Characteristics of Intravenous Midazolam Sedation with Nitrous Oxide in Pediatric Dental Treatment

Midazolam is a short-acting benzodiazepine that is widely used in pediatric dental sedation. However, its clinical effectiveness as an intravenous sedative agent in children has not been widely documented. A retrospective study was conducted to evaluate the efficacy and safety of intravenous midazolam and nitrous oxide inhalation sedation in pediatric dental treatment.<br/>The subjects were 115 patients (118 cases) who received dental treatment under intravenous midazolam and nitrous oxide inhalation sedation. Demographic factors, general health status, sedation time, midazolam and nitrous oxide dosage, and success rate of sedation were evaluated from electronic medical records.<br/>Behavioral management was the main reason of choosing sedation. Mean duration of sedation was 56.7 minutes for surgical treatment, and 74.4 minutes for restorative treatment. The initial dosage of intravenous midazolam was 0.051 ± 0.019 mg/kg. In 34 cases (28.8%), additional midazolam of 0.036 ± 0.057 mg/kg was delivered during the treatment. The concentration of nitrous oxide was maintained between 40% and 50%. The success rate of sedation was 99% (n = 117). In 1 case, laryngospasm occurred and the patient was reversed with benzodiazepine antagonist, flumazenil.<br/>Intravenous midazolam sedation with nitrous oxide was shown to be clinically effective for the dental treatment in children, if administered by trained personnel and patients are carefully selected in accordance with guidelines.

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Clinical Effectiveness of Ranibizumab And Aflibercept For Central RVO: A Retrospective Cohort Study Using Electronic Medical Records From The USA

Value in Health ◽

10.1016/j.jval.2016.09.1249 ◽

2016 ◽

Vol 19 (7) ◽

pp. A562

Author(s):

A Skelly ◽

F Milnes

Keyword(s):

Cohort Study ◽

Electronic Medical Records ◽

Retrospective Cohort Study ◽

Medical Records ◽

Retrospective Cohort ◽

Clinical Effectiveness ◽

The Usa

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Temperament as a Predictor of Nitrous Oxide Inhalation Sedation Success

Anesthesia Progress ◽

10.2344/anpr-63-03-01 ◽

2017 ◽

Vol 64 (1) ◽

pp. 17-21 ◽

Cited By ~ 4

Author(s):

Travis M. Nelson ◽

Thomas M. Griffith ◽

Katherine J. Lane ◽

Sarat Thikkurissy ◽

JoAnna M. Scott

Keyword(s):

Nitrous Oxide ◽

Inhibitory Control ◽

Dental Care ◽

Effortful Control ◽

Dental Treatment ◽

Short Form ◽

Child Temperament ◽

Health Insurance Status ◽

Inhalation Sedation ◽

Significant Difference

Little is known about implications of temperament for children who receive nitrous oxide inhalation sedation (N2O/O2) for dental care. The aim of this study was to investigate whether child temperament is associated with success in N2O/O2. Child-caregiver dyads were enrolled from patients aged 36–95 months receiving dental care with N2O/O2 at a university-based pediatric dental clinic. To assess child temperament, 48 caregivers completed the Children's Behavior Questionnaire Short Form. Patient behavior was abstracted from Frankl scores recorded in the patient's chart. The overall behavioral failure rate was 15% (n = 7/48). There was no significant difference in sedation outcome associated with sex, health, insurance status, or complexity of treatment provided. Sedation outcome was significantly associated with the broad temperament domain of Effortful Control and its subscales Attentional Focusing and Inhibitory Control. The Negative Affectivity subscales of Frustration, Sadness, and Soothability and the Extraversion/Surgency subscales Activity and Impulsivity were also significantly associated with sedation outcome. The results of this study suggest that Effortful Control is associated with behavior during dental treatment with N2O/O2. The subscales of Attention Focusing, Inhibitory Control, Frustration, Fear, Sadness, Soothability, Activity, and Impulsivity may also be important determinants of child behavior during dental treatment.

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Inhalation Sedation with Nitrous Oxide in Dental Treatment

Journal of the Korean Dental Society of Anesthesiology ◽

10.17245/jkdsa.2002.2.1.1 ◽

2002 ◽

Vol 2 (1) ◽

pp. 1

Author(s):

Hyung Bae Yoon

Keyword(s):

Nitrous Oxide ◽

Dental Treatment ◽

Inhalation Sedation

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Trends in Dental Sedation of Korean Children and Adolescents

THE JOURNAL OF THE KOREAN ACADEMY OF PEDTATRIC DENTISTRY ◽

10.5933/jkapd.2021.48.3.313 ◽

2021 ◽

Vol 48 (3) ◽

pp. 313-323

Author(s):

Minkyung Tak ◽

Jaegon Kim ◽

Yeonmi Yang ◽

Daewoo Lee

Keyword(s):

Nitrous Oxide ◽

Health Insurance ◽

Retrospective Study ◽

Side Effects ◽

Children And Adolescents ◽

Dental Treatment ◽

National Sample ◽

Korean Children ◽

Standard Data ◽

Inhalation Sedation

The purpose of this study was to investigate trends in dental sedation of Korean children and adolescents. A retrospective study was conducted on patients under 20 years of age who received dental treatment under sedation using National Health Insurance Service-National Sample Cohort Database from 2002 to 2015. Based on the 1 million standard data, there were 436 cases of dental treatment under sedation in 2002, but 4002 cases in 2015, showing a trend increasing every year. The 3 - 5 year old group accounted for the largest portion (54.2%), while the 6 - 8 year old group increased recently. Nitrous oxide inhalation sedation is the most commonly used, accounting for 45.9% in 2002, but increased to 89.5% in 2015. Combination of nitrous oxide inhalation sedation, chloralhydrate and hydroxyzine was the most common, accounting for 5.7% in 2002, but decreased to 2.9% in 2015. There is a trend to use the sedation method more safely and in a way that reduces side effects.

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An alternative sedation option for special care patients: combined inhalation sedation with nitrous oxide and oxygen and intravenous sedation with midazolam

Dental Update ◽

10.12968/denu.2021.48.7.533 ◽

2021 ◽

Vol 48 (7) ◽

pp. 533-538

Author(s):

Stephanie Fenesan ◽

Sadie Hughes ◽

Neha Patel

Keyword(s):

Nitrous Oxide ◽

Clinical Relevance ◽

Dental Treatment ◽

Case Reports ◽

Special Care ◽

Intravenous Sedation ◽

Advantages And Disadvantages ◽

Inhalation Sedation ◽

All Treatment ◽

Additional Option

This article highlights an alternative sedation technique by providing inhalation sedation with nitrous oxide and oxygen alongside intravenous sedation with midazolam as an additional option for patients within special care dentistry. Two case reports are described, as well as a short overview of the available literature on this technique and the indications, advantages and disadvantages. This technique should be considered alongside other sedation techniques. As with all treatment for which sedation is provided, each case needs to be considered on an individual basis and the most appropriate option selected following discussion with the patient. CPD/Clinical Relevance: Although single sedation techniques provide a good level of sedation to facilitate dental treatment for the majority of patients, it is desirable to have an awareness of alternative sedation options that may be available for patients.

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Outcome of coxofemoral luxation treated with closed reduction in 51 cats

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x211041535 ◽

2021 ◽

pp. 1098612X2110415

Author(s):

Marielle D LeFloch ◽

George S Coronado

Keyword(s):

Risk Factors ◽

Success Rate ◽

Electronic Medical Records ◽

Medical Records ◽

Closed Reduction ◽

Outcome Data ◽

Included Patient ◽

Potential Risk Factors ◽

Joint Reduction ◽

Joint Luxation

Objectives The aim of this study was to describe the outcomes and determine the reluxation rate of cats undergoing closed coxofemoral joint reduction, and to investigate potential risk factors for reluxation of the affected coxofemoral joint. Methods Case information was obtained from electronic medical records from Ocean State Veterinary Specialists and Bay State Veterinary Emergency and Specialty Services between January 2008 and May 2020. Data obtained from 51 cats with coxofemoral joint luxations included patient signalment, direction of coxofemoral joint luxation, concurrent injuries, ease of reduction, time of injury to closed reduction, bandage application and outcome. Data were analyzed for association with outcomes. Results Closed reduction of coxofemoral joint luxation in cats had a 51% success rate. The only risk factor demonstrating a statistically significant benefit to the success of closed coxofemoral joint reduction was the application of a bandage ( P = 0.02). Conclusions and relevance It may be worth attempting closed coxofemoral joint reduction in cats prior to recommending surgery. Placing a bandage (Ehmer or hobbles) after closed reduction may decrease the risk of the coxofemoral joint reluxating, but more studies are needed to evaluate this further. The outcome after closed reduction management for coxofemoral joint luxation in cats is similar to the previously reported success rate in dogs.

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Characteristics and Associated Comorbidities of Pediatric Dental Patients Treated under General Anesthesia

Journal of Clinical Pediatric Dentistry ◽

10.17796/1053-4628-41.6.12 ◽

2017 ◽

Vol 41 (6) ◽

pp. 482-485 ◽

Cited By ~ 1

Author(s):

Alexandra Delfiner ◽

Aaron Myers ◽

Christie Lumsden ◽

Steve Chussid ◽

Richard Yoon

Keyword(s):

General Anesthesia ◽

Medical History ◽

Electronic Medical Records ◽

Medical Records ◽

Dental Treatment ◽

Pediatric Dentistry ◽

Dental Disease ◽

Children's Hospital ◽

Children’S Hospital ◽

And Behavior

Objective: To describe characteristics and identify common comorbidities of children receiving dental treatment under general anesthesia at Children's Hospital of New York-Presbyterian. Study design: Electronic medical records of all children that received dental treatment under general anesthesia through the Division of Pediatric Dentistry from 2012–2014 were reviewed. Data describing patient characteristics (age, sex, race/ethnicity, insurance carrier, and American Society of Anesthesiologists physical status classification system), medical history, and justification for treatment were collected. Descriptive statistics, including frequencies, percentages and t-tests, were calculated. Results: A total of 298 electronic medical records were reviewed, of which 50 records were excluded due to missing information. Of the 248 electronic medical records included, the average age was 5-years-old and 58% were male. The most common reason for dental treatment under general anesthesia was extent and severity of dental disease (53%), followed by significant medical history (47%) and behavior/pre-cooperative age (39%). Those who were ASA III or IV were older (6.6-years) (p<.001). Common medical comorbidities appear evenly distributed: autism (12%), cardiac anomalies (14%), developmental delay (14%), genetic syndromes/chromosomal disorders (13%), and neurological disorders (12%). Younger age groups (1 to 2 years and 3 to 5 years) had a high percentage of hospitalizations due to the extent and severity of the dental disease (83%) and behavior (77%) (p<0.001). Conclusions: No single comorbidity was seen more often than others in this patient population. The range of medical conditions in this population may be a reflection of the range of pediatric specialty services at Children's Hospital of NewYork-Presbyterian.

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