Comparing the Efficacy of 3 and 5 mg/kg Intramuscular Ketamine with the Addition of Oral Midazolam and Atropine in Pediatric Dental Sedation

Abstract

Statement of the Problem: One of the main obstacles in dealing with pediatric patients is patients’ lack of cooperation when undergoing dental treatment. Providing a safe yet effective method to tackle such a problem is a priority of today’s pediatric dentistry. Purpose: The aim of this study was to compare the sedative effect of 3 and 5 mg/kg intramuscular (IM) ketamine with oral atropine and midazolam. Settings and Design: This clinical trial was performed on 25 uncooperative children aged 3–5 years. Each patient acted as self-control. Patients were randomly divided into two groups. Materials and Methods: In this experimental study, one group received 5 mg/kg ketamine (Daroupakhsh, Iran) IM at first and 3 mg/kg ketamine IM at the second visit, while the other received the same doses in the opposite order. All patients received oral midazolam (0.5 mg/kg) (Dales Pharmaceutical, England) with 0.02 mg/kg atropine (Caspian Co, Rasht, Iran) half an hour before the main IM ketamine injection. Statistical Analysis Used: Collected data were analyzed using ANOVA and Wilcoxon signed-rank test. Results: There was no significant difference between sedative effects of the two administered doses of ketamine (P < 0.1). In the 5 and 3 mg/kg ketamine groups, there were 80% and 76% success rates, respectively. For complications, two cases of emergence reaction and one case of visual disorders were reported in both sessions. Parents were more satisfied with child’s reactions after the 3 mg/kg ketamine dose session. Conclusion: No difference was found in effectiveness between the 3 and 5 mg/kg IM ketamine with the addition of oral midazolam and atropine in the sedation of very young children.