Number of Sedatives is Associated with Post-Sedation Morbidity in Children

Background: Procedural sedation (PS) is an accepted advanced behavior management technique approved by the American Academy of Pediatric Dentistry. Levels of PS have been identified to exist on a continuum based on level of sedation (minimal/moderate/deep). Previous studies have associated depth of sedation with number of PS agents used. Objective: To determine if post-sedation morbidities can be associated with number of sedative agents used in children. Methods: A Quality Assurance database was maintained of all PS conducted between 2008-2011. Intra-Sedation and Post-sedation morbidity data was assessed with a phone call to caregiver within 48 hours of procedure. All PS were performed under one standardized attending Pediatric Dentist.  Results: Data were collected from 493 procedural sedations, with 43% (213) being with one agent, 32% (156) with 2 agents and 25% (124) being with three agents. The most common single agent used was Midazolam (98% of all one agent sedations). The most common two agent combination was Midazolam and Meperidine (63% of all two agent sedations). The most common three agent regimen was Midazolam, Meperidine and Promethazine (71% of all three agent sedations). Sedations with one agent were significantly shorter in duration than those with three agents (p=.001), with children also experiencing significantly less post-sedation lip biting (p=.022). Sedations with one agent were rated as effective significantly more than those with two or three (p<0.0001). Children experienced significantly more nausea and vomiting when two agents were used compared to one or three agents (p=.002). There were no differences in incidence of cheek biting, tongue biting or hiccoughs. Conclusion: Number of sedative agents used during pediatric procedural sedation impacts post-sedation morbidity.