Needleman H L, Joshi A, Griffith D G
Harvard School of Dental Medicine, Boston, Massachusetts, USA.
Pediatr Dent. 1995 Nov-Dec;17(7):424-31.
This retrospective study assessed the effectiveness and safety of chloral hydrate (55 mg/kg), hydroxyzine (1 mg/kg), and nitrous oxide in the sedation of 336 uncooperative pediatric dental patients over 382 sedation sessions, and identified variables associated with effectiveness including: sex, weight, age, and preoperative behavior of the patient; route and combinations of the sedative drugs; and sex of the operating and monitoring dentists. The operating and monitoring dentists rated the sedation session as either effective or ineffective and also as either heavy, moderate, light or poor. The mean age of the children was 2.6 years and mean weight was 14.1 kg. Seventy-four percent of the sedation sessions were deemed effective. Boys had more effective sessions (80.6%) than girls (65.1%) (P = 0.001). Also, the percentage of sedations rated as effective increased as the preoperative behavior was more positively rated (P = 0.001). Oral regimen of chloral hydrate alone or in combination with oral hydroxyzine was more effective (75.5%) than rectal administration of chloral hydrate alone (65.7%) (P = 0.09). There was no significant difference in effectiveness when chloral hydrate was administered orally alone or in combination with oral hydroxyzine. Sedation sessions rated effective had longer operative times, included more sextants of treatment, were more likely to include restorative treatment, and were less likely to include extractions than the ineffective sedations. Vomiting was the only complication reported, occurring in 8.1% of the sedations. Vomiting did not vary significantly with either route of administration or inclusion of hydroxyzine in the oral regimen. Pulse rates were significantly higher for children in the ineffective sedation sessions. This sedative drug regimen was deemed safe and effective for treating young and uncooperative pediatric dental patients.
这项回顾性研究评估了水合氯醛（55毫克/千克）、羟嗪（1毫克/千克）和一氧化二氮对336名不合作的儿科牙科患者进行382次镇静治疗的有效性和安全性，并确定了与有效性相关的变量，包括：患者的性别、体重、年龄和术前行为；镇静药物的给药途径和组合；以及手术和监测牙医的性别。手术和监测牙医将镇静治疗评定为有效或无效，也评定为深度、中度、轻度或不佳。儿童的平均年龄为2.6岁，平均体重为14.1千克。74%的镇静治疗被认为是有效的。男孩的有效治疗次数（80.6%）多于女孩（65.1%）（P = 0.001）。此外，术前行为评定越积极，镇静被评定为有效的百分比越高（P = 0.001）。单独口服水合氯醛或与口服羟嗪联合使用的口服方案比单独直肠给予水合氯醛更有效（75.5%）（单独直肠给药为65.7%）（P = 0.09）。单独口服水合氯醛或与口服羟嗪联合使用时，有效性没有显著差异。评定为有效的镇静治疗比无效的镇静治疗手术时间更长，治疗的牙象限更多，更有可能包括修复治疗，而不太可能包括拔牙。呕吐是唯一报告的并发症，发生在8.1%的镇静治疗中。呕吐在给药途径或口服方案中是否包含羟嗪方面没有显著差异。无效镇静治疗的儿童脉搏率明显更高。这种镇静药物方案被认为对治疗年幼且不合作的儿科牙科患者是安全有效的。
