Preoperative Oral Sedation with Midazolam and Paracetamol vs Sedation Nasally with Midazolam and Ketamine for Children Scheduled for Dental Treatment

Abstract

Background: Preoperative anxiety is common among children. It can result in adverse physiological and psychological outcomes. Pharmacological and non-pharmacologic techniques used preoperatively to decrease anxiety and improve cooperation in pediatric patients. The extent of an individual child's risk for stress reflects genetics, personality, parenting, and previous life experience. Children 1 to 5 years of age are at the highest risk for extreme preoperative anxiety. Material and methods: The study is a double blinded clinical trial that conducted in Ain Sham University on 90 children for pulpotomy in the period from august 2015 to may 2017 after approval of the ethical committee and informed written consent from the guardians. The patients were divided randomly into two groups. Fifteen min. before the procedure, In group O, midazolam/paracetamol at a dose of 0.5 and 15 mg/kg respectively was given orally. In group N, midazolam/Ketamine 0.5 mg/kg and 10 mg/kg sprayed nasally. Ramsay sedation scale, child separation, mask acceptance, Aldrete's scoring system, postanesthetic discharge criteria and parent satisfaction scores were recorded. Results: group N showed more smooth parenteral separation [88.9 vs 8.9%] and better tolerance to the face mask "scale 1" [73.3% vs 22.2%] lam/paracetamol is orally comparable to the combination of midazolam/ketamine nasally; however "midazolam/paracetamol" achieves a higher parents satisfaction and earlier postoperative discharge.

Effect of two different doses of oral midazolam premedication on separation anxiety in children scheduled for herniotomy

“…4,16 Kamel et al similarly concluded that oral midazolam mixed with sweetened acetaminophen syrup was much more acceptable to the children compared to nasal midazolam and ketamine. 18 Significant alterations in respiratory parameters were not observed in this study similar to the study by Phaltankar et al and Shar et al as well as by Mcmillan et al 11,19 The majority of the children in the present study readily accepted the medication; comparison of the acceptability (85.7% in group A and 83.3% in group B), showed no statistically significant difference between the groups.…”