As it is becoming increasingly more common for pediatric patients to require general anesthesia for dental treatment, the Stony Brook School of Dental Medicine and the Renaissance School of Medicine at Stony Brook University analyzed the effectiveness and safety of two intramuscular (IM) sedation combinations for these procedures.
Children, particularly those with special needs, often require IM sedation for safe and effective transport into the operating room and induction of general anesthesia for dental procedures. Finding the correct mixture of medications with the least number of adverse events for IM sedation is a key factor for successful management of these patients, the researchers said.
A total of 105 patients treated by dental anesthesiologists at Stony Brook University Hospital between January 1, 2016, and January 1, 2019, met the criteria to have their charts reviewed by the researchers. Of the patients, 59% were younger than 13 years old, and 64% had at least one behavioral issue, with autism spectrum disorder being the most common.
The researchers compared the charts to determine if an IM injection with a combination of ketamine and dexmedetomidine (KD) was safer than IM with ketamine and midazolam (KM). There was no difference in the time from IM administration to operating room entry in either group, nor was there any difference between the groups regarding adverse events.
However, there was a notable difference in measuring mean arterial pressure (MAP) and heart rates, as the KD group showed significantly reduced minimal MAP, minimal HR, and maximum HR compared to the KM group.
There also was a slight increase in the time from IM injection to patient discharge in the KD group, 273 versus 240 minutes, as well as a longer median duration of surgery, 145 versus 130 minutes. However, neither of these differences was shown to be statistically significant.
The researchers concluded that IM administration with KD is an effective and safe alternative compared to KM for facilitating patient transfer into the operating room and inducing general anesthesia. They also suggest that performing additional randomized clinical trials would provide more data, especially relating to assessing accurate dosing options.
The study, “Retrospective Comparison of Intramuscular Admixtures of Ketamine and Dexmedetomidine Versus Ketamine and Midazolam for Preoperative Sedation,” was published by Anesthesia Progress.
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