Physiologic effects of intra-nasal sedation with midazolam and ketamine in 3-6 years old uncooperative children

Objective: Several medications have been used for sedation in children in dentistry and intra-nasal route has been reported to be an efficient way regarding patient cooperation. The aim of the present study was to compare the changes in physiologic parameters following intra-nasal midazolam and ketamine administration

Methods: In this randomized cross-over double-blind trial, 17 uncooperative 3-6 years old children requiring at least two dental treatments were selected randomly and received intra-nasal ketamine [0.5 mg/kg] and midazolam [0.2 mg/kg] prior to the treatment using the other drug in the next visit. Physiologic parameters including blood pressure, heart rate, respiratory rate and O[2] saturation were measured and compared during the different time intervals using two way repeated measure ANOVA

Results: The patients showed higher blood pressure and heart rate following ketamine administration compared to midazolam [p<0.001]. No significant difference was found between the drugs at different time intervals regarding respiratory rate and O[2] saturation. [p>0.05]

Conclusion: In spite of significant differences between midazolam and ketamine regarding heart rate and blood pressure, both drugs can b e used as effective sedative medications without treatment interruption in children

Comparison of oral and buccal midazolam for pediatric dental sedation: a randomized, cross-over, clinical trial for efficacy, acceptance and safety

Objective: Providing a safe and efficient dental treatment for a young patient is a challenge for the dentist and the child. The purpose of this study was to investigate the effectiveness, safety and acceptability of buccal midazolam in dental pediatric patients and to compare it with oral Midazolam

Methods: Eighteen uncooperative healthy children aged 2.5-6 years were randomized to each of buccal midazolam [0.3mg/kg] or oral midazolam [0.5mg/kg] at the first visit, the alternative has been used at the second visit in a cross-over manner. The study took place at pediatric dentistry clinic of Shahed University, Tehran, from November 2011 to June 2012. The patients' vital signs and behavioral scores were recorded. The patient, the operator and the observer were blinded to the applied medication. Post operatively, patients' and parents' satisfaction were assessed by Visual Analogue Score and a questionnaire respectively. The P-value was set at 0.05 for significance level

Findings: There were no significant differences in physiologic factors in the medication groups at time 0, 10, 20, 30 minutes and discharge. There was also no significant difference between the two groups in behavioral parameters. The majority of parents rated both sedative agents as "effective" or "very effective" and their children mostly were without anxiety or with minor anxiety

Conclusion: Buccal midazolam may be safely and efficiently used in sedation of pediatric dental patients