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Publication
Sedação consciente em odontopediatria : uma revisão umbrella
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| 1.29 MB | Adobe PDF |
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Abstract(s)
Objetivo: Avaliar todas as revisões sistemáticas existentes, acerca da sedação consciente em crianças/adolescentes, com especial incidência na taxa de sucesso dos fármacos e na qualidade da evidência.
Materiais e métodos: A pesquisa foi realizada, a partir de oito bases de dados, sendo elas Pubmed (Via Medline), Web of Science (WoS), Scopus, Cochrane Database of Systematic Reviews, Scielo (Scientific Electronic Library Online), Embase (The Excerpta Medica Database), LILACS (Latin-American scientific literature in health sciences) e TRIP (Turning Research into Practise), até janeiro 2023, sem restrições de data ou idioma. Foram incluídas revisões sistemáticas ou meta-análises que investigassem estudos em humanos, acerca da performance da sedação consciente, durante procedimentos dentários. A avaliação do risco de viés foi realizada através da ferramenta online AMSTAR 2 (Measurement Tool to Assess Systematic Reviews) para determinar a qualidade metodológica das revisões incluídas.
Resultados: Um total de 37 revisões sistemáticas foram incluídas nesta revisão Umbrella. Relativamente à qualidade metodológica, 43% apresentam elevada qualidade, 24% moderada, 11% baixa e 22% muito baixa. É recomendado o uso da técnica combinada (N2O (30-50%) + midazolam). Para além disso, 0,75 mg/kg parece ser a dose ótima de midazolam oral. De acordo com as diretrizes atuais, os fármacos de destaque
em Odontopediatria, usados em sedação consciente, são o óxido nitroso e o midazolam, contudo não são suportados por evidência suficiente, que permita inferir acerca da sua segurança e eficácia.
Conclusões: O nível de evidência quanto à eficácia e segurança da sedação consciente em Odontopediatria, é aceitável com um total de 67% de revisões sistemáticas com evidência moderada/elevada, sendo que 43% das totais apresentam elevada qualidade. O nível de qualidade metodológica das revisões sistemáticas deverá aumentar segundo os resultados e instruções futuras desta revisão umbrella.
Objective: Assess all systematic reviews ever produced on conscious sedation in children/adolescents with a particular focus on drugs success rate along with the quality of the evidence. Materials & Methods: Electronic data search was performed in eight electronic databases: PubMed (via Medline), Web of Science, Scopus, Cochrane Database of Systematic Reviews, Scielo (Scientific Electronic Library Online), EMBASE (The Excerpta Medica Database), LILACS (Latin-American scientific literature in health sciences), and TRIP (Turning Research Into Practise), up to January 2023. No restrictions to publication year or language were applied. Systematic reviews or meta-analyses investigating human studies on the performance of conscious sedation, during dental procedures, were included. Risk of bias was assessed using AMSTAR 2 (Measurement Tool to Assess Systematic Reviews) to determine the methodological quality of the included reviews. Results: A total of 37 systematic reviews were included in this Umbrella review. Regarding methodological quality, 43% of the studies were rated as high quality, 24% as moderate, 11% as low and 22% as critically low. The combined technique is recommended (nitrous oxide (30-50%) + midazolam). In addition, 0.75 mg/kg seems to be the optimal dose of oral midazolam. According to the current guidelines, the most common drugs in pediatric dentistry, used for conscious sedation, are nitrous oxide and midazolam, however they are not supported by sufficient evidence to make inferences about their safety and efficacy. Conclusion: The evidence level regarding the effectiveness and safety of conscious sedation in Pediatric Dentistry is acceptable, with a total of 67% of SRs having moderate/high evidence, and 43% of them demonstrating high quality. The level of methodological quality of SRs is expected to increase according to the results and future directions of this Umbrella review.
Objective: Assess all systematic reviews ever produced on conscious sedation in children/adolescents with a particular focus on drugs success rate along with the quality of the evidence. Materials & Methods: Electronic data search was performed in eight electronic databases: PubMed (via Medline), Web of Science, Scopus, Cochrane Database of Systematic Reviews, Scielo (Scientific Electronic Library Online), EMBASE (The Excerpta Medica Database), LILACS (Latin-American scientific literature in health sciences), and TRIP (Turning Research Into Practise), up to January 2023. No restrictions to publication year or language were applied. Systematic reviews or meta-analyses investigating human studies on the performance of conscious sedation, during dental procedures, were included. Risk of bias was assessed using AMSTAR 2 (Measurement Tool to Assess Systematic Reviews) to determine the methodological quality of the included reviews. Results: A total of 37 systematic reviews were included in this Umbrella review. Regarding methodological quality, 43% of the studies were rated as high quality, 24% as moderate, 11% as low and 22% as critically low. The combined technique is recommended (nitrous oxide (30-50%) + midazolam). In addition, 0.75 mg/kg seems to be the optimal dose of oral midazolam. According to the current guidelines, the most common drugs in pediatric dentistry, used for conscious sedation, are nitrous oxide and midazolam, however they are not supported by sufficient evidence to make inferences about their safety and efficacy. Conclusion: The evidence level regarding the effectiveness and safety of conscious sedation in Pediatric Dentistry is acceptable, with a total of 67% of SRs having moderate/high evidence, and 43% of them demonstrating high quality. The level of methodological quality of SRs is expected to increase according to the results and future directions of this Umbrella review.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Conscious sedation Pediatric Systematic review Meta-analysis