292 - A Prospective Observational Study Assessing Behavior During Pediatric Procedural Sedation.

Purpose:  Currently, there is insufficient data to support the synergistic effect of nitrous oxide (N2O) and midazolam (MDZ) and whether the use of N2O with MDZ deepens a child’s level of sedation. The purpose of this study is to assess the differences in patient behavior during procedural sedations using MDZ (oral/intra-nasal) versus MDZ and N2O.

Methods:  A prospective observational study was conducted on ASA 1 patients between the ages of 2 to 8 years to assess behavioral responses to two procedural sedation regimens in the pediatric dental setting: 0.5 mg/kg MDZ and 50% N2O (N2O and MDZ group 1) and 0.5mg/kg midazolam (MDZ group 1). Primary outcomes assessed were patient behavior and vital signs intra-operatively using the Pediatric Sedation State Scaling System (PSSS).

Results:  A total of 42 subjects were recruited for this study, n=26 in group 1(MDZ/N2O) and n=16 in group 2 (MDZ). The majority of subjects (n=38) received intra-nasal midazolam. Behavior trends were similar between both groups. A decline in behavior was observed for both groups during administration of local anesthetic and while treatment was being delivered. Additionally, there was a significant rise in heart rate for both groups during administration of local anesthetic administration and during treatment. Systolic blood pressure increased significantly during administration of local anesthetic and at the time of treatment for group 1 (MDZ and N2O). Oxygen saturation remained above 99 throughout the entirety of the appointment for all subjects.

Conclusions: When used in combination, midazolam and nitrous oxide do not produce a significant improvement in observed behavior when compared to midazolam only for procedural dental sedation. Patients who received nitrous oxide in addition to midazolam remained in a minimally sedated state without any significant respiratory distress or hypoxic events.