Sun Y, Li Q. Nasopharyngeal airway-assisted sedation enhances oxygenation and reduces perioperative adverse events in pediatric dental surgery: A comparative clinical study. J Investig Med. 2025 May 30:10815589251348914. doi: 10.1177/10815589251348914. Epub ahead of print. PMID: 40444890.
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Abstract
Perioperative airway management during pediatric dental procedures remains challenging, particularly in balancing oxygenation stability with procedural safety under intravenous sedation. This randomized trial compared nasopharyngeal airway (NPA)-assisted intravenous sedation (n = 30) versus traditional nasal cannula oxygenation (n = 30) in 60 children aged 6-12 years undergoing dental surgery. Both groups received standardized midazolam-propofol sedation and perioperative monitoring. Primary outcomes encompassed oxygen saturation (SpO2), adverse events (aspiration, choking, mucosal bleeding), sedation efficacy, and surgeon satisfaction. The NPA group demonstrated superior SpO2 maintenance at key procedural stages (p < 0.05), with a 78% reduction in hypoxemia episodes compared to controls. Notably, aspiration and choking incidents decreased significantly (p < 0.05), yielding a fourfold lower overall adverse event rate (6.67% vs 30.00%, p = 0.001). Sedation quality metrics revealed enhanced behavioral cooperation (p < 0.001) and optimal sedation depth (Ramsay scores: p < 0.001) in the NPA cohort, though pain perception remained comparable between groups (p > 0.05). Surgeons reported 93.33% satisfaction with NPA-assisted cases versus 33.33% with conventional methods (p < 0.001), correlating with fewer procedural interruptions. These findings establish NPA as a clinically superior modality for pediatric dental sedation, offering dual benefits of improved oxygenation stability and procedural workflow efficiency. The technology addresses critical gaps in perioperative safety while maintaining hemodynamic equilibrium, positioning it as a viable optimization strategy for high-risk pediatric populations.
Zhang X, Fan Z, He D, Liu Y, Shi X, Zhang H. Effectiveness of dexmedetomidine as a premedication for pediatric patients undergoing outpatient dental surgery under general anaethesia-systematic review and meta-analysis. PeerJ. 2025 Mar 31;13:e19216. doi: 10.7717/peerj.19216. PMID: 40183044; PMCID: PMC11967424.
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Abstract
Pediatric patients undergoing outpatient dental surgery often exhibit instinctive resistance and fear in face of the unknown, which in turn creates obstacles to subsequent treatment. Appropriate sedation can increase compliance, decrease the incidence of adverse events, and lead to improved treatment outcomes. To evaluate the effectiveness of dexmedetomidine as pre-medication in children undergoing tooth extraction with general anesthesia, we searched databases including the Medline, Embase and Cochrane library for eligible trials. Randomized controlled trials of dexmedetomidine for premedication vs. placebo or midazolam in pediatric patients were included, while trials involving children having dental treatment under local anesthesia were excluded. Two review authors independently participated in the inclusion of trials and assessment of bias. Decisions were made based on group discussion. We finally included seven trials in this review, with a total of 496 pediatric patients. Three of the included trials compared dexmedetomidine with placebo. A meta-analysis indicated that dexmedetomidine was effective for preoperative sedation and for preventing emergence delirium; two of these studies reported no incidences of bradycardia and hypoxemia during study observation period. Four trials compared dexmedetomidine with midazolam, meta-analysis of these four trials gave risk ratios (RR) for successful parental separation, satisfactory mask acceptance and emergence delirium rate of 1.26 (95% CI [0.86-1.84]); 1.07(95% CI [0.94-1.22]); -0.18(95% CI [-0.29 to -0.07]), respectively. Only one study reported complications arising from administration of premedication. Based on the current evidence, we can conclude that the dexmedetomidine appears to be an effective premedication, offering the advantage of reducing the incidence of postoperative delirium compared to midazolam. However, high-quality clinical trials with larger sample sizes are needed to determine the selection of different medication modes and doses, as well as to study perioperative adverse reactions.
Oladokun OD, Oyeleke SO, Adebayo AA, Shuaib NM, Omotuyole AS, Ajibare AO. Assessing the Safety of Ketamine as a Procedural Sedative in Paediatric Dentistry: A Comparative Study with Midazolam. West Afr J Med. 2024 Nov 29;41(11):1097-1104. PMID: 40231543.
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Abstract
Sedation has been employed to improve patient’s cooperation. This has contributed to quality of treatments as well as improving the patients’ and practitioners’ experience during some procedures especially among children. The price of some of the newer sedatives can hamper the use in resource-constraint environments, hence the need to explore other cost-effective options. We compared the safety of oral ketamine against oral midazolam among 100 ASA I and II children aged between 3 and 7 years requiring dental treatments in a tertiary hospital in Lagos, Nigeria. The patients were divided into 2 equal groups by balloting using the opaque envelope method. Group A received Ketamine (7.5 mg / kg) while group B received Midazolam (0.75 mg / kg). The intravenous formulation was mixed with apple juice and administered orally. The patient’s vital signs were monitored and the behaviour during procedure was assessed using the Frankl behaviour rating scale. Time to respond to verbal stimulus was recorded. The demographic characteristics and ASA status were similar between the 2 groups (p>0.05). the behaviour of the patients was better among the children in the midazolam group (p=0.026). the ease of administration of local anaesthesia (p=0.012) and examination of the buccal cavity after the procedure (p=0.019) was better in the ketamine group but there was no significant difference in the overall assessment of adequacy of sedation (p= 0.196). The trend of vital signs was similar between the 2 groups (P>0.05). Recovery was longer in the ketamine group (p=0.001). Side effects like vomiting, nystagmus, hypersecretion and somnolence, were significantly higher among the ketamine group, p<0.05. there was no significant difference in the acceptability of both drugs to the dental surgeons and the guardians of the patients (p= 0.093 and 0.308, respectively). Both drugs provided adequate conditions for complete treatments in the study groups. Although the side effect profile was better in the midazolam group, both were acceptable to both dental practitioners and the guardians of the patients.
Thorburn M, Dishman D, Glick A, Pazmiño K, Chiquet B. Identifying Post-Discharge Events in Pediatric Sedation Patients. Pediatr Dent. 2025 Mar 15;47(2):108-113. PMID: 40296262.
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Abstract
Purpose: To identify the incidence of parental-reported post-discharge events (PDEs) following moderate sedation and determine the sedation regimen and patient-specific factors that contribute to PDEs. Methods: Two thousand patient charts of pediatric patients who underwent sedation were screened. Information gathered from the patient record included patient body mass index (BMI), airway assessment, history of sleep-disordered breathing (SDB) symptoms, sedation medications and dosages, and parentally reported post-operative information. Results: Parents provided post-discharge information for 1,079 records (54 percent response rate). PDEs were reported for 35.2 percent of patients, with behavior issues (19.5 percent) and dental complications (17.6 percent) reported the most. Overall, more PDEs occurred in American Society of Anesthesiologists (ASA) I patients compared to ASA II patients (P<0.001) and increased as BMI increased (P=0.003) and tonsillar obstruction decreased (P=0.02). Comparing sedation regimens showed no difference in the proportion of PDEs (overall or by category; P>0.05). Patient age, ASA classification, height, BMI, Brodsky score, and sedation route influenced PDEs based on different sedation regimens and specific PDEs. Conclusions: Behavioral and dental issues are the most commonly parental-reported post-discharge events, and the rate of occurrence did not depend on the sedation regimen. The incidence of PDEs increased as body mass index increased, reinforcing the recommendation that obese patients should not sedated in the dental office, even if dosed to their lean body weight.
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