Conscious sedation in children: the need to strengthen the evidence base remains

Case Report: Applicability of sedation with nitrous oxide in the management of molar incisor hypomineralization in pediatric patients

Patients with molar-incisor hypomineralization (MIH) may manifest tooth hfypersensitivity and difficulties in undergoing dental treatment, including fear, anxiety, and behavior problems in the dental office. Then, the objective of this study was to report a clinical case series using inhalation sedation with nitrous oxide and oxygen as a clinical strategy in the management of MIH pediatric patients during dental treatment. Pediatric patients and their legal guardians were properly informed and data were extracted from clinical charts. Six clinical cases were included, whose patients were between 8 and 12 years old. Of these, 4 were female. The indication of moderate sedation took into account the clinical difficulties related to patients with MIH, such as obtaining anesthesia and cooperation, in addition to odontophobia and dental anxiety. All patients were carefully examined to undergo the sedation technique, including medical history and previous experiences with nitrous oxide inhalation sedation, as well as the vital signs were properly evaluated before, during and after the procedures. The nitrous oxide concentration ranged between 30% and 60%. The procedures were restorative, endodontic or surgical (extractions). In general, the use of sedation contributed to the performance of dental procedures. The use of inhaled sedation helped in behavioral management and during the treatment, increasing the effectiveness of local anesthesia. Patients were cooperative for treatment, while no adverse effects or complications related to sedation were observed. Thus, for the patients in this case series, the use of inhalation sedation with nitrous oxide and oxygen contributed to the clinical management of patients with MIH.

The Efficacy and Complications of Deep Sedation in Pediatric Dental Patients: A Retrospective Cohort Study

Background

Dental anxiety in children is a common problem. Currently, many of dental procedures are performed under sedation. Different methods of sedation have been employed for this purpose. Compared to adults, children usually need a deeper sedation level. The aim of this retrospective study is to assess the efficacy and complication of deep sedation in pediatric dental patients.

Method

This study was performed on 250 ASA (American Society of Anesthesiologists) I, II children undergoing deep sedation during the dental procedures. After the administration of oral midazolam as premedication, the monitoring process started. The patients that received the sedation dose of propofol and oxygen through nasal cannula during the procedure were carefully monitored for the purpose of evaluating hemodynamic and respiratory complications. The mean procedure and recovery time, postoperative nausea and vomiting (PONV), and success rate were further studied.

Result

The average age of the patients was 3.7. 32% of the patients were females, and 68% of them were males. Laryngospasm that occurred in 5 cases was resolved immediately by using positive pressure ventilation. Mild hypoxia was observed in 17 cases which were immediately managed by a bag-valve-mask ventilation. No cases of hemodynamic complications and PONV were reported. The mean length of the procedure was 57 minutes, and the mean length of recovery was 16 minutes. The success rate of this method was estimated to be 99.6%.

Conclusion

Deep sedation with propofol is a suitable technique with a high success rate for dental procedures in children. It was also concluded that in pediatric dental procedures, the presence of a skilled anesthetist and the implementation of a close monitoring process are required.