Abstract
The aim of this study was to compare the effects of preoperative intranasal dexmedetomidine and oral midazolam on preoperative sedation and postoperative agitation in pediatric dentistry. A total of 60 children (ASA grade I, aged 3–6 years) scheduled for elective pediatric dental treatment were randomly divided into the dexmedetomidine (DEX) and midazolam (MID) groups. Ramsay sedation score, parental separation anxiety scale, mask acceptance scale, pediatric anesthesia emergence delirium scale, and hemodynamic parameters were recorded. The Ramsay sedation scale and hemodynamic parameters of the children were observed and recorded immediately before administration and 10, 20, and 30 min after administration. A satisfactory mask acceptance scale rate was 93.33% in both MID and DEX groups, and there was no significant difference between the two groups (p > 0.05). The proportions of children that “successfully separated from their parents” were 93.33% (MID) and 96.67% (DEX). No significant difference was found between the two groups (p > 0.05). The incidence of agitation was 20% in the MID group and 0% in the DEX group, and the difference was statistically significant (p < 0.05). Intranasal dexmedetomidine and oral midazolam provided satisfactory sedation. No significant difference between the two groups was found in terms of parental separation anxiety and mask acceptance (p > 0.05). The incidence of postoperative pediatrics emergence delirium was significantly lower in the DEX group (p < 0.05).
Highlights
Young children often cannot tolerate dentistry in a routine clinical setting; dentists frequently administer general anesthesia through an advanced behavioral management technique to provide quality dental care [1]
The significance and precautions of intranasal dexmedetomidine and oral midazolam were communicated to the parents of the children. e approval of the parents was obtained, and informed consent was signed. e inclusion criteria were as follows: 3–6 years old, American Society of Anesthesiologists (ASA) grade I, and inability to cooperate in the pediatric dental clinic to treat children requiring general anesthesia. e exclusion criteria were as follows: patients with congenital diseases; allergy to dexmedetomidine, midazolam, or propofol; asthma; and patients with psychiatric and respiratory diseases
We assessed the depth of sedation in children through Ramsay Sedation Score (RSS), and we found that an RSS of 2 or 3 is the appropriate depth of sedation, during which a child is cooperative, conscious, oriented, and quiet
Summary
Young children often cannot tolerate dentistry in a routine clinical setting; dentists frequently administer general anesthesia through an advanced behavioral management technique to provide quality dental care [1]. Midazolam, which is anxiolytic, sedative, and hypnotic and exerts a compliant amnestic effect, has been widely used for premedication. It has some side effects, such as postoperative behavioral changes, cognitive impairment, paradoxical reactions, and respiratory depression. Dexmedetomidine is a highly selective α-2 agonist that produces sedative, anxiolytic, and analgesic effects without causing respiratory depression. Emergence agitation refers to thrashing, kicking, disorientation, inconsolable crying, hallucinations, and cognitive and memory impairment during the recovery period following the administration of general anesthesia [3].
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