Pharmacologic Sedation–Related Respiratory Complications in Pediatric Dentistry: A Decade-Long Scoping Review

Abstract

Context: Procedural sedation is widely used in pediatric dentistry to facilitate dental care in uncooperative children. From a pharmacological perspective, sedative agents differ substantially in their mechanisms of action, routes of administration, and safety profiles. Among the reported adverse effects, respiratory complications remain the most clinically significant and potentially life-threatening. Despite extensive clinical use, a comprehensive synthesis of respiratory adverse events (RAEs) associated with commonly used sedative drugs in pediatric dental settings is lacking. This scoping review aimed to map the existing evidence on respiratory complications associated with pharmacological sedation in pediatric dentistry. Evidence Acquisition: A scoping review was conducted in accordance with established methodological frameworks. Electronic databases were systematically searched for studies reporting the use of sedative or anesthetic agents in pediatric dental procedures. Eligible studies included clinical trials, cohort studies, case series, and retrospective analyses that documented respiratory outcomes. Data were extracted on patient characteristics, sedative agents and combinations, dosages, routes of administration, monitoring methods, and reported respiratory complications. Results: The included studies showed substantial variability in sedation protocols. The most frequently reported agents were benzodiazepines, chloral hydrate, ketamine, propofol, dexmedetomidine, and opioid combinations. For clarity, respiratory complications in this review are categorized as mild (e.g., transient oxygen desaturation, partial airway obstruction), moderate (e.g., hypoventilation requiring intervention), and severe (e.g., laryngospasm, apnea requiring advanced airway management). RAEs ranged from mild, transient events (e.g., oxygen desaturation and airway obstruction) to more serious conditions, including laryngospasm and apnea. Most complications were managed successfully with basic airway maneuvers, supplemental oxygen, or brief positive-pressure ventilation. Severe outcomes requiring advanced airway intervention were rare. Continuous respiratory monitoring, particularly pulse oximetry and capnography to facilitate earlier detection of ventilatory compromise, was consistently associated with prompt management of adverse events. Conclusions: Pharmacological sedation in pediatric dentistry is generally safe when appropriate drug selection, dosing, and monitoring are used. Respiratory complications are relatively common but are typically mild and reversible. From a pharmacological perspective, careful consideration of sedative combinations, cumulative respiratory depressant effects, and vigilant monitoring is essential to optimize patient safety. Further high-quality studies are needed to refine evidence-based sedation protocols and minimize respiratory risks.