The Effect of Biophysical Characteristics and Dosing on Pediatric Oral Sedation Outcome

Abstract

Purpose: For patients who are overweight or obese dosing sedation medications at actual weight may result in a relative overdose. These patients require special consideration because of physiologic differences in the volume of distribution, metabolism, and clearance of drugs. 1, 2 No single dosing scalar has been recommended for procedural sedation dosing. This study examined the biophysical characteristics of pediatric dental sedation patients to determine the effect of child weight and the impact of medication dose on sedation success. Methods: Records of pediatric dental sedations performed at a university-based dental clinic over the course of 5 years (2/2/11 – 2/1/16) were reviewed to determine eligibility for inclusion. Healthy children aged 24 -144 months, who received an oral preparation of meperidine (1.5mg/kg), midazolam (0.3mg/kg), and hydroxyzine (1.0mg/kg) whose treatment was supervised by the same attending pediatric dentist were included in the study. Sedation dose for all eligible cases was calculated using the lesser of actual weight or the Centers for Disease Control and Prevention (CDC) 50th weight for age percentile (Ideal Body Weight). Patient demographics and biophysical characteristics (age, height, and weight) were recorded and used to calculate body mass index (BMI) percentiles. Sedation dose for each case was compared with the child’s actual weight to determine if the dose delivered was therapeutic or sub-therapeutic. The outcome variables of sedation success and failure were analyzed to determine association with the dose delivered. Results: The sample population consisted of 427 children aged 24 – 144 months (mean = 76.8 months, SD = 21.6 months). The overall sedation success rate as measured by the Houpt scale was 74% (N=315). There was not a significant difference in success rate by gender, ASA status, insurance status, CDC BMI percentile for age, CDC weight for age percentile, or dose delivered (therapeutic or sub-therapeutic). Older age category and simple treatment type were significantly associated with sedation success (P = 0.036 and P = 0.045 respectively). The calculated ideal body weight (IBW) and lean body weight (LBW) of the study participants was significantly greater than the dosing weight used (P < 0.001 and P < 0.001 respectively). Conclusions: The majority of children who received oral sedation for dental care in this study were classified as having a healthy weight. However, patients were on average heavier than the CDC 50th weight for age percentile. For patients who are overweight or obese dosing sedation medications at actual weight may result in a relative overdose, therefore BMI percentile should be considered in case selection for oral sedation.