Kaygı düzeyi yüksek çocuklarda oral midazolam premedikasyonu: farklı dozların etkinliği

Giriş ve Amaç: Çocuk diş hekimliğinde korku ve kaygı nedeniyle diş tedavileri gerçekleştirilemediğinde sedasyon veya genel anestezi uygulamalarına ihtiyaç duyulmaktadır. Sedasyon amacıyla en sık uygulanan yöntemlerden biri ise oral sedatif premedikasyon ardından nitröz oksit (N2O) inhalasyonudur. Bu araştırmada diş tedavileri planlanan kaygı düzeyi yüksek çocuk olgulara oral yolla uygulanan midazolamın farklı dozlarının, sedasyon üzerine etkinliğinin değerlendirilmesi amaçlandı. Yöntem ve Gereçler: Nitröz oksit sedasyonu altında diş tedavisi planlanan, Frankl Davranış Skalası (FDS)'na göre kaygılı (FDS 3-4), ASA I, 3-7 yaş arası toplam 60 olgu randomize olarak 4 gruba ayrıldı. Yaşına uygun olarak gıda ve sıvı alımı 3-5 saat önlenen olgulara tedavi işleminden 15 dakika önce 0,2 mg kg'1 (Grup I), 0,5 mg kg'1 (Grup II), 0,75 mg kg'1 (Grup III), 1 mg kg1 (Grup TV) midazolam (Dormicum® 15 mg 3 mL'1) oral yolla verildi. Beşinci dakikadan itibaren Ramsay Sedasyon Skalası (RSS) ile sedasyon düzeyleri kaydedilmeye başlandı. On beşinci dakikada diş ünitine alınarak nabız oksimetresi ile periferik oksijen satürasyonu (SpO2) ve kalp atım hızı (KAH) monitorize edildi. Nazal maske ile % 40/60 N2O/O2 inhalasyonu altında diş tedavileri gerçekleştirildi. Tedavi bitiminde %100 O2 uygulaması ardından derlenme odasına alınan olgular en az 45 dakika izlenmek kaydıyla derlenme kriterleri gerçekleşene kadar gözlem altında tutuldu. Görülen yan etkiler kaydedildi. Hastalar; 45.dakikada ya da derlenme kriterleri gerçekleştiğinde önerilerle taburcu edildiler. Bulgular: RSS ortalamaları Grup T de tüm gruplardan düşük olmak üzere Grup İT de de 15-45. dk arası ölçümlerde Grup III ve TV'den düşük bulundu (p

Oral midazolam premedication in anxious children: Efectiveness of different doses

Aim: In pediatric dentistry, applications sedation or general anesthesia are necessary when the treatment is not carried out because of children's fear or anxiety. After premedication with nitrous oxide (N2O) inhalation for the purpose of sedation is a common application. This research's aim was to investigate effectiveness of different midazolam doses on sedation in anxious children who were scheduled for dental treatment. Material and methods: Sixty children planned for dental treatment under N2O sedation, ASA I, 3-7 years of age, with anxiety according to Frankl Behavior Scale (FBS 3-4) were randomized into 4 groups. After completion of fasting 3-5 hours prior to application, 0,2 mg kg'1 (Group I),fi,5 mg kg1 (Group II), 0.75 mg kg'1 (Group III) and 1 mg kg'1 (Group TV) midazolam (Dormicunf 15 mg 3 mL'1) were administered orally 15 minutes before dental treatment. Five minutes later midazolam administrations, Ramsay Sedation Scores (RSS) were recorded. Patients were monitored with pulse oximetry at 15 minutes after giving oral midazolam and followed up in terms of saturation of oxygen (SpO2) and heart rate (HR) values. Dental treatment was carried out applied under % 40160 N2O/O2 sedation. Patients were inhalated by 100 % O2 at the end of the treatment procedure, and then transported to recovery room. Patients were observed for minimum 45 minutes or until recovery parameters completed. If any side effects happened, it was recorded. Results: Mean RSS values in Groups I were smaller than the others and mean RSS values in Group II smaller than the Group III and Group IV at 15-^45 minute time interval (p<0,05). Time dependent mean heart rate and SpO2 values in Groups III and TV were lower than Group I and Group II (p<0,05). Conclusion: It is concluded that giving midazolam orally as premedication in pediatric age group scheduled for dental treatment is acceptable, and effective at 0,75 mg kg'1 dose.

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