Morphine Revisited in Pediatric Dentistry: A Retrospective Study of a Moderate Sedation Regimen of Morphine + Hydroxyzine + Ibuprofen
- Author(s): Shaffer, Adam Matthew
- Advisor(s): Den Besten, Pamela K
- et al.
Purpose: The purpose was to evaluate the safety and efficacy of a moderate sedation drug regimen consisting of P.O. morphine (0.66 mg/kg, up to a maximum of 30 mg), hydroxyzine (25 mg flat dose), and ibuprofen (100 mg flat dose), as utilized with nitrous oxide and oxygen sedation.
Methods: A convenience sample of 595 sedation records were retrieved from one group of dentists all utilizing the same protocols. The sedation records were chronologically screened and those meeting inclusion and exclusion criteria were subsequently analyzed for descriptive data, oxygen saturation, cardiovascular stability, behavioral data, and adverse events.
Results: Of the original sample of 595 sedation records, 360 (60.5%) met inclusion and exclusion criteria for further analysis. Of the 360 records analyzed, the distribution of males and females was roughly equal (49.4% male, 50.6% female), with a median age of 5.0 years (range: 2.0 years to 11.8 years) and a median weight of 18.6 kg (range 9.5 kg to 43.18 kg). The median wait time was 63 minutes, and the median working time was 70 minutes. Asymptomatic hypotension occurred in 18 of 340 records (5.3%); asymptomatic tachycardia occurred in 20 of 327 records (6.1%), and asymptomatic bradycardia occurred in 14 of 349 records (4.3%). Sedated patients were quiet 72.1% of the time, crying 13.4% of the time, struggling 6.0% of the time, sleeping 4.0% of the time, and engaging in other behaviors 4.6% of the time. Significant adverse events occurred in 5 of 360 records (1.4%), with a true desaturation event occurring in one sedation record (SpO2=87), prolonged or excess sedation occurring in three sedation records, and intraoperative nausea/vomiting occurring in one sedation record.
Conclusions: The results suggest morphine may serve as a viable opiate in P.O. moderate sedation regimens in pediatric dentistry.