Children sedated for dental care: a pilot study of the 24-hour postsedation period

The purpose of this prospective, pilot study was to investigate postsedation events during the first 24 hours after discharge from the treatment facility in children sedated for dental treatment.

This prospective study involved a convenience sample of 30 healthy patients, ranging from 2 to 5 years of age, who were scheduled to undergo sedation in the dental clinic for operative procedures. Depending on the extent of dental need, child temperament, and other preoperative assessment variables, the children received either a triple combination of chloral hydrate, meperidine, and hydroxyzine ranging in dose from 20 to 30 mg/kg, 1 to 2 mg/kg, 1 to 2 mg/kg, respectively, or midazolam alone (0.5-0.75 mg/kg). Care was provided consistent with the American Academy of Pediatric Dentistry (AAPD) and hospital sedation guidelines. Parents were given a questionnaire concerning events that may occur during the 24 hours after the sedation and were told they would be interviewed via telephone regarding these events. The principal investigator called 24 hours after the sedation visit and interviewed the parents using the questionnaire given to the parents. Data analysis included descriptive statistics, frequency, and chi-square analysis.

Data from 30 sedations were used. Differences were noted between a chloral hydrate, meperidine, and hydroxyzine regimen compared to midazolam alone for incidence of sleep on the way home or shortly after arriving at home, but not for postoperative pain, vomiting, eating, evening sleep, and memory. Those receiving the combination regimen were more likely to sleep on the way to and at home than those who received midazolam alone.

It may be concluded that: (1) opportunities for the occurrence of an adverse event may occur on the way or at home following a sedation appointment; and (2) discharge criteria of the AAPD guidelines on elective use of minimal, moderate, or deep sedation and general anesthesia for pediatric dental patients should be met or exceeded as a precautionary measure to prevent adverse events once a child who has received sedative agents leaves a health care facility.