No description available.

Purpose: Compare moderate oral sedation of pediatric patients using Hydroxyzine and Meperidine with either Diazepam or Midazolam in management of pediatric dental patients. Methods: Randomized, double-blind, crossover pilot study of patients 3 to 7 years of age requiring two sedation visits. Frankl and Houpt behavior scores recorded at injection time, initiation of treatment and 100% oxygen at end of treatment. Postoperative phone call surveys conducted within eight hours and within 24 hours of discharge. Wilcoxon Signed-Rank tests, Fisher’s Exact Chi-squared test and 0.10 significance level. Results: 25 subjects completed 35 sedations. Eight participants completed both treatments and demonstrated significantly higher total Houpt Scores with Diazepam at all treatment stages. Frankl scores favored Diazepam at injection time. More abnormal behavior was found with Midazolam, less memory of the visit with Diazepam, but longer sleep time with Diazepam. Conclusions: Sedation with the Hydroxyzine, Meperidine and Diazepam regimen may allow for a better overall sedation experience. Postoperative monitoring is essential. The results are promising and demonstrate the value of a larger study on sedation with Diazepam.

No description available.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2018-07-17T19:36:02Z No. of bitstreams: 2 Tese - Geovanna de Castro Morais Machado - 2016.pdf: 3567398 bytes, checksum: a41e8b4d345af4e1180cf1e6e0b0fe15 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-07-18T11:37:16Z (GMT) No. of bitstreams: 2 Tese - Geovanna de Castro Morais Machado - 2016.pdf: 3567398 bytes, checksum: a41e8b4d345af4e1180cf1e6e0b0fe15 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-07-18T11:37:16Z (GMT). No. of bitstreams: 2 Tese - Geovanna de Castro Morais Machado - 2016.pdf: 3567398 bytes, checksum: a41e8b4d345af4e1180cf1e6e0b0fe15 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-12-13 / Objectives: Moderate sedation is indicated to control children’s behavior during dental care, reducing anxiety and maintaining the child's well-being. However, some sedated children do not present good behavior making it difficult to perform dental procedures. This study investigated the association of possible individual factors (temperament) and family (parents’ dental anxiety, parents’ pain catastrophizing and coping strategies adopted by parents) with the children’s behavior during dental treatment under moderate sedation. Methods: A total of 110 children/parents (<7 years), referred to sedation at Dental Sedation Center (NESO) of the Faculty of Dentistry of the Federal University of Goiás, for not have cooperated during dental care, and their parents, participated of this observational study of data from two clinical trials. Children had two appointments: clinical examination and tooth restoration, with local anesthesia and rubber dam, under moderate sedation. The restorative session was filmed for further evaluation of the children's behavior by trained and calibrated observers. The behavior was assessed using the Ohio State University Behavioral Rating Scale OSUBRS. Positive behavior was considered when the children presented 80% or more of the sum of the scores 1 and 2 (quiet or crying) during the entire session. The children’s stress was evaluated through the increased cortisol levels present in the saliva, collected in three moments: arrival, 25 min after local anesthesia, and 25 min after the end of the procedure. Children’s temperament was assessed through the Children’s Behavior Questionnaire (CBQ) answered by parents. Factors related to parents’ anxiety were thus evaluated: dental anxiety using Corah Dental Anxiety Scale; level of pain catastrophizing through the Pain-Catastrophizing Scale-parents; coping strategies through Brief COPE. Data were analyzed using descriptive statistics and the Chi-square test, Friedman, Wilcoxon, Mann-Whitney, Kruskal Wallis or t-test for independent samples. Results: More than half of the children displayed negative behavior (n = 60 54.5%). Temperament did not associate with the negative behavior of children. Extroversion/surgency (P = 0.03) and the subscales ‘activity level’ (P = 0.04), ‘impulsivity’ (P = 0.04) and ‘smiling/laughter’ (P = 0.01) differed between behavior groups, where children with positive behavior had higher scores than those who had negative behavior. In a sample of 42 children, 31 (73.8%) were reactive to stress during local anesthesia and temperament was not associated with increased levels of children’s stress. Dental anxiety and pain catastrophizing were not associated with negative children’s behavior. Parents of children with negative behavior had higher scores in maladaptive coping and Venting subscale, and lower scores in the Acceptance subscale. Conclusion: Coping strategies adopted by the parents explained, in part, negative or positive children´s behavior. These results have shown that parental coping strategies may have protective or destructive effects on children's behavior. Temperament was not associated with negative behavior and did not influence the children´s stress during the injection of local anesthesia. However, many children were stressed during this procedure, a fact that should be always considered by the professional who assist children under moderate sedation. / Objetivos: Sedação moderada é recomendada para o controle do comportamento infantil durante o atendimento odontológico. Ainda assim, algumas crianças sedadas não colaboram dificultando o tratamento. Esse estudo investigou a associação de possíveis fatores individuais (temperamento) e familiares (ansiedade odontológica dos pais, nível de catastrofização da dor pelos pais e estratégias de coping adotadas pelos pais) com o comportamento da criança durante sedação odontopediátrica. Métodos: Um total de 110 crianças/110 acompanhantes, (< 7 anos) encaminhadas para sedação no Núcleo de Estudos em Sedação Odontológica (NESO) da Faculdade de Odontologia da Universidade Federal de Goiás, por não colaborarem durante atendimento odontológico, fizeram parte deste estudo observacional que usou dados de dois ensaios clínicos. As crianças foram atendidas em duas sessões: exame clínico e restauração de um dente, com anestesia local e isolamento absoluto, sob sedação moderada. A sessão do atendimento restaurador foi filmada para posterior avaliação do comportamento da criança por observadores treinados e calibrados. O comportamento foi avaliado por meio da Ohio State University Behavioral Rating Scale OSUBRS. Comportamento positivo foi considerado quando a criança apresentou 80% ou mais da soma dos escores 1 e 2 (quieto ou com choro) durante toda a sessão de atendimento. O estresse da criança foi avaliado através do aumento dos níveis de cortisol presentes na saliva coletada em três momentos: chegada, 25 minutos após anestesia local e 25 minutos após o final do procedimento. O temperamento foi avaliado usando o Children’s Behavior Questionnaire (CBQ) respondido pelos pais. Fatores relacionados à ansiedade dos pais foram assim avaliados: ansiedade odontológica usando a Escala de Ansiedade Odontológica de Corah; nível de catastrofização da dor através da Escala de Catastrofização da Dor-Pais; estratégias de coping por meio do COPE Breve. Os dados foram analisados por meio de estatística descritiva e dos testes qui-quadrado, Friedman, Wilcoxon, Mann-Whitney, Kruskal Wallis ou teste t para amostras independentes. Resultados: O temperamento não se associou ao comportamento negativo das crianças. Extroversão (P=0.03) e as subescalas ‘nível de atividade’(P=0.04), ‘impulsividade’ (P=0.04) e ‘riso/sorriso’ (P=0.01) diferiram entre os grupos de comportamento, onde as crianças com comportamento positivo tiveram escores mais altos que as que tiveram comportamento negativo. Entre 42 crianças, 31 mostraram-se reativas ao estresse durante a anestesia local e o temperamento não se associou ao aumento no nível de estresse das crianças. Ansiedade odontológica e catastrofização da dor pelos pais não se associaram ao comportamento negativo das crianças. Pais de crianças com comportamento negativo apresentaram escores mais altos no coping mal-adaptativo e na subescala Desabafo e escores mais baixos na subescala de Aceitação do COPE Breve. Conclusão: Estratégias de coping adotadas pelos pais explicaram, em parte, o comportamento negativo ou positivo das crianças. Estes resultados mostraram que estratégias de enfrentamento dos pais podem ter efeitos protetores ou destrutivos sobre o comportamento das crianças. O temperamento não se associou ao comportamento negativo e nem influenciou no estresse das crianças durante a aplicação da anestesia local. No entanto, muitas crianças mostraram-se estressadas durante esse procedimento, fato que deve ser sempre considerado pelo profissional que atende crianças sob sedação moderada.

Magister Scientiae Dentium - MSc(Dent) / This study was done to show that sedation is a safe and a viable option in young children. Dental procedures were done on children aged two to ten years. Two hundred children were included in the study. In all of these children the procedures were completed. Only two children were excluded, because an intravenous line could not be placed on the one child, and the other child was unmanageable under sedation. The safety of sedation was evaluated looking at the incidence of adverse events and complications. No serious adverse effects or complications occurred. The complications that occurred were all corrected with minimal or non-invasive interventions. Only six of the two hundred children required oxygen to correct a drop in oxygen saturation.