Sedation
Sonya Lin, DDS
PGY2 Resident
Herman Ostrow School of Dentistry of USC
Herman Ostrow School of Dentistry of USC
Moraga, California, United States
Alexander Alcaraz, DMD
Program Director, Advanced Pediatric Dentistry
University of Southern California, Herman Ostrow School of Dentistry
Los Angeles, California, United States
Catherine Pham, DDS, MPH
Assistant Professor of Clinical Dentistry
Herman Ostrow School of Dentistry of USC
Los Angeles, California, United States
Catherine Pham, DDS, MPH
Assistant Professor of Clinical Dentistry
Herman Ostrow School of Dentistry of USC
Los Angeles, California, United States
Alexander Alcaraz, DMD
Program Director, Advanced Pediatric Dentistry
University of Southern California, Herman Ostrow School of Dentistry
Los Angeles, California, United States
Purpose: This retrospective cohort study aims to determine if reducing the dose of morphine affected sedation success in overweight/obese children and measure incidence of adverse events in overweight/obese children during dental treatment under oral conscious sedation (OCS).
Methods: Data was collected from electronic health records of patients seen for OCS at the USC Pediatric Dental Clinic from January 2012 to September 2022. Inclusion criteria consisted of children 3-18 years old who were overweight (BMI from the 85th to less than the 95th percentile) or ASA II due to obesity (BMI at or above the 95th percentile). OCS was done with a triple drug regimen of either morphine, midazolam, hydroxyzine or morphine, diazepam, hydroxyzine. Adverse events, sedation level, and sedation effectiveness were recorded.
Results: Of 1,079 charts, 137 were included (60 overweight, 76 obese). In overweight patients, success rate was 75.0% when morphine dose was less than or equal to 0.3 mg/kg, 88.9% at 0.31-0.49 mg/kg, 80.0% at 0.5-0.65 mg/kg, and 78.8% greater than or equal to 0.66 mg/kg. In obese patients, success rate was 73.3% when morphine dose was less than or equal to 0.3 mg/kg, 81.8% at 0.31-0.49 mg/kg, 85.7% at 0.5-0.65 mg/kg, and 90.9% at or greater than or equal to 0.66 mg/kg. Incidence of adverse events in overweight patients was 5.0% versus 5.2% in obese patients. Statistical significance pending analyses.
Conclusion: Sedation success was similar among the four groups in obese and overweight patients. Incidence of adverse events was low in overweight and obese patients.