Safety and effectiveness of intranasal administration of sedative medications (ketamine, midazolam, or sufentanil) for urgent brief pediatric dental procedures.
Thirty children presenting to the dental clinic of a pediatric hospital who required brief but urgent dental care, and who could not be satisfactorily examined or treated, were administered one of three medications--ketamine (Ketalar), 3 mg/kg; midazolam (Versed), 0.4 mg/kg; or sufentanil (Sufenta), 1.5 or 1.0 micrograms/kg--intranasally in a randomized, double-blinded protocol. The patients were brought to the day surgery area following appropriate fasting and administered one of the medications diluted in a dose of 0.1 mL/kg normal saline while sitting in a nurse's arms. Cardiorespiratory monitors were applied when tolerated, and the child was placed on the operating room table. Each child was injected locally with up to one dental cartridge of 2% lidocaine with 1:100,000 epinephrine before dental extractions. A sedation score was recorded using a scale where 1 = hysterical/untreatable, 5 = ideal sedation, and 10 = obtunded and desaturated, requiring airway management assistance. Midazolam administration resulted in acceptable sedation (mean score: 4) with no desaturations below 90% as measured by pulse oximetry and a mean recovery room observation time of only 3 +/- 2 min (+/- SD). Ketamine also had a mean sedation score of 4 and a short recovery period (7 +/- 7 min); however, two children experienced brief desaturations. Sufentanil at 1.5 micrograms/kg was noted to produce much more heavily sedated children (mean score 7), with a high incidence of significant oximetry desaturation (80%) and prolonged recovery room duration (58 +/- 40 min). Use of 1.0 microgram/kg sufentanil resulted in no desaturations, less sedation (mean score 4), and a brief recovery time (7 +/- 13 min).(ABSTRACT TRUNCATED AT 250 WORDS)
Abrams
R
R
Department of Pediatric Dentistry, The Children's Hospital, Denver, Colorado 80218, USA.
Morrison
J E
JE
Villasenor
A
A
Hencmann
D
D
Da Fonseca
M
M
Mueller
W
W
D000281:Administration, Intranasal; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental / Q000379:methods*; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D004311:Double-Blind Method; D006801:Humans; D000860:Hypoxia / Q000139:chemically induced; D007223:Infant; D007649:Ketamine / Q000008:administration & dosage; D008874:Midazolam / Q000008:administration & dosage; D010377:Pediatric Dentistry / Q000379:methods; D010865:Pilot Projects; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects; D014081:Tooth Extraction
D007649:Ketamine; D017409:Sufentanil; D008874:Midazolam