Haridoss Selvakumar, Shan Sushmita, Madiraju Guna Shekhar, Swaminathan Kavitha, Mohan Rohini, Asiri Faris Yahya I, Almugla Yousef Majed, Hamidaddin Mohammad Alhussein
Department of Pediatric and Preventive Dentistry, Sri Ramachandra Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research, Chennai 600116, India.
Department of Preventive Dental Sciences, College of Dentistry, King Faisal University, AlAhsa 31982, Saudi Arabia.
J Clin Med. 2025 Jun 7;14(12):4038. doi: 10.3390/jcm14124038.
Intranasal sedation is commonly used in pediatric dentistry to manage dental anxiety and improve patient compliance. This systematic review and meta-analysis aimed to evaluate the recovery time, patient satisfaction, and adverse effects of the intranasal sedatives midazolam, dexmedetomidine, and ketamine in pediatric dental procedures. : A systematic search of PubMed, Scopus, the Web of Science, the Cochrane Library, Embase, and Google Scholar was conducted following the PRISMA 2020 guidelines. Only randomized controlled trials (RCTs) involving intranasal sedation in pediatric patients (≤18 years) were included. The revised Cochrane risk of bias tool (RoB 2) was employed to assess study quality. A meta-analysis using a random-effects model was performed to evaluate the recovery time. : Twenty-one RCTs were included in this review. A meta-analysis of seven studies revealed that dexmedetomidine was associated with significantly longer recovery times compared to midazolam and ketamine. Specifically, midazolam demonstrated the shortest recovery time (mean difference: -19.1 min, < 0.05), followed by ketamine (mean difference: -15.6 min, < 0.05). A qualitative analysis of adverse effects showed mild to moderate complications, including nasal irritation (midazolam), prolonged sedation (dexmedetomidine), and hypersalivation (ketamine). Patient satisfaction was found to be highest with dexmedetomidine, although midazolam was preferred for its faster onset of sedation. : Intranasal sedation in pediatric dentistry is a safe and effective approach, with each agent exhibiting distinct recovery profiles and safety considerations. The findings emphasize the importance of standardized sedation protocols and the need for further research into the long-term outcomes of these sedatives in pediatric populations.
鼻内镇静常用于儿童牙科治疗，以控制牙科焦虑并提高患者的依从性。本系统评价和荟萃分析旨在评估鼻内镇静剂咪达唑仑、右美托咪定和氯胺酮在儿童牙科手术中的恢复时间、患者满意度及不良反应。：按照PRISMA 2020指南，对PubMed、Scopus、科学网、考克兰图书馆、Embase和谷歌学术进行了系统检索。仅纳入涉及18岁及以下儿科患者鼻内镇静的随机对照试验（RCT）。采用修订后的考克兰偏倚风险工具（RoB 2）评估研究质量。采用随机效应模型进行荟萃分析以评估恢复时间。：本评价纳入了21项RCT。对7项研究的荟萃分析显示，与咪达唑仑和氯胺酮相比，右美托咪定的恢复时间明显更长。具体而言，咪达唑仑的恢复时间最短（平均差：-19.1分钟，<0.05），其次是氯胺酮（平均差：-15.6分钟，<0.05）。对不良反应的定性分析显示为轻度至中度并发症，包括鼻刺激（咪达唑仑）、镇静时间延长（右美托咪定）和流涎过多（氯胺酮）。发现右美托咪定的患者满意度最高，尽管咪达唑仑因其镇静起效更快而更受青睐。：儿童牙科中的鼻内镇静是一种安全有效的方法，每种药物都有不同的恢复情况和安全注意事项。研究结果强调了标准化镇静方案的重要性，以及对这些镇静剂在儿科人群中的长期结局进行进一步研究的必要性。
