment needs, monitoring requirements, treatment methods, and recovery protocols necessary for the safe administration of off-floor anesthesia for dentistry.
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Mozafar S, Bargrizan M, Golpayegani MV, Shayeghi S, Ahmadi R. Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial. Dent Res J (Isfahan) 2018; 15:411-419. [PMID: 30534169 PMCID: PMC6243808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND This study compared the safety and efficacy of nitrous oxide (N2O)/midazolam and N2O/promethazine for dental treatment of uncooperative children. MATERIALS AND METHODS In this randomized, cross-over, clinical trial investigation Eighteen healthy uncooperative children with a pair of similar teeth requiring the same treatment were included. Combination of N2O/midazolam was given in one visit, where N2O/promethazine was administrated in the other appointment for each patient in a cross-over manner. Oxygen saturation and heart rate as well as behavior parameters according to Houpt behavior scales were recorded. Postoperatively, patients' anxiety and parents' satisfaction were assessed by visual analog score and a questionnaire, respectively. Data were analyzed using Wilcoxon' s signed rank test and Paired t-tests with a P value set at 0.05. RESULTS Physiologic parameters were within normal limit in both groups. Children in midazolam group were significantly deeper sedated compared to other groups. In the first phase, children sedated with midazolam behaved superiorly in comparison to promethazine, while there was no difference at the final phase of the treatment between the two groups. CONCLUSION Both of the drug combinations resulted in acceptable, efficient, and safe sedation outcomes.
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Affiliation(s)
- Sedigheh Mozafar
- Department of Pediatric Dentistry, Dental School, Shahed University, Tehran, Iran
| | - Majid Bargrizan
- Department of Pediatric Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Vahid Golpayegani
- Department of Pediatric Dentistry, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahnaz Shayeghi
- Department of Anesthesiology, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rahil Ahmadi
- Department of Pediatric Dentistry, Dental School, Shahed University, Tehran, Iran,Address for correspondence: Dr. Rahil Ahmadi, Department of Pediatric Dentistry, Dental School, Shahed University, Tehran, Iran. E-mail:
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Abstract
This article is a concise review of discharge criteria following sedation or anesthesia relevant to the oral and maxillofacial surgeon. Topics covered include a general overview of the need for objective discharge criteria, a review of standardized criteria, and a brief discussion on specific anesthetic, patient, and surgical factors that can impact the safety of the immediate postoperative recovery and postdischarge periods.
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Affiliation(s)
- Kyle J Kramer
- Department of Oral Surgery and Hospital Dentistry, Indiana University School of Dentistry, 550 University Boulevard, Room 3195, Indianapolis, IN 46202, USA.
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Affiliation(s)
- C. R. Bailey
- Evelina London Children's Hospital; Guy's and St. Thomas' NHS Foundation Trust; London UK
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Roback MG, Carlson DW, Babl FE, Kennedy RM. Update on pharmacological management of procedural sedation for children. Curr Opin Anaesthesiol 2016; 29:S21-35. [DOI: 10.1097/aco.0000000000000316] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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