scholarly journals Comparison of Nitrous Oxide-Oxygen as Inhalation Agent, Midazolam, Ketamine alone and in Combination as Oral Sedative Agents for In-office Paediatric Patients- A Randomised Control Trial

2021 ◽  
Author(s):  
Monika Nagpal ◽  
Mohan Lal Khatri ◽  
Anil Gupta ◽  
Ankit Srivastava ◽  
Shalini Garg
Keyword(s):  
Nitrous Oxide ◽  
Local Anaesthesia ◽  
Randomised Control Trial ◽  
Old Patients ◽  
Oxygen Saturation Level ◽  
Oral Ketamine ◽  
Paediatric Patients ◽  
Oral Midazolam ◽  
Significant Difference ◽  
Nitrous Oxide Oxygen

Introduction: In-office pharmacological sedation techniques are best applied to manage an extremely fearful preschooler, especially during primary dentition or a child’s early mixed dentition period. These should be used when non pharmacological behavioural management techniques fail either due to lack of communication or in children with special care needs. Aim: To compare the efficacy of oral administrations of midazolam, ketamine, combination of midazolam-ketamine (M+K) and nitrous oxide-oxygen (N2O) inhalational sedation in achieving favorable behavioural outcome compared by using the Houpt scale in the treatment of anxious and uncooperative paediatric patients. Materials and Methods: A randomised clinical trial was conducted in the Department of Paediatric and Preventive Dentistry, SGT University, Haryana, India between September 2018 to December 2019. The study included 100 anxious children (Venham’s picture scale) aged three to five years, who required procedures under local anaesthesia administration were divided into four groups using envelop method. Each group was given either oral midazolam (M) (0.3 mg/kg) or oral ketamine (K) (3 mg/kg) or oral combination of midazolam+ketamine (M+K) (0.3 mg/kg and 2 mg/kg) or inhalational nitrous oxide-oxygen (N2O). The behaviour response of the child was recorded using the Houpt scale. The oxygen saturation level and heart rate of each patient were also recorded before, after, and during the procedure. Adverse drug reactions post-treatment was also recorded. Analysis of Variance (ANOVA), Chi-square test and Mann-Whitney U test was used for statistical analysis. Results: The study comprised of 100 anxious children (mean age was 4.1±0.5 years) requiring administration of local anaesthesia with intent to complete in-office treatment. Statistically, a significant difference was found among behaviour outcomes of four groups (p-value=0.047). Acceptable behaviour was seen best in K+M group (88%), followed by oral ketamine (K) (68%), N2O (59%), and oral midazolam (M) (52%). Adverse reactions were most commonly seen in the oral ketamine group. Conclusion: Oral M+K combination group is significantly better than oral ketamine (K), oral midazolam (M) or N2O inhalation sedation to achieve the required behaviour for dental treatment in three to five years old patients.

scholarly journals Predictable sedation: Safe administration of oral Midazolam and nitrous oxide gas for paediatric patients in the general dental practice

2021 ◽  
Vol 76 (08) ◽  
pp. 471-476
Author(s):  
Nicoline Potgieter ◽  
Günther Streit
Keyword(s):  
Nitrous Oxide ◽  
Dental Health ◽  
Review Literature ◽  
Health Providers ◽  
Behaviour Management ◽  
Dental Patients ◽  
Paediatric Patients ◽  
Oral Midazolam ◽  
Nitrous Oxide Oxygen ◽  
Hypnotic Agent

Behaviour management for anxious paediatric dental patients is challenging. Solutions include education and sedation. Various drugs have been used to effectively sedate paediatric patients during treatment. The aim of this study was to review literature on the sedation of paediatric patients. The study specifically looked at those reviews covering the combination of two sedation methods in case of more challenging paediatric patients. The study undertook a literature review focused on studies using nitrous oxide, Midazolam, or a combination of the two substances. An electronic search was done on EBSCOhost to source articles published from 1979 to 2019. A deeper form of sedation can be achieved for paediatric patients when using a combination of nitrous oxide, oxygen and a hypnotic agent such as Midazolam. Dealing with the anxiety levels of paediatric patients is a challenge for dental health providers. Two of the main strategies used to deal with anxious children are behaviour management and sedation. A critical review of journal articles on the use of nitrous oxide and oxygen in combination with Midazolam was therefore undertaken. The findings suggest that, in order to achieve a deeper form of sedation, the combination of nitrous oxide, oxygen and Midazolam works well to reduce discomfort, anxiety and/or pain in paediatric patients.

Nitrous oxide-oxygen or oral midazolam for pediatric outpatient sedation

2002 ◽  
Vol 93 (6) ◽  
pp. 643-646 ◽  
Author(s):  
Sarah A. Hulland ◽  
Marshall M. Freilich ◽  
George K.B. Sàndor
Keyword(s):  
Nitrous Oxide ◽  
Oral Midazolam ◽  
Nitrous Oxide Oxygen

scholarly journals DEATH AFTER NITROUS OXIDE-OXYGEN AND LOCAL ANAESTHESIA

BMJ ◽  
1916 ◽  
Vol 2 (2899) ◽  
pp. 109-109 ◽  
Author(s):  
W. J. McCardie
Keyword(s):  
Nitrous Oxide ◽  
Local Anaesthesia ◽  
Nitrous Oxide Oxygen

scholarly journals Effect of Nitrous Oxide on Pulpal Anesthesia: A Preliminary Study

2018 ◽  
Vol 65 (3) ◽  
pp. 156-161
Author(s):  
Papimon Chompu-inwai ◽  
Sophon Simprasert ◽  
Patchanee Chuveera ◽  
Areerat Nirunsittirat ◽  
Thanapat Sastraruji ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Rating Scale ◽  
Permanent Teeth ◽  
Chi Square ◽  
Significant Difference ◽  
Nitrous Oxide Oxygen ◽  
Chi Square Test ◽  
Preliminary Study ◽  
Pulpal Anesthesia ◽  
Irreversible Pulpitis

To compare the success of perceived pulpal anesthesia between groups using nitrous oxide/oxygen (N2O/O2) and oxygen (O2) in children premedicated with ibuprofen with symptomatic irreversible pulpitis permanent teeth. Thirty-three children (mean age 10.4 ± 1.9 years) with 33 symptomatic irreversible pulpitis permanent teeth were included in this preliminary study. All children were premedicated with ibuprofen and randomly assigned to receive either N2O/O2 (17 participants) or O2 (16 participants). Four percent articaine with epinephrine 1:100,000 was administered, and vital pulp therapy was performed. Children used the Wong-Baker FACES Pain Rating Scale (WBFPS) to report their pain at baseline as well as during carious dentin removal, pulpal exposure, and pulpal tissue removal steps. The success was determined when the reported WBFPS score was ≤4. The chi-square test was used to compare the success between both groups. The success of pulpal anesthesia was 71% (12/17) and 19% (3/16) in the N2O/O2 and O2 groups, respectively. The success in the N2O/O2 group was 52% higher than that in the O2 group (confidence interval = 22.9% to 80.7%; significant difference p = .003). From the result of this preliminary study, N2O/O2 significantly increased the success of perceived pulpal anesthesia in children premedicated with ibuprofen with symptomatic irreversible pulpitis permanent teeth. However, further study with a larger sample is required to confirm this result.

Effects of Anticholinergics on Postoperative Vomiting, Recovery, and Hospital Stay in Children Undergoing Tonsillectomy with or without Adenoidectomy 

1999 ◽  
Vol 90 (3) ◽  
pp. 697-700 ◽  
Author(s):  
Ashwani K. Chhibber ◽  
Stewart J. Lustik ◽  
Rajbala Thakur ◽  
David R. Francisco ◽  
Kenneth B. Fickling
Keyword(s):  
Nitrous Oxide ◽  
Hospital Stay ◽  
Neuromuscular Blockade ◽  
Oxygen Mixture ◽  
Postanesthesia Care Unit ◽  
Postoperative Vomiting ◽  
Inhalation Induction ◽  
Number Of Patients ◽  
Significant Difference ◽  
Nitrous Oxide Oxygen

Background Nausea and vomiting are the most frequent problems after minor ambulatory surgical procedures. The agents used to induce and maintain anesthesia may modify the incidence of emesis. When neuromuscular blockade is antagonized with anticholinesterases, atropine or glycopyrrolate is used commonly to prevent bradycardia and excessive oral secretions. This study was designed to evaluate the effect of atropine and glycopyrrolate on postoperative vomiting in children. Methods Ninety-three patients undergoing tonsillectomy with or without adenoidectomy were studied. After inhalation induction of anesthesia with nitrous oxide, oxygen, and halothane, anesthesia was maintained with a nitrous oxide-oxygen mixture, halothane, morphine, and atracurium. Patients were randomized to receive, in a double-blinded manner, either 15 microg/kg atropine or 10 microg/kg glycopyrrolate with 60 microg/kg neostigmine to reverse neuromuscular blockade. Patient recovery, the incidence of postoperative emesis, antiemetic therapy, and the duration of postoperative hospital stay were assessed. Results There were no significant differences in age, gender, weight, or discharge time from the postanesthesia care unit or the hospital between the groups. Twenty-four hours after operation, the incidence of vomiting in the atropine group (56%) was significantly less than in the glycopyrrolate group (81%; P<0.05). There was no significant difference between the atropine and glycopyrrolate groups in the number of patients who required antiemetics or additional analgesics. Conclusions In children undergoing tonsillectomy with or without adenoidectomy, reversal of neuromuscular blockade with atropine and neostigmine is associated with a lesser incidence of postoperative emesis compared with glycopyrrolate and neostigmine.

scholarly journals DEATH AFTER NITROUS OXIDE-OXYGEN AND LOCAL ANAESTHESIA

BMJ ◽  
1916 ◽  
Vol 2 (2900) ◽  
pp. 159-160 ◽  
Author(s):  
D. W. Buxton
Keyword(s):  
Nitrous Oxide ◽  
Local Anaesthesia ◽  
Nitrous Oxide Oxygen
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