Title During Conscious Sedation the Risk of Adverse Events Is Likely Increased in Obese Children Compared to Those of Healthy Weight
Clinical Question Are obese children undergoing conscious sedation at increased risk for adverse events compared to children who are at healthy weight?
Clinical Bottom Line For children with childhood obesity, conscious sedation may lead to more adverse events including oxyhemoglobin desaturation, nausea and true apnea. However, additional evidence is needed to know if there is any clinical and statistical difference between obese children and healthy weight children during conscious sedation. This is supported by both a cross-sectional retrospective study and a review of literature on the relationship between childhood obesity and conscious sedation.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
23211915Kang/2012512 patients met inclusion criteriaCross-sectional, retrospective chart review
Key results510 patients met the inclusion criteria. BMI data was examined for 103 patients in which height data was available. Males experienced more adverse events than females. Out of the 510 patients, 14% experienced 1 or more adverse events and the remaining 86% experienced no adverse event. The patients who experienced adverse events had higher mean weight and higher BMI, although not a statistically significant difference was observed. Adverse events include oxyhemoglobin desaturation, nausea/vomiting, and true apnea.
17249428Baker/2006N/ALiterature Review
Key resultsThe purpose of this literature review is to explain the effect childhood obesity has on sedation of patients in pediatric dentistry and offer recommendations on how to manage these patients. The greatest challenge with obese children is respiratory complications. Other complications involve the cardiovascular and gastrointestinal system. Recommendations include: a through physical exam, reducing maximum dosages, avoiding opioids, monitoring patient throughout procedure, and proper positioning of the patient.
Evidence Search MeSH Terms: dental conscious sedation; pediatric obesity
Comments on
The Evidence
Validity: Both articles have limitations and strengths. As a retrospective study, the researchers in the Kang article had to exclude some data because it was incomplete (a limitation). The literature review gives a general summary of existing research but fails to outline methods and clinical data. The strength of both papers is that they are among the few articles to focus on examining adverse events in with sedation pediatric dental patients based on weight. Perspective: There is very little research on childhood obesity and conscious sedation. No results were retrieved of the highest evidence level, a systematic review. This shows that more research should be done on this topic to help make guidelines for treating obese/overweight patients clearer and more definitive.
Applicability This topic is more applicable to pediatric dentists and general dentists who treat children using conscious sedation. The evidence suggests that modifications and accommodations should be made for pediatric dental patients who are obese or overweight because those patients are possibly more likely to have adverse events during conscious sedation. It is important for dentists to be aware of the complications that exist in treating these patients and understand what adverse events occur in order to prevent or manage such situations accordingly.
Specialty (General Dentistry) (Pediatric Dentistry)
Keywords Childhood obesity, sedation, adverse event
ID# 3394
Date of submission 10/31/2019
E-mail asare@livemail.uthscsa.edu
Author Abrefi Asare, DDS, MS
Co-author(s) Miriam Muniz, DDS
Co-author(s) e-mail munizlopez@livemail.uthscsa.edu
Faculty mentor Elva Jordan, DDS
Faculty mentor e-mail JORDANEV@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available