Rs. Litman et al., CHLORAL HYDRATE SEDATION - THE ADDITIVE SEDATIVE AND RESPIRATORY DEPRESSANT EFFECTS OF NITROUS-OXIDE, Anesthesia and analgesia, 86(4), 1998, pp. 724-728
The combination of chloral hydrate and nitrous oxide (N2O) is often us
ed for sedation in pediatric dentistry. The purpose of this study was
to determine the extent to which N2O increases the level of sedation a
nd respiratory depression in children sedated with chloral hydrate. Th
irty-two children, 1-9 yr, received chloral hydrate, 70 mg/kg (maximum
1.5 g), and then received N2O (30% and 50%). Hypoventilation (maximal
PETCO2 > 45 mm Hg) occurred in 23 (77%) children during administratio
n of chloral hydrate alone, in 29 (94%) breathing 30% N2O (P = 0.08 ve
rsus control), and in 29 (97%) breathing 50% N2O (P = 0.05 versus cont
rol). Mean PETCO2 was increased during 30% (P = 0.007) and 50% (P = 0.
02) N2O administration. Using chloral hydrate alone, 8 (25%) children
were not sedated, 10 (31%) were consciously sedated, and 14 (44%) were
deeply sedated. Using 30% N2O, 2 children (6%) were not sedated, 0 we
re consciously sedated, and 29 (94%) were deeply sedated (P < 0.0001).
Using 50% N2O, 1 child (3%) was not sedated, 0 were consciously sedat
ed, 27 (94%) were deeply sedated, and 1 (3%) had no response to a pain
ful stimulus (P < 0.0001). We conclude that the addition of 30% or 50%
N2O to chloral hydrate often causes decreases in ventilation and usua
lly results in deep, not conscious, sedation in children. Implications
: Pediatric sedation in the dental office often consists of nitrous ox
ide (N2O) after chloral hydrate premedication. We found that the addit
ion of 30% or 50% N2O to chloral hydrate often causes decreases in ven
tilation and usually results in deep, not conscious, sedation in child
ren.