Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial

Abstract

BackgroundThere is little evidence concerning the effect of sevoflurane in outpatient procedural sedation, especially in children. We hypothesised that the addition of sevoflurane to a sedation regimen improves children’s behaviour with minimal adverse events.MethodsThis is a randomised, triple-blind clinical trial conducted on an outpatient basis. Participants were 27 healthy children aged 4 to 6 years, who previously refused dental treatment with non-pharmacologic methods. All participants received oral midazolam (0.5 mg/kg, maximum 20 mg) and oral ketamine (3 mg/kg, maximum 50 mg) and, in addition: Group MK – 100% oxygen; Group MKS – inhalational sevoflurane at a sedative dose (final expired concentration between 0.3 and 0.4%). Dental appointments were video recorded for assessment of the children’s sleep patterns, crying, movements, and overall behaviour during the procedure with the Houpt scale. Intra- and post-operative adverse events were systematically reported. Data were analysed by bivariate analyses in the IBM SPSS v. 19, at a significance level of 5%.ResultsMK (n = 13) and MKS (n = 14) did not differ regarding the Houpt scores (P > 0.05), but 53.8% of children in the MK group showed hysterical and continuous crying at the time of the local anaesthesia injection, compared to 7.1% of children in the MKS group (P = 0.01; phi = 0.5). There was a trend toward less crying and movement over time during the dental appointment in the MKS group (P = 0.48). Minor adverse events were observed in 10 MK children and 4 MKS children (P = 0.01).ConclusionsThe addition of sevoflurane to oral midazolam-ketamine improved the children’s crying behaviour during local anaesthetic administration, and did not increase the occurrence of adverse events.Trial registrationClinical Trials NCT02284204. Registered 5 October 2014.

Effect of sevoflurane anaesthesia on nasal mask in endoscopic retrograde cholangiopancreatography: is it a preferred alternative?

“…In another study by Gomes et al [13], an oral midazolam + ketamine + nasal mask with oxygen group and nasal mask sedation concentration of sevoflurane + oxygen applied group were examined in children's oral dental treatment. In this pilot study, haemodynamic parameters (HR, oxygen saturation) were found to be similar during the procedure and at post -anaesthesia recovery.…”

Randomized clinical trial on the efficacy of intranasal or oral ketamine-midazolam combinations compared to oral midazolam for outpatient pediatric sedation

“…Adverse events were “unexpected and undesirable responses to sedatives that threaten or cause patient injury or discomfort” [ 10 ] and were assessed according to the World SIVA International Sedation Task Force Tool [ 22 ] complemented by a previous publication when appropriate [ 23 ]. The same observer who accompanied the child throughout the dental sedation procedure registered any adverse event during the intra- or post-operative periods.…”

“…Midazolam is the drug most commonly used in this context, whereas other drugs such as ketamine have also demonstrated efficacy in behavioral control [ 7 , 8 ]. Moreover, it has been shown that administration of both ketamine and midazolam could be a good choice for pediatric dental sedation, including for very young children [ 9 , 10 ].…”

Psychological Factors in Dental Patient Care: Odontophobia

“…Some clinical trials also report the effects of some aids, such as art, music, or even the presence of domestic animals [11,14,15,16]. Furthermore, methods of conscious sedation and deep sedation are recognized, with the use of oral, intravenous, or gaseous drugs [17,18].…”