Janiani Palak, Gurunathan Deepa, Manohar Ramsesh
Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.
Department of Anaesthesiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND.
Cureus. 2023 Jul 11;15(7):e41676. doi: 10.7759/cureus.41676. eCollection 2023 Jul.
Background Behavioral management techniques are employed for children who are fearful and uncooperative. Pharmacologic sedation and anesthesia are frequently utilized to manage pain and anxiety in pediatric dental patients. Aim To evaluate the intraoperative and postoperative pain levels during dental treatment of children sedated with 1.5 μg/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide. Materials and methods In this crossover study, 24 children between the ages of five and seven years were randomly assigned to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhaled nitrous oxide during three different visits. At each visit, a single pulp therapy procedure was conducted after administering the respective sedative agent, and the pain levels were documented. There was a one-week interval between each visit to allow for a washout period. The data were analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp, Armonk, NY, United States) using the Wilcoxon signed-rank test and Kruskal-Wallis H test (p < 0.05). Results All three sedative agents were equally effective in controlling postoperative and intraoperative pain. Although there was no statistically significant difference among the groups, clinically, midazolam showed lower intraoperative pain levels (mean 1.78 ± 1.42). Conclusion In pediatric dental patients, intranasal midazolam at a dosage of 0.3 mg/kg and intranasal dexmedetomidine at a dosage of 1.5 μg/kg demonstrate comparable effectiveness to nitrous oxide sedation in pain management. These options serve as effective alternatives for anxious children who may not tolerate nitrous oxide sedation.
行为管理技术适用于恐惧且不合作的儿童。药物镇静和麻醉常用于管理儿科牙科患者的疼痛和焦虑。
评估用1.5μg/kg鼻内右美托咪定、0.3mg/kg鼻内咪达唑仑和氧化亚氮镇静的儿童在牙科治疗期间的术中和术后疼痛水平。
在这项交叉研究中，24名5至7岁的儿童被随机分配在三次不同的就诊中分别接受鼻内雾化右美托咪定、鼻内雾化咪达唑仑和吸入氧化亚氮。每次就诊时，在给予相应的镇静剂后进行单次牙髓治疗程序，并记录疼痛水平。每次就诊之间间隔一周以留出洗脱期。使用IBM SPSS Statistics for Windows，版本22.0（2013年发布；IBM公司，美国纽约州阿蒙克），通过Wilcoxon符号秩检验和Kruskal-Wallis H检验（p<0.05）对数据进行分析。
所有三种镇静剂在控制术后和术中疼痛方面同样有效。尽管各组之间没有统计学上的显著差异，但在临床上，咪达唑仑的术中疼痛水平较低（平均1.78±1.42）。
在儿科牙科患者中，0.3mg/kg剂量的鼻内咪达唑仑和1.5μg/kg剂量的鼻内右美托咪定在疼痛管理方面与氧化亚氮镇静效果相当。这些选择是那些可能无法耐受氧化亚氮镇静的焦虑儿童的有效替代方案。
