J Dent Anesth Pain Med.  2015 Mar;15(1):1-4.

The alternative of oral sedation for pediatric dental care

Affiliations
  • 1Department of Pediatric Dentistry, School of Dentistry, Dankook University, Korea.
  • 2Department of Anesthesiology, School of Dentistry, Dankook University, Korea.
  • 3Department of Oral and Maxillofacial surgery, Kyung Hee University Dental Hospital at Gangdong, Kyung Hee University, Korea. verycutebear@hanmail.net

Abstract

In pediatric dentistry, chloral hydrate is habitually selected for sedation of uncooperative children. Although chloral hydrate has been used for decades, various adverse effects are reported and necessity for new alternative drugs has increased. Dexmedetomidine was approved by FDA for sedation at intensive care units (ICU) in 1999. Compared to conventional sedative drugs, dexmedetomidine has not only analgesic and sedative effects but also it barely suppresses the respiratory system. Due to these characteristics, dexmedetomidine is known as safe sedative drug for children and elderly patients. Furthermore, approved by KFDA in 2010 in Korea, the frequency of sedation using dexmedetomidine is increasing. However, due to its intravenous administration method, it was difficult to apply in pediatric dentistry. Recently, intranasal administration method was introduced which might be a new possible alternative of oral sedation. In this study, we compare the mechanisms, pros and cons of chloral hydrate and dexmedetomidine, introducing new possibilities.

Keyword

Chloral hydrate; Dexmedetomidine; Oral Sedation; Sedation

MeSH Terms

Administration, Intranasal
Administration, Intravenous
Aged
Child
Chloral Hydrate
Dental Care*
Dexmedetomidine
Humans
Hypnotics and Sedatives
Intensive Care Units
Korea
Methods
Pediatric Dentistry
Respiratory System
Chloral Hydrate
Dexmedetomidine
Hypnotics and Sedatives

Reference

1. Yang YM, Shin TJ, Yoo SH, Choi SC, Kim JY, Jeong TS. Survey of sedation practices by pediatric dentists. J Korean Acad Pediatr Dent. 2014; 41:257–265.
Article
2. Malviya S, Voepel-Lewis T, Prochaska G, Tait AR. Prolonged recovery and delayed side effects of sedation for diagnostic imaging studies in children. Pediatrics. 2000; 105:e42.
Article
3. Liebig J. Ueber die verbindungen, welche durch die einwirkung des chlors auf alkohol, aether, ölbildendes gas und essiggeist entstehen. Ann Phys. 1832; 100:243–295.
Article
4. Chowdhury J, Vargas KG. Comparison of chloral hydrate, meperidine, and hydroxyzine to midazolam regimens for oral sedation of pediatric dental patients. Pediatr Dent. 2005; 27:191–197.
5. Davila JM, Herman A, Proskin H, Vitale D. Comparison of the sedative effectiveness of two pharmacological regimens. ASDC J Dent Child. 1993; 61:276–281.
6. Boswinkel JP, Litman RS. Sedating patients for radiologic studies. Pediatr Ann. 2005; 34:650–654. 656
Article
7. Greenberg SB, Faerber EN, Aspinall CL. High dose chloral hydrate sedation for children undergoing ct. J Comput Assist Tomogr. 1991; 15:467–469.
Article
8. Cortellazzi P, Lamperti M, Minati L, Falcone C, Pantaleoni C, Caldiroli D. Sedation of neurologically impaired children undergoing MRI: a sequential approach. Paediatr Anaesth. 2007; 17:630–636.
Article
9. Smith MT. Chloral hydrate warning. Science. 1990. p. 250.
10. Meadows M. The fda takes action against unapproved drugs. FDA Consum. 2006; 41:34–35.
11. Wilson S, Hosey MT, Costa LR. Sedation of pediatric patients for dental procedures: The united states, european, and south american experience. Pediatric Sedation Outside of the Operating Room. 2015. p. 423–459.
12. Yoon JY, Kim CH. Dexmedetomidine: Clinical use. J Korean Dent Soc Anesthesiol. 2013; 13:61–166.
Article
13. Pisalchaiyong T, Trairatvorakul C, Jirakijja J, Yuktarnonda W. Comparison of the effectiveness of oral diazepam and midazolam for the sedation of autistic patients during dental treatment. Pediatr Dent. 2005; 27:198–206.
14. Sivilotti ML, Messenger DW, van Vlymen J, Dungey PE, Murray HE. A comparative evaluation of capnometry versus pulse oximetry during procedural sedation and analgesia on room air. CJEM. 2010; 12:397–404.
Article
15. Munoz R, Berry D. Dexmedetomidine: Promising drug for pediatric sedation? Pediatr Crit Care Med. 2005; 6:493–494.
Article
16. Kamibayashi T, Maze M. Clinical uses of α2-adrenergic agonists. Anesthesiology. 2000; 93:1345–1349.
17. Venn R, Karol M, Grounds R. Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive care. Br J Anaesth. 2002; 88:669–675.
Article
18. Lin L, Guo X, Zhang MZ, Qu CJ, Sun Y, Bai J. Pharmacokinetics of dexmedetomidine in chinese post-surgical intensive care unit patients. Acta Anaesthesiol Scand. 2011; 55:359–367.
Article
19. Yu C, Li S, Deng F, Yao Y, Qian L. Comparison of dexmedetomidine/fentanyl with midazolam/fentanyl combination for sedation and analgesia during tooth extraction. Int J Oral Maxillofac Surg. 2014; 43:1148–1153.
Article
20. Jung JH, Lee DW, Lee S, Yi JW. Dexmedetomidine is a very safe and useful drug for sedation during third molar extraction, easily reversed with verbal or physical stimuli. Int J Oral Maxillofac Surg. 2014; 43:131–132.
Article
21. Maze M, Scarfini C, Cavaliere F. New agents for sedation in the intensive care unit. Crit Care Clin. 2001; 17:881–898.
Article
22. Choi YJ, Baik JW, Ro YJ. Effect of age on optimal clinical dose of dexmedetomidine sedation. J Korean Dent Soc Anesthesiol. 2014; 14:151–155.
Article
23. Tobias JD, Berkenbosch JW. Initial experience with dexmedetomidine in paediatric-aged patients. Paediatr Anaesth. 2002; 12:171–175.
Article
24. Mason KP, Zurakowski D, Zgleszewski S, Prescilla R, Fontaine PJ, Dinardo JA. Incidence and predictors of hypertension during high-dose dexmedetomidine sedation for pediatric mri. Paediatr Anaesth. 2010; 20:516–523.
Article
25. Mason KP, Zurakowski D, Zgleszewski SE, Robson CD, Carrier M, Hickey PR, et al. High dose dexmedetomidine as the sole sedative for pediatric mri. Paediatr Anaesth. 2008; 18:403–411.
Article
26. Anttila M, Penttilä J, Helminen A, Vuorilehto L, Scheinin H. Bioavailability of dexmedetomidine after extravascular doses in healthy subjects. Br J Clin Pharmacol. 2003; 56:691–693.
Article
27. Yuen VM, Irwin MG, Hui TW, Yuen MK, Lee LH. A double-blind, crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine. Anesth Analg. 2007; 105:374–380.
Article
Full Text Links
  • JDAPM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr