Comparison of the Sedative Effect of Inhaled Nitrous Oxide and Intranasal Midazolam in Behavior Management and Pain Perception of Pediatric Patients: A Split-mouth Randomized Controlled Clinical Trial

Panchal, Veerale; Subramanian, Emg; Srinivasan, Navaneetha Krishnan; Karunagaran, Pradeep

doi:10.5005/jp-journals-10005-2085

Cited by 3 publications

(9 citation statements)

References 23 publications

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“…However, this difference was not found to be statistically significant. These findings are consistent with the results reported by Panchal et al [ 22 ]. Despite the lack of statistical significance, it was clinically observed that children who received intranasal midazolam exhibited better acceptance of the treatment.…”

Section: Discussionsupporting

confidence: 94%

“…Previously, few studies have focused on evaluating the acceptability of the nasal hood and intranasal drug administration methods in children undergoing dental treatment. Srinivasan et al observed that children displayed greater acceptance and reduced anxiety when using the nasal hood, which was attributed to its noninvasive and comfortable nature [ 22 ]. These findings align with the results of the present study.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Temperament on the Acceptance of Two Conscious Sedation Techniques in Toddlers Undergoing Dental Treatment: A Randomised Cross Over Trial

Janiani,

Gurunathan,

Nuvvula

2023

Pain Research and Management

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Background. Pediatric dentists often find it challenging to handle pediatric patients due to their fear, unease, and anxiety toward dental procedures. To address this, sedation agents such as intranasal midazolam and nitrous oxide are commonly used as pharmacological behavior management methods. A child’s temperament affects their behavior in unfamiliar settings. Aim. To study the effect of child temperament on the acceptance of the nasal mask and intranasal drug administration in children undergoing dental treatment. Methods. Thirty-two anxious children aged three to five were randomly assigned to two groups. During the first visit, one group received intranasal midazolam sedation, while the other group received nitrous oxide administered through a mask. On the subsequent visit, the groups crossed over. The parent assessed the child’s temperament, and the acceptance of the sedation methods was recorded. The Ohio State University Behavioral Rating Scale (OSUBRS) was employed to assess behavior during the administration of local anesthesia. Statistical analysis was carried out using the chi-square test and Mann–Whitney U test ( p value <0.05). Results. Children exhibited greater acceptance of the nasal mask compared to using the intranasal route for delivering midazolam during the induction process. A significant statistical influence of temperament was observed on the acceptance of the nasal mask and the intranasal atomisation device ( p value <0.05). The mean OSUBRS scores did not show any statistically significant differences between the sedation groups ( p = 0.14). Conclusion. Most children demonstrated a more favorable acceptance of the nasal mask during the induction process; however, intranasal midazolam can serve as an effective alternative for anxious patients who struggle to keep the nitrous oxide mask on during the dental procedure. The adoption of these methods is influenced directly by the child’s temperament.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Influence of Temperament on the Acceptance of Two Conscious Sedation Techniques in Toddlers Undergoing Dental Treatment: A Randomised Cross Over Trial

Janiani,

Gurunathan,

Nuvvula

2023

Pain Research and Management

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“…Additionally, consistent application of topical anesthetic prior to administering articaine may have contributed to the uniformity in intraoperative pain levels. Individual patient factors, including anxiety levels, pain threshold, and response to sedation, can also influence perceived pain during dental procedures [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Contrary to our findings, Takkar et al observed a notable decrease in pain scores when administering an inferior alveolar nerve block with nitrous oxide-oxygen sedation [ 15 ]. Similarly, Srinivasan et al conducted a comparison between nitrous oxide inhalation and intranasal midazolam, concluding that intraoperative pain was significantly lower in the nitrous oxide group compared to the midazolam group [ 11 ]. In contrast, our study yielded contrasting results when compared to both of these studies.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Pain During Pediatric Dental Treatment Using Different Sedative Agents: A Crossover Trial

Janiani¹,

Gurunathan²,

Manohar³

2023

Cureus

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Background Behavioral management techniques are employed for children who are fearful and uncooperative. Pharmacologic sedation and anesthesia are frequently utilized to manage pain and anxiety in pediatric dental patients. Aim To evaluate the intraoperative and postoperative pain levels during dental treatment of children sedated with 1.5 μg/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide. Materials and methods In this crossover study, 24 children between the ages of five and seven years were randomly assigned to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhaled nitrous oxide during three different visits. At each visit, a single pulp therapy procedure was conducted after administering the respective sedative agent, and the pain levels were documented. There was a one-week interval between each visit to allow for a washout period. The data were analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp, Armonk, NY, United States) using the Wilcoxon signed-rank test and Kruskal-Wallis H test (p < 0.05). Results All three sedative agents were equally effective in controlling postoperative and intraoperative pain. Although there was no statistically significant difference among the groups, clinically, midazolam showed lower intraoperative pain levels (mean 1.78 ± 1.42). Conclusion In pediatric dental patients, intranasal midazolam at a dosage of 0.3 mg/kg and intranasal dexmedetomidine at a dosage of 1.5 μg/kg demonstrate comparable effectiveness to nitrous oxide sedation in pain management. These options serve as effective alternatives for anxious children who may not tolerate nitrous oxide sedation.

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“…The included studies were randomised, controlled, cross-over clinical trials conducted in the UK and India, published between 2002 to 20022. Of these, three studies used oral midazolam as the intervention [18][19][20], one utilised midazolam intravenously [8], one administered it buccally (transmucosal) [21], and two administered it intranasally [22,23]. All studies titrate nitrous oxide to a maximum dose of 30% and oxygen at 70%.…”

Section: Descriptive Analysismentioning

confidence: 99%

Comparison of Efficacy and Safety of Midazolam versus Nitrous Oxide as Sedative Agents during Paediatric Dental Treatment: A Systematic Review

Janiani,

Gurunathan

2024

Pesqui. Bras. Odontopediatria Clín. Integr.

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Objective: To identify and study the existing literature on the efficacy and safety of midazolam compared to inhalation of nitrous oxide in children undergoing dental treatment. Material and Methods: Electronic resources such as PubMed Central, Cochrane Database of Systematic Reviews, Lilacs, Science Direct, and SIGLE were thoroughly searched. The title scan was used to find randomised controlled trials reviewed for inclusion by reading the abstract. Studies comparing the sedative, behavioural, and anxiolytic effects and safety in children undergoing dental treatment under midazolam and nitrous oxide inhalation were included. The Cochrane Reviews system software, Revman 5.4.1, was used to assess the quality of the included studies. Results: 11328 articles were identified by screening the electronic databases, of which 10906 were eliminated after titles were read and duplicates were removed. Ten full-text articles were examined, of which three were excluded as they did not match the eligibility criteria. Hence, a total of 7 studies were included. Midazolam and nitrous oxide inhalation were not statistically different in terms of the success of treatment and behaviour modification. However, midazolam showed a deeper level of sedation and resulted in amnesia in more children when compared to nitrous oxide sedation. All of the included studies were found to have a high risk of bias. Conclusion: Though all the studies included showed an increased risk of bias, midazolam and nitrous oxide inhalation seem equally effective sedative agents for controlling behaviour in children undergoing dental treatment. Midazolam shows a deeper sedation level when given orally and produces a higher rate of anterograde amnesia.

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Comparison of the Sedative Effect of Inhaled Nitrous Oxide and Intranasal Midazolam in Behavior Management and Pain Perception of Pediatric Patients: A Split-mouth Randomized Controlled Clinical Trial

Cited by 3 publications

References 23 publications

Influence of Temperament on the Acceptance of Two Conscious Sedation Techniques in Toddlers Undergoing Dental Treatment: A Randomised Cross Over Trial

Influence of Temperament on the Acceptance of Two Conscious Sedation Techniques in Toddlers Undergoing Dental Treatment: A Randomised Cross Over Trial

Assessment of Pain During Pediatric Dental Treatment Using Different Sedative Agents: A Crossover Trial

Comparison of Efficacy and Safety of Midazolam versus Nitrous Oxide as Sedative Agents during Paediatric Dental Treatment: A Systematic Review

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