UBC Theses and Dissertations
Review of pediatric dentistry oral sedation outcomes and influences Alkafaji, Zina
Objectives: The UBC Graduate Pediatric Dentistry Program’s oral sedation clinic has evolved since it began in 2011. The study aimed to evaluate the effectiveness and safety of the various sedation regimens used, and to assess how regimens were influenced by the experience and opinions of clinical instructors. Methods: A retrospective chart review of all oral sedation appointments that took place between March 2011 and May 2014 was completed. The outcome variables of interest were effectiveness and safety. Descriptive and comparative statistics were applied to analyze quantitative data. Six UBC Pediatric Dentistry clinical instructors were invited for interviews through a purposive sampling technique to further understand both their views toward sedation regimens and teaching sedation to graduate students. Thematic analysis was applied to code interview transcripts. Results: There were 195 oral sedation appointments during the study period. The three most commonly used regimens were: midazolam and hydroxyzine (MZH) (45%); midazolam (MZ) (24%); and meperidine, chloral hydrate, hydroxyzine, and dimenhydrinate (MCHHD) (17%). With respect to safety, vital signs and level of sedation were examined. Children undergoing MZH sedations were rated to be in “deep” sedation 1.4% of the time, compared to 12.5% in the MCHHD group. MZH sedations were rated “effective/very effective” 90% of the time, compared with 88% for MCHHD sedations. Data for sedation level and effectiveness of the MZ group was limited. Domains that emerged from the interviews were safety, effectiveness, preparation, and preferences; with risk tolerance as the overarching theme. Conclusion: MZH and MCHHD have similar effectiveness however MZH has a better safety profile. Clinicians with higher risk tolerance tended to practice sedation more frequently than those with low risk tolerance. Accordingly, high risk tolerance clinicians felt students should learn sedation more extensively than did those with low risk tolerance. Two main recommendations emerged from the study: (1) complete and inclusive sedation records are critical to fully understanding the effectiveness and safety of sedation regimens; 2) clinicians may desire to have self-awareness regarding their risk tolerances in the context of both practicing and teaching oral sedation in pediatric dentistry.
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