Comparison of two different dosages of hydroxyzine for sedation in the paediatric dental patient. Reevaluation of Rectal Ketamine Premedication in Children: Comparison with Rectal Midazolam Monitoring pediatric dental patients with nasal mask capnography. Effects of chloral hydrate on nitrous oxide sedation of children. Dose-responsive characteristics of meperidine sedation in preschool children. A comparison study between ketamine and ketamine-promethazine combination for oral sedation in pediatric dental patients. Effect of submucosal midazolam on behavior and physiologic response when combined with oral chloral hydrate and nitrous oxide sedation. Comparison of oral midazolam with and without hydroxyzine in the sedation of pediatric dental patients. A randomized double-blinded trial of chloral hydrate with or without hydroxyzine versus placebo for pediatric dental sedation. Safety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures. A comparison of two oral ketamine-diazepam regimens for the sedation of anxious pediatric dental patients. Conscious sedation of pediatric dental patients: an investigation of chloral hydrate, hydroxyzine pamoate, and meperidine vs. chloral hydrate and hydroxyzine pamoate. The effects of nitrous oxide on behavior and physiological parameters during conscious sedation with a moderate dose of chloral hydrate and hydroxyzine. Conscious sedation and pulse oximetry: false alarms? Comparison of three conscious sedation regimens for pediatric dental patients. The effects of nitrous oxide on anxious young pediatric patients across sequential visits: a double-blind study. Comparison of oral midazolam with a combination of oral midazolam and nitrous oxide-oxygen inhalation in the effectiveness of dental sedation for young children. Randomized, controlled, cross-over clinical trial comparing intravenous midazolam sedation with nitrous oxide sedation in children undergoing dental extractions. [A comparison of the child's behavior between two groups of oral sedative drugs]. Outcomes of moderate sedation in paediatric dental patients. Sedative effect of oral diazepam and chloral hydrate in the dental treatment of children. A retrospective study of chloral hydrate, meperidine, hydroxyzine, and midazolam regimens used to sedate children for dental care. Facial electromyography and chloral hydrate in the young dental patient. The sedative effects of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 2: optimal concentration of intranasal midazolam. Intranasal midazolam better at effecting amnesia after sedation than oral hydroxyzine: a pilot study. A comparison of chloral hydrate and diazepam sedation in young children. A randomised controlled trial of paediatric conscious sedation for dental treatment using intravenous midazolam combined with inhaled nitrous oxide or nitrous oxide/sevoflurane Effect of drinks that are added as flavoring in oral midazolam premedication on sedation success. Children sedated for dental care: a pilot study of the 24-hour postsedation period. Behavioral assessments of two drug combinations for oral sedation. Comparison of the effectiveness of oral diazepam and midazolam for the sedation of autistic patients during dental treatment. A randomized, controlled, crossover trial of oral midazolam and hydroxyzine for pediatric dental sedation. Dental treatment of fearful children, using nitrous oxide. Part I: Treatment times. Comparison of oral midazolam with oral tramadol, triclofos and zolpidem in the sedation of pediatric dental patients: an in vivo study. Comparison of rectal midazolam and diazepam for premedication in pediatric dental patients. Evaluation of two dosages of oral midazolam as a conscious sedation for physically and neurologically compromised pediatric dental patients. Sedation in pediatric dentistry: a practical assessment procedure. Comparison of sevoflurane and nitrous oxide mixture with nitrous oxide alone for inhalation conscious sedation in children having dental treatment: a randomised controlled trial A comparative evaluation of oral midazolam with other sedatives as premedication in pediatric dentistry. Preanesthetic medication with rectal midazolam in children undergoing dental extractions. A study of the effectiveness of oral midazolam sedation for orthodontic extraction of permanent teeth in children: a prospective, randomised, controlled, crossover trial Intra-nasal midazolam in conscious sedation of young paediatric dental patients. Multidrug intravenous sedation: determinants of the sedative dose of midazolam. A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients. A comparative study of midazolam to meperidine/promethazine as an IM sedative technique for the pediatric dental patient. Assessment of two doses of intranasal midazolam for sedation of young pediatric dental patients. A clinical trial comparing two doses of oral temazepam for sedation of paediatric dental patients. Chloral hydrate and its effects on multiple physiological parameters in young children: a dose-response study. Sedative effects of oral midazolam, intravenous midazolam and oral diazepam. The effect of metoclopramide and hydroxyzine in sedation of infants undergoing dental treatment. Intravenous sedation in pediatric dentistry using midazolam, nalbuphine and droperidol. A randomized double-blind trial of chloral hydrate/hydroxyzine versus midazolam/acetaminophen in the sedation of pediatric dental outpatients. Nasal versus oral midazolam sedation for pediatric dental patients. Is chloral hydrate/hydroxyzine a good option for paediatric dental outpatient sedation? A comparison of two meperidine/hydroxyzine sedation regimens for the uncooperative pediatric dental patient. The physiological effects of supplemental oxygen versus nitrous oxide/oxygen during conscious sedation of pediatric dental patients. A pilot study of the efficacy of oral midazolam for sedation in pediatric dental patients. Ambient nitrous oxide levels during pediatric sedations. Evaluation of the sedative effect of rectally administered diazepam for the young dental patient. Effectiveness of premedication agents administered prior to nitrous oxide/oxygen Comparing the safety, efficacy and recovery of intranasal midazolam vs. oral chloral hydrate and promethazine. Comparison of the efficacy of oral midazolam alone versus midazolam and meperidine in the pediatric dental patient. An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment — an alternative to general anaesthesia Comparison of various physiologic and psychomotor parameters in patients sedated with intravenous lorazepam, diazepam, or midazolam during oral surgery. Efficacy and acceptabilty of oral-transmucosal midazolam as a conscious sedation agent in pre-school children. Premedication with melatonin vs midazolam in anxious children. A comparison of oral midazolam and nitrous oxide sedation for dental extractions in children Side effects of triazolam in children. Comparison of chloral hydrate with and without promethazine in the sedation of young children. Oral Clonidine Pre-treatment and Diazepam/Meperidine Sedation Rectal sedation with diazepam or midazolam during extractions of traumatized primary incisors: a prospective, randomized, double-blind trial in Swedish children aged 1.5-3.5 years. A comparative evaluation of newer sedatives in conscious sedation. Comparison of oral chloral hydrate with intramuscular ketamine, meperidine, and promethazine for pediatric sedation--preliminary report. Effect of nitrous oxide-oxygen inhalation with scavenging on behavioral and physiological parameters during routine pediatric dental treatment. Dental treatment of fearful children using nitrous oxide. Part 4: Anxiety after two years. A randomised, controlled, crossover trial of oral midazolam and nitrous oxide for paediatric dental sedation Double-blind comparison of rectally administered diazepam to placebo for pediatric sedation: the cardiovascular response. Oral midazolam as premedication for the apprehensive child before dental treatment. The effect of supplemental oxygen on apnea and oxygen saturation during pediatric conscious sedation. A study of the sedative effect of home-administered oral diazepam for the dental treatment of children. Conscious sedation--an artist's science! An Indian experience with midazolam. Midazolam-fentanyl analgo-sedation in pediatric dental patients--a pilot study. The effectiveness of midazolam and hydroxyzine as sedative agents for young pediatric dental patients. A study to compare the effectiveness of temazepam and a chloral hydrate/hydroxyzine combination in sedating paediatric dental patients. Anxiety reduction with nitrous oxide: a permanent solution? A double blind randomized comparison of oral trimeprazine-methadone and ketamine-midazolam for sedation of pediatric dental patients for oral surgical procedures. A comparison of four sedation techniques for pediatric dental surgery. Conscious sedation by rectal administration of midazolam or midazolam plus ketamine as alternatives to general anesthesia for dental treatment of uncooperative children. An evaluation of the effect of oral ketamine and standard oral premedication in the sedation of paediatric dental patients. Midazolam premedication in children: a pilot study comparing intramuscular and intranasal administration. Optimising the dose of oral midazolam sedation for dental procedures in children: a prospective, randomised, and controlled study. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials Combined oral midazolam-ketamine better than midazolam alone for sedation of young children: a randomized controlled trial.
AIM This study compared the effect of two different dosages of hydroxyzine supported by 50 % nitrous oxide inhalation sedation in child patients . SUBJECTS AND METHODS Thirty uncooperative healthy children with an age range of 31 - 120 months were included in this study . Patients were r and omly assigned into two groups . The patients in group 1 were given 20 mg of hydroxyzine ( Atarax ) 24 h preoperatively and on the operation day , 3.7 mg/kg hydroxyzine was administered orally . The patients in group 2 received 3.7 mg/kg hydroxyzine orally only on the operation day . All patients also received 50 % nitrous oxide inhalation sedation . The child 's behaviour was evaluated every 5 min by using Houpt Sedation Rating Scale . The oxygen saturation and heart rates were also followed . RESULTS The mean age of the children in the study was 61.9 months ( SD 11.9 ) for group 1 and 53.7 months ( SD 12.8 ) for group 2 . Evaluation of the results showed that there were no significant differences ( P < 0.05 ) between behavioural attitudes and sedation degree of the patients . CONCLUSIONS Twenty milligrams of hydroxyzine administered 24 h preoperatively has no significant benefit on sedation of the child Background Results of previous studies of rectal ketamine as a pediatric premedication are clouded because of lack of dose – response relation , inappropriate time of assessing sedative effects , and previous administration or coadministration of benzodiazepines . Therefore , the authors reevaluated the efficacy of rectally administered ketamine in comparison with 1 mg/kg rectal midazolam . Methods Sixty-six infants and children ( age , 7–61 months ) who were American Society of Anesthesiologists physical status I and who were undergoing minor surgeries as in- patients were r and omized to receive 5 mg/kg ketamine ( n = 16 ) , 7 mg/kg ketamine ( n = 16 ) , 10 mg/kg ketamine ( n = 17 ) , or 1 mg/kg midazolam ( n = 17 ) via rectum . A blinded observer scored sedation 45 min and 15 min after administration of ketamine and midazolam , respectively , when children were separated from parent(s ) for inhalational induction . All children underwent st and ardized general anesthesia with sevoflurane , nitrous oxide , and oxygen with endotracheal intubation .  Blood pressure , heart rate , and oxyhemoglobin saturation were determined before , during , and after anesthesia . Postoperative recovery characteristics and incidence of adverse reactions were also assessed . Results Most children ( 88 % ) who received rectally 10 mg/kg ketamine or 1 mg/kg midazolam  separated easily from their parents compared with those ( 31 % ) who received 7 or 5 mg/kg rectal ketamine ( P < 0.05 ) . Similarly , more children who received 10 mg/kg ketamine or 1 mg/kg midazolam underwent mask induction without struggling or crying compared with those who received 7 or 5 mg/kg ketamine ( P < 0.05 ) . There were no clinical ly significant changes in blood pressure , heart rate , and oxyhemoglobin saturation after administration of either drug . Immediately after surgery , more children receiving midazolam or 5 mg/kg ketamine were agitated compared with 7 or 10 mg/kg ketamine . Ketamine , 7 and 10 mg/kg , provided postoperative analgesia , but the largest dose of ketamine was associated with delayed emergence from general anesthesia . Conclusions The results indicate that rectally administered ketamine alone produces dose-dependent sedative effects in children , when evaluated at its predicted peak plasma concentration . Ketamine , 10 mg/kg , has a delayed onset but is as effective as 1 mg/kg midazolam for sedating healthy children before general anesthesia . However , 10 mg/kg rectal ketamine is not recommended for brief surgeries because of prolonged postoperative sedation PURPOSE The purpose of this study was to evaluate the potential of using capnography to analyze respiratory sample s taken from a scavenging nitrous oxide nasal hood during routine pediatric dental procedures . METHODS Twenty-two subjects , aged 60 - 116 months , were administered alternately either 40 % nitrous oxide/60 % oxygen or 100 % oxygen during two sequential restorative appointments . All subjects were monitored continuously for end-tidal carbon dioxide and respiratory rate using a capnograph whose sampling line was attached directly to the nitrous oxide nasal hood . The subject 's breath sound , displayed behavior , type of dental procedure being performed , and presence of rubber dam isolation were recorded every minute throughout the two appointments . RESULTS Values for end-tidal carbon dioxide and respiratory rate were displayed on the capnograph when administering either oxygen or a combination of nitrous oxide/oxygen inhalation through the nasal hood . These respiratory values were lowered significantly when comparing 40 % nitrous oxygen-60 % oxygen to 100 % oxygen inhalation . They were not significantly altered by the type of breath sound , patient behavior , dental procedure , or presence of rubber dam isolation , with the exception of some dental procedures which significantly lowered end-tidal carbon dioxide . The apnea alarm on the capnograph occurred during 5 % of the total treatment time , but its occurrence represented a 97 % false positive rate . The occurrence of the apnea alarm was significantly associated with the type for breath sound , patient behavior , and dental procedure . When used in this manner , the capnograph was effective in alerting the practitioner to potential apneic events , but likely has limited value in monitoring valid end-tidal carbon dioxide levels due to limitations in the sampling technique . CONCLUSIONS This study demonstrated the potential of the capnograph as a respiratory monitor for pediatric dental patients when the sampling line was attached to a scavenging nitrous oxide nasal hood This study was conducted to examine the effects of chloral hydrate on  nitrous oxide sedation  of young children for dental treatment . Nineteen children , ranging in age from 19 to 41 months ( mean 30 months ) , participated in this double-blind study . The subjects were assigned r and omly to receive either a placebo or chloral hydrate ( 50 mg/kg ) for the first visit with the alternate regimen administered during the second appointment . In addition , all subjects received inhalation nitrous oxide/oxygen at a concentration of 50 % , and were restrained in a Papoose board ( Olympic Medical Group ; Seattle , WA ) with head restraint . Seventy-four per cent of sedations were classified as very good or excellent when chloral hydrate was administered with nitrous oxide compared with only 26 % when the placebo was administered Using double-blind conditions , 60 uncooperative and fearful preschool children ( 24 - 66 months ) received intramuscular injections of meperidine 0.25 , 0.50 , 1.00 mg/lb or placebo prior to restorative dental treatment .  Behavior was assessed by the dentist and an independent observer during five specific treatment procedures . Behavioral ratings found meperidine to be an effective sedative , with 0.50 mg/lb and 1.00 mg/lb being significantly more effective than placebo ( P less than 0.05 , Kruskal-Wallis ) . Children receiving 1.0 mg/lb of meperidine had significantly more nausea and vomiting than patients receiving lower doses of the drug ( P less than 0.05 , Chisquare ) . Physiologic monitoring demonstrated that the highest dose of meperidine was associated with transient drops in arterial oxygen saturation .  Meperidine sedation was found to be more effective for older children ( 37 - 66 months ) and for children initially rated as being only moderately uncooperative and fearful This study compared the incidence of vomiting and the sedative effectiveness of ketamine to a ketamine-prornethazine combination in pediatric dental patients . Twenty-two patients with American Society of Anesthesiologists ' classification I physical status who were between the ages of 21 and 43 months were r and omly divided into 2 groups . The control group received 10 mg/kg of ketamine orally , whereas the experimental group received 10 mg/kg of ketamine and 1.1 mg/kg of promethazine orally . Nitrous oxide in oxygen was supplemented between 35 and 50 % . Each patient received 1 or 2 quadrants of restoration by one operator . Heart rate , blood pressure , and oxygen saturation were monitored and recorded during the treatment . Crying , alertness , movement , and overall general behavior were rated using the scale by Houpt et al. A dentist-anesthesiologist conducted the vital sign monitoring and behavioral assessment . Ketamine combined with promethazine eliminated the incidence of vomiting . A 2 x 2 chi-square contingency table showed a statistical difference between the 2 groups at P < .05 ( control group , 27 % ; experimental group , 0 % ) . Ketamine alone yielded better sedations than the combined agents as shown by the Mann-Whitney U statistical analysis ( P < .05 ) . Ketamine and a ketamine-promethazine combination are effective in the sedation of pediatric dental patients PURPOSE This study was design ed to examine the efficacy and safety of submucosal ( SM ) midazolam and oral chloral hydrate ( CH ) when used for pediatric conscious sedation in a clinical dental environment . METHODS Twenty children ages 32 to 63 months participated in this institutionally approved study . Selection criteria included good health ( ASA I ) , 2 to 5 years of age , uncooperative behavior , and the need for multiple restorative visits . In a double-blind crossover design , patients were r and omly assigned to receive either oral CH ( 50 mg/kg ) and SM midazolam ( 0.2 mg/kg ) , or oral CH ( 50 mg/kg ) and SM saline placebo on their first sedation visit . On the second sedation visit , the patient received the opposite drug regimen than the first visit . Nitrous oxide ( 50 % ) was used during each sedation visit . Behavior response was rated as quiet ( Q ) , crying ( C ) , movement ( M ) , or struggling ( S ) every 2.5 minutes through 40 minutes of operative procedures . Sedations were monitored using a capnograph , pulse oximeter , an automated blood pressure cuff , and precordial stethoscope . Respiratory rate ( RR ) , heart rate ( HR ) , and blood pressure ( BP ) were evaluated for each procedure . Data was analyzed using ANOVA and multinomial repeated- measures logistic regression . RESULTS Analysis showed a significant difference in behavior during sedation across drug regimen ( chi-square = 55.6 , df = 3 , P < .0001 ) . Patients given SM midazolam in addition to oral CH showed increased Q rating and decreased C , M , and S ratings . RR , BP , and HR for both groups remained within the normal values for 2- to 5-year-olds . CONCLUSIONS SM midazolam improved the quality of sedation without compromising safety . Quiet behavior was increased and struggling behavior was decreased . In addition , mean HR , RR , and BP analysis did not deviate from the norm for this age group PURPOSE The purpose of this study was to compare the effectiveness of midazolam ( MDZ ) alone to a combination of MDZ and hydroxyzine ( MDZH ) when sedating young children for dental treatment . METHODS This was a prospect i ve , double-blinded , crossover clinical study of young uncooperative children in need of at least 2 restorative visits . Twenty-eight children , ages 21 to 56 months , with a mean age of 36.6 months , participated in this study . The subjects were assigned r and omly to receive either 0.5 mg/kg of oral MDZ 20 minutes prior to the beginning of dental treatment or the combination of 0.3 mg/kg oral MDZ with 3.7 mg/kg of hydroxyzine 30 minutes before treatment . The alternative drug regimen was administered at the second appointment . All subjects also received 50 % nitrous oxide and were restrained with a papoose board . The child 's behavior ( quiet or crying , relaxed or moving ) was evaluated every 5 minutes by an experienced pediatric dentist who was unaware of the drug given to the child . At the conclusion of treatment , each session was evaluated for overall effectiveness . RESULTS Regardless of the type of premedication , more patients exhibited quiet behavior at the beginning of treatment , with an increase in crying and movement toward the end of treatment . Regarding movement , a significant difference was observed during the first 20 minutes between the 2 regimens . MDZ showed more children exhibiting movement . During the first 30 minutes of treatment , more children cried in the MDZ group , while MDZH presented more children asleep or quiet . No significant differences were found in behavior as a function of the order the sedative regimens were given . No significant differences between the 2 regimens regarding overall behavior and success ( t=0.655 at 27 degrees of freedom ; P=.518 ) were found . CONCLUSIONS The combination of hydroxyzine ( 3.7 mg/kg ) with MDZ ( 0.3 mg/kg ) administered 30 minutes before treatment result ed in safe and effective sedation for the dental treatment of young children . This combination 's use might be more advantageous when compared to MDZ alone , result ing in less crying and movement during the first 30 and 20 minutes , respectively Chloral hydrate and hydroxyzine are a drug combination frequently used by practitioners to se date pediatric dental patients , but their effectiveness has not been compared to a negative control group in humans . The aim of this crossover , double-blinded study was to evaluate the effect of these drugs compared to a placebo , administered to young children for dental treatment . Thirty-five dental sedation sessions were carried out on 12 uncooperative ASA I children aged less than 5 years old . In each session patients were r and omly assigned to groups P ( placebo ) , CH ( chloral hydrate 75 mg/kg ) and CHH ( chloral hydrate 50 mg/kg plus hydroxyzine 2.0 mg/kg ) . Vital signs and behavioral variables were evaluated every 15 min . Comparisons were statistically analyzed using Friedman and Wilcoxon tests . P , CH and CHH had no differences concerning vital signs , except for breathing rate . All vital signs were in the normal range . CH and CHH promoted more sleep in the first 30 min of treatment . Overall behavior was better in CH and CHH than in P. CH , CHH and P were effective in 62.5 % , 61.5 % and 11.1 % of the cases , respectively . Chloral hydrate was safe and relatively effective , causing more satisfactory behavioral and physiological outcomes than a placebo Thirty children presenting to the dental clinic of a pediatric hospital who required brief but urgent dental care , and who could not be satisfactorily examined or treated , were administered one of three medications -- ketamine ( Ketalar ) , 3 mg/kg ; midazolam ( Versed ) , 0.4 mg/kg ; or sufentanil ( Sufenta ) , 1.5 or 1.0 micrograms/kg -- intranasally in a r and omized , double-blinded protocol . The patients were brought to the day surgery area following appropriate fasting and administered one of the medications diluted in a dose of 0.1 mL/kg normal saline while sitting in a nurse 's arms . Cardiorespiratory monitors were applied when tolerated , and the child was placed on the operating room table . Each child was injected locally with up to one dental cartridge of 2 % lidocaine with 1:100,000 epinephrine before dental extraction s. A sedation score was recorded using a scale where 1 = hysterical/untreatable , 5 = ideal sedation , and 10 = obtunded and desaturated , requiring airway management assistance . Midazolam administration result ed in acceptable sedation ( mean score : 4 ) with no desaturations below 90 % as measured by pulse oximetry and a mean recovery room observation time of only 3 + /- 2 min ( + /- SD ) . Ketamine also had a mean sedation score of 4 and a short recovery period ( 7 + /- 7 min ) ; however , two children experienced brief desaturations .  Sufentanil at 1.5 micrograms/kg was noted to produce much more heavily se date d children ( mean score 7 ) , with a high incidence of significant oximetry desaturation ( 80 % ) and prolonged recovery room duration ( 58 + /- 40 min ) . Use of 1.0 microgram/kg sufentanil result ed in no desaturations , less sedation ( mean score 4 ) , and a brief recovery time ( 7 + /- 13 min ) . ( ABSTRACT TRUNCATED AT 250 WORDS PURPOSE This study compared 2 oral ketamine-diazepam regimens ( 8 mg/kg and 10 mg/kg of ketamine in combination with 0.1 mg/kg diazepam ) in preschool age children with respect to physiological , behavioral and amnestic parameters . METHODS Twenty-five children completed the double-blind , crossover design . Physiologic , behavioral and amnestic effects were evaluated . RESULTS ANOVA demonstrated significant changes in systolic blood pressures and heart rates in both the 8 mg/kg group and 10 mg/kg group ( P < 0.05 ) , as well as significant changes in diastolic blood pressures in the 10 mg/kg group ( P < 0.05 ) . However , these changes were not clinical ly significant . Success rates were 28 % for the 8 mg/kg dosage and 44 % for the 10 mg/kg dosage . There was a cumulative vomiting rate of 50 % and a psychic phenomena rate of 10 % . There were no statistically significant differences between the two dosages with regard to success rates , postoperative vomiting , or psychic phenomena using McNemar 's test . CONCLUSIONS There is no advantage of 10 mg/kg dose of ketamine over the 8 mg/kg dose . Ketamine did not demonstrate amnestic effects in this study . There were statistically but no clinical ly significant changes in physiological parameters in either group . This study does not support the use of either 8 mg/kg or 10 mg/kg oral ketamine for the sedation of uncooperative children This study evaluated two oral sedative regimens for the conscious sedation of pediatric dental patients ( mean age 37.0 months ) unmanageable by traditional behavior management techniques . Regimen A included chloral hydrate ( Noctec -- E.R. Squibb and Sons , Princeton , NJ ) at 50 mg/kg with 25 mg hydroxyzine pamoate ( Vistaril -- Pfizer Laboratories , New York , NY ) , plus meperidine ( Demerol -- Winthrop-Breon , New York , NY ) at 1.5 mg/kg . Regimen B included chloral hydrate at 50 mg/kg with 25 mg hydroxyzine pamoate . In a crossover research design , 10 patients were assigned r and omly to receive one regimen , to be followed by the alternative regimen during the second appointment . The primary purpose of this study was to determine if meperidine would improve patient behavior , and increase the prevalence of respiratory compromise . A secondary purpose of the study was to develop an objective method to assess behavior during the conscious sedation of pediatric dental patients . Results revealed that the addition of oral meperidine to chloral hydrate and hydroxyzine pamoate result ed in improved behavior ( P less than 0.01 ) during local anesthetic injection , rubber dam delivery , and the operative dental procedure . There was no increase in the prevalence of respiratory compromise with the addition of meperidine The purpose of this study was to determine differences in heart rate ( HR ) , blood pressure ( BP ) , peripheral oxygen saturation ( pO2 ) , expired CO2 ( CO2 ) , and behavior ( using two scales ) comparing nitrous oxide/oxygen ( N2O ) with oxygen ( O2 ) alone in 20 children ( mean age 45 + /- 5.1 months ) se date d with chloral hydrate ( CH ) and hydroxyzine in a double-blind crossover design . Administration of CH ( 40 mg/kg ) and hydroxyzine ( 2 mg/kg ) was held constant for each patient visit ; however , N2O ( 50 % ) was administered during one visit and O2 ( 100 % ) at the other in a r and omly determined manner . Physiologic and behavioral parameters were collected during eight specific procedural events ( e.g. , administration of local anesthesia ) . Data were analyzed with a repeated- measures ANOVA , one-way ANOVA , t-test , Kruskal Wallis ANOVA , and descriptive statistics . There was no statistically significant difference in any physiologic or behavioral parameter as a function of inhalation agent . However , significant differences were found for certain physiological parameters ( i.e. , HR [ F = 5.41 , P < 0.001 ] , pO2 [ F = 6.04 , P < 0.001 ] , and CO2 [ F = 2.33 , P < 0.027 ] ) and all behavioral measures ( % crying [ F = 2.82 , P < 0.008 ] , % quiet [ F = 5.38 , P < 0.001 ] , % movement [ F = 3.88 , P < 0.001 ] , and % struggle [ F = 2.83 , P < 0.007 ] ) of one scale ( Ohio State University Behavioral Rating Scale [ OSUBRS ] ) as a function of procedural events . Although no statistically significant differences were attributable to inhalation agent , evidence suggests that N2O result ed in less crying and struggling and more quiet behaviors than O2 . Significant correlations existed between sub-categories of the two behavioral rating scales , suggesting some association between the scales . One may conclude from the results of this study that moderate doses of CH and hydroxyzine in combination with nitrous oxide are not associated with any significant potentiation effects on physiologic parameters compared with the same oral agents with oxygen alone . Certain procedural events ( e.g. , administration of local anesthesia ) do result in patient responses that affect specific behaviors and physiology . Although the effects of N2O may not be statistically significant , generally it produces an attenuation in physiological and behavioral responses as measured under the conditions of this study The use of pulse oximetry in dental procedures involving sedation and children has been encouraged strongly . Reports have indicated that hemoglobin desaturations are not uncommon when a variety of drugs ( including nitrous oxide ) and dosages are used . The present study investigated the nature of desaturations in relation to patient activity as a function of a drug combination , single drug dose-response design , and placebo conditions . Twenty-two patients ( mean age 29.45 months ; range 20 - 37 months ) participated in this two-part study . In part 1 , 12 patients received a placebo and a combination of chloral hydrate and hydroxyzine in a crossover , double-blind design . In part 2 , 10 patients received a placebo and three doses of chloral hydrate in a double-blind , r and omized sequence of four visits involving a dose-response design . During each restorative visit , the peripheral oxygen saturation , expired carbon dioxide , heart and respiratory rates , blood pressure , and frontalis electromyogram of each child was monitored . The overall results of 63 visits indicated that 87 - 90 % of the 235 desaturation episodes were due to patient movement . The clinical implication s of the findings are discussed The aim of this study was to compare the clinical success of three conscious sedation regimens for pediatric dental patients . A clinical trial was performed wherein dental treatment was administered to pediatric patients ASA I and II under conscious sedation .. Fifty-four children were divided into three groups of 18 patients each , r and omly assigned Group A received hydroxyzine ( 2 mg/kg 2 h before treatment and a subsequent dose of 1 mg/kg 20 min before treatment ) orally ; group B received 0.50 mg/kg midazolam mixed with 1.5 mg/kg hydroxyzine 20 min before treatment orally ; group C received chloral hydrate , 50 mg/kg mixed with 1.5 mg/kg hydroxyzine 20 min before treatment orally . The Ohio State Behavioral Rating Scale ( OSBRS ) showed statistically significant differences between groups B and C with respect to group A. The regimens of midazolam or chloral hydrate mixed with hydroxyzine represent excellent choices for conscious sedation regimens for pediatric dental patients Nitrous oxide has acquired widespread use as a tool for managing young dentally anxious children . Clinical impressions have suggested it eliminates uncooperative behavior while alleviating anxiety and facilitating coping skills . Data to support these cl aims documenting the effects of nitrous oxide across sequential visits has not previously been presented . Research which attempts to clarify the impact of a particular intervention on anxiety reduction , the development of coping skills , or the modification of patient attitudes toward care can anticipate numerous and complex method ological obstacles . Nevertheless , it seems important that longitudinal approaches which examine the anxiety process prospect ively are necessary to clarify the immediate and long-term consequences of proposed anxiety management strategies . Further work seems particularly urgent to develop improved methods , in which to assess and measure  childhood dental anxiety and the impact of strategies directed at its reduction . Further study which addresses these issues is needed to guide best the effective and appropriate use of nitrous oxide for the pediatric patient AIM To compare the effectiveness of 0.6 mg/kg oral midazolam sedation alone and a combination of 0.6 mg/kg oral midazolam plus nitrous oxide-oxygen inhalation sedation , in controlling the behavior of uncooperative children during dental treatment . STUDY DESIGN The study had a crossover design where the same patient received two different sedation regimens , that is , oral midazolam 0.6 mg/kg and oral midazolam 0.6 mg/kg with nitrous oxide-oxygen inhalation during two dental treatment visits . MATERIAL S AND METHODS Thirty children ( 17 males and 13 females ) were r and omly selected for the study , with a mean age of 55.07 ( + /- 9.29 ) months , ranging from 48 - 72 months . A scoring system suggested by Houpt et al. ( 1985 ) was utilized for assessment of the children 's behavior . RESULTS There was no significant ( p > 0.05 ) difference in the overall behavior assessment between the two sedation regimens , that is , oral midazolam alone and oral midazolam plus nitrous oxide-oxygen . However , the combination of midazolam and nitrous oxide-oxygen showed significantly ( p < 0.05 ) superior results as compared to midazolam alone , in terms of controlling movement and crying during local anesthesia administration and restorative procedures . CONCLUSION Compared to oral midazolam alone , a combination of oral midazolam and nitrous oxide inhalation sedation appears to provide more comfort to pediatric dental patients and operators during critical stages of dental treatment BACKGROUND The use of benzodiazepines for paediatric dental sedation has received limited attention with regard to research into clinical effectiveness . A study was therefore design ed to investigate the use of midazolam , for i.v . sedation in paediatric dental patients . METHOD The aim of the study was to assess the effectiveness of i.v . midazolam in a r and omized , controlled , cross-over trial . Children aged 12 - 16 yr ( ASA I and II ) , requiring two appointments for equivalent but contralateral dental extraction s for orthodontic purpose s , were recruited . Conscious sedation with either i.v . midazolam titrated at 0.5 mg x min(-1 ) , to a maximum of 5 mg , or nitrous oxide/oxygen titrated to 30%/70 % inhalation sedation was used at the first visit , the alternative being used at the second visit . Vital signs including blood pressure , arterial oxygen saturation and ventilatory frequency , as well as sedation levels and behavioural scores , were recorded every 2 min . RESULTS Forty patients , mean age 13.2 yr ( range 12 - 16 yr ) , participated in the trial . A mean dose of midazolam 2.8 mg was administered in the test group . The median time to the maximum level of sedation was 8 min for midazolam compared with 6 min for nitrous oxide ( P<0.001 ) . Vital signs for both treatments were comparable and within acceptable clinical limits and communication with the patient was maintained at all times . The median ( range ) lowest arterial oxygen saturation level recorded for midazolam was 97 (91 - 99)% compared with 97 (92 - 100)% for nitrous oxide . The mean ( range ) recovery time for midazolam was 51.6 ( 39 - 65 ) min and 23.3 ( 20 - 34 ) min for nitrous oxide ( P<0.0001 ) . Fifty-one per cent said they preferred i.v . midazolam , 38 % preferred nitrous oxide , and 11 % had no preference . CONCLUSION I.V. midazolam sedation ( 0.5 mg x min(-1 ) to a maximum of 5 mg ) appears to be as effective as nitrous oxide sedation in 12 - 16-yr-old healthy paediatric dental patients The purpose of this study was to compare the child 's  behavior between the two groups of oral sedative drugs : a ) Chloral hydrate and Promethazine and b ) Hydroxyzine and Diazepam .  Fourteen healthy children , aged 3 to 5 years old , participated in this study . All children exhibited negative behavior and required at least two restorative appointments with the use of oral sedative drugs and nitrous oxide-oxygen inhalation sedation .  The drugs were r and omly administered in a double-blind manner . The degree of sleep , crying , movement and overall behavior were evaluated during the operative procedures . With respect to sleeping , there was no significant difference in the child 's behavior between the two drug groups . With respect to crying , the children who had Hydroxyzine and Diazepam  cried significantly less than when they had Chloral hydrate and Promethazine at the time of injection and rubber dam placement ( P less than 0.05 ) . With respect to movement , the children who had Hydroxyzine and Diazepam moved significantly less than when they had Chloral hydrate and Promethazine at the time of injection , rubber dam placement , and the 60 minute interval ( P less than 0.05 ) . For overall behavior , the children who had Hydroxyzine and Diazepam behaved better than when they had Chloral hydrate and Promethazine ( P less than 0.05 ) BACKGROUND The aim of this study was to evaluate the outcomes of moderate sedation with nitrous oxide/oxygen ( N(2 ) O/O(2 ) ) alone or combined with different dosages and administration routes of midazolam in uncooperative paediatric dental patients using the Bispectral Index System ( BIS ) . METHODS This one-year clinical study examined first-visit moderate sedation  performed in 240 healthy children aged 4 - 6 years . Subjects were r and omly divided into four groups according to drug , route and dosage , as follows : Group 1 - 0.20 mg/kg midazolam ( 40 mg/ml ) delivered intranasally ; Group 2 - 0.75 mg/kg midazolam ( 15 mg/3 ml ) delivered orally ; Group 3 - 0.50 mg/kg midazolam ( 15 mg/3 ml ) delivered orally . All children in these three groups also received inhalation sedation with 50%-50 % N(2 ) O/O(2 ) , whereas children in Group 4 received inhalation sedation with 50%-50 % N(2 ) O/O(2 ) only . The outcome of sedation was evaluated as either ' successful ' , ' failed ' or ' not accepted ' . RESULTS The highest success rate was found in Group 1 ( 0.20 mg/kg intranasally , 87 % ) , followed by Group 2 ( 0.75 mg/kg orally , 79 % ) . The overall mean success rate for all groups was 73 % . CONCLUSIONS Moderate sedation can be successfully used in the clinical management of paediatric dental patients , with both intranasal and oral sedation using midazolam in conjunction with nitrous oxide found to be effective methods PURPOSE The purpose was to evaluate two sedation protocol s during dental sessions in anxious children . MATERIAL S AND METHODS It was a r and omized and double-blind study , with each individual being his/her own control within each protocol . Furthermore , the two protocol s were compared . Twenty children ( 36 to 84 months old ) who exhibited " definitely negative " behavior according to the Frankl scale were assigned to receive oral chloral hydrate ( 40 mg/kg ) ( Group I ) or Diazepam ( 5 mg ) ( Group II ) . Behavior during local anesthesia , application of rubber dam , cavity preparation , restorative procedures was evaluated , considering the degree of sleep , body movement , crying and overall behavior . Vital signs were assessed at three different times . The Wilcoxon , Mann-Whitney , Exact Fisher 's and Spearman correlation tests were used to analyze the data . RESULTS Group I presented higher scores for sleep during the CH session than placebo session during rubber dam application ( P = 0.0431 ) and restoration ( P = 0.0431 ) . In Group II there was no statistically significant difference ( p > 0.05 ) . There were no statistically significant differences between sessions and groups in the evaluation of body movement , crying and vital signs . Overall behavior in the placebo session was better than in the CH session during local anesthesia , but there was no difference between the two drug regimens . There was influence of age during anesthesia and cavity preparation in Group I and during rubber dam application in Group II . It was concluded that oral diazepam and chloral hydrate had no influence on the behavior management for dental treatment with the studied sample PURPOSE The purpose of this retrospective study was twofold : a ) to examine the behavior and physiology of pre-school children each se date d with 1 of 3 drug regimens based on patient age , dental needs , and pre-operative clinical impression ; and b ) to determine the association between pre-operative behaviors to the behavior and physiology of the se date d children . METHOD Records of more than 600 patients se date d at Columbus Children 's Hospital dental clinic over a two-year period were culled for patients who ranged in age from 2 to 5 years of age and had received one of three different drug regimens : a ) chloral hydrate and hydroxyzine ( CH-H ) , b ) chloral hydrate , meperidine , and hydroxyzine ( CH-D-H ) , or c ) midazolam ( M ) . A minimum of 300 patients ( 100/drug regimen ) were r and omly selected . The st and ard sedation sheet used in all sedations at the clinic included , among other factors , pre-operative assessment s of patient behavior , interaction , and cooperation . Physiological and behavioral variables during the intraoperative sedation periods were also available . These periods included initial baseline vitals , vitals following drug administration , topical and local drug administration , rubber , dam placement , and a minimum of the first 15 minutes of restorative procedures . The three drug regimens were compared for these variables . Data were entered into SPSS for data analysis using one-way ANOVA , Chi-square , regression analysis , and descriptive statistics . RESULTS The results indicated significant mean differences in patient age , weight , and duration by drug regimen ( F = 20.3 , P < 0.001 ; 16.2 , P < 0.001 ; and 48.7 , P < 0.001 , respectively ) . ANOVA indicated a significant difference among drug regimens for percent of quiet , sleeping , and struggling behaviors . Quiet behavior accounted for 26 % , 41 % , and 67 % of all behaviors for CH-H , CH-D-H , and M , respectively . Sleep accounted for 50 % , 43 % , 0.4 % and struggling 11 % , 8 % , and 19 % for CH-H , CH-D-H , and M , respectively . Pre-operative behaviors were also significantly different and patient cooperation was the only variable found minimally predictable of intra-operative behaviors ( R = 0.32 , P < 0.001 ) . Significant differences among drug regimens were found for heart rate ( HR ) and mean arterial blood pressure ( MAP ) during certain procedures ( e.g. , CH-H produced lower MAP compared to the other drug regimens ) ; however , all physiological variables were within normal limits for the children . CONCLUSION Significant differences were found for behavioral and physiological variables among the drug regimens ( e.g. , CH-D-H produced significantly more quiet and sleeping behaviors than M ) . Prospect i ve studies are needed to confirm these findings The purpose of this report is to describe facial electromyography ( EMG ) as a monitoring technique and to demonstrate the relationship of EMG amplitude to rated patient behavior during sedative trials using variable doses of chloral hydrate ( CH ) [ 25 , 50 , and 70 mg/kg ] . Twenty healthy , uncooperative children ( mean age = 30.7 + /- 4.8 months ) participated in this institutionally approved double-blind , repeated- measures study . Following baseline vital signs , administration of CH , and a 45-min period , the children were secured in a Papoose Board ( Olympic Medical Group , Seattle , WA ) with electronic monitors attached including the EMG . EMG amplitude was recorded continuously by computer and each visit was videotaped for later analysis of behavior using the Ohio State University Behavior Rating Scale ( OSUBRS ) . Statistical analysis using SPSS/PC+ V2.0 ( SPSS Inc. , Chicago , IL ) included descriptive statistics of the study sample , one-way ANOVA , and Pearson Product-Moment Correlation Coefficient to determine differences in EMG amplitude as a function of CH dose and associations between per cent of rated behavioral categories of the OSUBRS to EMG amplitude , respectively . The results indicated a significant difference in EMG amplitude , per cent crying and quietness as a function of dose ( F = 3.87 , P < 0.03 ; F = 4.64 , P < 0.01 ; F = 3.38 , P < 0.04 , respectively ) . Scheffe post-hoc analysis indicated that the difference was between 25 and 70 mg/kg doses . Significant correlations were noted between EMG amplitude and per cent crying and quietness ( R = 0.640 , P < 0.001 ; R = -0.664 , P < 0.001 ) , respectively . ( ABSTRACT TRUNCATED AT 250 WORDS In a previous paper , we reported on the effect of a 0.2 mg/kg dose of midazolam , administered intranasally , prior to performing various restorative dental procedures on a group of mentally disabled patients under local anesthesia and nitrous oxide/oxygen analgesia .  The purpose of this study was to compare the clinical and possible adverse effect of doses of 0.2 mg/kg and 0.3 mg/kg midazolam , administered intranasally , and to determine the most appropriate concentration for the drug when administered by this route . Patients were assessed by a behavioral test which consisted of a scale from 1 - 7 with 3 ranges : markedly effective ( 1 - 3 ) , effective ( 4 - 5 ) or ineffective ( 6 - 7 ) . Forty-three mentally h and icapped patients , aged 5 to 20 years , all of whom had previously exhibited highly combative and resistant behavior toward dental treatment under local anesthesia , were stratified by age and r and omly assigned in a double blind manner to two groups , receiving either 0.2 mg/kg or 0.3 mg/kg midazolam administered intranasally . Group 1 , consisting of 22 patients , average age 11 years 8 months , received 0.2 mg/kg . Group 2 consisted of 21 patients , average age 13 years 8 months , each of whom was administered 0.3 mg/kg intranasal midazolam .  Only patients assessed as ASA anesthesia status I or II were admitted to the study . Subsequent to intranasal administration of midazolam , no patient rejected the nasal mask nor refused to inhale nitrous oxide/oxygen . The induction of nitrous oxide/oxygen sedation and oral examination were effected smoothly in every case in the two groups . ( ABSTRACT TRUNCATED AT 250 WORDS Providing amnesia about a surgery is a desired side effect of a medication . This study compares antero grade amnesic effects of midazolam with hydroxyzine in children undergoing dental treatment with those drugs plus nitrous oxide  , using a recall test . Thirty ASAI children 24 - 28 months , were shown a St and ard-Binet intelligence scale-memory for objects subtest before entering treatment room . Twenty-lone r and omly determined children received 3.7 mg/kg hydroxyzine 45 min before treatment or 0.2 mg/kg intranasal midazolam in two succeeding appointments , alternatively . Recall in the 30-subject treatment group was 90 % . Recall in the 21-subject treatment group was 71 % for hydroxyzine and 29 % for midazolam . Midazolam was more effective in creating amnesia than hydroxyzine in this study The purpose of this study was to compare a high and low dose of diazepam with chloral hydrate in the sedation of young children . Thirty healthy children between the ages of 20 and 48 months , with a mean age of 33.5 months , participated in the study . All children exhibited negative behavior during a screening visit and required at least two restorative appointments with the use of sedation . A dose of either 0.3 mg/kg or 0.6 mg/kg of diazepam at one visit and 50 mg/kg of chloral hydrate at another visit was administered in a double-blind manner . All children were restrained in a Papoose Board with auxiliary head restraint and received 50 % nitrous oxide/oxygen during treatment . The degree of sleep , body movement , crying , pulse rate , respiratory rate , and blood oxygen saturation were monitored before and during the operative procedures . Vital signs remained essentially unchanged during treatment , except for transitory elevations of the pulse during periods of stimulation . There were no statistically significant differences among the three drug regimens with regard to movement and crying . Significantly more patients who received chloral hydrate were asleep than when either dose of diazepam was given during the first 60 min of treatment . The only side effect found was vomiting in one patient with both chloral hydrate and diazepam . It is concluded that the sedative effects of chloral hydrate and diazepam are similar when young children are se date d for dental treatment . The use of diazepam might be more advantageous because chloral hydrate produces more sleep during the first hour of treatment Failure of dental treatment due to anxiety is a common problem in children . The aim of this study was to establish whether the use of a combination of intravenous midazolam with inhalation agents ( nitrous oxide alone or in combination with sevoflurane ) was any more likely to result in successful completion of treatment than midazolam alone . A further aim was to evaluate the clinical viability of these techniques as an alternative to general anaesthesia . In total , 697 children too anxious for management with relative analgesia and requiring invasive dental procedure for which a general anaesthetic would usually be required , were recruited and r and omly assigned to one of three groups given the following interventions : group 1 – a combination of inhaled medical air and titrated intravenous midazolam , group 2 – a combination of inhaled 40 % nitrous oxide in oxygen and titrated intravenous midazolam , and group 3 – a combination of an inhaled mixture of sevoflurane 0.3 % and nitrous oxide 40 % in oxygen with titrated intravenous midazolam . The primary outcome measure was successful completion of the intended dental treatment with a co‐operative child responsive to verbal comm and s. In group 1 , 54 % ( 94/174 children ) successfully completed treatment . In group 2 , 80 % ( 204/256 children ) and in group 3 , 93 % ( 249/267 children ) completed treatment . This difference was significant at the 1 % level . Intravenous midazolam , especially in combination with inhaled nitrous oxide or sevoflurane and nitrous oxide , are effective techniques , with the combination of midazolam and sevoflurane the one most likely to result in successful treatment BACKGROUND Midazolam is one of the most frequently used agents for sedation in pediatric dentistry . The injectable form of midazolam can also be given orally . However , its bad taste has negative effects on ingestion of the drug . In this study , we aim ed to evaluate the effect of drinks which were added to mask the bitter taste of midazolam for drug acceptance and sedation . METHODS In the laboratory ; the pH values of 2.5 ml midazolam ( 15 mg x 3 ml(-1 ) ) and the mixtures of Pepsi Cola , 10 % sodium citrate , fresh pomegranate juice , and fresh grapefruit juice in equal volumes were measured . Seventy-five patients between 2 and 8 years of age who were assessed to have anxiety with the Frankl Behavior Scale and whose dental treatment was planned under sedation were r and omly divided into five groups . Pepsi Cola ( Group I ) , 10 % sodium citrate ( Group II ) , pomegranate juice ( Group III ) , and grapefruit juice ( Group IV ) which were added to 0.75 mg x kg(-1 ) midazolam in equal volumes , and ( Group V ) 0.75 mg x kg(-1 ) midazolam given orally to children . The drug compliance of children was evaluated . After 15 min , 4 - 5 l x min(-1 ) of N(2)O : O(2 ) ( 40 : 60 ) inhalation was started via a nasal hood . During the procedure , heart rate , and SpO2 were monitored with pulse oximetry and sedation levels with the Ramsay Sedation Scale ( RSS ) . Anesthetist , dentist , and parental satisfaction levels were recorded . RESULTS The groups had similar demographics , drug ingestion was better in Groups I and II , but the mean RSS was the highest in Group II ( P < 0.05 ) . CONCLUSIONS As well as making drug ingestion much simpler , the addition of sodium citrate to the midazolam administered orally to the children increased the effectiveness of sedation PURPOSE The purpose of this prospect i ve , pilot study was to investigate postsedation events during the first 24 hours after discharge from the treatment facility in children se date d for dental treatment . METHODS This prospect i ve study involved a convenience sample of 30 healthy patients , ranging from 2 to 5 years of age , who were scheduled to undergo sedation in the dental clinic for operative procedures . Depending on the extent of dental need , child temperament , and other preoperative assessment variables , the children received either a triple combination of chloral hydrate , meperidine , and hydroxyzine ranging in dose from 20 to 30 mg/kg , 1 to 2 mg/kg , 1 to 2 mg/kg , respectively , or midazolam alone ( 0.5 - 0.75 mg/kg ) . Care was provided consistent with the American Academy of Pediatric Dentistry ( AAPD ) and hospital sedation guidelines . Parents were given a question naire concerning events that may occur during the 24 hours after the sedation and were told they would be interviewed via telephone regarding these events . The principal investigator called 24 hours after the sedation visit and interviewed the parents using the question naire given to the parents . Data analysis included descriptive statistics , frequency , and chi-square analysis . RESULTS Data from 30 sedations were used . Differences were noted between a chloral hydrate , meperidine , and hydroxyzine regimen compared to midazolam alone for incidence of sleep on the way home or shortly after arriving at home , but not for postoperative pain , vomiting , eating , evening sleep , and memory . Those receiving the combination regimen were more likely to sleep on the way to and at home than those who received midazolam alone . CONCLUSIONS It may be concluded that : ( 1 ) opportunities for the occurrence of an adverse event may occur on the way or at home following a sedation appointment ; and ( 2 ) discharge criteria of the AAPD guidelines on elective use of minimal , moderate , or deep sedation and general anesthesia for pediatric dental patients should be met or exceeded as a pre caution ary measure to prevent adverse events once a child who has received sedative agents leaves a health care facility This study compares the efficacy of two drug regimens used for oral sedation in pediatric dental patients :  chloral hydrate ( 50 mg/kg)/promethazine ( 1 mg/kg ) and meperidine ( 1 mg/kg)/promethazine ( 1 mg/kg ) . Twenty-four pediatric dental patients , ASA Class I , were evaluated in this double-blind , r and omized study . The patients ranged in age from 18 to 48 months . Each dental procedure under sedation was videotaped and rated independently by two raters . Intraoperative ratings of sleep , movement , crying , an overall behavior score for each treatment interval , and an overall behavior score for each sedation were also evaluated . No treatment was aborted for either regimen . In all cases , chloral hydrate/promethazine sedations had significantly better results for sleep ( P = 0.0001 ) , movement ( P = 0.0168 ) , crying ( P = 0.0041 ) , and overall behavior score ( P = 0.0186 ) for the sedations compared to meperidine/promethazine sedations . Although chloral hydrate/promethazine sedations produced significantly better results , clinical ly , both drug regimens were equally effective PURPOSE This study was undertaken to compare the effectiveness of oral diazepam and midazolam in sedating autistic patients during dental treatment . METHODS The treatment regimen consisted of nitrous oxide/oxygen inhalation in conjunction with oral administration of either diazepam 0.3 mg/kg or midazolam 0.5 mg/kg in a cross-over design study of 13 subjects aged 5.8 to 14.7 years . A drug was classified as being effective when over 70 % of the patients taking the drug were judged as " success " in all 3 behavioral criteria : ( 1 ) sleeping ; ( 2 ) body movement ; and ( 3 ) crying behaviors . The study was observed by an independent clinician with an intraexaminer reliability of 88 % . RESULTS For sleeping behavior , midazolam was found to be significantly more effective than diazepam as the duration of stimulation increased ( P<.05 ) . For the movement and crying behaviors , midazolam also proved to be significantly more effective from the start of treatment through the 35- and 40-min markers , respectively ( P<.05 ) . For the remainder of treatment , however , there was no statistically significant difference in these behaviors between the trials ( P>.05 ) . Diazepam and midazolam were rated as 77 % and 100 % successful , according to the overall behavior evaluation criteria ( P=.02 ) . CONCLUSIONS Both diazepam and midazolam were shown to be effective sedative agents , successfully and safely used to se date autistic patients for dental treatment . Midazolam was significantly more effective than diazepam in those portions of the procedure with increased stimulation The effectiveness of oral midazolam in pediatric dentistry is controversial . This r and omized , controlled , crossover , double blind clinical trial was conducted in order to study the effect of midazolam , used either alone or in association with hydroxyzine , during child dental treatment . Thirty seven dental sedation sessions were carried out on 11 ASA I uncooperative children less than five years-old . In each appointment children were r and omly assigned to groups : P - placebo , M - midazolam ( 1.0 mg/kg ) , or MH - midazolam ( 0.75 mg/kg ) plus hydroxyzine ( 2.0 mg/kg ) .  Vital signs ( blood pressure , breathing rate , pulse and oxygen saturation ) and behavior parameters ( consciousness , crying , movement , overall behavior ) were evaluated every 15 minutes . Friedman and Wilcoxon statistical tests were used to compare groups and different moments in the same group . Normal values of vital signs were usually registered . Heart rate increased in groups P and M as the session went on . Group M presented less crying and movement at the first 15 minutes of treatment . Group MH caused more drowsiness at the beginning of the session . Overall behavior was better in group M than in groups P or MH . Group M produced effective sedation in 77 % of the cases , and group MH did so in 30.8 % . It was concluded that midazolam was effective and safe , and its association with hydroxyzine did not lead to additional advantages in pediatric dental sedation This study investigated the influence of nitrous oxide on treatment time when it is used as an additional aid to behavior management . Different parts of the treatment of highly anxious child dental patients may vary during sequential dental visits , and separate consecutive parts of the treatment were considered in terms of their duration . Fifty-six children between the ages of six and eleven , each with a previous negative dental experience , were selected . They were r and omly assigned into one of two matching groups : one with behavioral management only ( control ) ; the other also having nitrous oxide sedation ( experimental ) . Interval 1 , involved getting used to the procedures ; interval 2 was sedation ; interval 3 , local anesthesia ; and interval 4 , preparation and filling . Most children required between four and six sessions . Results show that in terms of total treatment time ( TTT ) , the use of nitrous oxide does not save time , although dental treatment did not require a greater number of sessions . For the dentist to erase the negative imprint of a previous dental experience , special skills are required . Further research is advised concerning the anxiety levels of this age-group OBJECTIVE oral sedation is the simplest and most convenient sedation method for managing uncooperative child patients because it is easy to administer and there is no need for nasal hood or injection . Oral midazolam is the most commonly used preanesthetic medication for children . When given in amounts between 0.5 and 0.75 mg/kg of body weight , oral midazolam has been found to be an effective sedative agent for pediatric out patients . Tramadol is a synthetic , central ly acting analgesic indicated for moderate to severe pain . Chloral hydrate is one of the sedatives most commonly used , has excellent absorption , fast induction , and exert minimal effects on respiration . zolpidem is the most commonly prescribed hypnotic due to its clinical efficacy , safety , and ability to be well tolerated with patients . MATERIAL S AND METHODS 60 anxious and fearful children who reported to the department were treated under conscious sedation for the accomplishment of dental treatment . Patients were r and omly assigned to four groups . Statistical analysis was done using Kruskal Wallis Test and decision criterion was to reject the null hypothesis if the P-value is less than 0.05 . RESULTS it was observed that there is a statistically significant difference in median scores recorded for the level of sedation between the different groups ( P < 0.001 ) . CONCLUSION this study concluded that midazolam is the best drug for producing conscious sedation followed by tramadol and triclofos . Zolpidem was not able to produce a sufficient level of sedation and it can not be supported as a sedative agent at the present dosage Rectally administered midazolam ( 0.35 mg/kg ) and diazepam ( 0.70 mg/kg ) were compared with each other and with placebo for preanesthetic medication in children undergoing dental extraction s. All rectal medications were very well accepted , but mask acceptance , improvement in anxiety , and sedation were best in the midazolam group . Improvement in anxiety and sedation were significantly better in the two drug groups than in those patients who had received placebo . Thirty minutes after rectal administration of midazolam , patients showed a decrease in both systolic and diastolic blood pressure and heart rate . Although these decreases differed significantly from the premedication values , they were probably of little clinical importance . Only minor adverse effects were observed in this study . Overall rectally administered midazolam appeared to be somewhat more efficacious than diazepam Physically and neurologically h and icapped pediatric dental patients are often a challenge to treat and may require the use of pharmacological agents for behavior modification . The purpose of this study was to investigate the safety , in terms of vital sign changes and complications , and the effectiveness , in terms of behavioral changes , of two dosages of oral midazolam as a conscious sedative agent for this unique population . Participating in this study were 31 patients of Texas Scottish Rite Hospital for Children , who were uncooperative ( as rated on the Frankl scale ) at a previous dental appointment . The patients , 3 - 18 years old , were r and omly selected to receive one of the two dosage regimens ; Group A received 0.3 mg/kg oral midazolam and Group B received 0.5 mg/kg .  Physiologic parameters and behavior were recorded throughout the appointment and overall safety and success were determined . Although clinical ly insignificant , Group A 's pulse rates 20 min into treatment were significantly higher than at baseline or treatment start , and oxygen saturations were lower during treatment than at baseline and start of treatment . Intratreatment systolic and diastolic blood pressures and pulse rates of Group B were significantly higher than the baseline figures ; however , these changes were not clinical ly significant . No clinical or postoperative complications were noted for either dosage . The regimen of 0.3 mg/kg of oral midazolam was successful 75 % of the time , and the regimen of 0.5 mg/kg of oral midazolam was successful 60 % of the time in providing adequate sedation to allow operative treatment to be safely and efficiently performed . ( ABSTRACT TRUNCATED AT 250 WORDS An assessment model for evaluating sedation in pediatric dental patients has been described . The model in whole or in part can be a valuable asset in drug trials and clinical evaluations . The unique characteristics of this model include : assessment s are easily and quickly carried out without interruption of normal patient care ; the criteria for sedation behavior can be st and ardized and are clinical ly relevant ; a determination of the level of consciousness using an airway obstruction maneuver permits an assessment of safety ; and the reliability of the observer ratings is extremely high , thereby avoiding the necessity of specially trained personnel . Using the assessment procedure , a placebo-controlled , double-blind clinical trial of various doses of chloral hydrate with and without N2O was performed . The results indicate that : children receiving the placebo treatment behaved favorably for at least 46 % of the ratings ; the 20 mg/kg and 40 mg/kg chloral hydrate groups showed little or no improvement when compared with the placebo group ; the group receiving 60 mg/kg chloral hydrate had as much as a 33 % improvement in behavior as compared with placebo ; and with the addition of 40 % N2O/60 % O2 to 60 mg/kg chloral hydrate premedication , four of 15 children ( 27 % ) were unable to maintain a patent airway when intentionally obstructed Summary We studied 411 children aged 3–10 years who were referred for dental treatment . They were r and omly allocated to have inhalation conscious sedation  with either sevoflurane/nitrous oxide mixture or nitrous oxide alone . Dental treatment was satisfactorily completed in 215/241 children who were given sevoflurane/nitrous oxide mixture ( 89 % ) compared with 89/170 who were given nitrous oxide alone ( 52 % ) ( Chi square 70.3 , p < 0.0001 ) . All children remained conscious and responsive to verbal contact throughout the treatment and in the recovery room . No adverse side‐effects were recorded in either group and there were no significant differences in oxygen saturation , heart rate , recovery profile , or time to discharge home between the groups . The study concluded that , for every 100 children treated with sevoflurane/nitrous oxide mixture , 37 children would be saved a general anaesthetic if given combined sevoflurane and nitrous oxide mixture rather than nitrous oxide alone . The use of sevoflurane in low concentrations 0.1–0.3 % to supplement nitrous oxide and oxygen for inhalation conscious sedation is safe , practical , and significantly more effective than nitrous oxide alone in children having dental treatment The purpose of present study was to evaluate the safety and efficacy of orally administered midazolam in children as a sedative agent and to compare it with two other older agents , triclofos and promethazine . The study was conducted on ninety child patients requiring some short dental procedure . All the patients were with a good physical status ( ASA-I ) . The ages ranged between 3 and 9 years . The patients were r and omized into three study groups : Group 1 , midazolam , Group II , triclofos and Group III , promethazine , on the basis of the drugs to be administered . After administration of drugs in each group , the effects were evaluated in terms of onset of action , sedative effect , ease of treatment completion , recovery time and postoperative amnesia .  Midazolam was found to be the best drug among the three to produce conscious sedation in children Three different dosages ( 0.25 , 0.35 , and 0.45 mg/kg ) of rectally administered midazolam were compared with each other and with placebo for preanesthetic medication in children undergoing dental extraction s. Eighty patients between the ages of 2 and 10 years were r and omly allocated into four groups in this double-blind study . The results from this trial show that 30 minutes after rectal administration of all doses of midazolam , good anxiolysis , sedation , and cooperation were obtained in most patients . A high prevalence ( 23 % ) of disinhibition reactions was observed , particularly in the 0.45 mg/kg group . For this reason , 0.25 or 0.35 mg/kg appears to be the dose of choice when rectal midazolam is used for premedication in children Objectives To assess the safety , effectiveness and acceptability of oral midazolam sedation for orthodontic extraction of permanent teeth in children . Design A prospect i ve , r and omised , controlled , crossover trial . Methods A total of 26 children aged 10 – 16 ( ASA I ) , referred for orthodontic extraction of premolar or canine teeth under sedation , were included in the study . Each child required two treatment sessions for the extraction of equivalent teeth on opposite sides of the mouth . Each subject was se date d with either oral midazolam ( 0.5 mg/kg ) or nitrous oxide and oxygen ( 30%/70 % ) at the first visit and the alternative form at the second visit . At each visit two teeth were extracted , one upper and one lower . Heart rate , arterial oxygen saturation , respiration rate , sedation and behavioural scores were recorded every five minutes . Overall behaviour , patient acceptance and patient satisfaction were recorded at the end of treatment . Results Of the 26 children included in the study there were 12 males and 14 females . The mean age was 12.5 years .  The mean heart rate and respiratory rate for both groups were similar and within acceptable clinical limits . The lowest mean arterial oxygen saturation levels for nitrous oxide and midazolam sedation were 97.7 % and 95.0 % respectively . Although midazolam caused greater oxygen desaturation , the range ( 91 % – 100 % ) was within safe limits for conscious sedation . The mean level of sedation was greater in the midazolam group compared with the nitrous oxide group and all but one case completed treatment . A total of 23 patients ( 88 % ) said they would be prepared to have oral midazolam sedation again and 17 ( 65 % ) actually preferred oral midazolam to nitrous oxide sedation . Conclusion Oral midazolam ( 0.5mg/kg ) appears to be a safe and acceptable form of sedation for 10 – 16 year old paediatric dental patients OBJECTIVES To compare the effects of 3 different doses of intra-nasal midazolam in the conscious sedation of  young paediatric dental patients  and to compare the effectiveness of the sedation in the fasting and non-fasting child . DESIGN Double blind r and om controlled trial . SAMPLE AND METHODS Thirty-eight uncooperative young children aged 2 - 5 years ( mean age 4.02 years ) were r and omly assigned to one of 3 groups . The groups and the doses of midazolam administered intra-nasally were A : 0.3 mg/kg , B : 0.4 mg/kg , and C : 0.5 mg/kg body weight . Each child in each group had two visits for restorative treatment : one without food ( fasting ) and the other with soft drink and light food ( non-fasting ) before treatment . Child behaviour and sedative effects were evaluated using the scoring system of Houpt . The vital signs were monitored continuously using a pulse oximeter and Dinamap machine . RESULTS There was rapid onset of sedation with the maximal effect between 8 and 15 minutes . This sedation lasted for 25 - 40 minutes in Groups A and B and for 60 minutes in Group C. Conscious sedation and dental treatment were achieved in 79 % , 96 % and 100 % of the children in Groups A , B and C , respectively . Consistently higher Houpt scores were seen in Groups B and C , with statistically significant differences between Groups A and C , and B and C ( Tukey 's range test , P < 0.05 ) . There were no significant differences in the general behaviour of the child , the onset and the duration of sedation between the fasting and the non-fasting child ( nonparametric ANOVA P > 0.05 ) . All the vital signs were within normal physiological limits and there were no significant adverse effects either with or without fasting . CONCLUSIONS All 3 doses of intranasal midazolam were effective in modifying the behaviour of the uncooperative child patient to accept dental treatment . This was irrespective of fasting OBJECTIVES The efficacy of multidrug intravenous sedation regimens in oral surgery is based on the ability to titrate opioids , benzodiazepines , and barbiturates to a desired level of relaxation . Dosage requirements to reach the initial sedation end points of slurred speech and ptosis of eyelids vary widely from one patient to another . STUDY DESIGN An assessment of physical , cardiovascular , behavioral , and pharmacologic factors that might predict midazolam dosage requirements for the initial sedation titration was carried out with data collected from a large controlled clinical trial of fentanyl , midazolam , and methohexital sedation for third molar surgery . RESULTS Dosage requirements for the initial titration of midazolam  were found to be significantly higher when fentanyl was not included in the sedation regimen and when presedation heart rate and presedation systolic blood pressure were elevated PURPOSE The safety and efficacy of a new sedation technique for children having dental procedures under local anesthesia were evaluated . MATERIAL S AND METHODS One hundred children between the ages of 2 and 7 years who required sedation for dental procedures were administered either a combination of midazolam ( 0.35 mg/kg ) and ketamine ( 5 mg/kg ) or midazolam alone ( 1 mg/kg ) rectally 30 minutes before removal to the dental chair . Pulse rate , respiratory rate , arterial pressure , oxygen saturation , adverse reactions , postoperative recovery , and behavior were recorded . RESULTS Satisfactory sedation and anxiolysis were achieved with both drugs used in the study . When evaluating postoperative recovery , statistically significantly more children receiving midazolam alone were fully awake on admission to the recovery room and 30 minutes later . Results of physiologic monitoring , behavioral ratings , and adverse effects are reported . Excessive salivation occurred in 26 % of children receiving the combination of drugs , compared with 14 % receiving midazolam alone . Seven ( 14 % ) of the children receiving the combination of drugs hallucinated , compared with 21 ( 42 % ) receiving midazolam alone . Both drug groups had reliably good anxiolysis and sedation without loss of respiratory drive or protective airway reflexes . CONCLUSION The use of a combination of midazolam and ketamine or midazolam alone is a safe , effective , and practical approach to managing children for minor dental procedures under local anesthesia . With this technique , advanced airway management proficiency is recommended This study evaluated the efficacy and safety of midazolam ( 0.2 mg/kg ) as an IM sedative agent in the pediatric population as compared to the st and ard IM meperidine ( 2.0 mg/kg)/promethazine ( 1.0 mg/kg ) sedation technique . Ten pediatric dental patients , ASA Class I , were evaluated in this double-blind , r and omized , crossover study . The patients ranged in age from two to four years .  Vital signs , sedation levels , and anxiety levels were evaluated . Midazolam was shown to be safe , but the inferior drug compared to the st and ard IM meperidine/promethazine sedation technique The purpose of this study was to assess the effectiveness of two doses of intranasal midazolam on sedation of young children for dental treatment . Thirty uncooperative children , mean age of 32 months , who needed at least two restorative visits , participated in this study . The patients were assigned r and omly to receive either 0.2 mg/kg or 0.3 mg/kg of midazolam intranasally , with the alternate regimen administered at the second appointment . All the children received 50 % nitrous oxide , and were restrained in a Papoose Board ( Olympic Medical Group , Seattle , WA ) with a head holder . Degree of alertness , crying , and movement were evaluated at baseline and at 5-min intervals throughout the procedure . Evaluation of overall behavior at each session was performed by one investigator , blind to the dose , using a separate rating scale . The reliability of ratings was assessed by two investigators from videotapes of the procedures . Statistical analysis showed no differences ( P > 0.05 ) in the behavior of the children receiving the two doses . Successful sedation , as assessed by lack of or minimal crying and /or movement that interrupted treatment , was observed in all the treatment visits with both doses ( mean score 4.66 + /- 1.09 for 0.3 mg and 4.40 + /- 1.04 for 0.2 mg ) . No adverse effects were observed , and all the treatments were completed successfully A study was carried out to compare the effectiveness of two doses of temazepam elixir for the behaviour management of paediatric dental patients . Twenty-two children aged 2 - 5 years ( mean 4.06 years ) , classified as ASA Class I and II ( American Society of Anesthesiologists Classification ) , were assigned to receive either 0.3 or 0.5 mg/kg temazepam elixir in a double-blind r and omized cross-over study . All treatment sessions were videotaped and rated independently by three paediatric dentists for the degree of crying , movement , sleep and overall behaviour at 15-minute intervals while being treated . The results showed no statistically significant differences between the two doses This study evaluated the dose-response effect of chloral hydrate ( CH ) used alone on several physiological parameters in 26 healthy children 21 to 42 months old . Selection criteria for the children in this institutionally approved study included : a ) uncooperative behavior during an initial examination ; b ) a minimum of four sextants with caries involvement ; c ) healthy , ASA I ; d ) parental informed consent ; e ) a noncompromised airway ( e.g. , minimal tonsillar enlargement ) and f ) no known allergies . A repeated measures , Latin-square design was used in evaluating either a placebo and three dosages of CH ( 25 , 50 , 70 mg/kg ) over four visits for each of eight patients or the same three dosages over three visits for each of the remaining patients . The physiological parameters included : heart and respiratory rate , systolic and diastolic blood pressure , peripheral oxygen saturation , and expired carbon dioxide . For statistical purpose s , physiological parameters were analyzed during specific phases which included : baseline , topical and local anesthesia administration , at initiation of cavity preparation ; and at the end of the appointment . A repeated measures ANOVA and descriptive statistics were used to analyze the data . The results indicated that the diastolic blood pressure and expired carbon dioxide were affected significantly by CH dosage ( P less than 0.02 and 0.005 , respectively ) . The findings should be tempered in light of patient behavior during the visits . Dental procedures also had an influence on cardiovascular parameters . The significance of these findings related to patient safety and behavior in these very young children is discussed OBJECTIVES To evaluate and compare the behavioral changes and effect of sedative techniques in pediatric dental patients using Oral Midazolam , Intravenous Midazolam and Oral Diazepam as sedative agents . MATERIAL S AND METHODS Triple blind r and omized control trial with 40 patients aged between 2 - 10 years , exhibiting definitely negative behavior was considered Patients were r and omly assigned to one of the four treatment groups . Group I received midazolam 0.5 mg/kg orally , Group II received 0.5 mg/kg diazepam orally , Group III received 0.06 mg/kg midazolam intravenously and Group IV received oral placebo .  Behavioral changes ( sleep , crying , movement , and overall behavior ) and effect of sedative techniques on pediatric patients were assessed . RESULTS All the patients in group 3 were significantly better in post administrative behavior viz . sleep , crying and movement . Over all behavior scores for group 3 patients were significantly better than other three groups ( p < 0.001 ) . Positive behavior of patients in group 2 and 3 did not show significant difference but positive behavior in group 3 was significantly ( p < 0.05 ) more than group 2 . Placebo group showed the highest negative behavior . CONCLUSION Sedative effects of oral midazolam and oral diazepam were comparable , where as intravenous midazolam produced more sedation . Anxiolysis was found to be more in both the midazolam groups than the diazepam group . Most number of positive changes were observed in midazolam groups as compared to diazepam group The purpose of the present study was to determine whether the administration of 5 mg of the anti-emetic drug metoclopramide ( MTP ) would improve the effectiveness of 3.7 mg/kg of hydroxyzine ( HYZ ) in dental treatment of young patients . Thirty uncooperative children , with a mean age of twenty-nine months , and needing at least two restorative visits , participated in this study . The patients were assigned r and omly to receive either 3.7 mg/kg HYZ or the same drug in conjunction with MTP ; alternate regimens were administered at the two appointments . All the children received 50 percent nitrous oxide , and were restrained in a Papoose Board with a head holder . The following parameters were evaluated at baseline ( before initiation of treatment ) , and at five-minute intervals throughout the procedure : degree of alertness , crying and movement . Evaluation of the overall behavior at each session was performed by one investigator , who was blind to the drug regimen the child had received , utilizing a separate rating scale . The results were su bmi tted to statistical analysis . No differences were observed in the behavior of the children receiving both regimens . Successful sedation , as assessed by lack or minimal crying and /or movement was observed in all the treatment visits , with both regimens ( mean score 4.4 for HYZ + MTP and 4.6 for HYZ ) . In the few occasions , however , where the restorative sessions were longer ( 45 to 60 minutes ) , more children fell asleep after receiving protocol A ( pramin + hydroxyzine ) , suggesting a possible trend to improve effectiveness in these situations . No adverse effects were observed , and all the treatments were successfully completed . Although no significant differences could be observed in treatments lasting up to a half hour , the addition of MTP could help in sedations lasting longer than a half hour PURPOSE The purpose of this pilot investigation was to study the efficacy , physiologic responses , and safety of a multi-drug intravenous conscious sedation technique in an outpatient setting in children who demonstrated uncooperative behavior when comprehensive restorative dental treatment was attempted . METHODS Using a time-based sedation record , the physiologic responses of 153 healthy children , age range 23 months to 14.5 years , were measured after they had received midazolam ( Versed ) , nalbuphine ( Nubain ) , and droperidol ( Inapsine ) , each administered intravenously , and nitrous oxide and oxygen administered by nasal mask , while each child received comprehensive restorative or surgical dental care . Each patient was monitored according to the American Academy of Pediatrics Sedation Guidelines . Heart rate and rhythm , blood pressure , respiratory rate , hemoglobin oxygen saturation , end-tidal CO2 , level of sedation , and behavioral responses were recorded preoperatively , at 5 minute intervals during treatment and in recovery until discharge . Sedation was titrated to Level 2 or 3 during treatment as defined by the American Academy of Pediatric Dentistry Reference Manual . RESULTS For each child , the sedation level was judged to be either acceptable or optimal for the completion of all planned dental treatment . There were no sedation failures . Children under 20 kg required significantly higher dosages of each sedative medication than children more than 20 kg to achieve the same level of sedation ( P < 0.001 , ANOVA ) . There were no episodes of intraoperative vomiting , hypotension , cardiac arrhythmias , respiratory depression requiring respiratory support , or dysphoria during treatment , in the recovery period , or after discharge . CONCLUSION This multi-drug intravenous conscious sedation technique is a safe and effective method to control the behavior of uncooperative children who require comprehensive dental treatment The purpose of this study was to evaluate in a r and omized , double-blinded fashion the sedative and behavioral responses of children undergoing pediatric dental procedures as out patients and who had received a combination of either oral chloral hydrate 50 mg/kg , not to exceed 1 gm , with hydroxyzine 25 mg ( Group 1 ) ; or oral midazolam 0.5 mg/kg with acetaminophen elixir 10 mg/kg ( Group 2 ) . The children were rated according to sleep , movement , crying and overall behavior at preselected intervals that included presedation , introduction to the operating suite , injection , and overall behavior . There were no statistical differences between the two groups in regards to age , weight , length of procedure , or sex . Group 1 was more asleep in the later time intervals ( P < 0.05 ) . Their were no statistically significant differences between the groups in relation to the overall evaluation for the procedure . In conclusion , midazolam/acetaminophen is as effective as chloral hydrate/hydroxyzine in the sedation of young children undergoing outpatient dental procedures PURPOSE The purpose of this study was to evaluate and compare intranasal ( IN ) and oral ( PO ) midazolam for effect on behavior , time of onset , maximum working time , efficacy , and safety for patients requiring dental care . METHODS Forty anxious subjects ( 20 IN , 20 PO , Frankl Scale 3 and 4 , ages 2 - 6 years , ASA I and II ) were se date d r and omly with either IN ( 0.3 mg/kg ) or PO ( 0.7 mg/kg ) midazolam .  The dental procedure under sedation was videotaped and rated by a blinded and calibrated evaluator using Houpt 's behavior rating scale . RESULTS There was no statistical difference for overall behavior ( F3,27 = 0.407 ; P = .749 ) . The planned contrasts showed significant interactions between time and route ( IN vs PO ) between 25 and 30 minutes after starting sedation . The time of onset ( P = .000 ) and the working time ( P = .007 ) were significantly different between IN and PO midazolam . There were no statistically significant differences in vital signs ( O2 sat , HR , RR , BP ) between PO and IN ( P = .595 ) . IN subjects showed more movement and less sleep toward the end of the dental procedures , and faster onset time but shorter working time than PO . Vital signs were stable throughout the procedures with no significant differences . CONCLUSIONS Mean onset time was approximately 3 times faster with IN administration compared to PO administration . Mean working time was approximately 10 minutes longer with PO administration than it was with IN administration . Overall behavior under PO and IN was similar . However , more movement and less sleep were shown in subjects under IN than those under PO toward the end of the dental session . All vital signs were stable throughout the procedures and showed no significant differences between PO and IN administration The primary objective of this study was to evaluate in a r and om double-blind design , the sedative and behavioural responses of children undergoing outpatient paediatric dental procedures receiving either chloral hydrate ( CH ) alone or in combination with hydroxyzine . Forty American Society of Anaesthesiologists class I children ( 21 to 36 months of age ) were r and omly allocated to receive either 70 mg/kg CH alone or with 2 mg/kg hydroxyzine . The degree of crying , movement and overall behaviour was evaluated during treatment at different times . The combination of chloral hydrate/hydroxyzine ( CH/H ) significantly decreased crying and movement in relation to the effect induced by CH alone ( p < 0.05 ) only at 45 - 60 min following the insertion of a rubber dam , whereas the overall behavior in both groups was no different throughout the dental procedures . In conclusion , our study demonstrated that hydroxyzine increased the effect of CH .  However , because of the presence of high rates of oxygen desaturations and of deep sedation , careful use of this drug combination should be stressed PURPOSE The purpose of this study was to compare the safety and efficacy of submucosal-administered meperidine ( SM ) and oral-administered meperidine ( OM ) . Both regimens were used in conjunction with oral hydroxyzine for the sedation of children for dental treatment . METHODS Twenty preschool-age children , with previous histories of uncooperative behavior , were r and omly assigned to first receive a sedation regimen of either SM ( 0.5 mg/ lb ) , or OM ( 1 mg/lb ) , both with oral hydroxyzine ( 0.5 mg/lb ) . A cross-over design was utilized so that each child received both regimens . Safety was monitored through vital signs and side effects . Efficacy was measured with Houpt and Frankl behavior ratings . RESULTS Vital signs remained stable during both treatments . Differences noted were clinical ly insignificant . The major side effects reported during submucosal injection included pain ( 58 % ) and edema ( 26 % ) . All blinded behavior ratings , in both sedation regimens , significantly improved from presedation Frankl ratings . No significant differences existed between treatments . Success was 63 % in the SM group and 80 % in the OM group . The percentages were not statistically significant ( P=.219 ) . CONCLUSIONS Both methods of administration were found to be safe and effective for sedating uncooperative pediatric dental patients . Neither was significantly more effective or safer than the other PURPOSE This study was performed to compare the effects of nitrous oxide/oxygen ( N2O/O2 ) versus oxygen ( O2 ) as adjuncts to an oral narcotic regimen for pediatric conscious sedation .  METHODS Using a r and omized double-blind crossover design , 19 children ( mean age 41 + /- 8.6 months ) were se date d with chloral hydrate ( 50 mg/kg ) , meperidine ( 1.5 mg/kg ) and hydroxyzine pamoate ( 25 mg ) for two appointments . Patients were assigned r and omly to receive 100 % O2 at one visit and 50 % N2O/O2 at the other . Physiologic parameters were measured in five-minute intervals , including respiratory rate , pulse rate ( PR ) , oxyhemoglobin saturation ( SpO2 ) and end-tidal carbon dioxide . Data analyses focused on true desaturations and apnea , level of sedation and sedation outcomes . RESULTS There were no differences in PR , SpO2 and risk of desaturation between the inhalation agents . The level of sedation was deeper and the sedation outcomes were better in the N2O/O2 group . CONCLUSION N2O/O2 deepened the sedation while improving its success with minimal alteration in physiologic parameters Oral midazolam is being used for conscious sedation in dentistry with little documentation assessing its efficacy . In order to accumulate preliminary data , a r and omized , double-blind , controlled , crossover , multi-site pilot study was conducted . The objective was to determine if 0.6 mg/kg of oral midazolam was an equally effective or superior means of achieving conscious sedation in the uncooperative pediatric dental patient , compared with a commonly used agent , 50 mg/kg of oral chloral hydrate .  Twenty-three children in three clinics who required dentistry with local anesthetic and were determined to exhibit behavior rated as " negative " or " definitely negative " based on the Frankl scale were assessed . They were evaluated with respect to acceptance of medication ; initial level of anxiety at each appointment ; level of sedation prior to and acceptance of local anesthetic ; movement and crying during the procedure ; and overall behavior . The results showed that the group r and omly assigned to receive midazolam had a significantly greater initial level of anxiety for that appointment ( P < 0.02 ) , a finding that could clearly confound further determination of the efficacy of these drugs . Patients given oral midazolam had an increased level of sedation prior to the administration of local anesthetic compared with those given chloral hydrate ( P < 0.015 ) . No statistically significant differences were noted in any of the other parameters . The age of the patient was found to have no correlation with the difference in overall behavior ( r = -0.09 ) . These preliminary data warrant further clinical trials Various studies have implicated generalized health problems with chronic exposure to trace levels of nitrous oxide . Recent investigations have reported that higher-than-recommended levels of nitrous oxide exist in the breathing zone of the dental staff . This study was undertaken to accurately determine waste nitrous oxide levels during pediatric sedations and to evaluate the effect of scavenging in reducing environmental exposure . Conscious sedations were performed on 20 uncooperative 2 - 4-year old children . Each child was assigned r and omly to one of two groups , a scavenged group and a nonscavenged control . Sedations were accomplished with oral administration of chloral hydrate and hydroxyzine . All patients received nitrous oxide ( 40 % ) in oxygen throughout the procedure . Waste nitrous oxide levels were monitored 22 - 24 in from the dentist 's nose using an infrared spectrophotometer and recorded by a microprocessor . Results indicate that environmental levels of nitrous oxide exceed the National Institute for Occupational Safety and Health ( NIOSH ) recommendations by 12 times , regardless of whether a scavenging system was employed or not . It is concluded that the scavenging system tested in this investigation may not be as efficient as previously thought at complying with NIOSH recommendations Rectal diazepam was evaluated for its sedative effect on the difficult-to-manage child in the dental setting . A placebo was used as a control . In a double-blind study , 12 uncooperative patients with a mean age of 3.75 years were selected using the Frankl scale , Ratings I and 2 . Each child was seen fbr an initial examination and 2 st and ardized restoratfve treatment visits . R and omly , a dosage of 0.6 mg/kg of either diazepam or sodium chloride was dispensed through a soft , rubber catheter . Videotapes were recorded for bot}i treatment visits on all children during a specific 6-min segment . These were review ed later by 3 judges using a kinesics/vocalization instrument . The results of this study indicated that rectal diazepam ( 0.6 mg/kg ) is an effective , predictable , and safe sedative which adapts : well to the routine dental appointment for the young pediatric dental patient 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 aim ed 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≥3 ) , were enrolled into the study after obtaining informed parental consent . The children were then r and omly 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 PURPOSE The purpose of this study was to compare the safety , efficacy and recovery time of intranasal midazolam spray administered using an atomizer to orally administered chloral hydrate and promethazine for the sedation of pediatric dental patients . METHODS A r and omized double-blind crossover study design was utilized in which 31 patients ( mean age 41.8 months , range 26 - 58 months ) underwent two restorative dental appointments . At one appointment , subjects received 0.2 mg/kg intranasal midazolam ; at the other appointment subjects received 62.5 mg/kg chloral hydrate with 12.5 mg promethazine . Administered at each appointment was 25%-50 % N(2)0/0(2 ) . Physiologic parameters ( heart rate , blood pressure , respiratory rate , oxygen saturation ) and behavior assessment s ( crying , movement , sleep ) using the Houpt Sedation Rating Scale were recorded at baseline and every five minutes during treatment . Overall behavior was assessed at baseline and at the end of treatment . Following treatment , a modified Vancouver Recovery Scale was used to determine the length of time it took each subject to meet established discharge criteria . RESULTS There were no clinical ly significant differences in physiologic parameters , however a statistically significant decrease in systolic and diastolic blood pressure was observed in patients se date d with chloral hydrate/promethazine . There were no significant differences in behavior between groups . Patients se date d with intranasal midazolam  slept less and recovered quicker than patients se date d with oral chloral hydrate/promethazine . CONCLUSIONS Intranasal midazolam administered using an atomizer is as safe ( as assessed by physiologic parameters ) and effective ( as assessed by behavior ratings ) as oral chloral hydrate/promethazine for conscious sedation of pediatric dental patients PURPOSE The purpose of this study was to compare midazolam alone ( Group A : 1 mg/kg ) vs midazolam plus meperidine ( Group B : 0.5 and 1 mg/kg , respectively ) in regard to physiology and behavior of young children se date d for dental restorative care . METHODS Twenty healthy children who met selection criteria were r and omly assigned to 1 of 2 groups and subsequently treated in a prospect i ve , crossover design . All sedative agents were administered orally , and all sedations included 50 % nitrous oxide administered via a nasal hood . Heart rate , systolic and diastolic blood pressure , and behavior were recorded at 8 procedural or time periods during the visits . Chi-square and ANOVA were used to analyze the data . RESULTS No difference in physiology or behavior was found between groups . However , higher heart rates and disruptive behaviors occurred more frequently during or after local anesthesia administration . CONCLUSIONS Oral midazolam alone is just as effective as midazolam with meperidine . Disruptive behaviors accounted for increased heart rates Aim To add to the evidence base for acceptable and effective paediatric conscious sedation techniques in dental primary care . Objectives To compare three conscious sedation techniques for primary care as an alternative to dental general anaesthesia ( DGA ) in children . To assess the feasibility and practicality of running the trial in general dental practice . To form the basis for sample size calculations and assess scales of measurement . Design Single centre , r and omised control trial ( RCT ) . Setting Queensway Anxiety Management Clinic ( QAMC ) . A primary care based general and referral dental practice for the management of anxious patients .Subjects , material s and methods Sixty five children too anxious for management with relative analgesia , requiring invasive dental procedure for which dental general anaesthesia ( DGA ) will be required if an alternative can not be found . Interventions Group 1 ( n = 20 ) — A combination of inhaled medical air and titrated intravenous midazolam . Group 2 ( n = 22 ) — A combination of inhaled 40 % nitrous oxide in oxygen and titrated intravenous midazolam . Group 3 ( n = 23 ) — A combination of an inhaled mixture of 0.3 % sevoflurane and 40 % nitrous oxide in oxygen with titrated intravenous midazolam . Main outcome measures Successful completion of the intended dental treatment with a child who is co-operative and responsive to verbal comm and s. Results Fifty per cent ( ten children ) successfully completed treatment in Group 1 , 73 % ( 16 children ) in Group 2 and 83 % ( 19 children ) in Group 3 . This difference was not significant at a 5 % level ( χ2 = 5.53 , df = 2 , P = 0.07 ) Of the total of 20 failures , eight children in Group 1 and one child in Group 2 were successfully treated with the addition of sevoflurane and nitrous oxide in oxygen . Only two children required referral to a hospital setting for DGA and the remaining nine children were managed with an alternative conscious sedation technique . Conclusion This pilot shows that intravenous midazolam especially in combination with the addition of inhaled nitrous oxide or sevoflurane and nitrous oxide were promising safe and effective techniques , sufficient to justify progression to a definitive RCT with appropriate methods Intravenously administered lorazepam ( 0.05 mg/kg ) , diazepam ( 0.25 mg/kg ) , and midazolam ( 0.1 mg/kg ) were compared for sedation  during oral surgery under local anesthesia . Sixty patients were r and omly allocated into three groups in this double-blind , parallel study . The results from this trial show that all three drugs provide satisfactory sedation . Average mean arterial pressures , however , decreased significantly with midazolam and diazepam . Statistically significantly higher heart rates during the entire procedure were also found for lorazepam when compared with diazepam and midazolam . At the postblock stage , the midazolam group had respiratory rates that were significantly higher than those of the other two drug groups . Patients in the diazepam and midazolam groups took significantly longer to complete the pegboard test at the preblock stage than those in the lorzepam group . At 1 , 1.5 , and 2 hours after arrival in the recovery room , an inversion of groups took place , with the lorazepam group taking significantly longer for their tests than the other two groups . Significantly more improvement in anxiety levels was found at 10 minutes postdrug for the patients who had received diazepam and this tended to remain so on arrival in the recovery room . When compared with the other two groups , significantly more patients in the lorazepam group reported giddiness/dizziness and significantly more in the diazepam group reported pain on injection The purpose of the present study was to test the efficacy of oral-transmucosal route of administration of midazolam in young potentially un-cooperative children . A sample of 40 children up to 4 years of age with ASA I status were r and omly divided into experimental and control groups of 20 each . The children in experimental group received 0.5-mg/kg-body weight midazolam mixed in strawberry syrup via the oral-transmucosal route and those in control group were given the same syrup diluted with normal saline . A class II amalgam restoration was performed and routine behavior management techniques were employed in both groups . It was found that the number of procedures successfully completed and sedation produced 15 minutes after test solution administration was significantly greater in the experimental group compared to the control group . The total treatment time was also much lesser in the experimental group children . There was no significant difference in the acceptability of the test solutions in the children of the two groups AIM Failure of dental treatment caused by anxiety is a common problem in children . Oral midazolam has been the most commonly used premedication for pediatric patient but the use of midazolam may be associated with paradoxical reactions in children .  Melatonin may induce a natural sleepiness and improve sedation . We have investigated premedication with melatonin compared with midazolam in children under nitrous oxide/oxygen ( N(2)O/O(2 ) ) sedation for dental treatment . METHODS In a r and omized study , 60 children received either 3 mg of melatonin [ Melatonina ( 3 mg(R ) ) 60 min before the procedure ( n = 15 ) ; group I ] , 0.5 mg.kg(-1 ) melatonin  60 min before the procedure ( n = 15 ; group II ) , 0.75 mg.kg(-1 ) midazolam [ Dormicum ( 15 mg/3 ml ( R ) ) 15 min before the procedure ( n = 15 ) ; group III ] or 3 ml of 0.09 NaCl 15 min ( n = 7 ) or 60 min before the procedure ( n = 8 ; group IV ) orally . The children were se date d with 40/60 % N(2)O/O(2 ) inhalation . The heart rate and O(2 ) saturation were monitored during the treatment period . The level of sedation was assessed according to the Ramsay Sedation Scale . The children 's sedation success during dental treatment was classified . The sedation success and other sedation-related events recorded . Comparisons among the four groups were made using one-way anova or Kruskal-Wallis test , and if any significant differences were noted , the Tukey 's HSD or Mann-Whitney U-test were used for intergroup comparisons . All differences were considered significant at P < 0.05 . RESULTS The evaluation of sedation success was as follows : group I : satisfactory ( n = 1 ) , average satisfactory ( n = 4 ) , and unsatisfactory ( n = 10 ) ; group II : satisfactory ( n = 2 ) , average satisfactory ( n = 3 ) , and unsatisfactory ( n = 10 ) ; group III : satisfactory ( n = 9 ) , average satisfactory ( n = 6 ) ; and group IV : satisfactory ( n = 1 ) , average satisfactory ( n = 3 ) , and unsatisfactory ( n = 11 ) . CONCLUSION In these doses and clinical conditions , melatonin was similar to that of placebo and did not contribute to N(2)O/O(2 ) sedation of anxious children The aim of the study was to compare oral midazolam and inhaled nitrous oxide as sedative agents during the management of children aged 5–10 years presenting for extraction of primary teeth under local anaesthetic . Subjects required two visits for the extraction of four primary teeth , one in each quadrant of the mouth , and were r and omly allocated to be given nitrous oxide 30 % in oxygen or oral midazolam 0.3 mg.kg−1 at the first visit , the other technique being used at the second visit . Vital signs , sedation levels and behavioural scores were recorded , and postoperative recall and satisfaction were reported by the patients . Thirty‐five children , with a mean [ range ] age of 7.4 [ 5–10 ] years , completed the treatment . The mean dose of oral midazolam given was 8.6 [ 3.3–16.5 ] mg . The mean times taken to achieve the maximum level of sedation for midazolam and nitrous oxide sedation were 15.9 [ 2–30 ] min and 6.8 [ 2–10 ] min , respectively . Physiological parameters remained within acceptable clinical limits for both types of sedation . Oral midazolam was considered acceptable by 59 % and was preferred by 36 % .  Oral midazolam sedation in 5 to 10‐year‐old children was shown to be as safe and effective as nitrous oxide in oxygen  sedation for extraction of primary teeth but would not be the method of choice for all patients PURPOSE This study examined the incidence of side effects occurring with three doses of orally administered triazolam in children undergoing restorative dental procedures . METHODS Thirty children , aged 39 - 81 months , participated in the study . The children were pretested for gait ataxia , amnesia , visual acuity , stereoscopic depth perception , and diplopia during a screening session . In a subsequent appointment , children received one of three triazolam dosages ( 0.005 , 0.015 , and 0.030 mg/kg ) prior to dental treatment . Dosage assignment was r and om and double blind . Each child received a single triazolam dosage . Tests for gait ataxia , amnesia , and visual disturbances were repeated following drug administration . RESULTS The proportion of children experiencing ataxia , amnesia , and diplopia increased with increasing triazolam dosages . The 0.030-mg/kg triazolam dosage impaired visual acuity and stereoscopic depth perception . CONCLUSION Triazolam produces ataxia , amnesia , and diplopia in a dose-dependent manner in children This study was performed to compare the effectiveness of chloral hydrate with and without promethazine when young children were se date d for dental treatment . Twenty-one children , participated in the study ranging in age from 15 to 45 months with a mean age of 32 months . Subjects were assigned r and omly to receive either 75 mg ! kg of chloral hydrate alone or 50 mg/kg together with 25 mg of promethazine ; alternate regimens were administered at two appointments . ( Eight children requiring three visits received 50 mg/kg chloral hydrate without promethazine at one visit . All children received 50 % nitrous oxide and were restrained in a Papoose Board ® with head holder . The degree of sleep , crying , body movements , blood pressure , pulse , respiration rate and pupil size were evaluated before , during , and after operative procedures . Successful sedation , as evidence d by lack of crying and ! or movement which interrupted treatment , was found in 89 % of the children administered chloral hydrate and promethazine compared with 72 % adminstered chloral hydrate alone . Vital signs remained essentially unchanged throughout all treatments . The only adverse side effect noted was vomiting in 14 % of the administrations with promethazine and 48 % without . Sedation is recommended frequently when extensive dental treatment is performed for young children . Chloral hydrate is used commonly because of its wide margin of safety and relatively few adverse side effects . 1 Numerous investigators have used different dosage regimens determined by behavior , age , or weight;2"7 however , varying degrees of success were obtained . Some practitioners administer promethazine together with chloral hydrate to augment the sedation effect and lessen the vomiting which may occur with chloral hydrate alone.l’8 Sim9 reported that  chloral hydrate effectiveness would be increased if supplemented with nitrous oxide . This study compares  chloral hydrate  effectiveness with and without promethzine together with nitrous oxide when young children are se date d for dental treatment Clonidine has recently been used as a pre-operative medication and sedative/anxiolytic drug . Its extended duration of action makes it suitable for longer procedures . In this r and omized , crossover , placebo-controlled clinical trial , we characterized the effects of oral clonidine pre-treatment on intravenous diazepam/meperidine sedation using the bi-spectral index ( BIS ) in 13 participants .  Clonidine significantly increased the numbers of BIS-depressed readings and percent memory loss during sedation , while reducing total diazepam and post-operative analgesic dosages by 44 % and 55 % , respectively . Systolic , diastolic , and mean arterial blood pressures , as well as pulse rates , were reduced . Respiratory rate , oxygen saturation , end-tidal CO2 , and recovery from sedation were unchanged . Participants , surgeons , and sedationists preferred clonidine over the placebo . Clonidine pre-treatment increased and prolonged sedation and amnesia and stabilized vital signs while significantly decreasing diazepam and post-operative analgesic usage . These results suggest that pre-operative clonidine administration could be a useful supplement to intravenous sedation for dental procedures of long duration The aim of this study was to compare rectal sedation with diazepam and rectal sedation with midazolam with regard to sedative effect , treatment acceptance , and amnesia .  Ninety children , 1.5 - 3.5 years of age , consecutively referred for extraction s of traumatized primary incisors were r and omly se date d with diazepam ( 0.7 mg/kg body weight ) or midazolam ( 0.3 mg/kg body weight ) . The study design was r and omized and double-blind . The level of sedation ( state of mind ) was assessed prior to and 10 and 60 min after administration of the drug by use of a behavioral scale ( Wilton ) . The children 's acceptance of procedures was assessed using another behavioral scale ( Holst ) during administration of the sedative , application of topical anesthesia , injection of a local anesthesia , and extraction . Amnesia was evaluated by the parents on the following day , with the child being asked st and ardized questions . Parental ratings of the child 's and their own distress during and after treatment were made on a visual analog scale ( VAS ) . No differences were found between the sedatives concerning level of sedation during treatment , acceptance of procedures , or amnesia . At discharge , 60 min after administration of the sedative , the children receiving diazepam were significantly more agitated ( P=0.006 ) . Parental rating on a VAS of the child 's discomfort after treatment was significantly higher in the diazepam group ( P=0.006 ) . There was a tendency for children with poor acceptance of the rectal administration to display a more negative acceptance of the dental treatment . In conclusion , the present results , in combination with known pharmacological advantages , indicate that midazolam is preferable in out patients when sedation is needed and amnesia is desirable This double blind study was undertaken to determine the safety and efficacy of orally administered newer sedatives and analgesics for conscious sedation in 120 child patients . Patients were r and omly assigned into : Midazolam ( I ) , Ketamine ( II ) , Zolpidem ( III ) , Midazolam plus Ketamine ( IV ) , Midazolam plus Tramadol ( V ) and Zolpidem plus Tramadol ( VI ) groups of 20 each . Onset of action , level of sedation , ease of treatment completion , recovery time , and post-operative amnesia were assessed for all and compared . Midazolam plus ketamine was found the most effective combination providing a fast and adequate analgo-sedation in anxious and uncooperative child patients Fifteen consecutive pediatric patients ranging from 3 to 5 years old were selected to receive one of three sedative/hypnotic techniques . Group 1 received oral chloral hydrate 50 mg/kg , and groups 2 and 3 received intramuscular ketamine 2 mg/kg and 3 mg/kg , respectively . In addition to ketamine , patients in groups 2 and 3 received transmucosal intramuscular injections of meperidine and promethazine into the masseter muscle . Sedation for the satisfactory completion of restorative dentistry was obtained for over 40 min on average in the chloral hydrate group , but completion of dental surgery longer than 40 min was achieved in groups 2 and 3 only by intravenous supplements of ketamine PURPOSE The purpose of this study was to determine the influence of 40 % nitrous oxide/60 % oxygen inhalation with scavenging on the behavioral and physiological parameters during routine pediatric dental procedures . METHODS Twenty-two subjects , aged 60 - 116 months , were r and omized into a double blind , cross-over study design and administered alternately either 40 % nitrous oxide/60 % oxygen or 100 % oxygen during two sequential restorative appointments . All subjects were monitored continuously for respiratory rate , pulse rate , and hemoglobin oxygen saturation using a combined capnograph and pulse oximeter . The subject 's breath sound and behavior were recorded every minute along with vital signs . RESULTS When compared to 100 % oxygen inhalation , 40 % nitrous oxide/60 % oxygen inhalation produced significant reductions in adverse patient behavior , respiratory rate , and pulse rate , but did not affect percent hemoglobin oxygen saturation . Nitrous oxide inhalation had no effect on breath sound revealed by auscultation or on the occurrence of the apnea alarm displayed by the capnograph . CONCLUSIONS This study demonstrated that the administration of 40 % nitrous oxide/60 % oxygen delivered via a scavenging nasal hood significantly improved patient behavior and altered physiological parameters commonly monitored during conscious sedation A group of highly fearful children were treated using behavioral management , or nitrous oxide and behavioral management . This article describes the childrens ' fears during the first curative treatment one to two years after the first treatment phase , and to study whether the reduction in the child 's anxiety level found previously is of a permanent nature . The results of this study indicate that fear reduction using behavioral management is not permanent : the first curative treatment after seventy-two weeks results in significantly higher fear scores ( PS ) . When combining the behavioral management with nitrous oxide , the fear scores show the same low level as at the previous treatment . The fear score during the last session of a course of treatment is clearly related to the score of the following curative session , even if it takes place two years later Summary A r and omised , controlled , crossover trial was design ed to assess the safety and effectiveness of oral midazolam sedation for orthodontic extraction s. Forty‐six ASA physical status I children aged 10–16 years were recruited . Each child required two treatment sessions . Sedation with either oral midazolam 0.5 mg.kg−1 or nitrous oxide in oxygen was used at the first visit , the alternative being used at the second visit . Blood pressure , heart rate , arterial oxygen saturation , and sedation and behavioural scores were recorded every 5 min . Anxiety levels and postoperative satisfaction were also recorded . Blood pressure , heart rate and arterial oxygen saturation in both groups were similar and within acceptable clinical limits . The median [ range ] lowest arterial oxygen saturation levels for subjects in the midazolam and nitrous oxide groups were 95 [90–100]% and 98 [93–100]% , respectively . The median [ range ] time to the maximum level of sedation in the midazolam group was 20 [ 5–65 ] min compared with 5 [ 5–10 ] min in the nitrous oxide group ( p < 0.001 ) . The median [ range ] duration of treatment was similar in both groups ( midazolam group : 10 [ 5–30 ] min , nitrous oxide group : 10 [ 5−25 ] min ) . Seventy‐four per cent of subjects were prepared to have oral midazolam sedation again , 54 % preferring it . Oral midazolam appears to be a safe and acceptable form of sedation for 10–16‐year‐old paediatric dental patients The sedative and cardiovascular effects of rectally administered diazepam ( 0.6 mg/kg ) were compared to placebo in uncooperative children who required sedation during dental treatment . Twelve healthy preschool children , who required amalgam restorations , were treated during two st and ardized restorative appointments in a double-blind , crossover study . Blood pressure and pulse were obtained during four specified intervals during the appointment . The behavior of the children during the treatment visits was videotaped and later statistically analyzed using a kinesics/vocalization instrument . Behavioral ratings of cooperation were significantly improved during the treatment visit following diazepam . All interfering bodily movements , patient vocalizations and operator comm and s for the diazepam group were reduced significantly ( p≤0.0001 ) . No significant differences were observed for noninterfering behavioral response . Rectally administered diazepam did not alter blood pressure or pulse significantly in these se date d children when compared to the placebo . These findings indicate that rectal diazepam is an effective sedative agent with minimal effect on the cardiovascular system for the management of the young pediatric dental patient A double-blind study was undertaken to determine the efficacy of an oral dose of midazolam 7.5 mg as compared to placebo in a sample of 32 children who had refused dental care after the conventional psychological approach alone was used to reduce fear and apprehensive behavior . Parameters assessed before and 30 minutes after the oral administration of either midazolam or placebo were mental attitude , hypnotic activity , motor activity , quality of sedation and of dental treatment . A three-point scale was design ed in each studied parameter and mean values + /- s.e.m . were compared before and after treatment by using Wilcoxon 's rank test . It was shown that an oral dose of midazolam 7.5 mg significantly improved all parameters under evaluation ( p < 0.01 ) as compared to placebo , effects which appeared thirty minutes after administration . It is concluded that oral midazolam provides a fast and adequate sedation in children refusing dental care . Thus , the drug is an alternative to other sedative or hypnotic drugs currently used in the premedication of the apprehensive child PURPOSE This study compared the effect of supplemental oxygen ( O2 ) on pediatric patients ' apnea status and oxyhemoglobin saturation during : 1 )  conscious sedation for dental procedures and 2 ) the recovery period following sedation . METHODS Fourteen child patients ( mean age 42 months ) se date d with 50 mg/Kg chloral hydrate , 25 mg hydroxyzine pamoate , and 1.5 mg/Kg meperidine were treated for two separate appointments . The patients received supplemental O2 via nasal cannulae at r and om at one of the two appointments . Following the operative period , all patients were monitored sitting upright for an additional 15 min . RESULTS Intraoperative results showed that the risk of apnea was 39 % ( 11/28 ) , with apneic events distributed equally between O2 and non-O2 supplemented sedations . The overall risk of desaturation was 29 % ( 8/28 ) . Mean SpO2 was always elevated with O2 supplementation and the mean difference in O2 versus non-O2 was statistically significant . The risk of apnea in the postoperative period was 7 % ( 1/14 ) for both the non-O2 and O2-supplemented patients . The risk of desaturation in the postoperative period was 11 % ( 3/28 ) with one desaturation in a non-O2 and two desaturations in O2-supplemented patients . CONCLUSION We conclude that intraoperative O2 supplementation prevents desaturations even in the presence of apnea during pediatric conscious sedation This study investigated the effects of oral diazepam administered at home to fearful child patients prior to dental treatment . Twenty-five healthy , uncooperative children , mean age 3 years 8 months ( + /- 1 year 3 months ) , requiring at least three visits for the treatment of dental caries , were studied . Each child 's behaviour was assessed during three treatment sessions : ( i ) control , with no diazepam or placebo ; ( ii ) with diazepam ; and ( iii ) with a placebo . Each child acted as his/her own control , being initially assigned to the control session . Subsequently each was r and omly assigned to receive either diazepam or placebo for the second session and the other for the third session . The diazepam and placebo were administered by the parents at home approximately 60 minutes before treatment . Each patient 's behaviour was assessed on a scale of 1 ( definitely positive ) to 4 ( definitely negative ) by two calibrated examiners who were blind to the medications given and independent of the treatment . Vital signs were monitored at 5-minute intervals . Behaviour was significantly better with diazepam than with the placebo or with neither . No significant differences were observed between the placebo and control sessions . At no time were any adverse effects noted , such as vomiting or respiratory depression . It was concluded that oral administration of 0.3 mg/kg diazepam at home by the parent is an effective and safe technique for preoperative sedation of fearful child patients The present study was undertaken to evaluate Midazolam as a Paediatric conscious sedative agent for a routine Indian dental setup and to compare its efficacy and safety when administered by intranasal and intramuscular routes , at a dosage of 0.2 mg/kg body weight . The present study was accomplished in two phases : Phase 1 : Preliminary dose finding pilot study on 10 children . Phase 2 : Single dose , r and omized parallel clinical trial on 40 children between the ages of 2 and 5 years . These children were r and omly assigned to two groups consisting of 20 subjects each . Group M , received Midazolam intramuscularly , while Group N received Midazolam intranasally . Both the intranasal and intramuscular groups showed highly significant decrease in crying levels , motor movements and sensory perception levels , post-sedation ( P P < 0.001 ) . Midazolam could be safely and successfully employed by intranasal and intramuscular routes for Paediatric conscious sedation in a routine dental setup with basic facilities at a dosage of 0.2 mg/ kg body weight . Whenever the clinical situation warrants a faster action , peak and recovery , the intranasal route should be the obvious choice OBJECTIVE The objective of this study was to comparatively evaluate the effectiveness ofsubmucosalfentanyl when administered in conjunction with oral midazolam during pediatric procedural sedations . STUDY DESIGN Twenty three uncooperative ASA type I children who met the selection criteria were r and omly assigned to receive either submucosal fentanyl ( 3 microg/kg ) or placebo , along with oral midazolam ( 0.5 mg/kg ) . A triple blind , 2-stage cross-over design was adopted so that each child received both the regimens . RESULTS Transient oxygen desaturation was observed in 4 children who were se date d with the combination of oral midazolam and submucosalfentanyl . The overall success was 73.91 % with oral midazolam and submucosal fentanyl regimen and 47.83 % for oral midazolam and submucosal placebo regimen . The chances of ' satisfactorily'completing a 45 minute dental procedure in an uncooperative pediatric patient was 2.8 times more , when submucosalfentanyl was used along with oral midazolam . CONCLUSION Submucosal fentanyl appears to improve the short working time associated with oral midazolam . But the oxygen desaturation associated with this regimen necessitates further studies to evaluate the efficacy of this combination at relatively lower doses before being used routinely for pediatric procedural sedation and analgesia The purpose of the study was to compare hydroxyzine ( HYD ) and 0.2mg/Kg midazolam ( MDZ ) as sedative agents for young pediatric dental patients . Twenty-nine healthy two-to-four-year-old children participated in the study . Hydroxyzine was dripped nasally 10 minutes before treatment . The patient 's crying , alertness , movement and general behavior were blindly assessed and statistically analyzed . No differences were found between the mean general behavior scores nor between the first and second visits in both groups . A significant difference ( p < 0.02 ) was found in the acceptance of the face and nasal masks by children of the midazolam group between the first and second appointments . None of the children of this group cried nor moved at the first visit . The results of the study indicate that midazolam is somewhat more effective than hydroxyzine as a sedative agent for short procedures in young pediatric dental patients The study compared the effectiveness of temazepam and a mixture of chloral hydrate and hydroxyzine in sedating 20 young children aged 20 to 60 months ( mean age 38.7 months ) . All the children exhibited negative behaviour during a screening visit and required at least two visits for restorative treatment with the use of sedation . The children were assigned r and omly to receive either 50 mg/kg of chloral hydrate with 25 mg of hydroxyzine or 0.3 mg/kg of temazepam for the first visit , and the alternate regimen for the second visit , in a double-blind manner . Pulse rate and blood oxygen saturation levels were monitored before , during and after the operative procedures . All the treatment sessions were video-recorded and evaluated independently by three paediatric dentists for the degree of crying , movement , sleep and overall behaviour during specific procedures and at specific time intervals . The results showed no statistically significant differences between the two pharmacologic regimens with regard to crying , movement , sleep and overall behaviour . No significant difference in behaviour was found related to either the order of administration of the drugs or to the sex of the patients . It was concluded that 0.3 mg/kg temazepam and a mixture of 50 mg/kg chloral hydrate with 25 mg hydroxyzine had similar sedative effects on the children receiving dental treatment Anxiety scores of highly fearful children were registered during a control period after their curative treatment . The average length of the control period was seventy-two weeks . The anxiety scores of the children who were treated curatively with the aid of nitrous oxide were significantly lower than those of children from a behavioral management group . All the semiannual check-ups were performed without the use of nitrous oxide .  Anxiety scores of all the children during the control period correlated closely with the anxiety scores of the curative treatment before and after the control period . It was concluded that nitrous oxide helps children to lower their anxiety levels during a long period after treatment . Influencing anxiety in highly anxious children might be characterized as a long-term process The safety and efficacy of an oral sedation technique for children having minor oral surgical procedures under local anesthesia were studied . One hundred healthy children between the ages of 2 and 7 yr received either a combination of midazolam ( 0.35 mg/kg ) and ketamine ( 5 mg/kg ) ( Group A ) , or a combination of trimeprazine ( 3 mg/kg ) and methadone ( 0.2 mg/kg ) ( Group B ) 30 min preoperatively . Hemodynamic parameters , adverse reactions , postoperative recovery , and behavior were evaluated . More children were asleep , but rousable to verbal comm and s , 30 min after drug administration in Group A ( 40 % ) than in Group B ( 8 % ) . Immediately before the dental procedure , 46 % of children in Group A were asleep in contrast to 8 % of children in group B. Significantly more children in Group A were awake , coughing , crying , and moving purpose fully 30 and 60 min after admission to the recovery room . Two children ( 4 % ) in Group A vomited . Ten ( 20 % ) children in Group A hallucinated compared to none in Group B. The surgeon rated the procedure as good or very good in 94 % of children in Group A compared to 78 % in Group B. Our results show that the combination of midazolam and ketamine , administered orally , is a safe , effective , and practical approach to managing children for minor oral surgical procedures under local anesthesia BACKGROUND We prospect ively assessed the efficacy and side effects of four sedation techniques in our dental clinic : oral midazolam , intranasal ( IN ) midazolam , IN midazolam combined with oral transmucosal fentanyl citrate ( OTFC ) , and IN midazolam combined with IN sufentanil . MATERIAL S & METHODS With IRB approval , a nonr and omized open label study of moderate sedation in children undergoing dental surgery was administered during a 6 -month period . The sedation regimen was rotated daily at the anesthesiologist 's discretion . Each sedation was monitored by a research nurse who assessed the quality of sedation and the frequency of complications . All children were monitored during the procedure and recovery for at least 20 min , before discharge based on the University of Michigan Sedation and Ohio State behavior rating scores . RESULTS One hundred and two children were se date d in the dental clinic during this period . The sedation was successful in 73 % ( range 64 % to 88 % ) of the children . The time to onset was greatest with OTFC ( 37 min ) and least with IN midazolam ( 17 min ) compared with the other two groups ( 20 and 30 min ) . Recovery after OTFC was prolonged ( 39 min ) significantly compared with the other three groups ( 26.5 - 30 min ) . Efficacy of sedation and frequency of complications ( 9 % incidence of nausea and 6 % of mild hemoglobin desaturation ) were similar among the groups . CONCLUSIONS All four sedation regimens were equally effective in this cohort of healthy children . The onset and recovery with OTFC was significantly delayed compared with the other regimens . The frequency of side effects was small ; there were no side effects in the PO midazolam group The trial included 24 children ( aged 2 - 7 yr ) referred for dental treatment under general anesthesia , since conventional behavioral management methods had failed to achieve treatment acceptance . As an alternative , they received , on two separate occasions with " identical " dental treatment , conscious sedation by rectal administration of either midazolam ( 0.3 mg/kg body weight ( bwt ) ) or midazolam ( 0.3 mg/kg bwt ) plus ketamine ( 1.0 mg/kg bwt ) . This allowed a double-blind , crossover design . The aims were to assess conscious sedation , combined with local anesthesia , as an alternative to general anesthesia , and further to evaluate the effects obtained by addition of a low dose of ketamine to rectally administered midazolam . The feasibility of dental treatment was rated as excellent or good for 16 of the 24 children when premedicated with midazolam , and for 18 of the 24 children when ketamine was added to midazolam . At least some treatment could be given to all children . Verbal contact was maintained with all children throughout both treatment sessions . The children were significantly less anxious when they arrived for the second session . Amnesia and drowsiness were significantly increased when ketamine was added to midazolam . The combination also tended to be more efficient in relief of anxiety and prevention of pain , but there were large variations in the children 's responses to the drugs . Midazolam significantly reduced the blood oxygen level , but not with ketamine added . For most children , both regimens proved to be appropriate as alternatives to general anesthesia . ( ABSTRACT TRUNCATED AT 250 WORDS We compared the effectiveness of ketamine with st and ard oral premedication ( SOP ) in 60 children , 2 - 7 years of age , se date d orally for dental treatment under local anaesthesia . Children were assigned r and omly to receive either 12.5 mg/kg ketamine or 0.5 ml/kg of SOP orally 60 min before the dental procedure . Pulse rate , systolic , diastolic and mean arterial pressures , respiratory rates and blood oxygen saturation were recorded prior to drug administration , 60 min thereafter and immediately before the dental procedure . Anxiety levels were measured at the same time intervals . The level of sedation was measured 60 min after drug administration . No significant differences were found in the anxiety levels between the groups 60 min after oral administration . The level of sedation in both groups before surgery was excellent . Operator evaluation for overall effectiveness of treatment showed that sedation was very good in 60 per cent of children in the ketamine group compared with 20 per cent in the SOP group . More children in the ketamine group were better se date d ( p < 0.05 ) . Both premedicants produce good sedation and anxiolysis 60 min after premedication and immediately before the surgical procedure The purpose of this study was to compare the effectiveness of intramuscular and intranasal midazolam used as a premedication before intravenous conscious sedation . Twenty-three children who were scheduled to receive dental treatment under intravenous sedation participated . The patients ranged in age from 2 to 9 years ( mean age , 5.13 years ) and were r and omly assigned to receive a dose of 0.2 mg/kg of midazolam premedication via either intramuscular or intranasal administration . All patients received 50 % nitrous oxide and 50 % oxygen inhalation sedation and local anesthetic ( 0.2 mL of 4 % prilocaine hydrochloride ) before venipuncture . The sedation level , movement , and crying were evaluated at the following time points : 10 minutes after drug administration and at the times of parental separation , passive papoose board restraint , nitrous oxide nasal hood placement , local anesthetic administration , and initial venipuncture attempt . Mean ratings for the behavioral parameters of sedation level , degree of movement , and degree of crying were consistently higher but not significant in the intramuscular midazolam group at all 6 assessment points . Intramuscular midazolam was found to be statistically more effective in providing a better sedation level and less movement at the time of venipuncture than intranasal administration . Our findings indicate a tendency for intramuscular midazolam to be more effective as a premedication before intravenous sedation BACKGROUND Midazolam sedation poses a significant dilemma in paediatric dentistry , which is to find out the optimal dosing with minimal undesirable adverse events . In this study , we aim ed to compare the effect of three doses of oral midazolam ( 0.5 , 0.75 , and 1 mg/kg ) on the sedative state and cooperative behaviour of children during dental treatment . We further compared completion rates , parent satisfaction , and all adverse events . DESIGN Ninety children aged 3 - 10 years were r and omised to three equal groups . Groups A , B , and C received 0.5 , 0.75 , and 1 mg/kg of oral midazolam , respectively . Levels of sedation , cooperative behaviour , procedures completion rates , parent satisfaction , and adverse events were prospect ively recorded . RESULTS Sedation scores in B and C were higher ( P < 0.001 ) than in A. Cooperation scores ( CS ) in B and C were higher ( P < 0.001 ) than in A. Significant increase in completion rates was observed between A and C ( P = 0.025 ) . Parent satisfaction was greater in B and C ( P < 0.001 ) compared to A. Adverse events were higher in C ( P < 0.05 ) than in A or B. CONCLUSION Amount of 0.75 mg/kg oral midazolam appears to be the optimal oral dose in terms of effectiveness , acceptability , and safety for dental treatments in paediatric patients , when administered by an experienced , paediatric anaesthetist To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrollment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results BACKGROUND . There is a lack of clinical trials on paediatric dental sedation . AIM . We investigated whether young children 's behaviour improves during dental treatment with oral ketamine/midazolam compared with midazolam alone or no sedation . DESIGN . Healthy children under 36 months of age , presenting early childhood caries were r and omly assigned to receive protective stabilization plus : combined oral midazolam ( 0.5 mg/kg ) and ketamine ( 3 mg/kg ) ( MK ) , or oral midazolam ( 1.0 mg/kg ) ( MS ) , or no sedative ( PS ) . One observer scored children 's behaviour using the Ohio State University Behavior Rating Scale ( OSUBRS ) at determined points in a dental exam ( no sedative ) and treatment session . Data were analysed using nonparametric bivariate tests . RESULTS . Forty-one children were included . In the dental exam session , the sum of OSUBRS scores was similar for the three groups ( P = 0.81 ) . In the treatment session , the MK produced more cooperative behaviour than MS and PS ( P = 0.01 ) , longer sessions ( P = 0.04 ) , and a pattern of homogeneous OSUBRS scores from the reception area ( before sedative administration ) to the end of the session ( P = 0.06 ) . No immediate and post-discharge side effects were observed in groups MK and MS . CONCLUSIONS . The combination of oral midazolam and ketamine is efficacious for guiding the behaviour of children under 3 years old
BACKGROUND Children 's fear about dental treatment may lead to behaviour management problems for the dentist , which can be a barrier to the successful dental treatment of children .
Sedation can be used to relieve anxiety and manage behaviour in children undergoing dental treatment .
There is a need to determine from published research which agents , dosages and regimens are effective .
OBJECTIVES To evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry .