Comparison of Nitrous Oxide-Oxygen as Inhalation Agent, Midazolam, Ketamine alone and in Combination as Oral Sedative Agents for In-office Paediatric PatientsA Randomised Control Trial
Introduction: In-office pharmacological sedation techniques are best applied to manage an extremely fearful preschooler, especially during primary dentition or a child’s early mixed dentition period. These should be used when non pharmacological behavioural management techniques fail either due...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2021-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/15270/48519_CE[Ra1]_F(SL)%20GC(AnK)_PF1(SC_OM)_PFA(SC_KM)_PN(KM).pdf |
| Summary: | Introduction: In-office pharmacological sedation techniques
are best applied to manage an extremely fearful preschooler,
especially during primary dentition or a child’s early mixed
dentition period. These should be used when non pharmacological
behavioural management techniques fail either due to lack of
communication or in children with special care needs.
Aim: To compare the efficacy of oral administrations of midazolam,
ketamine, combination of midazolam-ketamine (M+K) and nitrous
oxide-oxygen (N2
O) inhalational sedation in achieving favorable
behavioural outcome compared by using the Houpt scale in the
treatment of anxious and uncooperative paediatric patients.
Materials and Methods: A randomised clinical trial was
conducted in the Department of Paediatric and Preventive
Dentistry, SGT University, Haryana, India between September
2018 to December 2019. The study included 100 anxious
children (Venham’s picture scale) aged three to five years, who
required procedures under local anaesthesia administration were
divided into four groups using envelop method. Each group was
given either oral midazolam (M) (0.3 mg/kg) or oral ketamine (K)
(3 mg/kg) or oral combination of midazolam+ketamine (M+K)
(0.3 mg/kg and 2 mg/kg) or inhalational nitrous oxide-oxygen
(N2
O). The behaviour response of the child was recorded using
the Houpt scale. The oxygen saturation level and heart rate of
each patient were also recorded before, after, and during the
procedure. Adverse drug reactions post-treatment was also
recorded. Analysis of Variance (ANOVA), Chi-square test and
Mann-Whitney U test was used for statistical analysis.
Results: The study comprised of 100 anxious children (mean age
was 4.1±0.5 years) requiring administration of local anaesthesia
with intent to complete in-office treatment. Statistically, a
significant difference was found among behaviour outcomes of
four groups (p-value=0.047). Acceptable behaviour was seen
best in K+M group (88%), followed by oral ketamine (K) (68%),
N2
O (59%), and oral midazolam (M) (52%). Adverse reactions
were most commonly seen in the oral ketamine group.
Conclusion: Oral M+K combination group is significantly better
than oral ketamine (K), oral midazolam (M) or N2
O inhalation
sedation to achieve the required behaviour for dental treatment
in three to five years old patients. |
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| ISSN: | 2249-782X 0973-709X |