Abstract
The incidence of peri-procedural amnesia following procedural sedation in children is unclear and difficult to determine. This study aimed to apply quantitative and qualitative approaches to better understand amnesia following dental sedation of children. After Institutional Review Board Approval, children scheduled for sedation for dental procedures with oral midazolam (OM), oral midazolam and ketamine (OMK), or intranasal midazolam and ketamine (IMK) were recruited for examination of peri-procedural amnesia. Amnesia during the dental session was assessed using a three-stage method, using identification of pictures and an animal toy. On the day following the sedation, primary caregivers answered two questions about their children’s memory. One week later, the children received a semi-structured interview. Behavior and level of sedation during the dental session were recorded. Quantitative data were analyzed using descriptive statistics and comparison tests. Qualitative data were analyzed using content analysis. Triangulation was used. Thirty-five children (age: 36 to 76 months) participated in the quantitative analysis. Most children showed amnesia for the dental procedure (82.9%, n = 29/35) and remembered receiving the sedation (82.1%, n = 23/28 for oral administration; 59.3%, n = 16/27 for intranasal administration). The occurrence of amnesia for the dental procedure was slightly higher in the oral midazolam group compared with the other groups (44.8%, n = 13/29 for OM, 13.8%, n = 4/29 for OMK, and 41.4%, n = 12/29 for IMK). Twenty-eight children participated in the qualitative approach. The major theme identified was that some children could remember their procedures in detail. We conclude that peri-procedural amnesia of the dental procedure was common following sedation.
Highlights
Sedation is often necessary in pediatric dentistry for children with anxiety, fear, and behavioral management problems [1]
The primary aim of the randomized controlled trial (RCT) was to compare the efficacy of three sedative regimes on behavior (NCT02447289): intranasal midazolam and ketamine (IMK) group—intranasal midazolam 0.2 mg/kg and ketamine 4.0 mg/kg [18]; oral midazolam and ketamine (OMK) group—oral midazolam 0.5 mg/kg and ketamine 4.0 mg/kg [19,20]; and OM group—oral midazolam 1.0 mg/kg [20]
‘memory’ was pre-planned as a secondary outcome (2015), we altered the original protocol when we found that children less than 3 years could not complete the memory tests owing to their cognitive development
Summary
Sedation is often necessary in pediatric dentistry for children with anxiety, fear, and behavioral management problems [1]. Amnesia, defined as an inability to recall information consciously [2], is a desirable feature of sedation. The incidence of recall during sedation varies widely by study, with reports from 0% [5] to 100% [6,7,8]. This difference can be attributed to the drug used; in the former study, children were sedated with nitrous oxide and melatonin, whereas in the other investigations, they were sedated with amnestic drugs (propofol, ketamine, or benzodiazepines)
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