title: A comparative evaluation of intranasal dexmedetomidine, midazolam and ketamine for their sedative and analgesic properties: a triple blind randomized study.
abstract: OBJECTIVE
  To evaluate and compare the efficacy and safety of Intranasal (IN) Dexmedetomidine, Midazolam and Ketamine in producing moderate sedation among uncooperative pediatric dental patients.
  
  
  METHODS
  This randomized triple blind comparative study comprises of eighty four ASA grade I children of both sexes aged 4-14 years, who were uncooperative and could not be managed by conventional behavior management techniques. All the children were randomized to receive one of the four drug groups Dexmedetomidine 1 microg/ kg (D1), 1.5 microg/kg (D2), Midazolam 0.2 mg/kg (M1) and Ketamine 5 mg/kg (K1) through IN route. These drug groups were assessed for efficacy and safety by gauging overall success rate and by monitoring vital signs, respectively.
  
  
  RESULTS
  The onset of sedation was significantly rapid with M1 and K1 as compared to D1 and D2 (p = < 0.001). The overall success rate was highest in D2 (85.7%) followed by D1 (81%), K1 (66.7%) and M1 (61.9%), however, the difference among them was not statistically significant (p = > 0.05). Even though all the vital signs were within physiological limits, there was significant reduction in pulse rate (PR) (p = < 0.001) and systolic blood pressure (SBP) (p = < 0.05) among D1 and D2 as compared to M1 and K1. D1, D2 and K1 produced greater intra- and post-operative analgesia as compared to M1. There were no significant adverse effects with any group.
  
  
  CONCLUSIONS
  Dexmedetomidine, Midazolam and Ketamine, all the three drugs evaluated in the present study can be used safely and effectively through IN route in uncooperative pediatric dental patients for producing moderate sedation.
authors.forename: M Natarajan
authors.initials: MN
authors.lastname: Surendar
authors.forename: R Kumar
authors.initials: RK
authors.lastname: Pandey
authors.forename: A Kumar
authors.initials: AK
authors.lastname: Saksena
authors.forename: R
authors.initials: R
authors.lastname: Kumar
authors.forename: G
authors.initials: G
authors.lastname: Chandra
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental / Q000379:methods*; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D016854:Dental Anxiety / Q000517:prevention & control; D020927:Dexmedetomidine / Q000008:administration & dosage*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D010149:Postoperative Pain / Q000517:prevention & control; D010349:Patient Compliance; D061214:Patient Safety; D012119:Respiration / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D007649:Ketamine; D008874:Midazolam; D010100:Oxygen