Malhotra Parul Uppal, Thakur Seema, Singhal Parul, Chauhan Deepak, Jayam Cheranjeevi, Sood Ritu, Malhotra Yagyeshwar
Department of Paediatric and Preventive Dentistry, HPGDC, Shimla, Himachal Pradesh, India.
Department of Oral and Maxillofacial Surgery, HPGDC, Shimla, Himachal Pradesh, India.
Contemp Clin Dent. 2016 Apr-Jun;7(2):186-92. doi: 10.4103/0976-237X.183058.
Pharmacological methods have been used as an adjunct to enhance child cooperativeness and facilitate dental treatment.
Purpose of this study was to evaluate and compare the effect of sedation by intranasal dexmedetomidine and oral combination drug midazolam-ketamine in a group of children with uncooperative behavior requiring dental treatment.
This was a prospective, randomized, double-blind study that included patients 3-9 years old with American Society of Anesthesiologists-I status. About 36 children presenting early childhood caries were randomly assigned to one of three groups studied: Group MK received intranasal saline and oral midazolam (0.5 mg/kg) with ketamine (5 mg/kg) mixed in mango juice; Group DX received intranasal dexmedetomidine (1 μg/kg) and oral mango juice; and Group C received intranasal saline and oral mango juice. Patients' heart rate, blood pressure, and oxygen saturation were recorded before, during, and at the end of the procedure. Patients' behavior, sedation status, and wake up behavior were evaluated with modified observer assessment of alertness and sedation scale. Ease of treatment completion was evaluated according to Houpt scale.
Hemodynamic changes were statistically insignificant in Group MK and Group DX. About 75% patients in Group MK were successfully sedated as compared to 53.9% Group DX and none of the patients in Group C. Ease of treatment completion was better with Group MK as compared to Group DX and least with Group C. Around 50% patients in Group MK had postoperative complications.
Oral midazolam-ketamine combination and intranasal dexmedetomidine evaluated in the present study can be used safely and effectively in uncooperative pediatric dental patients for producing conscious sedation.
药理学方法已被用作辅助手段，以提高儿童的配合度并促进牙科治疗。
本研究的目的是评估和比较鼻内给予右美托咪定与口服咪达唑仑 - 氯胺酮联合药物对一组需要牙科治疗的不合作行为儿童的镇静效果。
这是一项前瞻性、随机、双盲研究，纳入了美国麻醉医师协会身体状况分级为I级的3至9岁患者。约36名患有早期儿童龋的儿童被随机分配到三个研究组之一：MK组接受鼻内生理盐水和口服咪达唑仑（0.5 mg/kg）与氯胺酮（5 mg/kg）混合在芒果汁中；DX组接受鼻内右美托咪定（1 μg/kg）和口服芒果汁；C组接受鼻内生理盐水和口服芒果汁。在手术前、手术期间和手术结束时记录患者的心率、血压和血氧饱和度。使用改良的观察者警觉和镇静评分量表评估患者的行为、镇静状态和苏醒行为。根据豪普特量表评估治疗完成的难易程度。
MK组和DX组的血流动力学变化在统计学上无显著意义。MK组约75%的患者成功镇静，而DX组为53.9%，C组无患者成功镇静。与DX组相比，MK组治疗完成更容易，C组最难。MK组约50%的患者有术后并发症。
本研究中评估的口服咪达唑仑 - 氯胺酮组合和鼻内右美托咪定可安全有效地用于不合作的儿科牙科患者以产生清醒镇静。
