Variables influencing hemoglobin oxygen desaturation in children during routine restorative dentistry

Pulse oximetry to monitor oxygen saturation during pediatric dental sedations has revolutionized the early detection of hypoxemia. Previous sedation studies confirmed the occurrence of hemoglobin oxygen desaturation when sedative agents are administered in conjunction with nitrous oxide. The purpose of this study was to monitor the hemoglobin oxygen saturation levels of nonmedicated pediatric patients during routine restorative procedures to study the effect of nitrous oxide, chronologic age, tonsil size, and lidocaine dose. Two identical pulse oximeters and probes were attached to a patient's right and left feet to validate the occurrence of oxygen desaturations. The results revealed that 20.3% of the patients demonstrated at least one occurrence of oxygen desaturation during the routine dental procedure. Administration of nitrous oxide had no effect on the prevalence of oxygen desaturation. Although chronologic age, tonsil size, and lidocaine dose did not exert a statistically significant influence when analyzed independently, when combined they were related statistically (P < 0.0001) to the occurrence of oxygen desaturation as defined by the parameters of the study. These data suggest that some of the oxygen desaturations recorded during routine restorative appointments may result from probe error and a combination of patient-related variables.