Comparison of chloral hydrate-hydroxyzine with and without meperidine for management of the difficult pediatric patient.

This study attempted to examine the impact of low doses of meperidine on the effectiveness of two doses of CH for management of highly resistive young pediatric dental patients. The results suggest patient manageability was enhanced by the addition of oral meperidine. As an alternative to a parenteral technique or general anesthetic, the clinician may wish to consider this regimen after having experienced failure of CH either alone, or in combination with an antiemetic, to produce an adequate level of sedation. The extent to which application of physical restraint is considered necessary or acceptable should be taken into account, when evaluating the need for a regimen of medication. If the purpose of selecting a sedative technique is to accomplish lengthy treatment without harsh restraint, the degree to which restraint is needed no doubt reflects on the adequacy of the sedative regimen. The addition of meperidine was found to reduce significantly the need for persistent harsh physical restraint, to allow treatment of the refractory young child. While the brief application of harsh restraint measures may be warranted and justifiable in emergency medical situations, it seems unwise to make use of harsh restraint for lengthy elective dental procedures. Given the extent to which many adults report negative childhood dental experiences, avoidance of the use of aversive measures seems desirable. Of the cases receiving meperidine, 76.3 percent were treated successfully (no need for persistent restraint), compared to the successful treatment of only 30.7 percent of the patients sedated without meperidine.(ABSTRACT TRUNCATED AT 250 WORDS)