Avery Dr

Bio: Avery Dr is an academic researcher. The author has contributed to research in topics: Sedation & Bedtime. The author has an hindex of 1, co-authored 1 publications receiving 9 citations.

The effect of sleep on conscious sedation: A follow-up study

Abstract: This study evaluated the effect of preoperative sleep on the success of conscious sedation. Seventy-six children, from 18 to 61 months of age, participated in this study. Sixty-two children received chloral hydrate (50-60 mg/kg) and hydroxyzine (15-35 mg) and 14 children received intramuscular meperidine hydrochloride (2.2 mg/kg). Parents were asked to complete a questionnaire which asked several questions about their child's activity the previous day, and their bedtime. The operator ranked the sedations on a scale of 1 to 4, with 1 being good and 4 being poor. The results were statistically evaluated using the Wilcoxon Rank sum test. The children that received a normal amount or greater amount of sleep preoperatively did not show any significantly higher degree of success (p < 0.26) with their sedation appointment. The parents' perception of their child's tiredness did demonstrate borderline (p < 0.08) significance. Children greater than 36 months of age had a significantly higher (p < 0.03) degree of successful sedations. The results of this study demonstrated that there was no clear correlation between the child's preoperative sleep and the outcome of the sedation, but that a tired child may increase the likelihood of a poor sedation. In addition, the child's age at the time of the sedation may affect the outcome of the sedation.

Sedation of Children Undergoing Dental Treatment

Abstract: 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. Search methods Electronic searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Dissertation Abstracts, SIGLE, the World Wide Web (Google) and the Community of Science Database were conducted for relevant trials and references up to 4th August 2011. Reference lists from relevant articles were scanned and the authors contacted to identify trials and obtain additional information. There were no language restrictions. Trials pre-1966 were not searched. Selection criteria Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in children up to 16 years of age. Crossover trials were excluded. Data collection and analysis Information regarding methods, participants, interventions, outcome measures and results were independently extracted, in duplicate, by two review authors. Where information in trial reports was unclear or incomplete authors of trials were contacted. Trials were assessed for risk of bias. The Cochrane Collaboration statistical guidelines were followed. Main results Thirty-six studies were included with a total of 2810 participants. Thirty trials (83%) were at high risk of bias and six (17%) were at unclear risk of bias. There were 28 different sedatives used with or without inhalational nitrous oxide. Dosages, mode of administration and time of administration varied widely. Trials were grouped into placebo-controlled, dosage and head-to-head comparisons. Meta-analysis of the available data was possible for studies investigating oral midazolam vs placebo only. There is weak evidence from five small clinically heterogeneous trials at high risk of bias, that the use of oral midazolam in doses between 0.25 mg/kg to 0.75 mg/kg is associated with more co-operative behaviour compared to placebo; standardised mean difference (SMD) favoured midazolam (SMD 2.98, 95% confidence interval (CI) 1.58 to 4.37, P < 0.001, I² = 91%), which translates to an increase of approximately 1.8 points on the six-point Houpt behaviour scale. There is very weak evidence from two trials which could not be pooled that inhalational nitrous oxide is more effective than placebo. Authors' conclusions There is some weak evidence that oral midazolam is an effective sedative agent for children undergoing dental treatment. There is very weak evidence that nitrous oxide inhalation may also be effective. There is a need for further well designed and well reported clinical trials to evaluate other potential sedation agents. Further recommendations for future research are described and it is suggested that future trials evaluate experimental regimens in comparison with oral midazolam or inhaled nitrous oxide.

Sedation of anxious children undergoing dental treatment.

Abstract: Background: Anxiety about dental treatment or behaviour management problems can be a barrier to its uptake in children. Sedation can be used to relieve anxiety and manage behaviour, unfortunately it is difficult to determine from published research which agents, dosages and techniques are effective. Objectives: To evaluate the relative efficacy of the various conscious sedation techniques and dosages for behaviour management in paediatric dentistry. Search strategy: Computerised: MEDLINE, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Dissertation Abstracts, SIGLE, the World Wide Web (Google) and the Community of Science Database were searched for relevant trials and references up to December 2004. Reference lists from relevant articles were scanned and the authors contacted to identify trials and obtain additional information. There were no language restrictions. Trials pre-1966 were not searched. Selection criteria: Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in anxious children up to 16 years of age. Data collection and analysis: Information regarding methods, participants, interventions and outcome measures and results were independently extracted, in duplicate, by two authors. Authors of trials were contacted for details of randomisation and withdrawals and a quality assessment was carried out not using any formal scoring system. The Cochrane Oral Health Group statistical guidelines were followed. Main results: Sixty-one studies were included with 3246 subjects in total. Overall quality of studies was found to be disappointing with poor reporting often the main problem. Data reported could not be easily aggregated into groups to facilitate description of results. Meta-analysis of the available data was also not possible for the same reason. The variety of differing drug regimens compared made it difficult to isolate groups of studies that were sufficiently similar in design to allow sensible comparison. Where groups of studies could be isolated, then the differing outcome measures used made their meta-analysis impossible. Authors' conclusions: Review authors were not able to reach any definitive conclusion on which was the most effective drug or method of sedation used for anxious children. A list of proposed areas of study was described.

Sleep deprivation for pediatric sedated procedures: not worth the effort.

Abstract: OBJECTIVE Sleep deprivation is commonly used to enhance the effectiveness of pediatric sedation and to decrease sedation failures. We reviewed our sedation database to evaluate the efficacy of sleep deprivation. METHODS The entire pediatric sedation unit database (n = 5640) was reviewed retrospectively. Patients without complete data sets were excluded. The remaining patients were separated into 2 groups: 3272 patients who underwent noninvasive procedures and 1210 who underwent invasive procedures. A subgroup of noninvasive procedure patients <2 years old (n = 1398) was also analyzed. The sedation failure rate (%) and nursing care hours for both sleep-deprived and non-sleep-deprived patients were analyzed. RESULTS In the noninvasive procedure group, the sedation failure rate was 5.7% for the sleep-deprived patients and 5.6% for the non-sleep-deprived patients, whereas the sedation failure rate for children <2 years old was 4.2% for sleep-deprived patients and 4.7% for non-sleep-deprived patients. The sedation failure rate in the invasive procedure group was 7.5% for sleep-deprived patients and 7.2% for non-sleep-deprived patients. Nursing care hours in the noninvasive procedure group were significantly longer for the sleep-deprived patients (4.5 +/- 1.6 hours) versus the non-sleep-deprived patients (3.8 +/- 1.6 hours). This finding was true also for the subgroup of children <2 years old (sleep-deprived patients: 4.2 +/- 1.4 hours; non-sleep-deprived patients: 3.5 +/- 1.4 hours). No difference was noted in nursing care hours for the invasive procedure group. CONCLUSIONS Sleep deprivation had no effect in reducing the pediatric sedation failure rate. The patients having noninvasive procedures who were sleep deprived required significantly more nursing care hours than their non-sleep-deprived counterparts. Routine use of sleep deprivation for pediatric sedation should be critically reevaluated.

Dosis efectiva de midazolam para sedación consciente en estomatología pediátrica

Abstract: The study assessed the dosage, clinical sedative effect, and safety of intraoral and intranasal midazolam in 20 children from the pediatric dental clinic. Data was collected fasm children classified as ASA 1 and Frankl type II and III. Sedation was adequate to ensure successful completion of treatment in patients with oral sedation. Sedation was achieved with an oral dosage of 0.3 mg/kg of midazolam chlorhydrate. There were no signs of respiratory depression or of oxygen desaturation below 98% on pulse oximetry. No supplemental oxygen was required and there were no other complications. It is concluded that intraoral midazolam is a safe and effective alternative in the definitive treatment to reduce in pedodontics children.

Sedation of Pediatric Patients for Dental Procedures

Abstract: The challenges of sedating a child for dental procedures are multifactorial [1]: The patient’s age, health, temperament and emotional status, parental concerns, clinician philosophy on patient management, extent and quality of clinician training and experiences with sedation, state dental board regulation of sedation, issues of third party coverage or parental reimbursement, knowledge of and adherence by clinicians to sedation guidelines, facility preparedness, and support staff experiences are but a few of many important considerations. Equally important and challenging are the extent of the dental disease and the inherent requisites of those dental procedures which require complete patient cooperation, good manual dexterity, and dental materials whose outcomes are technically sensitive to and dependent on local factors in the operative field (e.g., salivary contamination). Probably the most disconcerting issue is that dental disease, more specifically dental caries or cavities, is the single most common chronic disease of childhood and it is preventable [2].