Oxygen Saturation and Pulse Rate Change in Children during Sedation with Oral Midazolam and Nitrous Oxide

2018 ◽  
Vol 42 (6) ◽  
pp. 461-464
Author(s):  
Sigalit Blumer ◽  
Rabea Iraqi ◽  
Roly Bercovich ◽  
Benjamin Peretz
Keyword(s):  
Nitrous Oxide ◽  
Oxygen Saturation ◽  
Pulse Rate ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Retrospective Chart Review ◽  
Pediatric Dentistry ◽  
Oral Midazolam ◽  
Clinically Significant

Objective: We aimed to examine if changes in oxygen saturation and pulse rate of pediatric patients during conscious sedation with midazolam and nitrous oxide are associated with child's behavior, midazolam dose, the type and duration of the treatment and demographic parameters. Study Design: This study was a retrospective chart review of consecutive pediatric patients, aged 2.5–12.5 years, who had undergone conscious sedation for dental treatment with oral midazolam (with or without nitrous oxide) between January 2011 and September 2015 at the Department of Pediatric Dentistry of Tel Aviv University. Oral midazolam was administered according to the patients' weight, either at 0.4 mg/kg, 0.5 mg/kg or at a maximum dose of 10 mg. In all cases pulse rate and oxygen saturation were monitored every 15 minutes during treatment, Results: 147 sedation sessions (82 of females and 65 of males) were included in the study. Sedation was successful in 80% of cases. Children with poor behavior scores had statistically significant different mean saturation levels, albeit within normal range, during the treatment (p<0.012) as well as a clinically significant higher mean pulse rate (p=0.0001), compared to children with good or excellent behavior scores. Treatment duration, the type of dental procedure or the patients' weight were not correlated with the change in oxygen saturation or pulse rate during the treatment. Conclusions: Poor behavior of pediatric patients does not affect oxygen saturation, but it increases the pulse rate of children under sedation with midazolam and nitrous oxide.

scholarly journals Midazolam and Its Effect on Vital Signs and Behavior in Children Under Conscious Sedation in Dentistry

2020 ◽  
pp. S305-S314
Author(s):  
J. VASAKOVA ◽  
J. DUSKOVA ◽  
J. LUNACKOVA ◽  
K. DRAPALOVA ◽  
L. ZUZANKOVA ◽  
...  
Keyword(s):  
Conscious Sedation ◽  
Dental Treatment ◽  
Vital Signs ◽  
Pediatric Dentistry ◽  
Clinical Effects ◽  
Blood Oxygen Saturation ◽  
Arterial Blood ◽  
Clinically Significant ◽  
And Behavior ◽  
First Time

Midazolam is a short acting sedative with small number of adverse effects. Administered orally, it is currently the most common form of conscious sedation in children. The objective of this paper is to describe effect of midazolam administered to children during dental treatment on their vital signs, and to monitor changes in children’s behavior. We described values of vital signs and behavior in 418 sedations conducted in 272 children between 1-12 years of age. To achieve the following results, we used data from 272 all first-time sedations. After administration of midazolam arterial blood pressure and blood oxygen saturation decreased by values which were not clinically significant. The heart rate increased, with values staying within the limits of physiological range. The speed of onset of midazolam’s clinical effects depends on age and dose. The lower age and dose correlated with the higher behavior score. The effectiveness of midazolam treatment is 97.8 %. Unwillingness of child to receive midazolam is predictor for disruptive behavior during sedation. 1.8 % of all sedation cases showed paradoxical reactions. The administration of midazolam in dose of 0.5 mg per 1 kg of child’s body weight is safe and could be recommended for dental treatment in pediatric dentistry.

scholarly journals Occipital headaches and neuroimaging in children

Neurology ◽  
2017 ◽  
Vol 89 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Joshua J. Bear ◽  
Amy A. Gelfand ◽  
Peter J. Goadsby ◽  
Nancy Bass
Keyword(s):  
Cohort Study ◽  
Chart Review ◽  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Radiographic Evidence ◽  
Head Pain ◽  
Neurology Clinic ◽  
The Common ◽  
Clinically Significant

Objective:To investigate the common thinking, as reinforced by the International Classification of Headache Disorders, 3rd edition (beta), that occipital headaches in children are rare and suggestive of serious intracranial pathology.Methods:We performed a retrospective chart review cohort study of all patients ≤18 years of age referred to a university child neurology clinic for headache in 2009. Patients were stratified by headache location: solely occipital, occipital plus other area(s) of head pain, or no occipital involvement. Children with abnormal neurologic examinations were excluded. We assessed location as a predictor of whether neuroimaging was ordered and whether intracranial pathology was found. Analyses were performed with cohort study tools in Stata/SE 13.0 (StataCorp, College Station, TX).Results:A total of 308 patients were included. Median age was 12 years (32 months–18 years), and 57% were female. Headaches were solely occipital in 7% and occipital-plus in 14%. Patients with occipital head pain were more likely to undergo neuroimaging than those without occipital involvement (solely occipital: 95%, relative risk [RR] 10.5, 95% confidence interval [CI] 1.4–77.3; occipital-plus: 88%, RR 3.7, 95% CI 1.5–9.2; no occipital pain: 63%, referent). Occipital pain alone or with other locations was not significantly associated with radiographic evidence of clinically significant intracranial pathology.Conclusions:Children with occipital headache are more likely to undergo neuroimaging. In the absence of concerning features on the history and in the setting of a normal neurologic examination, neuroimaging can be deferred in most pediatric patients when occipital pain is present.

scholarly journals Comparison of sedative effects of oral midazolam/chloral hydrate and midazolam/promethazine in pediatric dentistry

2018 ◽  
Vol 12 (3) ◽  
pp. 221-226 ◽  
Author(s):  
Majid Mehran ◽  
Ghassem Ansari ◽  
Mojtaba Vahid Golpayegani ◽  
Shahnaz Shayeghi ◽  
Leila Shafiei
Keyword(s):  
Chloral Hydrate ◽  
Dental Treatment ◽  
Vital Signs ◽  
Pediatric Dentistry ◽  
Double Blind ◽  
Treatment Standard ◽  
Group I ◽  
Oral Midazolam ◽  
Significant Difference ◽  
Sedative Effects

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.

scholarly journals Conscious Sedation with Nitrous Oxide to control Stress during Dental Treatment in Patients with Cerebral Palsy: An Experimental Clinical Trial

2017 ◽  
Vol 10 (4) ◽  
pp. 384-390 ◽  
Author(s):  
Fernando M Baeder ◽  
Daniel F Silva ◽  
Ana CL de Albuquerque ◽  
Maria TBR Santos
Keyword(s):  
Clinical Trial ◽  
Nitrous Oxide ◽  
Cerebral Palsy ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Test Analysis ◽  
Significance Level ◽  
Dental Procedures ◽  
Chi Squared ◽  
Student’S T

ABSTRACT Introduction Individuals with cerebral palsy (CP) often present with oral alterations that impact oral health and require dental treatment. Aim This study aimed to evaluate the use of conscious sedation with nitrous oxide (N2O) to control stress during dental treatment in individuals with CP using as parameters: Venham score (VS), heart rate (HR), and respiratory rate (RR). Materials and methods A total of 77 CP patients >3 years of age with a mean age of 11.8 (± 6.4) years were evaluated in a rehabilitation center. Stress control was measured at the following time points: T1 (presedation), T2 (induction), T3 (sedated patient), and T4 (end). Student's t-test, the Chi-squared test, analysis of variance (ANOVA), and the McNemar test were used. The significance level was 5%. Results Sedation ranged between 10 and 60% N2O, with an average of 35.6% (± 10.4). The RR did not vary among the times (p = 0.12). The HR and VS varied significantly between times (p < 0.001), as significantly higher values of HR were observed at T1. Conclusion Conscious sedation with N2O during dental care controls stress in CP patients, as verified by a decrease in HR, and does not promote respiratory depression. Higher concentrations of N2O are recommended for CP patients with tachycardia. Clinical significance Sedation modifies behavior during dental procedures, facilitating patient collaboration. How to cite this article Baeder FM, Silva DF, de Albuquerque ACL, Santos MTBR. Conscious Sedation with Nitrous Oxide to control Stress during Dental Treatment in Patients with Cerebral Palsy: An Experimental Clinical Trial. Int J Clin Pediatr Dent 2017;10(4):384-390.

scholarly journals Inhalation Conscious Sedation with Nitrous Oxide and Oxygen as Alternative to General Anesthesia in Precooperative, Fearful, and Disabled Pediatric Dental Patients: A Large Survey on 688 Working Sessions

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Angela Galeotti ◽  
Annelyse Garret Bernardin ◽  
Vincenzo D’Antò ◽  
Gianmaria Fabrizio Ferrazzano ◽  
Tina Gentile ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Adverse Effects ◽  
General Anesthesia ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Young Patients ◽  
Dental Patients ◽  
Dental Procedures ◽  
Significant Difference ◽  
Disabled Patients

Aim. To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients.Methods. 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score.Results. 688 conscious sedations were carried out. The success was 86.3%. Adverse effects occurred in 2.5%. 1317 dental procedures were performed. In relation to the success, there was a statistically significant difference between healthy and disabled patients. Sex and age were not significant factors for the success. Venham score was higher at the first contact with the dentist than during the treatment.Conclusions. Inhalation conscious sedation represented an effective and safe method to obtain cooperation, even in very young patients, and it could reduce the number of pediatric patients referred to hospitals for general anesthesia.

Comparison of Three Conscious Sedation Regimens for Pediatric Dental Patients

2007 ◽  
Vol 31 (3) ◽  
pp. 183-186 ◽  
Author(s):  
Javier Torres-Pérez ◽  
Israel Tapia-García ◽  
Miguel Ángel Rosales-Berber ◽  
Juan Francisco Hernández-Sierra ◽  
Amaury de Pozos-Guillén
Keyword(s):  
Clinical Trial ◽  
Chloral Hydrate ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Rating Scale ◽  
Dental Treatment ◽  
Clinical Success ◽  
Dental Patients ◽  
Group A ◽  
Group B

The aim of this study was to compare the clinical success of three conscious sedation regimens for pediatric dental patients. A clinical trial was performed wherein dental treatment was administered to pediatric patients ASA I and II under conscious sedation.. Fifty-four children were divided into three groups of 18 patients each, randomly assigned. Group A received hydroxyzine (2mg/kg 2 h before treatment and a subsequent dose of 1 mg/kg 20 min before treatment) orally; group B received 0.50mg/kg midazolam mixed with 1.5 mg/kg hydroxyzine 20 min before treatment orally; group C received chloral hydrate, 50 mg/kg mixed with 1.5mg/kg hydroxyzine 20 min before treatment orally. The Ohio State Behavioral Rating Scale (OSBRS) showed statistically significant differences between groups B and C with respect to group A. The regimens of midazolam or chloral hydrate mixed with hydroxyzine represent excellent choices for conscious sedation regimens for pediatric dental patients.

Sign in / Sign up

Export Citation Format

Share Document