NITROUS OXIDE SEDATION IN PEDIATRIC DENTISTRY: A NEW APPRAISAL

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.

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Effectiveness and Safety of Nitrous Oxide as a Sedative Agent at 60% and 70% Compared to 50% Concentration in Pediatric Dentistry Setting

Journal of Clinical Pediatric Dentistry ◽

10.17796/1053-4625-44.1.11 ◽

2020 ◽

Vol 44 (1) ◽

pp. 60-65

Author(s):

Johny Kharouba ◽

Mostafa Somri ◽

Christopher Hadjittofi ◽

Jomana Hasan ◽

Sigalit Blumer

Keyword(s):

Nitrous Oxide ◽

Adverse Events ◽

Study Design ◽

Dental Treatment ◽

Pediatric Dentistry ◽

Sedative Agent ◽

Complete Treatment ◽

Adequate Sedation ◽

Secondary Outcomes

Objective: Sedation using 50% nitrous oxide (N2O) concentration is common in pediatric dentistry. The aim to assess sedation and cooperation levels following sedation with 60% and 70% N2O concentrations in children whose dental treatment failed using 50% N2O concentration. Study design: Children (n=51) aged 5–10 years were included. Sedation started with N2O concentration of 50%; when appropriate cooperation and sedation were not achieved, N2O concentration was increased to 60%, and subsequently to 70% during the same session. Sedation and cooperation levels were the primary outcomes. Adverse events were defined as secondary outcomes. Results: At 50% N2O concentration, five children reached adequate sedation and cooperation and completed their dental treatment, where 32 children completed the treatment at 60% N2O concentration. Fourteen children required a concentration of 70% to complete treatment. For ten of the latter, treatment was successfully completed, while for four, treatment failed, despite the achievement of adequate sedation. Adverse events were observed in 9%, 22%, of the children who received 60%, 70% N2O concentrations, respectively. Conclusions: When sedation with 50% N2O concentration does not achieve satisfactory cooperation to complete pediatric dental treatment, 60% N2O concentration appears to be more effective than 50% and safer than 70%.

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