Survey of Sedation Practices by Pediatric Dentists

Abstract

The aim of this study was to establish the appropriate guidelines in the sedation techniques and to organize the continuing education programs for the sedation in future under the direction of Committee on Sedation, Education and Research under the Korean Academy of Pediatric Dentistry(KAPD). The surveys on the sedation technique were performed on 111 organizations which practices the sedation and responded to the survey via online and e-mail by February 2014. The collected survey were analyzed. The purpose of sedation was mainly to manage the children' s behavior and its uses were primarily on 3~4 years old children. The most frequent duration of treatment was 1~2 hours to treat both maxillary and mandible. The preferred dosages of sedative drugs were chloral hydrate(CH) 50~70 mg/kg, hydorxyzine(Hx) 1~2 mg/kg, and intramuscular midazolam(Mida IM) 0.1~0.2 mg/kg. The preferred combination of the sedative drugs were CH + Hx + N2O/O2(67.6%), CH + Hx + Mida submucosal administration (SM) + N2O/O2(29.7%), and Mida IM + N2O/O2(23.4%). The administration of additional sedatives was carried out at 48%, mainly using Midazolam. 87.5% of the respondents experienced the adverse effects of the sedation such as vomiting/retching, agitation during recovery, subclinical respiratory depression, staggering, and etc. Among them, only 20% periodically retrain the emergency management protocol. About the discharge criteria for patients after the sedation, the respondents either showed a lack of clear criteria or did not follow the recommended discharge criteria. 86% of the respondents expressed the interests in taking a course on the sedation and they wanted to learn mostly about the sedation-related emergency management, the safe dosage of the sedative drugs, and etc. The use of sedation in pediatric dentistry must be consider a patient' s safety as top priority and each dentist must show the evidence of sound practices for the prevention of any possible medical errors. Therefore, KAPD must establish the proper sedation guidelines and it needs to provide the systematic technical training program of sedation-related emergency management for pediatric dentists.

A retrospective study of deep sedation with concomitant administration of sedative agents in children undergoing surgical removal of a mesiodens

“…Midazolam has a very small toxicity rate, anticonvulsant, muscle-relaxant effects, and fewer effects on cardiovascular and respiratory systems [ 24 25 ], and produces anterograde amnesic effects wherein patients do not remember facts such as the surgical procedure, surgical pain, or convertsations during the sustained efficacy period [ 26 27 ]. To date, domestic pediatric dentists have mainly administered midazolam via submucosal, intranasal, and intramuscular routes [ 28 ]. Intravascular sedation has advantages in that it produces a rapid onset of action, offers fast recovery and easy density titration, and enables additional agents to be administered [ 29 ].…”

Safety of chloral hydrate sedation in dental practice for children: an overview

“…Dental Society of Anesthesiology also showed that the most preferred route of sedative administration for children was oral, while the most preferred sedative combination was CH, hydroxyzine, and N 2 O inhalation sedation [6,7].…”

“…mucosa and inducing adverse effects such as nausea and vomiting, it is often used in combination with hydroxyzine, which has anti-vomiting and sedative effects[35].According to a survey of KAPD members by Yang et al[6], a higher proportion of participants preferred acombination of two or more drugs and routes of administration including N 2 O inhalation to single-drug treatment, and 67.6% of participants used a combination of sedatives, CH, hydroxyzine, and N 2 O. However, administering two or more sedatives can increase the risk of adverse events [4].…”

Pediatric advanced life support and sedation of pediatric dental patients

“…The amount, type, and mixtures of drugs used during sedation are related to the side effects [ 8 ]. In a survey of pediatric dentists who used sedation, Yang et al [ 9 ] reported in 2014 that 88% had patients who experienced side effects such as nausea, vomiting, overexcitement, difficulty breathing, oversedation, foreign body aspiration, and drug allergy, among others. Most dental treatments involve procedures during which dentists invade the airway.…”