March 23, 2012 (Tampa, Florida) — Children experienced more adverse reactions when they were given more than 1 sedative to calm them during dental procedures than when they were given just 1, researchers reported here at the American Association for Dental Research 2012 Annual Meeting.
Although combinations of sedatives are often used to calm anxious children during dentistry, few studies have looked at the adverse reactions involved, said Sally Tor, DMD, MPH, a researcher at Nationwide Children's Hospital in Cincinnati, Ohio.
One previous study, focusing on severe reactions such as death and hospitalization, found that these were more frequent when 3 or more sedatives were used. "We wanted to look at more common complications," she said.
To analyze the effects of these sedatives, Dr. Tor and her colleagues maintained a quality-assurance database of all procedural sedation conducted from 2008 to 2011 at their hospital.
Using telephone interviews with patients' caregivers conducted within 48 hours of each procedure, they collected morbidity data from 493 procedures. The patients were all at least 24 months of age.
The researchers found that 213 procedures (43%) were conducted with 1 sedative, 156 (32%) with 2 sedatives, and 124 (25%) with 3 sedatives.
For the single-sedative procedures, the most common agent was midazolam (98%). For the 2-sedative procedures, the most common combination was midazolam and meperidine (68%); for the 3-sedative procedures, it was midazolam, meperidine, and promethazine (71%).
Dr. Tor and her colleagues found that in about 80% of procedures, sedation with 1 agent lasted less than an hour. In comparison, only about 60% of sedations with 2 agents and about 25% of sedations with 3 agents lasted longer than that (P < .001).
Single-agent sedations were also significantly less likely to fail (P = .013).
Only 8% of children sedated with just 1 agent bit their lips, compared with 10% who received 2 agents and 18% who received 3 agents (P = .022).
Just 5% of children sedated with 1 agent experienced nausea or vomiting, whereas 17% who received 2 agents and 9% who received 3 agents experienced this adverse effect (P = .002).
Cheek biting, tongue biting, and hiccups were all less frequent with 1 sedative than with multiple sedatives.
However, the study does not show that using more sedatives causes more adverse reactions, explained Daniel Haas, DDS, PhD, professor of dentistry at the University of Toronto in Ontario, Canada.
"Could some of the outcome be because [they were prescribed for] a more difficult child, not the number of sedatives?" he asked.
Dr. Tor agreed that the study did not control for the difficulty of the child. But she pointed out that the clinicians in the study were always aiming for a mild to moderate level of sedation.
If anyone needed deep sedation, they were referred to general anesthesia, she said. Also, the children were placed on papoose boards, which could be used to strap them in place if they became combative, she explained.
Dr. Tor and Dr. Haas have disclosed no relevant financial relationships.
American Association for Dental Research (AADR) 2012 Annual Meeting. Abstract 78. Presented March 22, 2012.
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Cite this: Added Complications With More Dental Sedatives for Children - Medscape - Mar 23, 2012.