Dionne Raymond A, Yagiela John A, Coté Charles J, Donaldson Mark, Edwards Michael, Greenblatt David J, Haas Daniel, Malviya Shobha, Milgrom Peter, Moore Paul A, Shampaine Guy, Silverman Michael, Williams Roger L, Wilson Stephen
Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, USA.
J Am Dent Assoc. 2006 Apr;137(4):502-13. doi: 10.14219/jada.archive.2006.0223.
Concerns about the safety of pediatric oral sedation and the incremental use of triazolam in adults prompted a workshop cosponsored by several professional organizations.
There is a strong need and demand for adult and pediatric sedation services. Using oral medication to achieve anxiolysis in adults appears to have a wide margin of safety. Mortality and serious morbidity, however, have been reported with oral conscious sedation, especially in young children. Most serious adverse events are related to potentially avoidable respiratory complications.
Clinical trials are needed to evaluate oral sedative drugs and combinations, as well as to develop discharge criteria with objective quantifiable measures of home readiness. Courses devoted to airway management should be developed for dentists who provide conscious sedation services. State regulation of enteral administration of sedatives to achieve conscious sedation is needed to ensure safety.
Safety in outpatient sedation is of paramount concern, with enteral administration of benzodiazepines appearing safe but poorly documented in the office setting. Conscious sedation by the enteral route, including incremental triazolam, necessitates careful patient evaluation, monitoring, documentation, facilities, equipment and personnel as described in American Dental Association and American Academy of Pediatric Dentistry guidelines.
对儿童口腔镇静安全性的担忧以及三唑仑在成人中的使用增加，促使多个专业组织共同举办了一次研讨会。
成人和儿童镇静服务有强烈的需求。使用口服药物实现成人抗焦虑似乎有广泛的安全范围。然而，口服清醒镇静已报告有死亡和严重发病情况，尤其是在幼儿中。大多数严重不良事件与潜在可避免的呼吸并发症有关。
需要进行临床试验来评估口服镇静药物及其组合，并制定出院标准以及衡量家庭准备情况的客观可量化指标。应为提供清醒镇静服务的牙医开设气道管理课程。需要国家对用于实现清醒镇静的镇静剂肠内给药进行监管以确保安全。
门诊镇静的安全性至关重要，苯二氮䓬类药物肠内给药看似安全，但在诊所环境中的记录不佳。通过肠内途径进行清醒镇静，包括递增使用三唑仑，需要按照美国牙科协会和美国儿科学会指南中所述，对患者进行仔细评估、监测、记录、配备设施、设备和人员。
