Physiologic response and adverse reactions in pediatric dental patients sedated with promethazine and chloral hydrate or meperidine.

Drug combinations for premedication are used to allay apprehension and to counter adverse reactions such as nausea and vomiting, but drug combinations potentially increase the risk of other adverse reactions. Monitoring is very important, and the Guidelines for elective use of conscious sedation of the American Academy of Pediatric Dentistry I recommend assessing heart rate and respiratory rate at various intervals during and after the sedation. Cardiopulmonary function should be assessed continuously at regular intervals during pediatric dental sedations. Pulse oximetry assists in the early detection of any oxygen saturation changes by measuring oxyhemoglobin levels2, 2 Reported side effects with chloral hydrate include gastric irritation, excitation, and respiratory depression. This drug is contraindicated in patients with renal or hepatic impairment.3 Nausea, vomiting, dizziness, and respiratory depression frequently are reported adverse reactions when meperidine is used as a sedative agent. ~-5 A comprehensive survey of narcotic sedations indicates that the risk of adverse reactions is approximately 1:5,000 compared to 1:30,000 for non-narcotic techniques. Also a higher risk exists with a narcotic agent and promethazine versus a narcotic and hydroxyzine combination, and that risk is increased with the addition of a local anesthetic. 6