Swaminathan Kavitha, Shan Sushmita, Ss Monika Sri, Renugalakshmi Apathsakayan, Ravi Ramanathan, Haridoss Selvakumar
Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Division of Pedodontics, Preventive Dental Sciences Department, College of Dentistry, Jazan University, Jazan, Saudi Arabia.
J Dent Anesth Pain Med. 2025 Feb;25(1):1-13. doi: 10.17245/jdapm.2025.25.1.1. Epub 2025 Jan 22.
Dental fear and anxiety management in children is considered one of the biggest challenges in pediatric dentistry. Intranasal sedation is a promising technique for managing unco-operative pediatric patients with rapid onset, ease of administration, and minimal invasiveness. We aimed to review the efficacy, onset time, duration, and behavioral success of intranasal sedation agents in pediatric dental procedures and identify the most effective regimens for clinical practice. This systematic review followed the PRISMA 2020 guidelines and included randomized controlled trials (RCTs) assessing intranasal sedation in children undergoing dental procedures. Primary outcomes were onset time, duration of sedation, and sedation success rates. The inclusion criteria were applied through search in six databases. Risk of bias was evaluated using the Cochrane RoB 2 tool. Meta-analyses were carried out using RevMan software, where pooled odds ratios and weighted mean differences were calculated on efficacy outcomes. Eighteen RCTs fulfilled the inclusion criteria, where intranasal agents such as midazolam, ketamine, dexmedetomidine, and their combinations were used. Meta analyses demonstrated intranasal sedation generally has a faster onset (moderate heterogeneity, I = 40%) and is associated with greater success rates for achieving sedation than other methods. A combination of midazolam with ketamine or dexmedetomidine provided better results for both onset and behavioral success. The duration of sedation appears equivalent to oral or intravenous routes. Overall risk of bias was moderate due to blinding and selective reporting concerns. Midazolam, especially when combined with ketamine or dexmedetomidine, yielded promising results in relation to rapid onset and success of sedation. However, further large-scale RCTs are necessary to standardize dosing protocols and ensure that these findings are validated and optimized for clinical applications.
儿童牙科恐惧与焦虑的管理被认为是儿科牙科领域最大的挑战之一。鼻内镇静是一种很有前景的技术，可用于管理不合作的儿科患者，具有起效快、给药方便和侵入性最小的特点。我们旨在综述鼻内镇静剂在儿科牙科手术中的疗效、起效时间、持续时间和行为成功率，并确定临床实践中最有效的方案。本系统评价遵循PRISMA 2020指南，纳入了评估牙科手术患儿鼻内镇静的随机对照试验（RCT）。主要结局指标为起效时间、镇静持续时间和镇静成功率。通过在六个数据库中检索来应用纳入标准。使用Cochrane RoB 2工具评估偏倚风险。使用RevMan软件进行Meta分析，计算疗效结局的合并比值比和加权平均差。18项RCT符合纳入标准，使用了咪达唑仑、氯胺酮、右美托咪定等鼻内用药及其组合。Meta分析表明，鼻内镇静通常起效更快（中度异质性，I² = 40%），与其他方法相比，实现镇静的成功率更高。咪达唑仑与氯胺酮或右美托咪定联合使用在起效和行为成功率方面均取得了更好的效果。镇静持续时间似乎与口服或静脉途径相当。由于存在盲法和选择性报告问题，总体偏倚风险为中度。咪达唑仑，尤其是与氯胺酮或右美托咪定联合使用时，在快速起效和镇静成功方面取得了有前景的结果。然而，需要进一步开展大规模RCT来规范给药方案，并确保这些结果在临床应用中得到验证和优化。
