Comparison of temazepam elixir and trimeprazine syrup as oral premedication in children undergoing tonsillectomy and associated procedures

Factors affecting efficacy of oral trimeprazine sedation for dental procedures in children: A retrospective study

OBJECTIVE

To investigate the influence of factors such as age, gender and pre-operative behavior rating on the outcome of sedation using oral trimeprazine during dental treatment of children.

METHOD

Records of children who received dental treatment under sedation with oral trimeprazine between 2000 and 2007 were reviewed and the following data were obtained: age and weight of patient at the time of treatment, gender, behavior classification prior to sedation, dose of medication used, efficacy of sedation and treatment accomplished. Descriptive statistics, cross-tabulations and χ (2) analysis were done.

RESULT

Forty-eight sedation sessions met the inclusive criteria for children whose mean age was 4.92 (SD 1.65, range 3.0-8.0) years and mean weight was 18.23 (SD 4.82, range: 12.0-31.0) kg. Overall, 54.2% (26/48) of the sedations were rated successful, 20.8% (10/48) were partially successful and 25.0% (12/48) not successful. Younger children 3-5 years, and those with only negative pre-operative behavior rating had more successful sedation sessions than older, 6-8 years or children with definitely negative pre-operative behavior rating (X (2) = 8.165, p = .017) and (X (2) = 17.258, p = .001), respectively.

CONCLUSION

Variables such as patient's age and pre-operative behavior but not gender and type of treatment could predict outcome of dental sedation using trimeprazine in children.

Prophylaxis of postoperative vomiting in children undergoing tonsillectomy: a systematic review and meta-analysis

Postoperative vomiting (POV) remains one of the commonest causes of significant morbidity after tonsillectomy in children. A variety of prophylactic anti-emetic interventions have been reported, but there has only been a limited systematic review in this patient group. A systematic search was performed by using Cochrane Controlled Trials Register, MEDLINE and EMBASE to identify double-blind, randomized, placebo-controlled trials of prophylactic anti-emetic interventions in children undergoing tonsillectomy, with or without adenoidectomy. The outcome of interest was POV in the first 24 h. Summary estimates of the effect of each prophylactic anti-emetic strategy were derived using fixed effect meta-analysis. Where appropriate, dose-response effects were estimated using logistic regression and 22 articles were identified. Good evidence was found for the prophylactic anti-emetic effect of dexamethasone [odds ratio (OR) 0.23, 95% CI 0.16-0.33], and the serotinergic antagonists ondansetron (OR 0.36, 95% CI 0.29-0.46), granisetron (OR 0.11, 95% CI 0.06-0.19), tropisetron (OR 0.15, 95% CI 0.06-0.35) and dolasetron (OR 0.25, 95% CI 0.1-0.59). Metoclopramide was also found to be efficacious (OR 0.51, 95% CI 0.34-0.77). There is not sufficient evidence to suggest that dimenhydrinate, perphenazine or droperidol, in the doses studied, are efficacious, nor were gastric aspiration or acupuncture. In conclusion, dexamethasone and the anti-serotinergic agents appear to be the most effective agents for the prophylaxis for POV in children undergoing tonsillectomy.

A clinical trial comparing two doses of oral temazepam for sedation of paediatric dental patients

A study was carried out to compare the effectiveness of two doses of temazepam elixir for the behaviour management of paediatric dental patients. Twenty-two children aged 2-5 years (mean 4.06 years), classified as ASA Class I and II (American Society of Anesthesiologists Classification), were assigned to receive either 0.3 or 0.5 mg/kg temazepam elixir in a double-blind randomized cross-over study. All treatment sessions were videotaped and rated independently by three paediatric dentists for the degree of crying, movement, sleep and overall behaviour at 15-minute intervals while being treated. The results showed no statistically significant differences between the two doses.

A study to compare the effectiveness of temazepam and a chloral hydrate/hydroxyzine combination in sedating paediatric dental patients

The study compared the effectiveness of temazepam and a mixture of chloral hydrate and hydroxyzine in sedating 20 young children aged 20 to 60 months (mean age 38.7 months). All the children exhibited negative behaviour during a screening visit and required at least two visits for restorative treatment with the use of sedation. The children were assigned randomly to receive either 50 mg/kg of chloral hydrate with 25 mg of hydroxyzine or 0.3 mg/kg of temazepam for the first visit, and the alternate regimen for the second visit, in a double-blind manner. Pulse rate and blood oxygen saturation levels were monitored before, during and after the operative procedures. All the treatment sessions were video-recorded and evaluated independently by three paediatric dentists for the degree of crying, movement, sleep and overall behaviour during specific procedures and at specific time intervals. The results showed no statistically significant differences between the two pharmacologic regimens with regard to crying, movement, sleep and overall behaviour. No significant difference in behaviour was found related to either the order of administration of the drugs or to the sex of the patients. It was concluded that 0.3 mg/kg temazepam and a mixture of 50 mg/kg chloral hydrate with 25 mg hydroxyzine had similar sedative effects on the children receiving dental treatment.

A comparison of oxygen therapy devices used in the postoperative recovery period

Seventy-one patients scheduled to undergo upper or lower abdominal surgical procedures were allocated at random to one of seven treatment groups: in the recovery room they were to receive oxygen via a 40% Ventimask with 10 litres/minute oxygen flow, or via either a Hudson mask or a nasal cannula with 3, 6 or 9 litres/minute oxygen flow. The 40% Ventimask gave the most consistent, satisfactory postoperative values of PaO2 but the much cheaper nasal cannula at 6 or 9 litres/minute was generally adequate in conscious patients. The performance of the intermediately priced Hudson mask was similar to that of the nasal cannula at these flows. The unconscious state was associated with a 45% lower PaO2 than the rousable or awake states. Differences between the treatments with regard to postoperative PaCO2 were small and non-significant. The nasal cannula with 6 litres/minute humidified oxygen flow is recommended for routine treatment, and the Ventimask for unconscious patients.