Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial

Somri, Mostafa; Matter, Ibrahim; Hadjittofi, Christopher; Hoash, Naser; Moaddi, Bian; Kharouba, Johnny; Parisinos, Constantinos; Peretz, Benjamin

doi:10.17796/1053-4628-41.2.154

Cited by 9 publications

(11 citation statements)

References 10 publications

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“…Our study found that the PTS was the monitor that detected adverse sedation‐related respiratory events first in the majority of patients. Our findings are similar to Somri et al, comparing observation, pulse oximetry, and capnography (standard monitoring) during dental sedation to the addition of continuous PTS auscultation to standard monitoring; PTS detecting most patients (86%, 19/22) who experienced a sedation‐related respiratory event . Several observations may explain the advantage of the PTS over other respiratory monitors in our patient population.…”

Section: Discussionsupporting

confidence: 89%

The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children

Boriosi

Zhao

Preston

et al. 2019

Pediatric Anesthesia

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Background: Monitoring of ventilation with capnography or a stethoscope is recommended because the detection of ventilatory abnormalities can be significantly delayed by the use of pulse oximetry alone in patients receiving supplemental oxygen.The aim of this study was to evaluate the diagnostic performance of the pretracheal stethoscope with pulse oximetry and capnography in detecting adverse respiratory events during propofol sedation in nonintubated children. We hypothesized that use of the pretracheal stethoscope would facilitate earlier detection of adverse respiratory events. Methods:This was a prospective observational study of children undergoing procedural sedation at a pediatric sedation program. A pretracheal stethoscope, pulse oximetry, and nasal capnography were attached at the discretion of the sedation nurse and provider to monitor ventilation. Results:We enrolled 104 patient encounters (mean recorded time, SD 8.3 ± 5.3 minutes) from February, 2015 to March, 2017. The pretracheal stethoscope was the first monitor to detect adverse events in 64% (25/39) of patients compared to 18% (7/39) for capnography and 15% (6/39) for pulse oximetry. Auscultation performed best at detecting upper airway obstruction but capnography and pulse oximetry performed best at detecting hypoventilation. The positive predictive value for detecting a true ventilation abnormality and 95% CI of the pretracheal stethoscope, pulse oximetry, and capnography was 100% (90%-100%), 18% (10%-31%), and 27% (18%-38%), respectively. The negative predictive value and 95% CI of the pretracheal stethoscope, pulse oximetry, and capnography was 88% (82%-92%), 68% (59%-75%), and 70% (61%-78%), respectively. Limitations are short observation time, nonstandardized application of respiratory monitors, and too much focus on auscultation. Conclusion:A pretracheal stethoscope in conjunction with capnography and pulse oximetry detects most sedation-related adverse events first. Auscultation performed best at detecting upper airway obstruction but capnography and pulse oximetry performed best at detecting hypoventilation. K E Y W O R D S anesthesia, auscultation, capnography, oximetry, propofol, stethoscopes S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Boriosi JP, Zhao Q, Preston A, Hollman GA. The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children.

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Section: Discussionsupporting

confidence: 89%

The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children

Boriosi

Zhao

Preston

et al. 2019

Pediatric Anesthesia

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“…Currently, the office has a female majority that accompanies the progressive enrollment of Brazilian women in higher Conscious or moderade sedation is becoming more common in pediatric patients undergoing minor procedures. 28,29 It is noteworthy that sedation techniques of the child patient, although much discussed, still generate difficulties dilemmas and insecurities for professionals and thus, it is suggested to conduct new studies that address this theme.…”

Section: Discussionmentioning

confidence: 99%

Sedation in Pediatric Patients: Assessment of Pediatric Knowledge

Sampaio¹,

Valadas²,

Neto³

et al. 2019

JYP

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Objectives: This study aimed to evaluate the knowledge of Pediatric Dentists in the city of Fortaleza-CE about the practice of sedation. Methods: Participated 66 professional's specialists registered in the Regional Council of Dentistry-Ceara who worked in public and private service. Data collection was performed through a structured and self-administered questionnaire. The data obtained were tabulated in the IBM SPSS Statistics program and analyzed through a descriptive and exploratory statistical analysis. Results: The results showed that 36.4% of the professionals had 5 to 10 years of specialization, 93.9% were female and 59.1% both worked in the public and private sectors. Only 21.1% had a sedation course and 33.3% used the technique. Midazolam and Cloral Hydrate were the most commonly cited drugs in the sedation technique. Allergic reactions were the most reported as risk of sedation. Conclusion: Considering the limitations of this study, it is possible to consider that the professionals have reasonable knowledge and few use the technique of sedation, mainly because they do not feel safe.

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“…Los fármacos comúnmente utilizados en la sedación corresponden a la familia de las benzodiazepinas, no benzodiazepinas, opioides, barbitúricos y bloqueadores de histamina, estos medicamentos se clasifican como sedantes -hipnóticos o ansiolíticos [26][27] .…”

Section: Introductionunclassified

“…El efecto que tengan dependerá de la dosis y de la respuesta del paciente, logrando así sedación o un efecto tranquilizante en cantidades bajas, y en dosis altas, hipnosis, que corresponde a un estado similar al que se presenta con el sueño 11,[26][27][28] .…”

Section: Introductionunclassified

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Uso del midazolam en el control y manejo de la ansiedad en niños durante la atención odontológica: una revisión bibliográfica

Aros¹,

Bustamante²,

Quezada³

et al. 2018

UstaSalud

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Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial

Abstract: PTS was found to be useful for detecting RAEs during pediatric dental sedation with 0.75mg/kg midazolam and oxygen, in the presence of an anesthesist.

Cited by 9 publications

References 10 publications

The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children

The utility of the pretracheal stethoscope in detecting ventilatory abnormalities during propofol sedation in children

Sedation in Pediatric Patients: Assessment of Pediatric Knowledge

Uso del midazolam en el control y manejo de la ansiedad en niños durante la atención odontológica: una revisión bibliográfica

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