Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial

BMC Pediatrics

Research Article

Heloisa de Sousa Gomes¹  Paulo Sucasas Costa²  Luciane Rezende Costa³  Hugo Sérgio de Oliveira Gomes⁴  Joji Sado-Filho⁵ 

[1] Dentistry Graduate Program, Universidade Federal de Goiás, Goiânia, Brazil;Department of Paediatrics, Universidade Federal de Goiás, Faculdade de Medicina, Rua 235 com Primeira Avenida, sem número, Setor Universitário, CEP 74605-020, Goiânia, Brazil;Faculty of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil;Universidade Federal de Goiás, Goiânia, Brazil;University Hospital, Universidade Federal de Goiás, Goiânia, Brazil;

关键词: Conscious sedation;    Midazolam;    Ketamine;    Sevoflurane;    Anti-anxiety agents;    Child behaviour;    Drug-related side effects and adverse reactions;    Pain management;    Dental anxiety;    Dental care for children;   

DOI  :  10.1186/s12887-017-0838-4

 received in 2015-10-14, accepted in 2017-03-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThere is little evidence concerning the effect of sevoflurane in outpatient procedural sedation, especially in children. We hypothesised that the addition of sevoflurane to a sedation regimen improves children’s behaviour with minimal adverse events.MethodsThis is a randomised, triple-blind clinical trial conducted on an outpatient basis. Participants were 27 healthy children aged 4 to 6 years, who previously refused dental treatment with non-pharmacologic methods. All participants received oral midazolam (0.5 mg/kg, maximum 20 mg) and oral ketamine (3 mg/kg, maximum 50 mg) and, in addition: Group MK – 100% oxygen; Group MKS – inhalational sevoflurane at a sedative dose (final expired concentration between 0.3 and 0.4%). Dental appointments were video recorded for assessment of the children’s sleep patterns, crying, movements, and overall behaviour during the procedure with the Houpt scale. Intra- and post-operative adverse events were systematically reported. Data were analysed by bivariate analyses in the IBM SPSS v. 19, at a significance level of 5%.ResultsMK (n = 13) and MKS (n = 14) did not differ regarding the Houpt scores (P > 0.05), but 53.8% of children in the MK group showed hysterical and continuous crying at the time of the local anaesthesia injection, compared to 7.1% of children in the MKS group (P = 0.01; phi = 0.5). There was a trend toward less crying and movement over time during the dental appointment in the MKS group (P = 0.48). Minor adverse events were observed in 10 MK children and 4 MKS children (P = 0.01).ConclusionsThe addition of sevoflurane to oral midazolam-ketamine improved the children’s crying behaviour during local anaesthetic administration, and did not increase the occurrence of adverse events.Trial registrationClinical Trials NCT02284204. Registered 5 October 2014.

【 授权许可】

CC BY   
© The Author(s). 2017