Pediatric procedural sedation outcomes using midazolam and hydroxyzine with and without meperidine

Abstract

Background: Procedural sedation is an advanced pharmacological behavior guidance technique frequently used in the pediatric dental setting. It can be offered as an option for dental treatment for a young, potentially uncooperative pediatric patient to safely and effectively complete dental restorative needs. However, there are no standard regimens or drug dosages used among pediatric dentists, and sedation outcomes vary widely. Purpose: The primary objective of this randomized trial was to assess the effects of oral sedation using midazolam and hydroxyzine with and without meperidine on sedation outcomes in pediatric dental patients. The relationship between child temperament and sedation outcomes was also assessed. Methods: This pilot study recruited 14 children between the ages of 3-7 who met study eligibility criteria and were planned to undergo dental treatment with oral sedation at the University of Washington Center for Pediatric Dentistry. The children were randomly assigned to receive a regimen of midazolam and hydroxyzine with or without meperidine. Parents completed the Child Behavior Questionnaire Short Form (CBQ-SF) to assess temperament. Results: Out of 14 participants, there were no significant differences in sedation outcome in regard to age, sex, insurance status, sedation regimen, isolation method, treatment complexity, and procedure. There were also no significant differences in the effect of child temperament on overall sedation outcome, although within the non-narcotic regimen children with sedation failures displayed higher levels of both effortful control and extraversion/surgency. Conclusion: Further data collection is needed to assess the effect of procedure variables and child temperament on sedation outcomes. Conclusions regarding these relationships cannot be drawn at this time due to the small sample size. However, results from this study will contribute to identification of best practices when choosing a sedation regimen and improve our ability to identify optimal candidates for pediatric procedural sedation.