In: Health17 Nov 2009
Pediatric dental patients from the Houston Medical Center Pediatric Dental Clinic, Houston, Tex, were chosen for the study, which was approved by the Committee for the Protection of Human Subjects. The selection criteria included healthy patients between IV2 and 3Vi years of age with no previous dental experience and those who demonstrated such poor behavior at the initial dental examination that they were deemed to need oral sedation for subsequent restorative visits. Poor behavior included crying, apprehension, uncooperation for the examination and cleaning, poor response to behavioral management techniques and verbal commands, and physical resistance. Risks and benefits of the sedation followed by the presedation instructions were explained to the parent at the initial examination appointment. The patients had taken nothing by mouth for at least 8 hours before the procedure. A written consent form was obtained for each parent or guardian at the initial appointment.
Twenty-two male and female patients participated, with 11 patients in the control group and 11 patients in the experimental group. Preoperative vital signs, including heart rate, blood pressure, and oxygen saturation, were obtained. The control group received 10 mg/ kg of body weight of ketamine orally (Ketalar; Parke-Davis, Morris Plains, NJ), whereas the experimental group received 10 mgAg of ketamine and 1.1 mgAg of promethazine orally (Phenergan syrup fortis; Wyeth-Ayerst, Philadelphia, Pa). Each regimen was disguised in 5 mL of Syrpalta (Emerson Laboratories, Texarkana, Tex), a concentrated, grape-flavored syrup, to mask the bitter taste of ketamine. The study was conducted in a double-blind fashion. The operator, the dentist-anesthesiologist, and the subjects did not know which regimen was selected. A third person randomly selected the drug regimen and administered it to the patients. After the drug administration, the patient remained in the waiting room with the parent until ready for treatment. At 25 minutes, each patient was brought to the operatory and placed onto the Papoose Board (Olympic Medical Corp, Seattle, Wash). The patient was monitored with a precordial stethoscope, pulse oximeter (Mini Pack 911-ST, Pace Tech, Clearwater, Fla), and blood pressure cuff. A total of 50% N2 0-02 was used at 3 L/min of total gas flow for the first 5 to 10 minutes. After the local anesthetic was given, the nitrous oxide was reduced to 35% for the remainder of treatment. A total of 100% oxygen was given during the last 5 minutes of the appointment. The patient received either 1 or 2 quadrants of restoration, including alloys, pulpotomies, and stainless steel crowns. All treatment was performed with rubber dam isolation. One operator performed the dental treatment on all of the patients. The dentist-anesthesiologist recorded the heart rate, oxygen saturation, and blood pressure at 5-minute intervals and also evaluated the patients for crying, alertness, and movement (Table 1) at each of the following intervals: (a) parental separation; (b) placement onto Papoose Board; (c) placement of nasal mask and monitors; (d) local anesthetic administration; (e) placement of rubber dam and bite block; (f) initiation of treatment; and (g) 15-minute intervals until completion of treatment.
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Table 1. Rating Scale for Crying, Alertness, and Movement
|1 Hysterical crying||Fully awake, alert||Violent, interrupting treatment|
|2 Continuous or strong crying||Drowsy, disoriented||Continuous, making treatment difficult|
|3 Intermittent or mild crying||Asleep||Controllable, not interfering with treatment|
|4 No crying||—||No movement|
The overall general behavior of each patient was assessed by the operator and dentist-anesthesiologist immediately after the completion of the treatment, using the rating scale by Houpt and coworkers consisting of 6 behavior classifications (Table 2). cialis soft tabs online
Table 2. Rating Scale for General Behavior
|1 Aborted||No treatment rendered|
|2 Poor||Treatment interrupted, only partial treat|
|3 Fair||Treatment interrupted but eventually all|
|4 Good||Difficult but all treatment performed|
|5 Very good||Some limited crying or movement, eg,|
|during anesthesia or mouth prop inser|
|6 Excellent||No crying or movement|
After the treatment, each patient was returned to the parent and remained in the waiting room for up to 1 hour. The patient’s physical status and alertness were assessed before discharge. Each patient had to be able to respond to verbal commands, be alert or easily arousable, breathe spontaneously, be able to walk with minimal assistance, and be accompanied by a responsible adult before being dismissed. A follow-up telephone call was made by the operator the same evening to determine the patient’s condition. Viagra Soft Tabs
Using the Mann-Whitney U test, the difference in the general behavior was evaluated. The chi-square test was used to compare the vomiting frequencies and the Student’s t test was used to compare the difference in total time in the operatory between the 2 groups.
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