A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients

Purpose: The safety and efficacy of a new sedation technique for children having dental procedures under local anesthesia were evaluated. Materials and Methods: One hundred children between the ages of 2 and 7 years who required sedation for dental procedures were administered either a combination of midazolam (0.35 mg/kg) and ketamine (5 mg/kg) or midazolam alone (1 mg/kg) rectally 30 minutes before removal to the dental chair. Pulse rate, respiratory rate, arterial pressure, oxygen saturation, adverse reactions, postoperative recovery, and behavior were recorded. Results: Satisfactory sedation and anxiolysis were achieved with both drugs used in the study. When evaluating postoperative recovery, statistically significantly more children receiving midazolam alone were fully awake on admission to the recovery room and 30 minutes later. Results of physiologic monitoring, behavioral ratings, and adverse effects are reported. Excessive salivation occurred in 26% of children receiving the combination of drugs, compared with 14% receiving midazolam alone. Seven (14%) of the children receiving the combination of drugs hallucinated, compared with 21 (42%) receiving midazolam alone. Both drug groups had reliably good anxiolysis and sedation without loss of respiratory drive or protective airway reflexes. Conclusion: The use of a combination of midazolam and ketamine or midazolam alone is a safe, effective, and practical approach to managing children for minor dental procedures under local anesthesia. With this technique, advanced airway management proficiency is recommended.Articl

An evaluation of the effect of oral ketamine and standard oral premedication in the sedation of paediatric dental patients.

We compared the effectiveness of ketamine with standard oral premedication (SOP) in 60 children, 2-7 years of age, sedated orally for dental treatment under local anaesthesia. Children were assigned randomly to receive either 12.5 mg/kg ketamine or 0.5 ml/kg of SOP orally 60 min before the dental procedure. Pulse rate, systolic, diastolic and mean arterial pressures, respiratory rates and blood oxygen saturation were recorded prior to drug administration, 60 min thereafter and immediately before the dental procedure. Anxiety levels were measured at the same time intervals. The level of sedation was measured 60 min after drug administration. No significant differences were found in the anxiety levels between the groups 60 min after oral administration. The level of sedation in both groups before surgery was excellent. Operator evaluation for overall effectiveness of treatment showed that sedation was very good in 60 per cent of children in the ketamine group compared with 20 per cent in the SOP group. More children in the ketamine group were better sedated (p < 0.05). Both premedicants produce good sedation and anxiolysis 60 min after premedication and immediately before the surgical procedure.Articl