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Open Access Publications from the University of California

A Retrospective Study of Chloral Hydrate vs. Midazolam Containing Triple Cocktail Oral Sedation in Pediatric Dentistry

  • Author(s): Uppula, Anuhya
  • Advisor(s): Le, Thuan
  • et al.


Purpose: To evaluate, retrospectively, the safety and efficacy of two moderate oral conscious sedation drug regimens used at UCSF Pediatric Dentistry Clinic: chloral hydrate, meperidine, and hydroxyzine (CH/M/H) versus midazolam, meperidine, and hydroxyzine (Mid/M/H).

Methods: Data was collected from sedation records from 7/21/2010- 6/3/2015 at UCSF Pediatric Dental Clinic. The records were screened and those meeting inclusion criteria were analyzed for patient behavior, completion of treatment, and adverse events. Appropriate statistically analyses were conducted based on specific collected data set with P-value <0.05 to be significant different.

Results: Of the original sample of 1016 sedation charts, 295 met the inclusion criteria for analysis. There were 27 adverse reactions (vomiting, over-sedation, or desaturation) of which 16 were in Mid/M/H cases and 11 were in CH/M/H cases. There was no statistically significant difference between the two regimens in safety. The average behavior scale was closer to sleeping for CH/M/H cases whereas it was closer to crying/moving for Mid/M/H cases. However, there was a significant difference between the two regimens in efficacy. CH/M/H worked significantly better on children younger than 9 years of age. Resident operator experience did not significantly affect sedation outcomes. Moderately uncooperative patients had significantly better sedation results with the CH/M/H regimen than with the Mid/M/H regimen. For fairly cooperative and extremely uncooperative patients, there was no significant difference.

Conclusion: There was a significant difference in efficacy between the two triple cocktail regimens, with the CH/M/H regimen showing better behavior outcomes and completion of treatment versus Mid/M/H regimen. There was no significant difference in safety between the two regimens. Per this study, as long as sedation guidelines are followed, the chloral hydrate regimen can be safely and effectively used in pediatric dental oral conscious sedation.

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