J Korean Dent Soc Anesthesiol.  2006 Dec;6(2):103-112. 10.17245/jkdsa.2006.6.2.103.

Safety and Efficacy of Submucosal Midazolam When Combined with Oral Chloral Hydrate, Hydroxyzine and Nitrous Oxide Sedation by using Houpt's Scale

Affiliations
  • 1Department of Pediatric Dentistry, Ewha Womans University Graduate School of Clinical Dentistry, Seoul, Korea. pedobaek@ewha.ac.kr
  • 2Department of Preventive Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.

Abstract

BACKGROUND
The purpose of this study was to compare the clinical safety and effect with and without additional submucosal midazolam to oral chloral hydrate and hydroxyzine when used for pediatric conscious sedation in a clinical dental environment.
METHODS
Thirty one cases of pediatric conscious sedations were performed in this study. Selection criteria included good health (ASA I), under 6 years old, 20 kg of body weight, uncooperative behavior and the need for sedation to receive dental treatment including anesthesia and restorative or surgical procedure for at least two teeth. In each visit, patients were randomly assigned into one of two groups; CH group: chloral hydrate (60 mg/kg), hydroxyzine (1 mg/kg), CH-M group: chloral hydrate (60 mg/kg), hydroxyzine (1 mg/kg) and submucoal midazolam (0.1 mg/kg). 50% nitrous oxide-oxygen was maintained during the sedation period Sedations were monitored using a pulse oximeter for estimating pulse rate (PR) and percutaneous oxygen saturation (SpOâ‚‚). Behavior response rated using Houpt's scale and need of restraint was assessed every 2 minutes through 30 minutes of operative procedure reviewing the videotape recording. Evaluation of overall behavior success was performed using modified overall behavior rate of Houpt's scale. Data was analyzed using t-test.
RESULTS
PR and SpOâ‚‚ for both groups remained within the normal values. The mean scores for sleep and movement of CH-M group were higher than those of CH group (P < 0.05). There were no significant difference in mean score for crying between two groups. The mean scores of overall behavior of CH-M group was higher than those of CH group (P < 0.01). Reinstraint of CH-M group was less required than that of CH group (P < 0.05).
CONCLUSIONS
Oral chloral hydrate (60 mg/kg) and hydroxyzine (1 mg/kg) combined with submucosal injection of midazolam was safer and showed more improved sedation effect than oral chloral hydrate (60 mg/kg) and hydroxyzine (1 mg/kg) without midazolam for sedation of pediatric dental patients.

Keyword

Conscious sedation; Submucosal midazolam; Chloral hydrate; Nitrous oxide; Houpt's scale

MeSH Terms

Anesthesia
Body Weight
Chloral Hydrate*
Conscious Sedation
Crying
Heart Rate
Humans
Hydroxyzine*
Midazolam*
Nitrous Oxide*
Oxygen
Patient Selection
Reference Values
Surgical Procedures, Operative
Tooth
Videotape Recording
Chloral Hydrate
Hydroxyzine
Midazolam
Nitrous Oxide
Oxygen
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