A DOCS Education member asks:
My first teen sedation patient will be coming into the office in a few days and I have a couple of questions I hope you can answer for me. The patient is a 14 year-old female weighing 106 lbs, taking no medications and has an unremarkable medical history. Her main complaint is anxiety of shots from a previous dental experience. Her treatment will consist of #18-0, #19-O and #31-O composites. I plan on using Teen Protocol 2.
If my math is correct I believe I can use 6.8 mls-17.0 mls Midazolam and 5.45 mls-18.18 mls of Hydroxyzine.
- Question 1: Do you give the Hydroxyzine an hour before you begin treatment as we do with adults?
- Question 2: Do you give Midazolam 10-15 minutes before beginning treatment?
- Question 3: With your experience, what would your initial dose size be for each medication?
Dr. Rodger Sanger, Director of DOCS Pediatric Sedation Dentistry Curriculum, responds:
Thank you for your question. I will have Kenji Saisho MD, DDS our DOCS faculty in charge of the Teen Sedation Course review your questions and respond.
Dr. Kenji Saisho, faculty member and instructor of DOCS Education's Pediatric Sedation Dentistry course, adds:
Thank you for your question regarding your first teen sedation case. Due to her weight I would normally dose at 0.5 mg per kg, with a maximum dose of 20 mg for Midazolam. Dosing for the Hydroxyzine would be 0.6 – 2 mg per kg at a maximum dosage of 50 mg. Both meds are given 15 minutes prior to the proposed start time of the appointment. At your patients weight, the dosage range of Midazolam would be 14 mg to a maximum of 20 mg. Hydroxyzine would be at a dosage range of 25 mg to a max of 50 mg.
I would, for this patient, use 20 mg of Midazolam and 20-25 mg of Hydroxyzine. It will be a short case and you will most likely not need the extended working time of Hydrozyzine, but you can use up to 50 mg if necessary.
To clarify, the member responds:
I am using 2 ml of Midazolam and 5 ml of Hydroxyzine. That’s how I arrived at my initial mg numbers. Is this still the strength you recommend?
Thanks again.
Dr. Saisho says:
Yes, these are the concentrations of Midazolam and Hydroxyzine that we recommend. Do not go over the maximum dosage of these medications, which would be 10ml of Midazolam and 10 ml of Hydroxyzine.
Good luck, and congratulations on your first teen sedation case.
