A comparative evaluation of newer sedatives in conscious sedation

Abstract

This double blind study was undertaken to determine the safety and efficacy of orally administered newer sedatives and analgesics for conscious sedation in 120 child patients. Patients were randomly assigned into: Midazolam (I), Ketamine (II), Zolpidem (III), Midazolam plus Ketamine (IV), Midazolam plus Tramadol (V) and Zolpidem plus Tramadol (VI) groups of 20 each. Onset of action, level of sedation, ease of treatment completion, recovery time, and post-operative amnesia were assessed for all and compared. Midazolam plus ketamine was found the most effective combination providing a fast and adequate analgo-sedation in anxious and uncooperative child patients.

What is the level of evidence for the amnestic effects of sedatives in pediatric patients? A systematic review and meta-analyses

“…Benzodiazepines, used solely or in combination, were the most well-studied drugs: only 7 out 54 trials did not include a benzodiazepine group [13,17,30,38,46,49,65]. Drugs currently used in clinical practice are reported in the following studies: midazolam was investigated in 33 trials [7, 14–16, 19, 27, 28, 31, 33, 35, 39–45, 47, 48, 50–54, 59, 61, 63, 66–71], nitrous oxide in seven [26, 30, 34, 42, 46, 50, 51], ketamine in eight [13–17, 26, 34, 37, 44, 49, 70], dexmedetomidine in one [49] and propofol in four [13, 14, 46, 47]. Besides, all drugs investigated in 23 studies were the ones currently used: 19 involved midazolam [7, 19, 27, 31, 33, 35, 40, 41, 50–52, 54, 61, 63, 66–70], three nitrous oxide [46, …”

“…Benzodiazepines were compared to non-benzodiazepines in 13 studies [18,44,45,48,50,51,56–60,70,71]. In four studies, anterograde amnesia was significantly more likely when benzodiazepines were used than when nitrous oxide [50], antihistamines [45,48,60], or triclofos [48] were used.…”

“…Benzodiazepines were used in combination with another drug and compared to any sedative in 11 studies [14–16,26,28,34,37,42,44,47,70]. Only three studies found that anterograde amnesia was significantly more likely in the benzodiazepine group than when another sedative, including meperidine, promethazine and chlorpromazine [26], meperidine alone [28], or melatonin plus nitrous oxide [42] was used.…”

Safety of oral midazolam sedation use in paediatric dentistry: a review

“…There were no RCTs found looking at side effects alone. After combining the results from Medline and Embase searches and removing papers that did not meet the criteria, 16 papers were included [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] . Data from these papers are summarised in Table 1.…”

Intravenous ketamine for adult procedural sedation in the emergency department: a prospective cohort study

“…One study comparing agents for conscious sedation in children concluded that midazolam and ketamine were most effective in combination 10. Other studies in children have questioned the benefit of adding midazolam, demonstrating equally effective sedation properties and no difference in the incidence of emergence phenomena with intravenous ketamine alone compared with the combination of agents 11.…”