预给一氧化二氮/氧气前给药对其效果的影响。

Effectiveness of premedication agents administered prior to nitrous oxide/oxygen.

机构信息

Department of Pediatric Dentistry, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey.

出版信息

Eur J Anaesthesiol. 2010 Apr;27(4):341-6. doi: 10.1097/EJA.0b013e3283313cdd.

DOI:10.1097/EJA.0b013e3283313cdd

PMID:20090541

Abstract

BACKGROUND AND OBJECTIVE

In paediatric dentistry, when anxiety, fear of dental procedures or behavioural impairment precludes the conduct of dental treatments, sedation procedures are required. However, sedation at the desired level might not be achieved despite administration of various agents. The present study aimed to evaluate the effectiveness of oral premedication with different agents on children scheduled for dental treatment under nitrous oxide/oxygen (N2O/O2) sedation.

METHODS

The present research was approved by the Ethics Committee of Gazi University Faculty of Medicine. Sixty children aged between 5 and 8 years, ASA I or II, having no mental or motor retardation, requiring at least two-visit dental treatment, having no sedation or general anaesthesia experience, and incompliant with dental treatment (Frankl Behaviour Scale>or=3), were enrolled into the study after obtaining informed parental consent. The children were then randomly assigned to one of four groups. The treatment regimen according to the study groups was as follows: oral administration of 1 mg kg(-1) hydroxyzine hydrochloride suspension (Atarax) 1 h preoperatively (group I, n=15), oral administration of 0.7 mg kg(-1) midazolam (Dormicum) 15 min preoperatively (group II, n=15), oral administration of 3 mg kg(-1) ketamine (Ketalar) with 0.25 mg kg(-1) midazolam (Dormicum) 15 min preoperatively (group III, n=15), and no oral premedication administration [group IV (controls), n=15]. Peripheral oxygen saturation (SpO2) and heart rate were monitored with a pulse oximeter during treatment. The sedation level was monitored with the bispectral index. Following premedication, 40% N2O and 60% O2 was administered to all groups by means of a nasal mask. Sedation depth was evaluated using the Ramsay Sedation Scale and data were recorded at 5 min intervals. Sedation success and other sedation-related events were recorded.

RESULTS

The evaluation of the findings of this study revealed that treatment procedures were completed without any serious complications. Achievement of sedation in terms of satisfactory/mid-level satisfactory/unsatisfactory was as follows: 13.3/53.3/33.3% in group I; 54/20/26% in group II; 33.3/33.3/33.3% in group III, and 6.7/60/33.3% in group IV, respectively. Ramsay Sedation Scale results revealed that the most effective medication was 0.7 mg kg(-1) midazolam.

CONCLUSION

It is concluded that 0.7 mg kg(-1) midazolam is more effective than 0.25 mg kg(-1) midazolam with 3 mg kg(-1) ketamine and 1 mg kg(-1) hydroxyzine hydrochloride in terms of oral premedication prior to N2O/O2 sedation in children scheduled for dental treatments.

摘要

背景与目的

在儿科牙科中，当焦虑、对牙科手术的恐惧或行为障碍妨碍进行牙科治疗时，需要进行镇静程序。然而，尽管使用了各种药物，仍可能无法达到所需的镇静水平。本研究旨在评估在接受氧化亚氮/氧气（N2O/O2）镇静的儿童中，使用不同药物进行口腔预给药对牙科治疗的效果。

方法

本研究得到了加济安泰普大学医学院伦理委员会的批准。选择了 60 名年龄在 5 至 8 岁之间、ASA I 或 II 级、无精神或运动障碍、需要至少两次就诊牙科治疗、无镇静或全身麻醉经验、且不配合牙科治疗（Frankl 行为量表>或=3）的儿童，在获得父母的知情同意后，将他们纳入研究。然后，将这些儿童随机分为四组。根据研究组的治疗方案如下：术前 1 小时口服 1mg/kg 盐酸羟嗪混悬液（Atarax）（组 I，n=15），术前 15 分钟口服 0.7mg/kg 咪达唑仑（Dormicum）（组 II，n=15），术前 15 分钟口服 3mg/kg 氯胺酮（Ketalar）和 0.25mg/kg 咪达唑仑（Dormicum）（组 III，n=15），以及不进行口腔预给药[对照组 IV（n=15）]。在治疗过程中，使用脉搏血氧仪监测外周血氧饱和度（SpO2）和心率。使用双谱指数监测镇静水平。预给药后，所有组均通过鼻罩给予 40%N2O 和 60%O2。使用 Ramsay 镇静量表评估镇静深度，并每 5 分钟记录一次数据。记录镇静成功和其他与镇静相关的事件。

结果

本研究结果评估表明，治疗过程无严重并发症完成。在令人满意/中度满意/不满意的镇静程度方面，结果如下：组 I 为 13.3%/53.3%/33.3%；组 II 为 54%/20%/26%；组 III 为 33.3%/33.3%/33.3%；组 IV 为 6.7%/60%/33.3%。Ramsay 镇静量表结果表明，最有效的药物是 0.7mg/kg 咪达唑仑。