Park et al10 reported that N2O when used for sedation during epidural anesthesia does not have the expected selleck kinase inhibitor effect on BIS signals. Two research showed that no change in BIS or Cerebral State Index value while the participants breathed 70% N2O in O2 although all of them lost consciousness clinically.29,30 In their research on 22 healthy volunteers who were sedated by low N2O, Hall et al21 reported that no correlation was found with OAA/S and BIS. But a correlation was found when N2O concentration was increased from 35% up to 70%. However Puri has reported paradoxical changes in BIS during N2O administration.22 Previous data regarding the use of BIS during N2O sedation remain insufficient.

Probably, the conflicting results of various studies may be explained by the differential effects of N2O on EEG when administered at high/low concentrations or alone/in combination with sedative or anesthetics. In this research, the administration of N2O alone was adequate to perform teeth extraction but no alteration or paradoxical changes were observed at BIS values. Nitrous oxide sedation is a reliable and practical method for pediatric dentistry. Nitrous oxide is effective and the anesthetic effect wears off quickly so there is no extended recovery time.1�C3 In our study none of the patients were observed to exceed the level of 3 with respect to OAA/S which is described as patient who responds only after loud or repeated calling. However adequate sedation (OAA/S=4.5) was obtained at study group.

Morse et al31 assessed the use of BIS monitoring in 22 patients undergoing conscious sedation with midazolam or midazolam plus ketamine for dental surgery and found that the BIS values remained close to baseline. In this research mean BIS value was 97.4 and it was similar to results of Morse et al. In children, especially at the little age group, it is difficult to perform BIS and its devices.27 In our study group, children were aged between 7�C12 years old. BIS and its devices were applied easily. Although the results of our study showed that N2O/O2 is enough to sedate children according to the RSS and OAA/S scores, we did not observe any significant changes BIS values. This means that using N2O/O2 to sedate children undergoing dental extractions without any sedative agents does not require measuring the depth of sedation with BIS monitor.

CONCLUSIONS Further investigations are needed for the validity and clinical applicability of BIS assessment with N2O/O2 sedation at different concentrations or combined with other sedative drugs of in a larger Cilengitide pediatric population under dental treatments. Table 5 Significant HR values during study period.Correction of dentofacial deformities often requires combined surgical orthodontic treatment in order to achieve optimal functional, aesthetic and psychosocial results. The clinical protocol involves prediction of both the surgical movements and soft tissue profile.