Physiologic Effects of Intra-nasal Sedation with Midazolam and Ketamine in 3-6 Years old Uncooperative Children
Journal of Dental School,
Vol. 33 No. 1 (2015),
7 March 2015
,
Page 59-65
https://doi.org/10.22037/jds.v33i1.24750
Abstract
Objective: Several medications have been used for sedation in children in dentistry and intra-nasal route has been reported to be an efficient way regarding patient cooperation. The aim of the present study was to compare the changes in physiologic parameters following intra-nasal midazolam and ketamine administration.
Methods: In this randomized cross-over double-blind trial, 17 uncooperative 3-6 years old children requiring at least two dental treatments were selected randomly and received intra-nasal ketamine (0.5 mg/kg) and midazolam (0.2 mg/kg) prior to the treatment using the other drug in the next visit. Physiologic parameters including blood pressure, heart rate, respiratory rate and O2 saturation were measured and compared during the different time intervals using two way repeated measure ANOVA.
Results: The patients showed higher blood pressure and heart rate following ketamine administration compared to midazolam (p<0.001). No significant difference was found between the drugs at different time intervals regarding respiratory rate and O2 saturation. (p>0.05)
Conclusion: In spite of significant differences between midazolam and ketamine regarding heart rate
and blood pressure, both drugs can b e used as effective sedative medications without treatment interruption in children.
- Cooperation
- Intra-nasal
- Ketamine
- Midazolam
- Physiologic parameters
- Sedation
How to Cite
References
Lökken P, Bakstad OJ, Fonnelöp E. Skogedal N, Hellsten K, Bjerkelund CE, et al . Conscious sedation by rectal administration of midazolam or midazolam plus Ketamine as alternatives to general anesthesia for dental treatment of uncooperative children. Scand J Dent Res 1994;102: 274-280.
Roelofse JA. What’s new in paediatric conscious sedation in dentistry? SAAD Dig 2010; 26: 3-7.
Nathan JE, Vargas KG. Oral midazolam with and without meperidine for management of the difficult young pediatric dental patient: a retrospective study. Pediatr Dent 2002; 24: 129-138.
Malamed SF. Sedation: A guide to patient management. 4th Ed. London: St.Louis: The C.V. Mosby Co. 2002; Chap10: 22-31, 187-195.
Moore PA. Administering sedation: the controversy continues. Gen Dent 2007; 55: 273-274.
Yamada CJ. New challenges in management of the anxious pediatric dental patient. Hawaii Dent J 2006; 37: 14-16.
Lee-Kim SJ, Fadavi S, Punwani I, Koerber a. Nasal versus oral midazolam sedation for pediatric dental patient. J Dent Child (Chic) 2004; 71: 2, 126-130.
Primosch RE, Guelmann M. Comparison of drops versus spray administration of intranasal midazolam in two-and three-year-old children for dental sedation. Pediatr Dent 2005; 27: 401- 408.
Roelofse JA, Roelofse PG. Oxygen desaturation in a child receiving a combination of ketamine and midazolam for dental extractions. Anesth Prog 1997; 44: 68-70.
Green SM, Rothrock SG, Lynch EL, Ho M, Harris T, Hestdalen R, et al. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Ann Emerg Med 1998; 31: 688-697.
Brosius KK, Bannister CF. Midazolam premedication in children: a comparison of two oral dosage formulations on sedation score and plasma midazolam levels. Anesth Analg 2003; 96: 392-395.
Lima AR, da Costa LR, da Costa PS. A randomized, controlled, crossover trial of oral midazolam and hydroxyzine for pediatric dental sedation. Pesqui Odontol Bras 2003; 17: 206-211.
Roelofse JA, Joubert JJ, Roelofse PG. A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients. J Oral Maxillofac Surg 1996; 54: 838–844.
Casamassimo PS, Fields HW, McTigue D, Nowak AJ. Pediatric dentistry, infancy through adolescence. 5th Ed. Elsevier: W.B. Saunders Co. 2013; Chap 8: 116.
Golpayegani MV, Dehghan F, Ansari G, Shayeghi S. Comparison of Midazolam-Ketamine and Midazolam-Promethazine as sedative agents in pediatric dentistry. Dent Res J (Isfahan) 2012; 9: 36-40.
Lotfy AO, Amir-Jahed AK, Moarefi P. Anesthesia with ketamine: indications, advantages and shortcomings. Anesth Analg 1970; 49: 969-974.
Tobias JD, Leder M. Procedural sedation: A review of sedative agents, monitoring and management of complications. Saudi J Anesth 2011; 5: 395-410.
Wilton NC, Leigh J,Rosen DR, Pndit UA. Preanesthetic sedation of preschool children using interanasal midazolam. Anesthesiology 1988; 69: 972-975.
Weldon BC, Watcha MF, White PF. Oral midazolam in children: effect of time and adjunctive therapy. Anesth Analg 1992; 75: 51-55.
Tanaka M, Sato M, Saito A, Nishikawa T. Reevaluation of rectal ketamine premedication in children, comparison with rectal midazolam. Anesthesiology 2000; 93: 1217-1224.
von Ungern-Sternberg BS, Erb TO, Habre W, Sly PD, Hantos Z. The impact of oral premedication with midazolam on respiratory function in children. Anesth Analg 2009; 108: 1771-1776.
Tavassoli-Hojjati S, Mehran M, Haghgoo R, Tohid-Rahbari M, Ahmadi R. Comparison of oral and buccal midazolam for pediatric dental sedation: A randomized, cross-over, clinical trial for efficacy, acceptance and safety. Iran J Pediatr 2014; 24: 198-206.
Holloway VJ, Husain HM, Saetta JP, Gautam V. Accident and emergency department led implementation of ketamine sedation in paediatric practice and parental response. J Accid Emerg Med 2000; 17: 25-28.
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