Deep sedation for pediatric dental procedures: Is this a safe and effective option?

Abstract

Objective: Sedation may be needed for safe, effective completion of pediatric dental procedures. Procedural sedation is performed in a children's hospital based dental office. The three sedation approaches: a propofolonly (P-O) approach (2-3mg/kg titrated to the needed level of sedation), an approach that includes either IV ketamine (K+P) (0.25 or 0.5mg/kg) or IV fentanyl (F+P) (0.5-1mcg/kg) prior to propofol administration. We sought to determine safety and efficacy of various propofol based sedation protocols. Study Design: Retrospective review of 222 patients receiving a propofol-only (P-O), ketamine+propofol (K+P) or fentanyl+propofol (F+P) approach. Results: There were 44 patients in P-O group, 154 in K+P group and 24 in F+P group with mean age (4.8±3.4y) and mean weight (19.7±6.7kg). All the patients completed procedures successfully. Mild hypoxemia occurred in 24% of cases and resolved with nasal cannula. Mean total dose of propofol was similar in all groups (P-O 8.2mg/kg, K+P 9.5mg/kg, F+P 9.6mg/kg, p=0.15). Although procedure and recovery times were similar in all groups, discharge times in K+P group were significantly shorter than P-O group and F+P group respectively (K+P 9.35±8.93.min, P-O 13.57±10.42min, F+P 10.42±4.40 p= 0.002). Conclusion: Sedation can be accomplished safely and effectively in a children's hospital based dental office using propofol-based sedation.