Sedation Article

A retrospective study of chloral hydrate, meperidine, hydroxyzine, and midazolam regimens used to sedate children for dental care.

Stephen Wilson, DMD, MA, PhD Jillian Easton Kirsty Lamb Robin Orchardson, BSc, BDS, PhD Paul Casamassimo, DDS, MS Dr. Wilson is a professor and director of the Postgraduate Pediatric Dentistry Program, The Ohio State University & Columbus Children’s Hospital,Columbus, Ohio; Jillian Easton is a dental student at Glasgow Dental Hospital and School, University of Glasgow, Glasgow, Scotland UK; Kirsty Lamb is a dental student at Glasgow Dental Hospital and School, University of Glasgow, Glasgow, Scotland UK; Dr. Orchardson is a professor at the Institute of Biomedical & Life Sciences, Laboratory of Human Anatomy, University of Glasgow, Scotland UK; and Dr. Casamassimo is a professor and chair, Section of Pediatric Dentistry, The Ohio State University & Columbus Children’s Hospital, Columbus, Ohio. Correspond with Dr. Wilson at wilson.42@osu.edu Abstract Purpose: The purpose of this retrospective study was twofold: a) to examine the behavior and physiology of pre-school children each sedated with 1 of 3 drug regimens based on patient age, dental needs, and pre-operative clinical impression; and b) to determine the association between pre-operative behaviors to the behavior and physiology of the sedated children. Method: Records of more than 600 patients sedated at Columbus Children’s Hospital dental clinic over a two-year period were culled for patients who ranged in age from 2 to 5 years of age and had received one of three different drug regimens: a) chloral hydrate and hydroxyzine (CH-H), b) chloral hydrate, meperidine, and hydroxyzine (CH-D-H), or c) midazolam (M). A minimum of 300 patients (100/drug regimen) were randomly selected. The standard sedation sheet used in all sedations at the clinic included, among other factors, pre-operative assessments of patient behavior, interaction, and cooperation. Physiological and behavioral variables during the intraoperative sedation periods were also available. These periods included initial baseline vitals, vitals following drug administration, topical and local drug administration, rubber dam placement, and a minimum of the first 15 minutes of restorative procedures. The three drug regimens were compared for these variables. Data were entered into SPSS for data analysis using one-way ANOVA, Chi-square, regression analysis, and descriptive statistics. Results: The results indicated significant mean differences in patient age, weight, and duration by drug regimen (F=20.3, P<0 .001="" 0.001="" 0.32="" 0.4="" 1.="" 10.="" 100="" 108="" 109="" 10:94-101="" 10="" 11.="" 110="" 111="" 112="" 11="" 12.="" 12:222-27="" 12:288-91="" 12:33-37="" 12:364-67="" 13.7="" 13.="" 13:9-="" 14.="" 14:171-77="" 15.3="" 15.8="" 15.="" 15:186-90="" 15:237-41="" 15:348-52="" 15:422-="" 15="" 16.2="" 16.6="" 16.="" 16:121-27="" 16="" 17.="" 17:406-12="" 17:413-18="" 17:424-31="" 17="" 18.="" 18:287-93="" 18:35-41="" 19.="" 1986.="" 1987.="" 1988.="" 1988="" 1989.="" 1990.="" 1991.="" 1992.="" 1993.="" 1994.="" 1995.="" 1996.="" 1998.="" 1999-2000.="" 1999.="" 1999="" 19="" 1:570-76="" 1="" 2.="" 20.3="" 20.="" 2000="" 20:253-58="" 21.="" 21:12-="" 21:235-41="" 21:68-73="" 22.="" 22:107-112="" 22:2="" 23.1="" 23.="" 231-45="" 24.="" 24="" 25.="" 26.="" 26="" 27.="" 27="" 28.="" 28="" 29.="" 2="" 3.8="" 3.="" 30.="" 300="" 31.="" 33="" 35.9="" 36="" 382="" 38:1309-24="" 39:789-816="" 3="" 4.="" 40.7="" 40="" 41="" 42.4="" 42.5="" 43.1="" 43:231-45="" 43="" 45="" 48.5="" 48.7="" 4="" 5.="" 50:225-29="" 50="" 53:425-29="" 54:437-44="" 56:302-309="" 5="" 6.="" 600="" 63:421-25="" 67="" 6="" 7.="" 71="" 76="" 7="" 8.="" 84="" 8="" 9.="" 9="" a="" aapd="" ab:="" abilities="" able="" above="" academy="" acceptance="" accepted="" accomplished="" according="" accounted="" acquisition="" acs="" action.="" action="" activities="" activity="" addition="" additionally="" adjacent="" administered.="" administered="" administration="" adverse="" adversely="" affect="" after="" again="" age-specific="" age.="" age="" agents="" al="" albeit="" all="" almost="" alone="" also="" although="" always="" am:="" am="" america="" american="" among="" amp="" an="" analgesia="" analgesic="" analysis.="" analysis="" analyzed="" analyzing="" and="" anderson="" anesthesia.2-9="" anesthesia.="" anesthesia="" anesthetic.="" anesthetic="" angry.23="" angry="" anova="" 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electronic="" elements="" elevated="" emphasis="" empirically="" enough="" entered="" environment.29="" escape="" estimated="" evaluated="" evaluations="" event="" every="" evidence="" ew="" examination="" examinations="" exception="" excluded="" exhibit="" exhibited="" expectations="" expected="" experience.12-15="" experience.="" experience="" expressing="" extensive="" extent="" extraction="" eyes="" f="" fact="" factor="" factors:="" factors="" failed="" fairly="" fairness="" farrington="" fear="" fearful="" febiger="" fg="" fh="" fig="" final="" finding="" findings.="" findings="" first="" five="" flu="" follow="" following="" follows:="" for="" foreign="" format="" found="" four="" fraone="" freely="" frequency="" frequent="" frequently="" from="" front="" fuks="" fully="" function="" further="" furthermore="" g="" gave="" general="" generally="" global="" goals="" good="" griffen="" griffith="" group.="" group="" groups="" guardian="" guidelines.29="" guidelines="" gws="" h="" 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ja="" jackson="" je:="" je="" jg="" joshi="" jr.="" jr:="" kc="" keeping="" kg="" kgs.="" knowledge="" koenigsberg="" kupietzky="" kupieztky="" labeled="" language="" larsen="" lasted="" lasting="" lasts="" latter="" lea="" least="" less="" level="" levels="" life.="" likelihood="" likely="" likewise="" limitations="" limited="" limits="" line="" liters="" little="" local="" lochary="" longer="" longest="" lower="" m.="" m:="" m="" ma="" made="" mainly="" maintaining="" major="" manage="" management="" managing="" many="" map="" match="" materials="" mature="" matusak="" maxillary="" maximize="" maxwell="" may="" mccann="" mckee="" me="" mean="" measured="" measurements="" medical="" mellow-like="" membership:="" mentioned="" meperidine.="" meperidine="" met="" methodology.="" methodology="" methods="" mf="" mi:="" mi="" midazolam:="" midazolam="" mild="" minimal="" minimally="" minimum="" minute="" minutes.="" minutes="" mj:="" ml="" mm="" mode="" moderate="" monitoring="" monitors="" months="" moody="" moore="" more="" most="" mourino="" mouth="" movement="" ms:="" multiple="" musselman="" musson="" mutual="" n2="" nasal="" nathan="" nazif="" need="" needed="" needleless="" needleman="" needs="" neither="" nellcor="" next="" nitrous="" no="" non-interactive="" none="" nonetheless="" noninteractive="" nor="" normal="" north="" nose="" nostril="" not="" notable.="" notably="" noted="" nothing="" number="" o="" obfuscate="" observations="" observed="" obtained="" obviously="" occasionally="" occur="" occurrence="" occurring="" of:="" of="" offer="" offered.="" often="" older="" on="" one-way="" one="" only="" onset="" open="" operating="" operative="" operatory.22="" opin="" opposed="" or="" oral="" orally="" oropharyngeal="" other="" others.31="" others="" otherwise="" our="" outcome.="" outcome="" outside="" over="" overcome="" overtly="" own="" oxide="" oximeter.="" oximetry="" oxisensor="" oxygen="" p:="" p="" pa:="" page="" pamoate.="" pamoate="" papoose="" parameters.="" parameters="" paravecchio="" parent="" parents.="" participation="" patient.="" patient="" patients.="" patients:="" patients="" pattern="" pcs.="" pediatr="" pediatric="" per="" perceived="" percent="" percentage="" percents="" performing="" period.="" period="" personality="" personnel.="" personnel="" pharmacological="" phase.="" phase="" phases.="" phases="" philadelphia="" physical="" physiologic="" physiological="" pj:="" placed.="" placed="" point.="" point="" pool="" poor="" poorer="" poorman="" portion="" portions="" possible.="" possible="" post-hoc="" post-operative="" potential="" potentially="" practitioner="" practitioners.11="" pre-="" pre-operative="" precooperative="" predict="" predictable="" predicting="" predictive="" predictor="" predictors="" predoctoral="" preisch="" preliminary="" preoperative="" preoperatively="" preparation="" preschool="" preschoolers="" pressure.="" pressure="" prevented="" previously.="" primarily="" primary="" prior="" probe="" procedural="" procedure="" procedures.="" procedures="" produced="" producing="" proffered="" program="" programs.="" project="" promethazine="" promising="" promote="" prompted="" prompting:="" prompting="" properties.8="" proposed="" prospective="" provide="" provided="" provider="" providers="" ps="" pulido="" pulse="" purpose="" purposes="" q="" quadrant="" quadrants="" quiet="" r.="" radis="" randomly="" ranges="" rapid="" rate.="" rate="" rated="" rates="" ratings="" reactions="" reasonable="" received="" receiving="" recorded="" recording="" rectally="" references="" refined="" reflecting="" refuse="" refused="" refuses="" regimen.="" regimen="" regimens.="" regimens="" regression="" related="" relationship="" relatively="" remains="" rendering="" report="" reported="" requests="" required="" requirements="" requires="" requiring="" research="" respectively.="" respectively="" respiratory="" responded="" response="" responses="" responsive="" resting="" restorative="" 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