A double-blind randomized controlled trial to compare the safety and efficacy of dexmedetomidine alone and in combination with ketamine in uncooperative and anxious paediatric dental patients requiring pulpectomy

Haider, Khushtar; Mittal, Nidhi; Srivastava, Bipin K.; Gupta, Nidhi

doi:10.1007/s40368-022-00706-w

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…Limitations of the present study include inability to include proper randomization, sequence generation and allocation concealment and the findings of the study are to be interpreted in this light only. 16,17…”

Section: Resultsmentioning

confidence: 99%

Amnesic potency of nitrous oxide at various titration levels

Singh¹,

Jain²,

Jain³

et al. 2023

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Introduction: Dental Treatment for an anxious child has always been a challenge to the pediatric dentist. Nitrous oxide has been documented as a safe and effective pharmacological mean of behaviour management which results in anxiolytic and analgesic effects along with slight amnesic effect. The objective of the study is to evaluate the amnesic effects of nitrous oxide during treatment at 30% and 50% concentrations of nitrous oxide and after 100% oxygen for 3 minutes. Materials and method: 30 Healthy Children (ASA I) of age group 7-12 years undergoing extraction were included in the study. Amnesic effects were evaluated visually by showing various cartoon pictures before the start of the treatment (A1) and subsequently asking the child to recognise them after 30% (A2), 50% (A3) nitrous oxide and after 100% oxygen (A4). Results: Nitrous oxide showed amnesic effects at various titration levels. Discussion: Any invasive dental intervention makes even a cooperative child uncooperative in the subsequent visits. However, any substance having amnesic effect results in no negative memory of the painful procedure performed.Nitrous oxide seems to be promising as a safe and potent amnesic agent. Conclusion: Nitrous oxide shows amnesic effects which can be helpful as it won’t let the child create any traumatic memory of the treatment.

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Section: Resultsmentioning

confidence: 99%

Amnesic potency of nitrous oxide at various titration levels

Singh¹,

Jain²,

Jain³

et al. 2023

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“…The results of this study further support the fact that 90% of children receiving IANB for dental treatments were able to successfully complete their treatment under sedation, with N 2 O sedation level at 50%. Deep drowsiness or effects similar to general anesthesia could result from a higher dose of N 2 O [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Nitrous Oxide Sedation on Child’s Anxiety and Parent Perception During Inferior Alveolar Nerve Block: A Randomized Controlled Trial

Mukundan,

Gurunathan

2023

Cureus

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Introduction Dental anxiety is a common phenomenon among children and can have significant implications for their overall oral health and well-being. Among the various dental procedures that induce anxiety in pediatric patients, the Inferior Alveolar Nerve Block (IANB) stands out as one of the most feared due to its perceived pain and discomfort. Dental anxiety not only affects the child's cooperation during the procedure but can also lead to long-lasting negative perceptions of dental care, resulting in the avoidance of necessary treatments in the future. Nitrous oxide (N 2 O) sedation is a well-established sedation technique in dentistry, widely used to manage anxiety and discomfort during dental procedures. However, its efficacy in reducing anxiety during the administration of IANB to pediatric patients remains the subject of ongoing research. The administration of N 2 O sedation during IANB may not only alleviate the child's anxiety but also influence the parent's perception of the procedure, which can have additional effects on the child's dental experience and future adherence to dental care. The aim of this study was to evaluate the effectiveness of N 2 O sedation on pain and anxiety in children before and after IANB administration and the parent's perceptions of sedation following the procedure. Methods The current study was a single-centered, double-blinded, randomized controlled trial. The participants were assigned randomly to two groups, with each group consisting of 20 participants. Group 1 (n = 20) was given only oxygen, and Group 2 (n = 20) was given N 2 O for sedation. Pain perception for local anesthesia was evaluated using the Face, Legs, Activity, Cry, Consolability scale. The anxiety of children was evaluated using the Facial Image scale. Parent satisfaction was analyzed using the Likert scale. Data were extracted before and after the procedure using the Mann-Whitney U test. Results Pain perception evaluated with the FLACC scale showed statistically low pain perception in Group 2 after the procedure with a p-value of 0.001, and anxiety levels assessed with FIS showed a significant difference in Group 2 after the procedure with a p-value of 0.003. Parent satisfaction was analyzed using the Likert scale, and Group 2 showed a statistically significant difference with a p-value of 0.001 after the procedure. Conclusion The administration of the N 2 O sedation results in a notable reduction in anxiety levels and pain perception, as well as better parental satisfaction. This method allows for a practically pain-free and anxiety-free environment.

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“…Therefore, this perioperative stress response caused by psychological factors cannot be ignored. [15] Different − X ± S anesthetic events are classi ed according to frequency and importance of clinical events to illustrate importance of preoperative anxiety. The ve clinical experiences, namely incision pain, nausea, vomiting, preoperative anxiety and discomfort of open veins, scored highest.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of effect of ketamine combined with different sedative and anesthetic drugs in children's short surgery

Zheng,

Fu,

et al. 2023

Preprint

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OBJECTIVE To study anesthesia effect and safety of ketamine combined with dexmedetomidine in short surgery in children. Methods Selected 60 cases of American Society of Anesthesiologists (ASA) I ~ II grades, children with short surgery, aged 2 ~ 7 years, weighing 10 ~ 30kg, and divided into three groups according to random double-blind method, 20 cases in each. All patients received intramuscular injection of ketamine 4–5 mg • kg", atropine 0.01 mg • kg" and midazolam 0.05 mg • kg" before operation. After child enters operating room, he/she will be given oxygen inhalation by mask with oxygen flow rate of 1 ~ 2L/min, and establish a venous pathway. He/she will be given 10% glucose injection 100ml intravenous drip. A: ketamine 1.5 mg • kg "was given intravenously before skin incision, and same amount of normal saline was continuously pumped intravenously; B: ketamine 1.5 mg • kg was given intravenously before skin incision, and dexmedetomidine was pumped intravenously at a load of 0.5µg • kg for 15 min, and then operation was completed at a speed of 0.25 pg • kg • h '; C: Ketamine 1.5 mg/kg was given intravenously before skin incision, and dexmedetomidine was pumped intravenously at a load of 1µg • kg for 15 min, then operation was completed at a speed of 0.5 pg • kg • h '. During operation, 1.5 mg • kg ketamine was given intravenously and intermittently according to degree of anesthesia and surgical stimulation of children. During perioperative period, ECG, mean arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (\(Sp{O_2}\)) of children were continuously monitored, and dose of ketamine added during operation, postoperative waking time and sedation degree score (Ramsay sedation score), as well as preoperative and postoperative blood glucose values were recorded. Results There was no change in \(Sp{O_2}\) during perioperative period; The MAP and HR increased during perioperative period. Compared with increase of MAP and HR, A > B > C, but no difference between A and B, and a difference between A and C; Compared with dosage of additional phenone, dosage of A was much higher than B and C; The Ramsay sedation scores of children after operation showed that A < B < C; The recovery time of children in C was longer than A and B; Compared blood glucose changes before and after operation, A was higher than B and C. Conclusion Dextrmedetomidine pumped with 0.5µg · kg load and 0.25µg · kg maintenance can reduce occurrence of restlessness after ketamine operation without respiratory inhibition, and has no effect on recovery time after operation, and can inhibit stress of hand operation to a certain extent. It can be safely used for anesthesia of children's short operation.

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A double-blind randomized controlled trial to compare the safety and efficacy of dexmedetomidine alone and in combination with ketamine in uncooperative and anxious paediatric dental patients requiring pulpectomy

Cited by 6 publications

References 28 publications

Amnesic potency of nitrous oxide at various titration levels

Amnesic potency of nitrous oxide at various titration levels

Effectiveness of Nitrous Oxide Sedation on Child’s Anxiety and Parent Perception During Inferior Alveolar Nerve Block: A Randomized Controlled Trial

Evaluation of effect of ketamine combined with different sedative and anesthetic drugs in children's short surgery

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