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), meperidine (M), and hydroxyzine (H). Hasty et al 7 reported excellent behavioral outcomes with this regimen and found this combination to be safe as assessed by pulse oximetery and capnography. A more recent and comprehensive retrospective review of 195 pediatric conscious sedations with the CH/M/H cocktail reported that 72% of the sedations were satisfactory and that adverse outcomes were few and minor under a strict protocol and use of oxygen supplementation. 8 In one retrospective study, 9 an 84% success rate was found when the regimen CH/M/H was used with N 2 O

behavior often takes more than 6 hours. 6 Martinez and Wilson 7 reported on postdischarge events following oral sedation utilizing 2 regimens: chloral hydrate, meperidine, and hydroxyzine or midazolam alone. In that study, patients who received the mixture of chloral hydrate, meperidine, and hydroxyzine were more likely to sleep on the way home and upon arriving at home, but no differences were seen for other postsedation adverse events associated with eating, postoperative pain, vomiting, evening sleep, and memory. Another recent study reported the most common

. It is critical to know the effects of these medications beyond the time spent by the child in the dental office, so that parents can be appropriately cautioned about the expected effects and how to distinguish them from any potential emergencies that may lead to airway obstruction. In a pilot study comparing the effects of a triple combination sedation regimen (meperidine, chloral hydrate, and hydroxyzine) with midazolam alone in pediatric dental patients, prolonged sleep and difficulty in waking up children was identified as a cause for concern. 8 However

Flow dynamics, 125 Gelfoam, 22 General anesthesia, 20, 22, 31, 66, 122, 168 Hydroxyzine, 91 Hyperalgesia, 135 Hypercapnia, 51 Hypocapnia, 51 Inferior alveolar nerve block, 106, 135 Injection speed, 106 Intravenous deep sedation, 25 Intravenous fluids, 168 Irreversible pulpitis, 14, 135 Ketamine, 25 Laryngeal mask airway, 20 Lidocaine, 106 Local anesthesia, 106, 153 Main-stem intubation, 66 Management of pediatric cardiac arrhythmias

). While this was once a popular medication, it has been supplanted by short-acting benzodiazepines and other agents. Sheroan et al 3 demonstrated similar success rates in triple-drug cocktails comparing chloral hydrate, meperidine, and hydroxyzine vs midazolam, meperidine, and hydroxyzine. Chloral hydrate is no longer commercially available and is on formulary at only some compounding pharmacies in the United States (US). Dosing recommendations are 50 to 100 mg/kg; however, deaths have occurred even within this range. BENZODIAZEPINES