Conscious Sedation of the pediatric dental patient: a comparison of meperidine versus butorphanol

Abstract

Treating pediatric dental patients four years old and younger can be difficult at times due to patient behavior. Conscious sedation has been employed as a means to control pediatric dental patients for several years. Butorphanol tartrate has been used safely for pain control in pediatric patients for several years, but has never been used for sedating pediatric dental patients. The purpose of this study is to compare the behavioral and physiologic effects of conscious sedation on pediatric dental patients using intramuscular meperidine and an equipotent dosage of intramuscular butorphanol. Forty conscious sedations of ASA I pediatric dental patients between the ages of 13 and 60 months were accomplished using either 2.0 mg/kg of intramuscular meperidine or 0.03 mg/kg of intramuscular butorphanol. Each sedation was videotaped and three viewers viewed the videotapes rating them with a computer program (ACS) involving a four-code behavior rating scale. The tlrree viewers rated patient behavior for each sedation also with a form with global rating, categorical, and dichotomous scales. Physiologic signs of oxygen saturation, blood pressure, heart rate, and respiration rate were monitored at baseline and every 5 minutes during treatment. The operator also rated the sedation patient behavior with a form that had pre-treatment Frankl, post-treatment Frankl, global rating categorical, dichotomous, and sedation success rating scales. The two groups demographic data, physiologic data, ACS data, the three viewer's behavior rating form, and the operator's behavior rating form were analyzed for any statistically significant differences between the groups. The statistical analysis of the demographic data revealed a statistically significant trend in the butorphanol group toward extractions. The meperidine group had a statistically significant higher mean oxygen saturation during treatment (99.63 percent) than the butorphanol group (99.20 percent). The butorphanol group spent significantly more time in the annoyed ACS behavior rating code and showed a trend toward less time spent in the quiet ACS behavior rating code. There were no statistically significant differences in the three viewers ratings of global rating, categorical, and dichotomous scales. The operators' ratings showed the meperidine group had a statistically significant better global rating than the butorphanol group. Overall butorphanol appears to be equal clinically to meperidine in physiologic effects and patient behavior effects. No adverse effects occurred with either medication. Butorphanol may be offered as an alternative sedative agent to other narcotic sedative agents with more side effects.