Conscious Sedation: Emerging Trends in Pediatric Dentistry

Joginder Pal Attri, Radhe Sharan, Vega Makkar, Kewal Krishan Gupta, Ranjana Khetarpal, Amar Parkash Kataria, Joginder Pal Attri, Radhe Sharan, Vega Makkar, Kewal Krishan Gupta, Ranjana Khetarpal, Amar Parkash Kataria

Abstract

Dental fear and anxiety is a common problem in pediatric patients. There is considerable variation in techniques used to manage them. Various sedation techniques using many different anesthetic agents have gained considerable popularity over the past few years. Children are not little adults; they differ physically, psychologically, and emotionally. The purpose of this review is to survey recent trends and concerning issues in the rapidly changing field of pediatric sedation. We will study the topic from the perspective of an anesthesiologist. It will also provide information to practitioners on the practice of conscious sedation in dentistry and will also outline the route of administration, pharmacokinetics, and pharmacodynamics of various drugs used.

Keywords: Benzodiazepines; dexmedetomidine; ketamine; monitoring; pediatric anesthesia; propofol; sedation; sevoflurane.

Conflict of interest statement

There are no conflicts of interest.

References

    1. Committee on Drugs. American Academy of Pediatrics. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: Addendum. Pediatrics. 2002;110:836–8.
    1. Standing Dental Advisory Committee. Conscious Sedation in the Provision of Dental Care: Report of an Expert Group on Sedation for Dentistry. Expert Group on Sedation for Dentistry. London: HMSO; 2003. [Downloaded on 2015 Sep 18]. Available from: .
    1. Keira PM. Pediatric sedation outside of the operating room: A multispecialty international collaboration. Pediatr Crit Care Med. 2013;14:112–3.
    1. Cantlay K, Williamson S, Hawkings J. Anesthesia for dentistry. Contin Educ Anaesth Crit Care Pain. 2005;5:71–5.
    1. Woolley SM. Conscious sedation the only tool in the box? J Disabil Oral Health. 2008;9:87–94.
    1. National Institute for Health and Care Excellence. Sedation in Children and Young People. 2010. [Downloaded on 2015 Sep 18]. Available from: .
    1. Berggren U. Long-term management of the fearful adult patient using behavior modification and other modalities. J Dent Educ. 2001;65:1357–68.
    1. Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011;55:111–5.
    1. Green SM, Krauss B. Pulmonary aspiration risk during emergency department procedural sedation – An examination of the role of fasting and sedation depth. Acad Emerg Med. 2002;9:35–42.
    1. Barker SJ, Hyatt J, Shah NK, Kao YJ. The effect of sensor malpositioning on pulse oximeter accuracy during hypoxemia. Anesthesiology. 1993;79:248–54.
    1. Mennerick S, Jevtovic-Todorovic V, Todorovic SM, Shen W, Olney JW, Zorumski CF. Effect of nitrous oxide on excitatory and inhibitory synaptic transmission in hippocampal cultures. J Neurosci. 1998;18:9716–26.
    1. British Dental Association. BDA Advice. Conscious Sedation. [Downloaded on 2015 Sep 18]. Available from: .
    1. Fleming P, Walker PO, Priest JR. Bleomycin therapy: A contraindication to the use of nitrous oxide-oxygen psychosedation in the dental office. Pediatr Dent. 1988;10:345–6.
    1. Pieri L, Schaffner R, Scherschlicht R, Polc P, Sepinwall J, Davidson A, et al. Pharmacology of midazolam. Arzneimittelforschung. 1981;31:2180–201.
    1. Averley PA, Girdler NM, Bond S, Steen N, Steele J. A randomised controlled trial of pediatric conscious sedation for dental treatment using intravenous midazolam combined with inhaled nitrous oxide or nitrous oxide/sevoflurane. Anesthesia. 2004;59:844–52.
    1. Erlandsson AL, Bäckman B, Stenström A, Stecksén-Blicks C. Conscious sedation by oral administration of midazolam in paediatric dental treatment. Swed Dent J. 2001;25:97–104.
    1. Jensen B, Matsson L. Oral versus rectal midazolam as a pre-anaesthetic sedative in children receiving dental treatment under general anaesthesia. Acta Paediatr. 2002;91:920–5.
    1. Jensen B. Benzodiazepine sedation in paediatric dentistry. Swed Dent J Suppl. 2002;153:1–45.
    1. Yanase H, Braham RL, Fukuta O, Kurosu K. A study of the sedative effect of home-administered oral diazepam for the dental treatment of children. Int J Paediatr Dent. 1996;6:13–7.
    1. Morray JP, Lynn AM, Stamm SJ, Herndon PS, Kawabori I, Stevenson JG. Hemodynamic effects of ketamine in children with congenital heart disease. Anesth Analg. 1984;63:895–9.
    1. Green SM, Johnson NE. Ketamine sedation for pediatric procedures: Part 2, Review and implications. Ann Emerg Med. 1990;19:1033–46.
    1. Heinz P, Geelhoed GC, Wee C, Pascoe EM. Is atropine needed with ketamine sedation? A prospective, randomised, double blind study. Emerg Med J. 2006;23:206–9.
    1. Meredith JR, O’Keefe KP, Galwankar S. Pediatric procedural sedation and analgesia. J Emerg Trauma Shock. 2008;1:88–96.
    1. Baduni N, Sanwal MK, Jain A, Kachru N. Recurrent episodes of intractable laryngospasm followed by laryngeal and pulmonary oedema during dissociative anaesthesia with intravenous ketamine. Indian J Anaesth. 2010;54:364–5.
    1. Duperon DF, Jedrychowski JR. Preliminary report on the use of ketamine in pediatric dentistry. Pediatr Dent. 1983;5:75–8.
    1. Tucker MR, Hann JR, Phillips CL. Subanesthetic doses of ketamine, diazepam, and nitrous oxide for adult outpatient sedation. J Oral Maxillofac Surg. 1984;42:668–72.
    1. Buck ML. Propofol use in children: Weighing the benefit and risk. Pediatr Pharmacother. 2000;6:5.
    1. Hosey MT, Makin A, Jones RM, Gilchrist F, Carruthers M. Propofol intravenous conscious sedation for anxious children in a specialist paediatric dentistry unit. Int J Paediatr Dent. 2004;14:2–8.
    1. Arya VS, Damle SG. Comparative evaluation of midazolam and propofol as intravenous sedative agents in the management of unco-operative children. J Indian Soc Pedod Prev Dent. 2002;20:6–8.
    1. Katoh T, Ikeda K. Minimum alveolar concentration of sevoflurane in children. Br J Anaesth. 1992;68:139–41.
    1. Lau EW, Low JM. Office-based sedation for pediatric dental patients. Dent Bull. 2007;12:1–6.
    1. Moore PA, Mickey EA, Hargreaves JA, Needleman HL. Sedation in pediatric dentistry: A practical assessment procedure. J Am Dent Assoc. 1984;109:564–9.
    1. Tobias JD, Leder M. Procedural sedation: A review of sedative agents, monitoring, and management of complications. Saudi J Anaesth. 2011;5:395–410.
    1. Haselkorn T, Whittemore AS, Udaltsova N, Friedman GD. Short-term chloral hydrate administration and cancer in humans. Drug Saf. 2006;29:67–77.
    1. Avalos-Arenas V, Moyao-García D, Nava-Ocampo AA, Zayas-Carranza RE, Fragoso-Ríos R. Is chloral hydrate/hydroxyzine a good option for paediatric dental outpatient sedation? Curr Med Res Opin. 1998;14:219–26.
    1. Chowdhury J, Vargas KG. Comparison of chloral hydrate, meperidine, and hydroxyzine to midazolam regimens for oral sedation of pediatric dental patients. Pediatr Dent. 2005;27:191–7.
    1. Hitt JM, Corcoran T, Michienzi K, Creighton P, Heard C. An evaluation of intranasal sufentanil and dexmedetomidine for pediatric dental sedation. Pharmaceutics. 2014;6:175–84.
    1. Abdallah C, Hannallah R. Premedication of the child undergoing surgery. MEJ Anesth. 2011;21:165–76.
    1. Binstock W, Rubin R, Bachman C, Kahana M, McDade W, Lynch JP. The effect of premedication with OTFC, with or without ondansetron, on postoperative agitation, and nausea and vomiting in pediatric ambulatory patients. Paediatr Anaesth. 2004;14:759–67.

Source: PubMed

3
Tilaa