92 - Safety and Efficacy of High-Dose Hydroxyzine for Pediatric Dental Sedation

Abstract:

Purpose: To evaluate the safety and clinical efficacy of hydroxyzine administered at 3.5–3.7 mg/kg for oral conscious sedation.

Methods: A retrospective cohort study of pediatric patients 3-10 years old who underwent dental treatment with hydroxyzine as the sole sedative agent between 2022 and 2025 was conducted. Sedation efficacy was defined as (1) treatment completion; (2) good sedation depth as Ramsey Sedation Scale (RSS) 2 and above for more than half of the treatment duration and Pediatric Sedation State Scale (PSSS) 4 or lower; and (3) managed behavior as post-treatment behavior Frankl Behavior Rating Scale (FBRS) 2 or higher. Safety was assessed through continuous vital sign monitoring and documented adverse events.

Results: A total 263 sedations were included in the analysis. Treatment was completed in 95% of cases. Most patients achieved good sedation depth when classified using RSS (75%) and PSSS (66%). A significant behavioral improvement (paired comparison of pre- and post-treatment FBRS) was observed (P=.027). Poor sedation depth was associated with longer treatment duration (P=.046), younger age (P=.016), lower total concentrations of hydroxyzine (P=.008) and lower number of teeth treated (P=.004). Reduced sedation depth resulted in lower frequency of two surface posterior composite restorations (RSS, (P=.035) and PSSS, (P=.029), but didn't significantly affect completion of other procedures. No severe adverse events were documented. Although low respiratory rate episodes occurred, none led to hypoxia or required intervention.

Conclusions: Oral hydroxyzine administered at 3.5–3.7 mg/kg is safe and clinically effective for pediatric dental conscious sedation, with few limitations.

Identify Supporting Agency and Grant Number: Research supported by Nicklaus Children's Hospital