Comparison of oral Midazolam-Ketamine and Midazolam-Promethazine as sedative agents in pediatric dentistry

Golpayegani, Mojtaba Vahid; Dehghan, Fereshteh; Ansari, Ghassem; Shayeghi, Shahnaz

doi:10.4103/1735-3327.92925

Cited by 15 publications

(22 citation statements)

References 12 publications

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“…In addition to the use of any sedative drugs, the use of local anesthesia is essential for most of the dental treatments. 8 , 11 , 24 , 27 Postoperative sleep phase was 0-1 hour for oral sedation with 2-3 hours for intranasal sedations at the recovery stage, with statistically significant differences.…”

Section: Discussionmentioning

confidence: 99%

“…Combination of midazolam and ketamine as oral or nasal medication have been reported to boost the results. Vahid et al 24 compared oral midazolam (0/4 mg/kg)-ketamine (5 mg/kg) and midazolam (0/5 mg/kg)-promethazine (5 mg/mL) as sedative agents and concluded that ketamine/midazolam combination could sufficiently sedate children even in lower doses, unlike midazolam/promethazine combination used in their study.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3‒6-year-old Uncooperative Dental Patients

Ghajari¹,

Ansari²,

Soleymani³

et al. 2015

J Dent Res Dent Clin Dent Prospects

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Background and aims. There are several known sedative drugs, with midazolam and ketamine being the most commonly used drugs in children. The aim of this study was to compare the effect of intranasal and oral midazolam plus ketamine in children with high levels of dental anxiety.Materials and methods.A crossover double-blind clinical trial was conducted on 23 uncooperative children aged 3-6 (negative or definitely negative by Frankel scale), who required at least two similar dental treatment visits. Cases were randomly given ketamine (10 mg/kg) and midazolam (0.5 mg/kg) through oral or intranasal routes in each visit. The sedative efficacy of the agents was assessed by an overall success rate judged by two independent pediatric dentists based on Houpt’s scale for sedation. Data analysis was carried out using Wilcoxon test and paired t-test.Results. Intranasal administration was more effective in reduction of crying and movement during dental procedures compared to oral sedation (P<0.05). Overall behavior control was scored higher in nasal compared to oral routes at the time of LA injection and after 15 minutes (P<0.05). The difference was found to be statistically significant at the start and during treatment. However, the difference was no longer significant after 30 minutes, with the vital signs remaining within physiological limits. Recovery time was longer in the intranasal group (P<0.001) with a more sleepy face (P=0.004).Conclusion.. Intranasal midazolam/ketamine combination was more satisfactory and effective than the oral route when sedating uncooperative children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3‒6-year-old Uncooperative Dental Patients

Ghajari¹,

Ansari²,

Soleymani³

et al. 2015

J Dent Res Dent Clin Dent Prospects

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“…Similarly, Golpayegani et al investigated that midazolam/ketamine cocktail had deeper sedative effects than midazolam/promethazine during the treatment ( 16 ). Pruitt et al observed that intramuscular injection of midazolam, ketamine, and glycopyrrolate cocktail has been accompanied with the suitable sedation level in medical diagnostic measures ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Oral Ketamine, Midazolam, and Atropine Cocktail Versus Oral Diphenhydramine for Pediatric Sedation in the Emergency Department

Soleimanpour¹,

Mahmoodpoor²,

Milani³

et al. 2014

Iran Red Crescent Med J

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Background:Sedation is a condition of reduced level of consciousness (LOC) for a patient that is created to decrease irritability, anxiety, and restlessness.Objectives:In this study, we compared the sedative effect of oral administration of ketamine, midazolam, and atropine cocktail with diphenhydramine in the referent children to the emergency department.Patients and Methods:Based on the double-blind randomized clinical trial in this investigation, 80 children, who needed to repair their wounds with suture were randomly divided into two groups: group 1 and group 2, who have received oral diphenhydramine and oral ketamine, midazolam, and atropine cocktail, respectively. Behavioral changes were collected and recorded before, during intervention and two weeks after intervention. Statistical data were analyzed by SPSS-16 software and chi-square and Mann-Whitney U tests were employed to study the relations among variables. P < 0.05 was considered statistically significant.Results:There was no significant difference between two groups in terms of drug acceptance and anxiety degree in children before intervention. Group 2 had achieved better and deeper sedation than group 1 during 45-minute post-medication (P < 0.05, P = 0.01). Regarding pediatric general behavior such as crying or interruptive moves, there was also a significant statistical difference between group 2 and group 1 (P = 0.009) based on Houpt Classification. The mean recovery times in groups 1 and 2 were 34.37 ± 14.23 min and 27.25 ± 5.14 min, respectively (P = 0.003). In terms of behavioral changes, the rate of cumulative frequency was computed for behavioral changes two weeks after the discharge from emergency department in which there were less behavioral changes in group 2 than in group 1 (P = 0.04).Conclusions:Oral administration of ketamine, midazolam, and atropine cocktail induces better sedation than diphenhydramine with respect to its limited mood changes in children, who need a medical procedure at emergency department.

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“…Intravenous sedation is the second most comfortable, effective, and the safest technique after inhalation sedation; however, the technique should be used only by trained personnel. [ 1 ] Sedative techniques do not involve intubation, contrasting general anesthesia and the recovery period is short. [ 2 ] There are basically two techniques available for intravenous sedation: Use of only one medication, which is usually benzodiazepine and a combination of several medicines.…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 ] There are basically two techniques available for intravenous sedation: Use of only one medication, which is usually benzodiazepine and a combination of several medicines. [ 1 ] In sedation, it is of the utmost importance to achieve analgesia. Due to the limitations of the use of local anesthetic agents such as overdose and reaching the toxic levels of medications, proper analgesic agents should be used in combination with sedative agents.…”

Section: Introductionmentioning

confidence: 99%

Comparative evaluation of bispectral index system after sedation with midazolam and propofol combined with remifentanil versus ketamine in uncooperative during dental procedures

et al. 2016

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Background:Proper analgesic agents should be used in combination with sedative agents. Remifentanil is a synthetic narcotic/analgesic agent with a short duration effect and decreases the risk of apnea during recovery. Bispectral index system (BIS) is a new noninvasive technique for the evaluation of the depth of sedation. The aim of present clinical trial was to evaluate and compare the efficacy of intravenous sedation with propofol/midazolam/remifentanil (PMR) in comparison to propofol/midazolam/ketamine (PMK) for dental procedures in children 3-7 years of age.Materials and Methods:In this clinical trial, 32 healthy uncooperative children who were candidates for dental treatments under sedation were randomly divided into two groups. Intravenous sedation was induced with PMR in one group and with PMK in the other group. After injection and during procedure BIS index, heart rate and respiratory rate, blood pressure, and oxygen saturation was evaluated every 5 min. After the procedure, recovery time was measured. Data were analyzed with ANOVA, Friedman, Wilcoxon, and t-test.Results:The BIS value was significantly low in ketamin group (P = 0.003) but respiratory rates and heart rates were same in both groups with no statistical difference (P = 0.884, P = 0.775). The recovery time was significantly shorter in remifentanil group (P = 0.008 and P = 0.003).Conclusion:It can be concluded that intravenous sedation technique with PMR combination induces effective and safe sedation, with less pain and more forgetfulness and a shorter recovery time for children 3-7 years of age during dental procedures.

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Comparison of oral Midazolam-Ketamine and Midazolam-Promethazine as sedative agents in pediatric dentistry

Cited by 15 publications

References 12 publications

Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3‒6-year-old Uncooperative Dental Patients

Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3‒6-year-old Uncooperative Dental Patients

Effectiveness of Oral Ketamine, Midazolam, and Atropine Cocktail Versus Oral Diphenhydramine for Pediatric Sedation in the Emergency Department

Comparative evaluation of bispectral index system after sedation with midazolam and propofol combined with remifentanil versus ketamine in uncooperative during dental procedures

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