Intranasal Premedication Effect of Dexmedetomidine versus Midazolam on the Behavior of 2-6-Year-Old Uncooperative Children in Dental Clinic
AbstractObjectives: The aim of this study was to compare the intranasal premedication effect of newly introduced dexmedetomidine (DEX) versus midazolam on the behavior of uncooperative children in the dental clinic.Materials and Methods: This crossover double-blind clinical trial was conducted on 20 uncooperative children aged 2-6 years who required at least two similar dental treatment visits. The subjects were randomly given 1 µg/kg of DEX and 0.5 mg/kg of midazolam via the intranasal route. For the sedation protocol in the two groups, 0.25 mg/kg of atropine in combination with 0.5 mg/kg of midazolam added to 1-2 mg/kg of ketamine were used 30 minutes after premedication and transferring the patient to the operating room. Dental treatments were carried out by a pediatric dentist blinded to the type of the administered premedication. The sedative efficacy (overall success rate) of the agents was assessed by two independent pediatric dentists based on the Houpt scale. Data analyses were carried out according to Wilcoxon signed-rank test and paired t-test.Results: There were no significant differences in the premedication efficacy of intranasal DEX and midazolam according to the Houpt scale (P>0.05).Conclusions: Intranasal midazolam and DEX are satisfactory and effective premedication regimens for uncooperative children.
- Webb MD, Moore PA. Sedation for pediatric dental patients. Dent Clin North Am. 2002 Oct;46(4):803-14.
- Nelson TM, Xu Z. Pediatric dental sedation: challenges and opportunities. Clin Cosmet Investing Dent. 2015 Aug;7:97-106.
- 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 Oct;102(5):274-80.
- Wolfe TR, Bernstone T. Intranasal drug delivery: an alternative to intravenous administration in selected emergency cases. J Emerg Nurs. 2004 Apr;30(2):141-7.
- Primosch RE, Bender F. Factors associated with administration route when using midazolam for pediatric conscious sedation. ASDC J Dent Child. 2001 Jul-Aug; 68(4):233-8, 228.
- Heard C, Smith J, Creighton P, Joshi P, Feldman D, Lerman J. A comparison of four sedation techniques for pediatric dental surgery. Paediatr Anaesth. 2010 Oct; 20(10):924-30.
- Surendar MN, Pandey RK, Saksena AK, Kumar R, Chandra G. A comparative evaluation of intranasal dexmedetomidine, midazolam and ketamine for their sedative and analgesic properties: a triple blind randomized study. J Clin Pediatr Dent. 2014 Spring;38(3):255-61.
- Hartgraves PM, Primosch RE. An evaluation of oral and nasal midazolam for pediatric dental sedation. ASDC J Dent Child. 1994 May-Jun;61(3):175-81.
- Kim HS, Kim JW, Jang KT, Lee SH, Kim CC, Shin TJ. Initial experience with dexmedetomidine for dental sedation in children. J Clin Pediatr Dent. 2013 Fall;38(1):79-81.
- Yuen VM, Hui TW, Irwin MG, Yuen MK. A Comparison of Intranasal Dexmedetomidine and Oral Midazolam for Premedication in Pediatric Anesthesia: A Double-Blinded Randomized Controlled Trial. Anesth Analg. 2008 Jun;106(6):1715-21.
- Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: a review of clinical applications. Curr Opin Anesthesiol. 2008 Aug;21(4):475-61.
- Sahoo S, Kaur M, Tripathy HK, Kumar A, Kohli S, Nanda S. Comparative evaluation of midazolam and clonidine as pediatric oral premedication. Anesth Essays Res. 2013 Sep;7(2):221-7.
- Peng K, Wu SR, Ji FH, Li J. Premedication with dexmedetomidine in pediatric patients: a systematic review and meta-analysis. Clinics (Sao Paulo). 2014 Nov;69(11):777-86.
- Devasya A, Sarpangala M. Dexmedetomidine: A Review of a Newer Sedative in Dentistry. J Clin Pediatr Dent. 2015 Fall;39(5):401-9.
- Fallahinejad Ghajari M, Ansari G, Soleymani AA, Shayeghi S, Fotuhi Ardakani F. Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3-6-year-old Uncooperative Dental Patients. J Dent Res Dent Clin Dent Prospects. 2015 Spring;9(2):61-5.
- Kogan A, Katz J, Efrat R, Eidelman LA. Premedication with midazolam in young children: a comparison of four routes of administration. Paediatr Anaesth. 2002 Oct;12(8):685-9.
- Sheta SA, Al-Sarheed MA, Abdelhalim AA. Intranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation: a double-blinded randomized controlled trial. Paediatr Anaesth. 2014 Feb;24(2):181-9.
- Krauss B, Green SM. Procedural sedation and analgesia in children. Lancet. 2006 Mar 4; 367(9512):766-80.
- Kawaai H, Yoshida K, Tanaka E, Togami K, Tada H, Ganzberg S, et al. Dexmedetomidine decreases the oral mucosal blood flow. Br J Oral Maxillofac Surg. 2013 Dec;51(8):928-31.
- Taniyama K, Oda H, Okawa K, Himeno K, Shikanai K, Shibutani T. Psychosedation with dexmedetomidine hydrochloride during minor oral surgery. Anesth Prog. 2009 Autumn;56(3):75-80.
- Shirakami G, Tanimoto K, Matsuura S, Fukuda K. [Ambulatory anesthesia for an adult patient with autism and epilepsy: sedation using oral and intravenous dexmedetomidine]. [Article in Japanese]. Masui. 2008 Jun;57(6):735-8.
- Bhat R, Santhosh MC, Annigeri VM, Rao RP. Comparison of intranasal dexmedetomidine and dexmedetomidine-ketamine for premedication in pediatrics patients: A randomized double-blind study. Anesth Essays Res. 2016 May-Aug;10(2):349-55.
- Attri JP, Sharan R, Makkar V, Gupta KK, Khetarpal R, Kataria AP. Conscious Sedation: Emerging Trends in Pediatric Dentistry. Anesth Essays Res. 2017 Apr-Jun;11(2):277-281.
- Jannu V, Mane RS, Dhorigol MG, Sanikop CS. A comparison of oral midazolam and oral dexmedetomidine as premedication in pediatric anesthesia. Saudi J Anaesth. 2016 Oct-Dec;10(4):390-4.