Department of Anesthesiology, the Stomatology Hospital Affiliated Chongqing Medical University.
Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences.
Int J Surg. 2023 Jul 1;109(7):1893-1899. doi: 10.1097/JS9.0000000000000340.
Severe dental phobia or failure to cooperate with treatment are very common in outpatient pediatric dentistry. Personalized and appropriate noninvasive anesthesia methods can save medical expenses, improve treatment efficiency, reduce the anxiety of children, and improve the satisfaction of nursing staff. Currently, there is little conclusive evidence for noninvasive moderate sedation strategies in pediatric dental surgery.
The trial was conducted from May 2022 to September 2022. Each child was first given midazolam oral solution 0.5 mg·kg -1 , and when the Modified Observer's Assessment of Alertness and Sedation score reached 4, a biased coin design up-down method was used to adjust the dose of esketamine. The primary outcome was the ED 95 and 95% CI of intranasal esketamine hydrochloride with midazolam 0.5 mg·kg -1 . Secondary outcomes included the onset time of sedation, treatment and awakening times, and the incidence of adverse events.
A total of 60 children were enrolled; 53 children were successfully sedated but 7 were not. The ED 95 of intranasal esketamine with 0.5 mg·kg -1 midazolam oral liquid for the treatment of dental caries was 1.99 mg·kg -1 (95% CI 1.95-2.01 mg·kg -1 ). The mean onset time of sedation for all patients was 43.7±6.9 min. 15.0 (10-24.0) min for examination and 89.4±19.5 min for awakening. The incidence of intraoperative nausea and vomiting was 8.3%. Adverse reactions such as transient hypertension and tachycardia occurred during the operations.
The ED 95 of intranasal esketamine with 0.5 mg·kg -1 midazolam oral liquid for the outpatient pediatric dentistry procedure under moderate sedation was 1.99 mg·kg -1 . For children aged 2-6 years with dental anxiety who require dental surgery, anesthesiologists may consider using midazolam oral solution combined with esketamine nasal drops for noninvasive sedation after a preoperative anxiety scale evaluation.
在儿童口腔科门诊中，严重的牙科恐惧症或无法配合治疗的情况非常常见。个性化和适当的非侵入性麻醉方法可以节省医疗费用，提高治疗效率，减轻儿童的焦虑，并提高护理人员的满意度。目前，对于儿童牙科手术中的非侵入性中度镇静策略，尚无确凿的证据。
试验于 2022 年 5 月至 2022 年 9 月进行。每个孩子首先给予咪达唑仑口服液 0.5mg·kg -1 ，当改良的警觉和镇静评分达到 4 分时，使用偏倚硬币设计上下法调整 Esketamine 的剂量。主要结局是 Esketamine 盐酸盐与咪达唑仑 0.5mg·kg -1 联合应用的鼻腔内 ED95 和 95%CI。次要结局包括镇静的起效时间、治疗和唤醒时间以及不良事件的发生率。
共纳入 60 例儿童，53 例成功镇静，7 例未成功。咪达唑仑 0.5mg·kg -1 口服溶液联合鼻腔内 Esketamine 治疗龋齿的 ED95 为 1.99mg·kg -1 （95%CI 1.95-2.01mg·kg -1 ）。所有患者的平均镇静起效时间为 43.7±6.9min，检查时为 15.0（10-24.0）min，唤醒时为 89.4±19.5min。术中恶心呕吐的发生率为 8.3%。术中出现短暂高血压和心动过速等不良反应。
咪达唑仑 0.5mg·kg -1 联合鼻腔内 Esketamine 用于中度镇静下的儿童口腔科门诊手术的 ED95 为 1.99mg·kg -1 。对于需要牙科手术且有牙科焦虑症的 2-6 岁儿童，在术前焦虑量表评估后，麻醉师可能会考虑使用咪达唑仑口服液联合 Esketamine 滴鼻剂进行非侵入性镇静。
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