Paediatric Dentistry, UCL Eastman Dental Institute, Rockefeller Building, University St, London, WC1E 6DE, UK.
Royal National ENT and Eastman Dental Hospitals, UCLH NHS Trust, 47-49 Huntley Street, London, WC1E 6DG, UK.
Eur Arch Paediatr Dent. 2021 Dec;22(6):989-1002. doi: 10.1007/s40368-021-00660-z. Epub 2021 Aug 28.
Due to fear and/or behaviour management problems, some children are unable to cooperate for dental treatment using local anaesthesia and psychological support alone. Sedation is required for these patients in order for dentists to be able to deliver high quality, pain-free dental care. The aim of this guideline is to evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry and to provide guidance as to which sedative agents should be used.
These guidelines were developed using a multi-step approach adapted from that outlined by the National Institute for Clinical Excellence (NICE (2020) Developing NICE Guidelines: the manual. https://www.nice.org.uk/process/pmg20/chapter/introduction#main-stages-of-guideline-development . Accessed 7 Oct 2020). Evidence for this guideline was provided from a pre-existing Cochrane review (Ashley et al. Cochrane Database Syst Rev 12:CD003877, 2018) supplemented by an updated search and data extraction up to May 2020.
Studies were from 18 different countries and had recruited 4131 participants overall with an average of 70 participants per study. Ages ranged from 0 to 16 years with an average age of 5.6 years across all included studies. A wide variety of drugs or combinations of drugs (n = 38) were used and delivered orally, intranasally, intravenously, rectally, intramuscularly, submucosally, transmucosally or by inhalation sedation. Twenty-four different outcome measures for behaviour were used. The wide range of drug combinations and outcome measures used greatly complicated description and analysis of the data.
Oral midazolam is recommended for conscious dental sedation. Midazolam delivered via other methods or nitrous oxide/oxygen sedation could be considered, but the evidence for both was very low.
由于恐惧和/或行为管理问题，一些儿童无法单独通过局部麻醉和心理支持来配合牙科治疗。对于这些患者，需要镇静才能让牙医提供高质量、无痛的牙科护理。本指南的目的是评估在儿科牙科中用于行为管理的清醒镇静剂和剂量的疗效和相对疗效，并提供应使用哪些镇静剂的指导。
本指南是使用改编自国家临床卓越研究所 (NICE (2020) Developing NICE Guidelines: the manual. https://www.nice.org.uk/process/pmg20/chapter/introduction#main-stages-of-guideline-development. Accessed 7 Oct 2020) 概述的多步骤方法制定的。本指南的证据来自于之前的 Cochrane 综述（Ashley 等人 Cochrane Database Syst Rev 12:CD003877, 2018），并辅以更新的搜索和截至 2020 年 5 月的数据提取。
研究来自 18 个不同的国家，总体上招募了 4131 名参与者，每个研究的平均参与者人数为 70 人。年龄从 0 到 16 岁不等，所有纳入研究的平均年龄为 5.6 岁。使用了（n=38）或组合使用了多种药物，通过口服、鼻内、静脉、直肠、肌肉内、黏膜下、黏膜间或吸入镇静的方式给药。使用了 24 种不同的行为结局测量。使用的药物组合和结局测量的广泛范围极大地增加了对数据的描述和分析的复杂性。
推荐使用口腔咪达唑仑进行清醒牙科镇静。也可以考虑其他方法给予咪达唑仑或氧化亚氮/氧气镇静，但这两种方法的证据都非常有限。
