The Pulse Oximeter in Pediatric Dental Sedations
A Pulse Oximeter is the primary monitoring system used with Conscious Sedation in Pediatric Dentistry. Used in combination with other monitoring methods, it measures the pulse rate and oxygen saturation of the blood. It is non-invasive. In fact it is just a little sensor that shines a red light accross the finger or earlobe to measure the saturation of the hemoglobin molecule. It can provide an early warning of respiratory depression and is especially useful in children. This machine also measures blood pressure. Although, in children you are likely to see a problem with oxygen saturation before BP.Labels: Behavior Management, Sedation
posted by Dr. Dean Brandon @ 1:50 PM
5 comments
5 Comments:
I was monitoring a sedation last week and we used a lighter oral medication on a 4y8m old. She cried through the whole thing, but was fairly cooperative. I realized the pulse ox most useful when the patients are asleep. When she was crying, the alarms kept going off and it became more annoying than helpful.
Oral sedation is such an art, I've found from our faculty. What is your method is choosing which med and what has worked best in your experience?
Keep up the good posts, hopefully we can start a good community of pediatric dentistry knowledge circulating on the web.
There is "motion artifact" that throws the sensor off when the child is moving. If the child is fussy, crying, or other wise moving around you pretty much know his saturation is ok and the pulse oximeter is not of much use. I really pay attention though when the child is sleepy. That's why you cannot just rely one one monitoring modality. By the way even if you give a large amount of medication you still can have a wiggly fussy patient (which is frustrating I know). Yes, as much an art as science.
Oh yes, which medication is the "best"? There is no magic bullet here. Every situation is different. I try and gauge the behavior at the recall appointment (anxious or defiant, gag reflex, did we get x-rays or not). Then I look at the procedure scheduled, the age of the patient, weight, past dental sedations and what worked and what didn't, and other things. Younger children needing more extensive work, well I tend to lean more towards a Chloral Hydrate/Demerol/Vistaril combination. Older kids perhaps Demerol/Vistaril combination. Really short procedures on anxious kids then Versed is good. Again it all depends. All this of course if "conscious sedation" is really indicated (which, of course with most children it is thankfully not).
What are the normal heart rate values for a child say 4 to 14 while undergoing dental treatment. Lets say nitrous is being used. When should we be concerned with hypoxia or excessive heart rate (what values)
Thanks
Kids have faster heart rates than adults. The age range you give is awfully large. For instance a 4 year old would likely be 90-100.....You could look online to get a specific answer to that.
In kids you are really more concerned with a slower heart rate (bradycardia).
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