Litman R S, Kottra J A, Verga K A, Berkowitz R J, Ward D S
Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, New York, USA.
Anesth Analg. 1998 Apr;86(4):724-8. doi: 10.1097/00000539-199804000-00009.
The combination of chloral hydrate and nitrous oxide (N2O) is often used for sedation in pediatric dentistry. The purpose of this study was to determine the extent to which N2O increases the level of sedation and respiratory depression in children sedated with chloral hydrate. Thirty-two children, 1-9 yr, received chloral hydrate, 70 mg/kg (maximum 1.5 g), and then received N2O (30% and 50%). Hypoventilation (maximal PETCO2 > 45 mm Hg) occurred in 23 (77%) children during administration of chloral hydrate alone, in 29 (94%) breathing 30% N2O (P = 0.08 versus control), and in 29 (97%) breathing 50% N2O (P = 0.05 versus control). Mean PETCO2 was increased during 30% (P = 0.007) and 50% (P = 0.02) N2O administration. Using chloral hydrate alone, 8 (25%) children were not sedated, 10 (31%) were consciously sedated, and 14 (44%) were deeply sedated. Using 30% N2O, 2 children (6%) were not sedated, 0 were consciously sedated, and 29 (94%) were deeply sedated (P < 0.0001). Using 50% N2O, 1 child (3%) was not sedated, 0 were consciously sedated, 27 (94%) were deeply sedated, and 1 (3%) had no response to a painful stimulus (P < 0.0001). We conclude that the addition of 30% or 50% N2O to chloral hydrate often causes decreases in ventilation and usually results in deep, not conscious, sedation in children.
Pediatric sedation in the dental office often consists of nitrous oxide (N2O) after chloral hydrate premedication. We found that the addition of 30% or 50% N2O to chloral hydrate often causes decreases in ventilation and usually results in deep, not conscious, sedation in children.
水合氯醛与一氧化二氮（N₂O）联合常用于儿科牙科镇静。本研究的目的是确定N₂O在多大程度上增加了接受水合氯醛镇静的儿童的镇静水平和呼吸抑制。32名1至9岁的儿童接受了70mg/kg（最大1.5g）的水合氯醛，然后接受N₂O（30%和50%）。单独使用水合氯醛时，23名（77%）儿童出现通气不足（最大呼气末二氧化碳分压>45mmHg）；呼吸30%N₂O时，29名（94%）儿童出现通气不足（与对照组相比，P = 0.08）；呼吸50%N₂O时，29名（97%）儿童出现通气不足（与对照组相比，P = 0.05）。在呼吸30%（P = 0.007）和50%（P = 0.02）N₂O期间，平均呼气末二氧化碳分压升高。单独使用水合氯醛时，8名（25%）儿童未被镇静；10名（3l%）儿童为清醒镇静；14名（44%）儿童为深度镇静。使用30%N₂O时，2名（6%）儿童未被镇静，0名儿童为清醒镇静，29名（94%）儿童为深度镇静（P < 0.0001）。使用50%N₂O时，1名（3%）儿童未被镇静，0名儿童为清醒镇静，27名（94%）儿童为深度镇静，1名（3%）儿童对疼痛刺激无反应（P < 0.0001）。我们得出结论，在水合氯醛中添加30%或50%的N₂O通常会导致通气减少，并通常会使儿童产生深度而非清醒的镇静。
牙科诊所的儿科镇静通常在水合氯醛预处理后使用一氧化二氮（N₂O）。我们发现，在水合氯醛中添加30%或50%的N₂O通常会导致通气减少，并通常会使儿童产生深度而非清醒的镇静。
