Revolutionizing Pediatric Sedation: Conscious Sedation Techniques and Agents
Main Article Content
Keywords
Conscious sedation, pediatric dentistry, novel, pharmacokinetics. psychology
Abstract
Conscious sedation is a technique used in pediatric dentistry to manage anxiety and pain in young patients undergoing dental procedures. The use of sedatives such as nitrous oxide, midazolam, and ketamine can help children remain calm and cooperative during dental treatments. The aim of this abstract is to provide an overview of conscious sedation in pediatric dentistry, including the pharmacology, indications, contraindications, and potential risks and complications associated with its use. The importance of proper patient selection, preoperative evaluation, and monitoring during the procedure is highlighted. In addition, alternative management strategies such as behavioural techniques, local anaesthesia, and general anaesthesia are briefly discussed. Ultimately, conscious sedation can be a valuable tool in pediatric dentistry, but its use should always be carefully considered and implemented by trained and experienced dental professionals.
References
1. Wiener-Kronish JP, Gropper MA. Conscious Sedation. 2001.
2. National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Sciences Policy, et al. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press, 2017.
3. Judie A. Wong’s Essentials of Pediatric Nursing: Second South Asian Edition. Elsevier India, 2018.
4. Ganapathy D, Others. Awareness On Chelating Agents Used In Rct Among Dental Students. International Journal of Early Childhood Special Education; 14, https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=13085581&AN=162720711&h=2XOM GqR%2BzisGdfskW0DzmX7l23h62iwgWtnF0eJj4%2FUMPHy0COAteZUzysomThZJ9gtUJc9eEEiSKMKn0nKWYQ%3D%3D&crl=c (2022).
5. Mohanty S, Ramesh S. Comparing quality and quantity of dentin bridge formed using mineral trioxide aggregate, biodentine, and Propolis: A double-blinded randomized controlled clinical trial. World J Dent 2020; 11: 373–379.
6. Bramhecha A, Sandhya R. Analysis of Marginal Gap between Dentin and Biodentine on Irrigation with 3% Sodium Hypochlorite-An In Vitro study. Int J Den-tistry Oral Sci 2021; 8: 3766–3769.
7. Srinivasan NK, Karunagaran P, Panchal V, et al. Comparison of the Sedative Effect of Inhaled Nitrous Oxide and Intranasal Midazolam in Behavior Management and Pain Perception of Pediatric Patients: A Split-mouth Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2021; 14: S111–S116.
8. World Health Organization. Basic Emergency Care: Approach to the Acutely Ill and Injured. World Health Organization, 2018.
9. Akshayaa L, Ravindran V, Madhulaxmi M. Choice Of Tricalcium Silicate Cements Among Children For Pulp Capping-A Retrospective Study. Int J Dentistry Oral Sci 2021; 8: 4527–4530.
10. Baskran RNR, Nivethigaa B, Balaji Ganesh S. The Prevalence and Gender Distribution of Midline Diastema among Patients Attending A Private Dental College-An Original Study. Int J Dentistry Oral Sci 2021; 8: 4124–4127.
11. Davis PJ, Cladis FP. Smith’s Anesthesia for Infants and Children E-Book. Elsevier Health Sciences, 2021.
12. O’Connell Smeltzer SC. Brunner and Suddarth’s Textbook of Medical-surgical Nursing. Lippincott Williams & Wilkins, 2010.
13. Malamed SF. Medical Emergencies in the Dental Office - E-Book. Elsevier Health Sciences, 2007.
14. Bonanthaya K, Panneerselvam E, Manuel S, et al. Oral and Maxillofacial Surgery for the Clinician. Springer Nature, 2021.
15. Jonker P, van den Heuvel S, Hoeks S, et al. Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery: A scoping review. Eur J Anaesthesiol 2023; 40: 343–355.
16. Rothrock JC. Alexander’s Care of the Patient in Surgery - E-Book. Elsevier Health Sciences, 2010.
17. World Health Organization. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. World Health Organization, 2013.
18. Wright GZ, Kupietzky A. Behavior Management in Dentistry for Children. John Wiley & Sons, 2014.
19. Girdler NM, Michael Hill C, Wilson KE. Conscious Sedation for Dentistry. John Wiley & Sons, 2017.
20. Clark MS, Brunick AL. Handbook of Nitrous Oxide and Oxygen Sedation. Elsevier Health Sciences, 2008.
21. Paul A, Anandabaskar N, Mathaiyan J, et al. Introduction to Basics of Pharmacology and Toxicology: Volume 2 : Essentials of Systemic Pharmacology : From Principles to Practice. Springer Nature, 2021.
22. Koch G, Poulsen S, Espelid I, et al. Pediatric Dentistry: A Clinical Approach. John Wiley & Sons, 2017.
23. MacLeod R, Vella-Brincat J, Macleod S. The Palliative Care Handbook: Guidelines for Clinical Management and Symptom Control. 2013.
24. Goudra BG, Singh PM. Out of Operating Room Anesthesia: A Comprehensive Review. Springer, 2016.
25. Little JW, Falace DA. Dental Management of the Medically Compromised Patient. Mosby Elsevier Health Science, 1993.
26. Saiz-Sapena N, Gil MG. Ketamine Revisited: New Insights into NMDA Inhibitors. BoD – Books on Demand, 2022.
27. McGrath PA. Pain in Children: Nature, Assessment, and Treatment. Scholastic, 1990.
28. Joshi VS, Kollu SS, Sharma RM. Comparison of dexmedetomidine and ketamine versus propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterization laboratory. Ann Card Anaesth 2017; 20: 422–426.
29. Evers AS, Maze M, Kharasch ED. Anesthetic Pharmacology: Basic Principles and Clinical Practice. Cambridge University Press, 2011.
30. Kelley SD. Monitoring Level of Consciousness During Anesthesia and Sedation. 2003.
31. Brustowicz RM. Pediatric Procedural Sedation and Analgesia. 1999.
32. Pilipowicz O. The Effects of Nitrous Oxide During Pediatric Dental Sedation with Oral Transmucosal Fentanyl Citrate and Hydroxyzine Pamoate. 2006.
33. Cui Y, Guo L, Mu Q, et al. Analysis of Risk Factors for Chloral Hydrate Sedative Failure with Initial Dose in Pediatric Patients: a Retrospective Analysis. Paediatr Drugs 2022; 24: 403–412.
34. Sinatra RS, Jahr JS, Michael Watkins-Pitchford J. The Essence of Analgesia and Analgesics. Cambridge University Press, 2010.
35. MacLeod RD, Van den Block L. Textbook of Palliative Care. Springer, 2019.
36. Young DA, Olutoye OA. Handbook of Critical Incidents and Essential Topics in Pediatric Anesthesiology. Cambridge University Press, 2014.
37. Davis CA, Seddighi R, Cox SK, et al. Effect of fentanyl on the induction dose and minimum infusion rate of propofol preventing movement in dogs. Vet Anaesth Analg 2017; 44: 727–737.
2. National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division, Board on Health Sciences Policy, et al. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. National Academies Press, 2017.
3. Judie A. Wong’s Essentials of Pediatric Nursing: Second South Asian Edition. Elsevier India, 2018.
4. Ganapathy D, Others. Awareness On Chelating Agents Used In Rct Among Dental Students. International Journal of Early Childhood Special Education; 14, https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=13085581&AN=162720711&h=2XOM GqR%2BzisGdfskW0DzmX7l23h62iwgWtnF0eJj4%2FUMPHy0COAteZUzysomThZJ9gtUJc9eEEiSKMKn0nKWYQ%3D%3D&crl=c (2022).
5. Mohanty S, Ramesh S. Comparing quality and quantity of dentin bridge formed using mineral trioxide aggregate, biodentine, and Propolis: A double-blinded randomized controlled clinical trial. World J Dent 2020; 11: 373–379.
6. Bramhecha A, Sandhya R. Analysis of Marginal Gap between Dentin and Biodentine on Irrigation with 3% Sodium Hypochlorite-An In Vitro study. Int J Den-tistry Oral Sci 2021; 8: 3766–3769.
7. Srinivasan NK, Karunagaran P, Panchal V, et al. Comparison of the Sedative Effect of Inhaled Nitrous Oxide and Intranasal Midazolam in Behavior Management and Pain Perception of Pediatric Patients: A Split-mouth Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2021; 14: S111–S116.
8. World Health Organization. Basic Emergency Care: Approach to the Acutely Ill and Injured. World Health Organization, 2018.
9. Akshayaa L, Ravindran V, Madhulaxmi M. Choice Of Tricalcium Silicate Cements Among Children For Pulp Capping-A Retrospective Study. Int J Dentistry Oral Sci 2021; 8: 4527–4530.
10. Baskran RNR, Nivethigaa B, Balaji Ganesh S. The Prevalence and Gender Distribution of Midline Diastema among Patients Attending A Private Dental College-An Original Study. Int J Dentistry Oral Sci 2021; 8: 4124–4127.
11. Davis PJ, Cladis FP. Smith’s Anesthesia for Infants and Children E-Book. Elsevier Health Sciences, 2021.
12. O’Connell Smeltzer SC. Brunner and Suddarth’s Textbook of Medical-surgical Nursing. Lippincott Williams & Wilkins, 2010.
13. Malamed SF. Medical Emergencies in the Dental Office - E-Book. Elsevier Health Sciences, 2007.
14. Bonanthaya K, Panneerselvam E, Manuel S, et al. Oral and Maxillofacial Surgery for the Clinician. Springer Nature, 2021.
15. Jonker P, van den Heuvel S, Hoeks S, et al. Alternatives to the in-person anaesthetist-led preoperative assessment in adults undergoing low-risk or intermediate-risk surgery: A scoping review. Eur J Anaesthesiol 2023; 40: 343–355.
16. Rothrock JC. Alexander’s Care of the Patient in Surgery - E-Book. Elsevier Health Sciences, 2010.
17. World Health Organization. Pocket Book of Hospital Care for Children: Guidelines for the Management of Common Childhood Illnesses. World Health Organization, 2013.
18. Wright GZ, Kupietzky A. Behavior Management in Dentistry for Children. John Wiley & Sons, 2014.
19. Girdler NM, Michael Hill C, Wilson KE. Conscious Sedation for Dentistry. John Wiley & Sons, 2017.
20. Clark MS, Brunick AL. Handbook of Nitrous Oxide and Oxygen Sedation. Elsevier Health Sciences, 2008.
21. Paul A, Anandabaskar N, Mathaiyan J, et al. Introduction to Basics of Pharmacology and Toxicology: Volume 2 : Essentials of Systemic Pharmacology : From Principles to Practice. Springer Nature, 2021.
22. Koch G, Poulsen S, Espelid I, et al. Pediatric Dentistry: A Clinical Approach. John Wiley & Sons, 2017.
23. MacLeod R, Vella-Brincat J, Macleod S. The Palliative Care Handbook: Guidelines for Clinical Management and Symptom Control. 2013.
24. Goudra BG, Singh PM. Out of Operating Room Anesthesia: A Comprehensive Review. Springer, 2016.
25. Little JW, Falace DA. Dental Management of the Medically Compromised Patient. Mosby Elsevier Health Science, 1993.
26. Saiz-Sapena N, Gil MG. Ketamine Revisited: New Insights into NMDA Inhibitors. BoD – Books on Demand, 2022.
27. McGrath PA. Pain in Children: Nature, Assessment, and Treatment. Scholastic, 1990.
28. Joshi VS, Kollu SS, Sharma RM. Comparison of dexmedetomidine and ketamine versus propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterization laboratory. Ann Card Anaesth 2017; 20: 422–426.
29. Evers AS, Maze M, Kharasch ED. Anesthetic Pharmacology: Basic Principles and Clinical Practice. Cambridge University Press, 2011.
30. Kelley SD. Monitoring Level of Consciousness During Anesthesia and Sedation. 2003.
31. Brustowicz RM. Pediatric Procedural Sedation and Analgesia. 1999.
32. Pilipowicz O. The Effects of Nitrous Oxide During Pediatric Dental Sedation with Oral Transmucosal Fentanyl Citrate and Hydroxyzine Pamoate. 2006.
33. Cui Y, Guo L, Mu Q, et al. Analysis of Risk Factors for Chloral Hydrate Sedative Failure with Initial Dose in Pediatric Patients: a Retrospective Analysis. Paediatr Drugs 2022; 24: 403–412.
34. Sinatra RS, Jahr JS, Michael Watkins-Pitchford J. The Essence of Analgesia and Analgesics. Cambridge University Press, 2010.
35. MacLeod RD, Van den Block L. Textbook of Palliative Care. Springer, 2019.
36. Young DA, Olutoye OA. Handbook of Critical Incidents and Essential Topics in Pediatric Anesthesiology. Cambridge University Press, 2014.
37. Davis CA, Seddighi R, Cox SK, et al. Effect of fentanyl on the induction dose and minimum infusion rate of propofol preventing movement in dogs. Vet Anaesth Analg 2017; 44: 727–737.
Article Sidebar
Published
May 13, 2023
Article Details
How to Cite
V.Ranjith Akshay Seshadri, & Mahesh Ramakrishnan. (2023). Revolutionizing Pediatric Sedation: Conscious Sedation Techniques and Agents. Journal of Population Therapeutics and Clinical Pharmacology, 30(10), 12–18. https://doi.org/10.47750/jptcp.2023.30.10.003
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.