Methods: 192 procedures under IV sedation in 172 children during 22 months. AGES: 4 mo -16 y. GROUPS: (1) normally developed (physically and mentally) with dental anxiety; (2) craniofacial anomalies/systemic disease (21% of cases): cleft lip/palate, Appert, San-Fillipo, epidermolysis bullosa, Pierre-Robin, cardiac anomalies, epilepsy; (3) mental retardation. DENTAL TREATMENTS: restorative (all quadrants in a single appointment), orthodontic, surgical interventions (extractions, bone/soft tissue biopsies, impacted tooth buds exposure). DURATION: 15-120 minutes. Although these children are prone to difficult intubation, we deliver sedation without intubation under spontaneous ventilation (99%). Patients with a history of regurgitation are electively intubated (1%). Sedation and dental treatments are performed by specialists. Deep sedation with no cooperation is administered, combining midazolam, propofol, remifentanil and pethidine. Adding remifentanil has improved emergence and reduced propofol requirements. Close cooperation between surgeon and anesthesiologist regarding airway control and pain management is mandatory. Local anesthesia, Suction, rubber dam and oropharyngeal pack are emphasized.
Results: No clinically significant adverse events (aspiration, laryngospasm, apnea, cardiac arrest) were encountered. One patient (0.5%) with dental anxiety was emergently intubated due to lack of experience of the anesthesiologist. All preplanned procedures were successfully completed except for one orthodontic case (3%) with epidermolysis bullosa for fear of excessive bulla formation. All patients were discharged home within 2-4 hours except for one case hospitalized for 24 hours supervision because of cardiac arrest in a previous GA.
Conclusions: IV sedation under spontaneous ventilation, with close cooperation between dental surgeon and anesthesiologist, is successfully and safely managed in dental treatment.