Evaluation of the Sedative Effect of Midazolam with and Without Ketamine, by Subcutaneous Via in Pediatric Dental Patients

Daniel Trejo-Herbert; Ricardo Martínez-Rider; Javier Lara-Guevara; Socorro Ruiz-Rodríguez; Arturo Garrocho-Rangel; Amaury Pozos-Guillén; Miguel Rosales-Berber

2018, Number 1

Odovtos-Int J Dent Sc 2018; 20 (1)

Evaluation of the Sedative Effect of Midazolam with and Without Ketamine, by Subcutaneous Via in Pediatric Dental Patients

Trejo-Herbert D, Martínez-Rider R, Lara-Guevara J, Ruiz-Rodríguez S, Garrocho-Rangel A, Pozos-Guillén A, Rosales-Berber M

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Language: Spanish
References: 30
Page: 89-97
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ABSTRACT

Children's fear and anxiety about dental treatment can lead to difficulties in the behavior management by the practitioner, which can be a barrier to successful dental treatment. Non cooperative children may need dental treatment under sedation, which is indicated when the non-pharmacological behavioral guidance is unsuccessful. There are randomized controlled trials comparing different sedative protocols for dental procedures; however, evidence of superiority from one form over another is weak. The aim of the present study was to evaluate the sedative effect of midazolam subcutaneously, with and without ketamine, on dental procedures performed in non-cooperative pediatric patients. A randomized, crossover clinical trial with single blinding was performed in 13 children (10 males and 3 females) from 19 to 48 months of age, ASA I and Frankl I behavior. The two methods were applied in the same patient, and the order of the same was assigned randomly, for the two treatment appointments. In each session were evaluated the patient's general behavior, body movements and crying through the modified Houpt scale. In addition, heart rate and oxygen saturation were monitored by means of a pulse oximeter.

REFERENCES

Cote C. J., Wilson S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: Update 2016. Pediatr Dent. 2016; 38 (4): 13-39.
Brown L., Christian-Kopp S., Sherwin T. S., Khan A., Barcega B., Denmark T. K., et al. Adjunctive atropine is unnecessary during ketamine sedation in children. Acad Emerg Med. 2008; 15 (4): 314-8.
Fernández Y., Luaces C. Manual de analgesia y sedación en urgencias en pediatría. Madrid: Ergon; 2008.
López-Castilla J. D., Soult-Rubio J. A. Analgesia y sedación en Pediatría. Pediatría Integral. 2006; X (4): 267-76.
Shervin T. S., Green S. M., Khan A., Chapman D. S., Dannenberg B. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo-controlled trial. Ann Emerg Med. 2000; 35 (3): 229-38.
Willman E. V., Andolfatto G. A prospective evaluation of “ketofol” (ketamine/propofol combination) for procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2007; 49 (1): 23-30.
Celis-Rodríguez E., Besso J., Birchenall C., de la Cal M. A., Carrillo R., Castorena G., et al. Guía de práctica clínica basada en la evidencia para el manejo de la sedo-analgesia en el paciente adulto críticamente enfermo. Med Intensiva. 2007; 31 (8): 428-71.
Torres J., Tapia I., Pozos A. J., Rosales M. A., Hernández J. F. Comparison of Three Conscious Sedation Regimens for Pediatric Dental Patients. J Clin Pediatr Dent. 2007; 31 (3): 183-186.
Velásquez J. H., Ortega M. E., Morales L., Pimienta M. Microdoses of ketamine to prevent postoperative pain. Rev Ciencias Med. 2005; 9 (3): 11-20.
Malamed S. Sedation, a guide to patient management. Mosby Elsevier. 5th Ed. 2010.
Menigaux C. H., Fletcher D., Dopont X., Guignard B., Guirimanel F., Chauxin M. The benefits of intraoperative small dose Ketamine on postoperative pain after anterior cruciate ligament repair. Anesth Analg. 2000; 90 (1): 129-35.
Sherwood E., Williams C., Prough. Anesthesiology principles, pain management, and conscious sedation. Sabiston textbook of surgery. Saunders Elsevier 18th Ed. 2008.
Al-Rakaf H., Bello I. L., Turkustani A., Adenu B. I. Intra-nasal midazolam in conscious sedation of young pediatric dental patients. International journal of pediatric dentistry. 2001; 11 (1): 33-40.
Chowdhury J., Vargas K. G. Comparision hydrate, meperidine, and hydroxyzine to midazolam regimens for oral sedation of pediatric dental patients. Pediatr Dent. 2005; 27 (3): 191-7.
De Gaudio A. R., Rinaldi S. Sedation in PACU: Indications, monitoring, complications. Curr Drug Targets. 2005; 6 (7): 729-40.
Young C., Knudsen N., Hilton A, Reves JG. Sedation in the intensive care unit. Crit Care Med. 2000; 28 (3): 854-66.
Castro E. S., Díaz M. E., Valdivieso M. Comparación de la efectividad del midazolam en niños: via oral y via intranasal. Rev Estomatol Herediana. 2005; 15 (2): 133-8.
Chávez E. J., Cortés E., Hinojosa A., Araiza MA. Estudio comparativo de la premedicación con midazolam y ketamina por vía oral en pacientes pediátricos sometidos a tratamiento de cirugía maxilofacial. Rev Odontol Mex. 2005; 9 (3): 131-6.
Darlong V., Shende D., Singh M., Garg R., Pandey R., Punj J. Low- versus high-dose combination of midazolam-ketamine for oral premedication in children for ophthalmologic surgeries. Singapore Med J. 2011; 52 (7): 512-6.
Wilson S., Farrell K. Conscious sedation experiences in graduate pediatric dentistry programs. Pediatr Dent. 2000; 23 (4): 307-14.
García C., Caprotta G., De Castro M., Germ R. Analgesia y sedación en procedimientos pediátricos. Parte 2: Requerimientos y medicación. Arch Argent Pediatr 2008; 106 (6): 524-32.
American Academy of Pediatrics. Committee on Drugs, Section and Anesthesiology. Guidelines for the elective use of sedation, deep sedation and general anesthesia in pediatric patients. Pediatr Dent. 2005-2006; 27 (7): 110-8.
Shankar V., Deshpande J. Procedural sedation in the pediatric patient. Anesth Clin North Am. 2005; 23 (4): 635-54.
Flores-Castillo D., Martínez-Rider R., Ruiz- Rodriguez S., Garrocho-Rangel A., Lara- Guevara J., Pozos-Guillén A. Subcutaneous Midazolam with and without Ketamine for sedation in children undergoing dental treatment: A pilot study. J Clin Pediatr Dent. 2015; 39 (4): 382-6.
Roelofse J. A., Joubert J. J., Roelofse P. G. A double blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients. J Oral Maxillofac Surg. 1996; 54 (7): 838-44.
Baying O., Bodur H., Isik B. Effectiveness of premedication agents administrated prior to nitrous oxide/oxygen. Eur J Anaesthesiol. 2010; 27 (4): 341-6.
Meléndez E., Bachur R. Serious adverse events during procedural sedation with ketamine. Pediatr Emerg Care. 2009; 25 (5): 325-8.
Bahetwar S. K., Pandey R. K., Saksena A. K., Chandra G. A comparative evaluation of intranasal midazolam, ketamine and their combination for sedation of young uncooperative pediatric dental patients: a triple blind randomized crossover trial. J Clin Pediatr Dent. 2011; 35 (4): 415-20.
Cagiran E., Eyigor C., Sipahi A., Koca H., Balciouqlu T., Uyar M. Comparison of oral Midazolam and Midazolam-Ketamine as sedative agents in paediatric dentistry. Eur J. Pediatr Dent. 2010; 11(1): 19-22.
Moreira T. A., Costa P. S., Costa L. R., Jesus- Franca C. M., Antunes D. E., Gomes H. S., Neto O. A. Combined oral midazolam-ketamine better than midazolam alone for sedation of young children: a randomized controlled trial. Int J Paediatr Dent. 2013; 23 (3): 207-15.