The effects of nitrous oxide on pediatric dental patients sedated with chloral hydrate and hydroxyzine

The purpose of this prospective, double-blind, crossover study was to evaluate the effect of 50% nitrous oxide (N2O) compared to oxygen (O2) alone on behavioral and physiologic parameters when a standard regimen of chloral hydrate (CH) (50 mg/kg) and hydroxyzine (2 mg/kg) was administered to young children for dental procedures.

Twenty children (mean age 42 +/- 7.3 months) were sedated, each for two appointments. At one appointment they received 100% O2 and at the other 50% N2O, the order randomized across patients. Physiologic parameters measured were heart and respiratory rate, systolic and diastolic blood pressure, oxygen saturation, and expired carbon dioxide. Behavior was rated using the Ohio State University Behavior Rating Scale. Physiologic and behavioral parameters were measured at eight defined procedural events.

Results indicated differences as a function of inhalation agent were seen for crying, quiet, and struggling, but not for any physiologic parameters. Significant differences across procedures were found for systolic and diastolic blood pressure and for all behaviors (crying, movement, quiet, and struggling).

Compared to O2, N2O significantly modifies some behaviors but not physiologic parameters in sedated children. However, certain dental procedures did significantly modify some physiologic parameters and all behaviors.