International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 11 , ISSUE 5 ( September-October, 2018 ) > List of Articles

Original Article

A Comparative Evaluation of the Sedative Effects of Nitrous Oxide-oxygen Inhalation and Oral Midazolam–Ketamine Combination in Children

Ila Srinivasan, Shyamachalam, Priya Mendiretta

Keywords : Anxiolysis, Nitrous oxide-oxygen inhalation, Oral ketamine–midazolam combination, Sedative effects

Citation Information : Srinivasan I, S, Mendiretta P. A Comparative Evaluation of the Sedative Effects of Nitrous Oxide-oxygen Inhalation and Oral Midazolam–Ketamine Combination in Children. Int J Clin Pediatr Dent 2018; 11 (5):399-405.

DOI: 10.5005/jp-journals-10005-1547

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2018; The Author(s).


Aims: To compare nitrous oxide-oxygen inhalation and low dose oral midazolam–ketamine combination for anxiolysis in the management of children aged between 3 to 10 years for dental treatment. Materials and methods: A comparative clinical study with equal number of subjects in both the groups evaluating efficacy of oral ketamine–midazolam combination and nitrous oxide-oxygen inhalation in children with Frankl behavior rating score 2 and ASA1. A total of 30 children were equally divided into 2 groups, oral midazolam-ketamine (MK) group which received 0.25mg/ kg midazolam with 3mg/kg ketamine in combination and the Nitrous oxide-oxygen (N) group which received nitrous oxideoxygen inhalation. The parameters evaluated were the drug/ mask acceptance, need for the use of a physical restraint. Houpt's sedation scale, faces pain score, sedation duration, time taken to achieve the maximum sedation and adverse reactions were assessed. Student t-test was used for comparison between the groups and proportions were compared using Chi-square test. Results: The results found no statistically significant differences between the groups in all the parameters except for the duration of sedation and the time taken to achieve maximum sedation which were higher in oral MK group than the Nitrousoxide oxygen inhalation group. Conclusion: Both oral-midazolam and ketamine combination and nitrous oxide-oxygen inhalation sedation were found to have similar clinical success among 3 to 10-year-old children in bringing about anxiolysis during dental treatment. Clinical Significance: Both oral ketamine-midazolam combination, nitrous oxide-oxygen inhalation are equally effective for anxiolysis in children during dental treatment.

PDF Share
  1. Wilson S. Pharmacological management of the pediatric dental patient. Pediatr Dent 2004;26:131-136.
  2. Peretz B. The use of sedation while treating pediatric dental patient in Isreal. Int. J. Pediatr. Dent 2002;12:355-356.
  3. Council O. Guideline on use of nitrous oxide for pediatric dental patients. Pediatr Dent. 2013;36(5):174-178.
  4. Gronbaek AB, Svensson P, Vaeth M, Hansen I, Poulsen S. A placebo-controlled, double-blind, crossover trial on analgesic effect of nitrous oxide-oxygen inhalation. Int J Paediatr Dent. 2014;24(1):69-75.
  5. Mohamed A, Daabiss, Mohamed H. Dexmedetomidine versus ketamine combined with midazolam;a comparison of anxiolytic and sedative premedication in chidlren. BJMP. 2011; 4(4):441.
  6. Somri M, Parisinos CA, Kharouba J, Cherni N, Smidt A, Abu Ras Z et al. Optimising the dose of oral midazolam sedation for dental procedures in children: a prospective, randomized and controlled study. Int J Paediatr Dent. 2012;22(4): 271-279.
  7. Shapira J, Kupietzky A, Kadari A, Fuks AB, Holan G. Comparison of oral midazolam with and without hydroxyzine in the sedation of pediatric dental patients. Pediatr Dent. 2004; 26(6):492-496.
  8. Ozen B, Malamed SF, Cetiner S, Ozalp N, Ozer L, Altun C. Outcomes of moderate sedation in paediatric dental patients. Aust Dent J. 2012;57:144-150.
  9. Barkaran S, Breitbart R, Brenner-Zada G, Feldon M, Assa A, Toledano M et al. A double-blind, randomised, placebo controlled trial of oral midazolam plus oral ketamine for sedation of children during laceration repair. Emerg Med J. 2014;31(8):649-653.
  10. Rabie ME. Combination of oral ketamine and midazolam versus midazolam alone as a premedication in children undergoing tonsillectomy. AJAIC. 2005;8(3):58-64.
  11. Kupietzky A, Houpt MI. Midazolam: a review of its use for conscious sedation of children. Pediatr Dent. 1993;15: 237-241.
  12. Golpayegani MV, Dehghan F, Ansari G, Shayeghi S. Comparison of oral Midazolam-Ketamine and Midazolam-Promethazine as sedative agents in pediatric dentistry. Dent Res J (Isfahan). 2012;9:36-40.
  13. Mahrotra G, sambhav J. Nitrous oxide inhalation sedation in Pediatric dentistry: a review. Int J Dent Health Sci. 2014;1(2):161-169.
  14. Gross JB, Bailey PL, Caplan RA, Connis RJ, Cote CJ. Practice guidelines for sedation and analgesia by non-anaesthelogists. Anaesthesiology. 2005-2006;96(4):1004.
  15. Rai K, Hegde A M, Goel K. Sedation in uncooperative children undergoing dental procedures: a comparative evaluation of midazolam, propofol and ketamine. J Clin Pediatr Dent. 2007;32(1):1-4.
  16. Burton JH, Auble TE, Fuchs SM. Effectiveness of 50% nitrous oxide and 50% oxygen during laceration repair in children. Acad. Emerg Med 1998;5(2):112-117.
  17. Dum-Russell T, Adair SM, Sams DR, Russell CM, Barenie JT. Oxygen saturation and diffusion hypoxia in children following nitrous oxide sedation. Pediatric Dent. 1993;15(2):112-117
  18. Curt goho. Oral midazolam-grape fruit juice drug interactin. Ped. Dent. 2001;23(4):365-366.
  19. Darlong V, Shende D, Subramanyam MS, Sunder R, Naik A. Oral ketamine or midazolam or low dose combination for premedication in children. Anaesth Intensive Care. 2004; 32:246-249.
  20. Silver T, Wilson C, Webb M. Evaluation of two dosages of oral midazolam as a conscious sedation for physically and neurologically compromised pediatric dental patients. Pediatr Dent. 1994;16:350-359.
  21. Wilson KE, Girdler NM, Welbury RR. Randomized, controlled, cross-over clinicalt rial comparing intravenous midazolam sedation with nitrous oxide sedation in children undergoing dental extractions. Br J Anaesth. 2003;91(6):850-856.
  22. Shepherd AR, Hill FJ. Orthodontic extractions: a comparative study of inhalation sedation and general anaesthesia. Br Dent J. 2000;188(6):329-331.
  23. Blain KM, Hill FJ. The use of inhalation sedation and local anaesthesia as an alternative to general anaesthesia for dental extractions in children. Br Dent J. 1998;184;(12):608-611.
  24. Lyratzopoulos G, Blain KM. Inhalation sedation with nitrous oxide as an alternative to dental general anaesthesia for children. J Public Health Med. 2003;25(4):303-312.
  25. Cagiran E, Eyigor C, Sipahi A, Koca H, Balcioglu T, Uyar M. Comparison of oral Midazolam and Midazolam-Ketamine as sedative agents in paediatric dentistry. Eur J Paediatr Dent. 2010;11:19-22.
  26. Darlong V, Shende D, Singh M, Garg R, Pandey R, Punj J. Low- versus high-dose combination of midazolam-ketamine for oral premedication in children for ophthalmologic surgeries. Singapore Med J. 2011;52:512-516.
  27. Baygin O, Bodur H, Isik B Effectiveness of premedication agents administered prior to nitrous oxide/oxygen. Eur J Anaesthesiol. 2010;27(4):341-346.
  28. Al-Zahrani AM, Wyne AH, Sheta SA. Comparison of oral midazolam with a combination of oral midazolam and nitrous oxide-oxygen inhalation in the effectiveness of dental sedation for young children. J Indian Soc Pedod Prev Dent. 2009; 27(1):9-16.
  29. Sekerci C, Dönmez A, Ateş Y, Okten F. Oral ketamine premedication in children (placebo controlled double-blind study). Eur J Anaesthesiol. 1996;13(6):606-611.
  30. Funk W, Jakob W, Riedl T, Taeger K. oral preanesthetic medication for children: double –blind randomized study of a combination of midazolam and ketamine vs midazolam or ketamine alone. Br J Anaesth. 2000;84(3):335-340.
  31. Roelofse JA, Louw LR, Roelofse PG. A double blind randomized comparison of oral trimeprazine-methadone and ketamine-midazolam for sedation of pediatric dental patients for oral surgical procedures. Anesth Prog. 1998; 45(1):3-11.
  32. Babita G, Radhika Prasad G. Comparative evaluation of midazolam and ketamine with midazolam alone as oral premedication. Pediatr Anesth. 2005; 15:554-549.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.