Pandey R K, Padmanabhan M Y, Saksena A K, Chandra Girish
Department of Pedodontics and Preventive Dentistry, Faculty of Dental Sciences, C.S.M. Medical University, Lucknow, Uttar Pradesh, India.
J Clin Pediatr Dent. 2010 Fall;35(1):105-10. doi: 10.17796/jcpd.35.1.t275680587226k66.
The objective of this study was to comparatively evaluate the effectiveness ofsubmucosalfentanyl when administered in conjunction with oral midazolam during pediatric procedural sedations.
Twenty three uncooperative ASA type I children who met the selection criteria were randomly assigned to receive either submucosal fentanyl (3 microg/kg) or placebo, along with oral midazolam (0.5 mg/kg). A triple blind, 2-stage cross-over design was adopted so that each child received both the regimens.
Transient oxygen desaturation was observed in 4 children who were sedated with the combination of oral midazolam and submucosalfentanyl. The overall success was 73.91% with oral midazolam and submucosal fentanyl regimen and 47.83% for oral midazolam and submucosal placebo regimen. The chances of 'satisfactorily'completing a 45 minute dental procedure in an uncooperative pediatric patient was 2.8 times more, when submucosalfentanyl was used along with oral midazolam.
Submucosal fentanyl appears to improve the short working time associated with oral midazolam. But the oxygen desaturation associated with this regimen necessitates further studies to evaluate the efficacy of this combination at relatively lower doses before being used routinely for pediatric procedural sedation and analgesia.
本研究的目的是比较评估在儿科手术镇静期间，黏膜下给予芬太尼联合口服咪达唑仑的有效性。
23名符合入选标准的不合作的美国麻醉医师协会（ASA）I级儿童被随机分配接受黏膜下芬太尼（3微克/千克）或安慰剂，同时口服咪达唑仑（0.5毫克/千克）。采用三盲、两阶段交叉设计，使每个儿童接受两种治疗方案。
4名接受口服咪达唑仑和黏膜下芬太尼联合镇静的儿童出现短暂性氧饱和度下降。口服咪达唑仑和黏膜下芬太尼治疗方案的总体成功率为73.91%，口服咪达唑仑和黏膜下安慰剂治疗方案的总体成功率为47.83%。当黏膜下芬太尼与口服咪达唑仑联合使用时，不合作的儿科患者“满意地”完成45分钟牙科手术的几率高出2.8倍。
黏膜下芬太尼似乎可改善与口服咪达唑仑相关的较短作用时间。但与该治疗方案相关的氧饱和度下降需要进一步研究，以在常规用于儿科手术镇静和镇痛之前，评估相对较低剂量下这种联合用药的疗效。
