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Safety of hydroxyzine in the sedation of pediatric dental patients

  • Taegyeom, Kim (Department of Pediatric Dentistry, School of Dentistry, Dankook University) ;
  • Keoungah, Kim (Department of Dental Anesthesiology, Dankook University Dental Hospital) ;
  • Seungoh, Kim (Department of Dental Anesthesiology, Dankook University Dental Hospital) ;
  • Jongbin, Kim (Department of Pediatric Dentistry, School of Dentistry, Dankook University)
  • Received : 2022.10.28
  • Accepted : 2022.11.18
  • Published : 2022.12.01

Abstract

Hydroxyzine is one of the most popular oral sedatives used in pediatric dentistry. This study aimed to investigate the safety and possible side effects of sedation using hydroxyzine in pediatric dentistry. "Hydroxyzine," "Dental sedation," "Child," and "Safety" and their associated synonyms were searched using the Cochrane Library, Embase, PubMed, KISS, KMBASE, and KoreaMed databases. Academic information and portals of DBpia and RISS were also perused. Altogether, 340 papers were found, among which a total of 24 papers were selected according to the detailed criteria. Nine studies used hydroxyzine as monotherapy, and 10 studies compared its safety when hydroxyzine used as multitherapy. In addition, seven studies employed a drug regimen wherein hydroxyzine was one of the components. All these studies revealed that the adverse events specific to hydroxyzine usage were drowsiness and dryness of the mouth, and that there were respiratory complications due to a synergistic reaction of hydroxyzine. Although classified as a histamine blocker, hydroxyzine with its sedative, antiemetic, anticonvulsant, and anticholinergic properties is an oral sedative available without serious adverse events, If the proper dosage of the drug is used and its synergistic effects with other drugs are ascertained in the route of administration.

Keywords

References

  1. Korean Academy of Pediatric Dentistry. Textbook of Pediatric Dentistry. 5th ed. Seoul, Yenang INC. 2014, pp 225
  2. Avalos-Arenas V, Moyao-Garcia D, Nava-Ocampo AA, Zayas-Carranza RE, Fragoso-Rios R. Is chloral hydrate/ hydroxyzine a good option for paediatric dental outpatient sedation?. Curr Med Res Opin 1998; 14: 219-26. https://doi.org/10.1185/03007999809113362
  3. Mason KP. Pediatric sedation outside of the operating room: a multispecialty international collaboration. 3rd edition. Boston, Springer. 2021, pp 171-91.
  4. Chopra R, Mittal M, Bansal K, Chaudhuri P. Buccal midazolam spray as an alternative to intranasal route for conscious sedation in pediatric dentistry. J Clin Pediatr Dent 2013; 38: 171-3.
  5. Primosch RE, Guelmann M. Comparison of drops versus spray administration of intranasal midazolam in two-and three-year-old children for dental sedation. Pediatr Dent 2005; 27: 401-8.
  6. Yang Y, Shin T, Yoo S, Choi S, Kim J, Jeong T. Survey of sedation practices by pediatric dentists. J Korean Acad Pediatr Dent 2014; 41: 257-65. https://doi.org/10.5933/JKAPD.2014.41.3.257
  7. Wilson S, Houpt M. Project USAP 2010: use of sedative agents in pediatric dentistry-a 25-year follow-up survey. Pediatr Dent 2016; 38: 127-33.
  8. Lang LL. An evaluation of the efficacy of hydroxyzine (Atarax-Vistaril) in controlling the behavior of child patients. J Dent Child 1965; 32: 253-8.
  9. Yoon DK. Studies on the clinical efficacy of hydroxyzine hydrochloride in dentistry for children. J Korean Acad Pediatr Dent 1976; 3: 41-7.
  10. Doring KR. Evaluation of an alphaprodine-hydroxyzine combination as a sedative agent in the treatment of the pediatric dental patient. J Am Dent Assoc 1985; 111: 567-76. https://doi.org/10.14219/jada.archive.1985.0165
  11. Moody EH Jr, Mourino AP, Campbell RL. The therapeutic effectiveness of nitrous oxide and chloral hydrate administered orally, rectally, and combined with hydroxyzine for pediatric dentistry. ASDC J Dent Child 1986; 53: 425-9.
  12. Lee KY, Yang KH. Clinical studies on the effect of premedicants for behavior management in uncooperative children. J Korean Acad Pediatr Dent 1991; 18: 11-22.
  13. Park HS, Kim YK. Clinical study on the effect of chloral hydrate and hydroxyzine in sedating child patients for dental treatment. J Korean Acad Pediatr Dent 1990; 17: 1-14.
  14. Kwon OY, Lee KH. Comparison of chloral hydrate with and without hydroxyzine HCl in the sedation of pediatric dental patients. J Korean Acad Pediatr Dent 1994; 21: 159-73.
  15. Kim HS, Han GJ, Lee CS, Lee SH. Clinical study on the side effects of the conscious sedation. J Korean Acad Pediatr Dent 1997; 24: 823-9.
  16. Kupietzky A, Blumenstyk A. Comparing the behavior of children treated using general anesthesia with those treated using conscious sedation. J Dent Child 1998; 65: 122-7.
  17. Ram D, Mamber E, Chosack A, Fuks AB. The effect of metoclopramide and hydroxyzine in sedation of infants undergoing dental treatment. ASDC J Dent Child 1999; 66: 49-52.
  18. Lee IC, Kim JS, Kwoon SW. The comparative study on the efficacy of chloral hydrate and hydroxyzine of different doses in sedating young pediatric dental patients. J Korean Acad Pediatr Dent 2001; 28: 430-40.
  19. Jung JH, Park KT. Evaluation of success rate and temporary hypoxia in pediatric dental sedation using chloral hydrate and hydroxyzine. J Korean Acad Pediatr Dent 2001; 28: 337-44.
  20. Leelataweedwud P, Vann WF Jr. Adverse events and outcomes of conscious sedation for pediatric patients: study of an oral sedation regimen. J Am Dent Assoc 2001; 132: 1531-9. https://doi.org/10.14219/jada.archive.2001.0086
  21. Lee JH, Park HW. Assessment of vital signs in pediatric dental sedation using chloral hydrate and hydroxyzine. J Korean Acad Pediatr Dent 2002; 29: 455-62.
  22. Lima AR, Costa LR, da Costa PS. A randomized, controlled, crossover trial of oral midazolam and hydroxyzine for pediatric dental sedation. Pesqui Odontol Bras 2003; 17: 206-11.
  23. Faytrouny M, Okte Z, Kucukyavuz Z. Comparison of two different dosages of hydroxyzine for sedation in the paediatric dental patient. Int J Paediatr Dent 2007; 17: 378-82. https://doi.org/10.1111/j.1365-263X.2007.00844.x
  24. Torres-Perez J, Tapia-Garcia I, Rosales-Berber MA, Hernandez-Sierra JF, Pozos-Guillen Ade J. Comparison of three conscious sedation regimens for pediatric dental patients. J Clin Pediatr Dent 2007; 31: 183-6. https://doi.org/10.17796/jcpd.31.3.e82526q0432375n0
  25. da Costa LR, da Costa PS, Lima AR. A randomized double-blinded trial of chloral hydrate with or without hydroxyzine versus placebo for pediatric dental sedation. Braz Dent J 2007; 18: 334-40. https://doi.org/10.1590/S0103-64402007000400012
  26. Kim KH, Kim SO, Kim JS. A study on the effects of sedation and related variables for pediatric dental patients. J Korean Acad Pediatr Dent 2007; 34: 234-46.
  27. Baygin O, Bodur H, Isik B. Effectiveness of premedication agents administered prior to nitrous oxide/oxygen. Eur J Anaesthesiol 2010; 27: 341-6. https://doi.org/10.1097/EJA.0b013e3283313cdd
  28. Lenahan M, Wells M, Scarbecz M. A retrospective study of 248 pediatric oral sedations utilizing the combination of meperidine and hydroxyzine for dental treatment. J Clin Pediatr Dent 2015; 39: 481-7.
  29. Kim G, Lee J, Kim H, Nam S. The effectiveness and side effects of conscious sedation using chloral hydrate, hydroxyzine, and nitrous oxide. J Korean Acad Pediatr Dent 2020; 47: 109-19. https://doi.org/10.5933/JKAPD.2020.47.2.109
  30. Pouliquen A, Boyer E, Sixou JL, Fong SB, Marie-Cousin A, Meuric V. Oral sedation in dentistry: evaluation of professional practice of oral hydroxyzine in the University Hospital of Rennes, France. Eur Arch Paediatr Dent 2021; 22: 801-11. https://doi.org/10.1007/s40368-021-00620-7
  31. Schneider HS. Clinical observation utilizing morphine sulfate and hydroxyzine pamoate for sedating apprehensive children for dental procedures: a nine-year report. Pediatr Dent 1986; 8: 280-4.
  32. Brandt SK, Bugg JL Jr. Problems of medication with the pediatric patient. Dent Clin North Am 1984; 28: 563-79. https://doi.org/10.1016/S0011-8532(22)02233-9
  33. Malamed S. Sedation: A Guide to Patient Management. 5th ed. Amsterdam, Elsevier. 2009, pp 119-20.
  34. Ayd FJ Jr. Chemotherapeutic management of emotional problems in children. Med Arts Sci 1957; 11: 54-8.
  35. Kopel HM. The use of ataraxics in dentistry for children. J Dent Child 1959; 26: 14-24.
  36. Shapira J, Holan G, Guelmann M, Cahan S. Evaluation of the effect of nitrous oxide and hydroxyzine in controlling the behavior of the pediatric dental patient. Pediatr Dent 1992; 14: 167-70.
  37. Tafaro ST, Wilson S, Beiraghi S, Weaver J, Travers J. The evaluation of child behavior during dental examination and treatment using premedication and placebo. Pediatr Dent 1991; 13: 339-43.
  38. Needleman HL, Joshi A, Griffith DG. Conscious sedation of pediatric dental patients using chloral hydrate, hydroxyzine and nitrous oxide-a retrospective study of 382 sedations. Pediatr Dent 1995; 17: 424-31.
  39. Cote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatr 2019; 143: 1-15
  40. Chicka MC, Dembo JB, Mathu-Muju KR, Nash DA, Bush HM. Adverse events during pediatric dental anesthesia and sedation: a review of closed malpractice insurance claims. Pediatr Dent 2012; 34: 231-8.
  41. Shapiro BA. Oxygenation: measurement and clinical assessment. ASA refresher courses in anesthesiology. 1979; 7: 189-202. https://doi.org/10.1097/00126869-197907000-00015
  42. Comroe JH Jr, Botelho S. The unreliability of cyanosis in the recognition of arterial anoxemia. Am J Med Sci 1947; 124: 1-6. https://doi.org/10.1016/j.amjmed.2010.09.004
  43. Mueller WA, Drummond JN, Pribisco TA, Kaplan RF. Pulse oximetry monitoring of sedated pediatric dental patients. Anesth Prog 1985; 32: 237-40.
  44. Becker DE, Haas DA. Recognition and management of complications during moderate and deep sedation. Part 2: cardiovascular considerations. Anesth Prog 2011; 58: 126-38. https://doi.org/10.2344/0003-3006-58.3.126
  45. Dial S, Silver P, Bock K, Sagy M. Pediatric sedation for procedures titrated to a desired degree of immobility results in unpredictable depth of sedation. Pediatr Emerg Care 2001; 17: 414-20. https://doi.org/10.1097/00006565-200112000-00004
  46. Nathan JE. Management of the difficult child: a survey of pediatric dentists' use of restraints, sedation and general anesthesia. ASDC J Dent Child 1989; 56: 293-301.
  47. Smith SJ. Cardiovascular toxicity of antihistamines. Otolaryngol Head Neck Surg 1994; 111: 348-54. https://doi.org/10.1177/01945998941113P203
  48. Olasinska-Wisniewska A, Olasinski J, Grajek S. Cardiovascular safety of antihistamines. Postepy Dermatol Alergol 2014; 31: 182-6.
  49. Schlit AF, Delaunois A, Colomar A, Claudio B, Cariolato L, Boev R, et al. Risk of QT prolongation and torsade de pointes associated with exposure to hydroxyzine: re-evaluation of an established drug. Pharmacol Res Perspect 2017; 5: e00309.