Abstract
Aim
To compare the sedation regimen Dexmedetomidine alone and its combination with low dose Ketamine through intravenous route in terms of safety, efficacy and recovery profile in uncooperative paediatric dental patients requiring pulpectomy.
Material and methods
Thirty anxious and uncooperative 2–6-year-old children requiring pulpectomy in at least one primary molar were enrolled. Propofol was used as an induction agent. Drugs were administered through the intravenous route as per group assignment, i.e., Dexmedetomidine (1 µg/kg) with ketamine (0.5 mg/kg) administered over 10 min followed by a maintenance dose of Dexmedetomidine (0.2–0.8 µg/kg/h) in group A and Dexmedetomidine (1 µg/kg) administered over 10 min followed by a maintenance dose in group B. The sedation was titrated to achieve Houpt’s overall behavior score of 4/5. The primary outcome measure was the successful completion of treatment. Secondary outcome measures were vital signs, quality of sedation, time need for the procedure, recovery time, intra-operative and post-operative adverse sequelae.
Results
Results showed that both of the regimens were similar in efficacy, safety and recovery profile. Also, the required dose of dexmedetomidine and the need for rescue boluses was similar in both of the study groups.
Conclusion
Dexmedetomidine either alone or in combination with ketamine proved to be a safe and efficacious agent for paediatric dental sedation. No beneficial evidence of adding ketamine was observed.
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Data availability
Yes.
Code availability
No.
References
Aldrete JA. Modifications to the postanesthesia score for use in ambulatory surgery. J Perianaesthesia Nurs. 1998;13:148–55. https://doi.org/10.1016/S1089-9472(98)80044-0.
Aroni F, Iacovidou N, Dontas I, Pourzitaki C, Xanthos T. Pharmacological aspects and potential new clinical applications of ketamine: reevaluation of an old drug. J Clin Pharmacol. 2009;49:957–64. https://doi.org/10.1177/0091270009337941.
Bergman SA. Ketamine: review of its pharmacology and its use in pediatric anesthesia. Anesth Prog. 1999;46:10–20.
Brown L, Christian-Kopp S, Sherwin TS, Khan A, Barcega B, Denmark TK, Moynihan JA, Kim GJ, Stewart G, Green SM. Adjunctive atropine is unnecessary during ketamine sedation in children. Acad Emerg Med. 2008;15:314–8. https://doi.org/10.1111/j.1553-2712.2008.00074.x.
Cheung CW, Ng KFJ, Liu J, Yuen MYV, Ho MHA, Irwin MG. Analgesic and sedative effects of intranasal dexmedetomidine in third molar surgery under local anaesthesia. Br J Anaesth. 2011;107:430–7. https://doi.org/10.1093/bja/aer164.
Corssen G, Miyasaka M, Domino EF. Changing concepts in pain control during surgery: dissociative anesthesia with CI-581. A Progress Report Anesth Analg. 1968;47:746–59.
Coté CJ, Wilson S. American academy of pediatric dentistry, American academy of pediatrics. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatr Dent. 2019;4:E26–52. https://doi.org/10.1542/peds.2019-1000.
Daabiss M, Elsherbiny M, Otaibi RA. Assessment of different concentrations of ketofol in procedural operations. Saudi J Anaesth. 2009;3:15. https://doi.org/10.4103/1658-354X.51829.
Devasya A, Sarpangala M. Dexmedetomidine: a review of a newer sedative in dentistry. J Clin Pediatr Dent. 2015;39:401–9. https://doi.org/10.17796/1053-4628-39.5.401.
Green SM, Roback MG, Krauss B, Brown L, McGlone RG, Agrawal D, McKee M, Weiss M, Pitetti RD, Hostetler MA, Wathen JE, Treston G, Garcia Pena BM, Gerber AC, Losek JD. Emergency department ketamine meta-analysis study group: predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children. Ann Emerg Med. 2008;54:171–80. https://doi.org/10.1016/j.annemergmed.2009.04.004.
Green SM, Roback MG, Krauss B. Emergency department ketamine meta-analysis study group. Anticholinergics and ketamine sedation in children: a secondary analysis of atropine versus glycopyrrolate. Acad Emerg Med. 2010;17:157–62. https://doi.org/10.1111/j.1553-2712.2009.00634.x.
Hammadyeh AR, Altinawi MK, Rostom F. Comparison of two intravenous sedation techniques for use in pediatric dentistry: a randomized controlled trial. Dent Med Probl. 2019. https://doi.org/10.17219/dmp/109929 (Published online as ahead of print on October 9, 2019).
Houpt M. Project USAP the use of sedative agents in pediatric dentistry: 1991 update. Pediatr Dent. 1993;15:36–40.
Jaikaria A, Thakur S, Singhal P, Chauhan D, Jayam C, Syal K. A comparison of oral midazolam-ketamine, dexmedetomidine-fentanyl, and dexmedetomidine-ketamine combinations as sedative agents in pediatric dentistry: a triple-blinded randomized controlled trial. Contemp Clin Dent. 2018;9:S197–203. https://doi.org/10.4103/ccd.ccd_818_17.
Kim HS, Kim JW, Jang KT, Lee SH, Kim CC, Shin TJ. Initial experience with dexmedetomidine for dental sedation in children. J Clin Pediatr Dent. 2013;38:79–81. https://doi.org/10.17796/jcpd.38.1.w86t8k7r51k72617.
Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth. 2015;115:171–82. https://doi.org/10.1093/bja/aev226.
Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation; a prospective study. Can Anaesth Soc J. 1985;32:429–34.
Messenger DW, Murray HE, Dungey PE, van Vlymen J, Sivilotti ML. Subdissociative-dose ketamine versus fentanyl for analgesia during propofol procedural sedation: a randomized clinical trial. Acad Emerg Med. 2008;15(10):877–86. https://doi.org/10.1111/j.1553-2712.2008.00219.x.
Mittal NP, Goyal M. Dexmedetomidine: a potential agent for use in procedural dental sedation. Indian J Dent. 2014;5:21–7.
Mittal N, Gauba K, Goyal A, Kapur A, Jain K. A double-blind randomized trial of ketofol versus propofol for endodontic treatment of anxious pediatric patients. J Clin Pediatr Dent. 2013;37:415–20. https://doi.org/10.17796/jcpd.37.4.thv8372410714342.
Mittal N, Gauba K, Goyal A, Kapur A. Pediatric dental sedation practice: evolution and current state-of the-art. J Postgrad Med Edu Res. 2014;48:139–47. https://doi.org/10.5005/jp-journals-10028-1119.
Mittal N, Goyal A, Jain K, Gauba K. Pediatric dental sedation research: where do we stand today? J Clin Pediatr Dent. 2015;39:284–91. https://doi.org/10.17796/1053-4628-39.3.284.
Patel V, Singh N, Saksena AK, Singh S, Sonkar SK, Jolly SM. A comparative assessment of intranasal and oral dexmedetomidine for procedural sedation in pediatric dental patients. J Indian Soc Pedod Prev Dent. 2018;36:370–5. https://doi.org/10.4103/JISPPD.JISPPD_40_18.
Sago T, Shiiba S, Ando E, Kondo K, Tsunakake M, Akitomi S, Ono A, Kato Y, Chogyoji Y, Watanabe S. Sedation with a combination of dexmedetomidine and midazolam for pediatric dental surgery. Anesth Prog. 2018;65(2):124–6.
Surendar MN, Pandey RK, Saksena AK, Kumar R, Chandra G. A comparative evaluation of intranasal dexmedetomidine, midazolam and ketamine for their sedative and analgesic properties: a triple blind randomized study. J Clin Pediatr Dent. 2014;38:255–61.
Taniyama K, Oda H, Okawa K, Himeno K, Shikanai K, Shibutani T. Psychosedation with dexmedetomidine hydrochloride during minor oral surgery. Anesth Prog. 2009;56:75–80.
Tobias JD. Dexmedetomidine: applications in pediatric critical care and pediatric anesthesiology. Pediatr Crit Care Med. 2007;8:115–31.
Ustün Y, Gündüz M, Erdoğan O, Benlidayi ME. Dexmedetomidine versus midazolam in outpatient third molar surgery. J Oral Maxillofac Surg. 2006;2006(64):1353–8.
Venham L, Bengston D, Cipes M. Children’s response to sequential dental visits. J Dent Res. 1977;56:454–9.
Visser E, Schug SA. The role of ketamine in pain management. Biomed Pharmacother. 2006;60:341–8.
Weinstein P, Nathan JE. The challenge of fearful and phobic children. Dent Clin North Am. 1988;32:667–92.
Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs. 1988;14:9–17.
Acknowledgements
The authors are thankful to former Dean, Dr Manoj Goyal for his support and to the children and parents for participating in this study. The authors are thankful to Mr. Ramesh Goyal for conducting the statistical analysis.
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NM, BS, NG conceived the idea and concept. KH collected the data and did clinical cases. NM analyzed the data and prepared first draft. All authors gave their inputs, helped in revising and finalizing the manuscript.
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Haider, K., Mittal, N., Srivastava, B. et al. 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. Eur Arch Paediatr Dent 23, 465–473 (2022). https://doi.org/10.1007/s40368-022-00706-w
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DOI: https://doi.org/10.1007/s40368-022-00706-w