Faghihian Reyhaneh, Eshghi Alireza, Faghihian Hessamoddin, Kaviani Nasser
Dental Research Center, Department of Pediatric Dentistry, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
Dental Student, Dental Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran.
Anesth Pain Med. 2018 Apr 16;8(2):e64236. doi: 10.5812/aapm.64236. eCollection 2018 Apr.
Dental anxiety is prevalent in children. This condition may cause uncooperative behavior and need a treatment under general anesthesia. The perioperative period, especially for children, is a stressing event. Premedication is commonly used to reduce perioperative anxiety and facilitate the induction of anesthesia.
132 children candidates for dental treatment under GA were enrolled in this study and randomly divided into 3 groups. Oral melatonin, midazolam, and normal saline were administered as premedication. Patient's sedation score before GA, the ease of intravenous line establishment, patient's need for painkillers, and duration of recovery were evaluated and compared.
Regarding the sedation score and response to IV access establishment, comparisons showed statistically significant differences between melatonin and midazolam groups (P < 0.05) as well as between midazolam and placebo groups (P < 0.001). The difference between melatonin and placebo groups was not significant (P > 0.05). The need for painkiller administration was statistically different between midazolam and placebo, melatonin and placebo, and midazolam and melatonin groups (P < 0.05). A statistically significant difference was also found between melatonin and midazolam as well as between melatonin and placebo groups (P < 0.05) with regard to the recovery duration while no significant difference was observed between midazolam and placebo groups (P > 0.05).
Midazolam is superior to melatonin for premedication regarding the patients' sedation score before anesthesia and the ease of IV access establishment. Premedication with midazolam decreases the need for painkillers and increases the rate of recovery in children undergoing GA for dental treatment.
牙科焦虑症在儿童中很常见。这种情况可能导致不合作行为，需要在全身麻醉下进行治疗。围手术期，尤其是对儿童来说，是一个压力较大的时期。术前用药通常用于减轻围手术期焦虑并促进麻醉诱导。
132名接受全身麻醉下牙科治疗的儿童入选本研究，并随机分为3组。分别给予口服褪黑素、咪达唑仑和生理盐水作为术前用药。评估并比较了全身麻醉前患者的镇静评分、静脉通路建立的难易程度、患者对止痛药的需求以及恢复时间。
关于镇静评分和对静脉通路建立的反应，比较显示褪黑素组和咪达唑仑组之间（P < 0.05）以及咪达唑仑组和安慰剂组之间（P < 0.001）存在统计学显著差异。褪黑素组和安慰剂组之间的差异不显著（P > 0.05）。咪达唑仑组与安慰剂组、褪黑素组与安慰剂组以及咪达唑仑组与褪黑素组之间在止痛药使用需求方面存在统计学差异（P < 0.05）。在恢复时间方面，褪黑素组与咪达唑仑组以及褪黑素组与安慰剂组之间也存在统计学显著差异（P < 0.05），而咪达唑仑组与安慰剂组之间未观察到显著差异（P > 0.05）。
在麻醉前患者的镇静评分和静脉通路建立的难易程度方面，咪达唑仑作为术前用药优于褪黑素。咪达唑仑术前用药可减少接受全身麻醉下牙科治疗儿童的止痛药需求并提高恢复率。
