Comparative Evaluation of Ease of Dental Treatment and Clinical Efficiency of Midazolam vs Midazolam and Ketamine Combination for Sedation in Young Uncooperative Pediatric Patients: A Systematic Review
Gauri Vijaykumar Rathi, Dimple Padawe, Vilas Takate, Kishor Dighe, Kshitija K Bansode, Ajinkya U Narwade
Clinical efficiency, Ease of dental treatment in uncooperative children, Midazolam, Midazolam and ketamine combination
Citation Information :
Rathi GV, Padawe D, Takate V, Dighe K, Bansode KK, Narwade AU. Comparative Evaluation of Ease of Dental Treatment and Clinical Efficiency of Midazolam vs Midazolam and Ketamine Combination for Sedation in Young Uncooperative Pediatric Patients: A Systematic Review. Int J Clin Pediatr Dent 2022; 15 (6):680-686.
Aim: To assess and compare the effectiveness of midazolam vs midazolam and ketamine combination in the management of young uncooperative pediatric patients.
Materials and methods: The research question was developed by using population, intervention, comparison, outcome, and study design framework. The literature search was performed using three electronic databases: PubMed, Scopus, and EBSCOhost. The risk of bias of the studies was independently appraised using the Cochrane Handbook for Systematic Reviews of Interventions.
Results: Out of 98 preliminary records, five studies were selected for analysis. Three hundred forty-six uncooperative children were randomized through the five randomized controlled trials (RCTs), with a mean age of 5.8 years. Midazolam with ketamine was the most successful combination for delivering rapid and sufficient analgosedation in uncooperative children. The clinical efficiency of midazolam and ketamine combination had an overall success rate of 84% when compared to ketamine and midazolam alone. 50% of children in the midazolam and ketamine group demonstrated calm behavior, compared to 37% in the midazolam group. 44% of the children experienced modest intra and/or postoperative adverse effects that did not necessitate any special treatment.
Conclusion: Midazolam and ketamine combination is more efficient than midazolam alone with respect to ease of treatment and clinical efficiency.
Kassebaum NJ, Smith AGC, Bernabé E, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res 2017;96(4):380–387. DOI: 10.1177/0022034517693566
Tinanoff N, Baez RJ, Diaz Guillory C, et al. Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: global perspective. Int J Paediatr Dent 2019;29(3):238–248. DOI: 10.1111/ipd.12484
Pitts N, Baez R, Diaz-Guallory C, et al. Early childhood caries: IAPD Bangkok declaration. Int J Paediatr Dent 2019;29:384–386. DOI: 10.1111/ipd.12490
Nematollahi H, Mehrabkhani M, Sheykhani M. Assessing the relationship between diet and prevalence of early childhood caries in Birjand preschool children. J Dent 2007;8(1):70–85.
Wagle M, D'Antonio F, Reierth E, et al. Dental caries and preterm birth: a systematic review and meta-analysis. BMJ Open 2018;8(3):e018556. DOI: 10.1136/bmjopen-2017-018556
Broumand S, Sharififar S, Alikhani S. The study of caries free indicator of milk teeth in children age 3–6 at dare care center affiliated to health centers of army. 2006.
Ganesh A, Muthu MS, Mohan A, et al. Prevalence of early childhood caries in India—a systematic review. Indian J Pediatr 2019;86(3): 276–286. DOI: 10.1007/s12098-018-2793-y
Dorri M, Martinez-Zapata MJ, Walsh T, et al. Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries. Cochrane Database Syst Rev 2017;12(12):CD008072. DOI: 10.1002/14651858.cd008072
Knapp R, Gilchrist F, Rodd HD, et al. Change in children's oral health-related quality of life following dental treatment under general anesthesia for the management of dental caries: a systematic review. Int J Paediatr Dent 2017;27(4):302–312. DOI: 10.1111/ipd.12259
Rantavuori K, Lahti S, Hausen H, et al. Dental fear and oral health and family characteristics of Finnish children. Acta Odontol Scand 2004;62(4):207–213. DOI: 10.1080/00016350410001586
Nicolas E, Bessadet M, Collado V, et al. Factors affecting dental fear in french children aged 5–12 years. Int J Pediatr Dent 2010;20(5):366–373. DOI: 10.1111/j.1365-263X.2010.01054.x
Townend E, Dimigen G, Fung D. A clinical study of child dental anxiety. Behav Res Ther 2000;38(1):31–46. DOI: 10.1016/s0005-7967(98)00205-8
Ashley PF, Chaudhary M, Lourenço-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev 2018;12(12):CD003877. DOI: 10.1002/14651858.cd003877.pub3
Conway A, Rolley J, Sutherland JR. Midazolam for sedation before procedures. Cochrane Database of Syst Rev 2016;2016(5):CD009491. DOI: 10.1002/14651858.cd009491
Davies FC, Waters M. Oral midazolam for conscious sedation of children during minor procedures. J Accid Emerg Med 1998;15(4):244–248. DOI: 10.1136/emj.15.4.244
Dionne R. Oral midazolam syrup: a safer alternative for pediatric sedation. Compend Contin Educ Dent 1999;20(3):221–222.
Nathan JE, Vargas KG. Oral midazolam with and without meperidine for management of the difficult young pediatric dental patient. A retrospective study. Pediatr Dent 2002;24(2):129–138.
Moreira TA, Costa PS, Costa LR, et al. Combined oral midazolam–ketamine better than midazolam alone for sedation of young children: a randomized controlled trial. Int J Pediatr Dent 2013;23(3):207–215. DOI: 10.1111/j.1365-263X.2012.01246.x
Roelofse JA, Shipton EA, de la Harpe CJ, et al. Intranasal Sufentanil/Midazolam versus Ketamine/Midazolam for analgesia/sedation in the pediatric population prior to undergoing multiple dental extractions under general anesthesia: a prospective, double-blind, randomized comparison. Anesth Prog 2004;51(4):114–121.
Moher D, Liberati A, Tetzla J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6(7):e1000097. DOI: 10.1371/journal.pmed.1000097
Higgins JPT, Thomas J, Chandler J, et al. Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. Chichester, UK: John Wiley & Sons; 2019.
Koirala B, Pandey RK, Saksen AK, et al. A comparative evaluation of newer sedatives in conscious sedation. J Clin Pediatr Dent 2006;30(4):273–276. DOI: 10.17796/jcpd.30.4.540025 283p827511
Bahetwar SK, Pandey RK, Saksena AK, et al. A comparative evaluation of intranasal midazolam, ketamine and their combination for sedation of young uncooperative pediatric dental patients: a triple blind randomized crossover trial. J Clin Pediatr Dent 2011;35(4):415–420.
Antunes DE, Viana KA, Costa PS, et al. Moderate sedation helps improve future behavior in pediatric dental patients—a prospective study. Braz Oral Res 2016;30(1):e107. DOI: 10.1590/1807-3107BOR-2016.vol30.0107
Sado-Filho J, Viana KA, Corrêa-Faria P, et al. Randomized clinical trial on the efficacy of intranasal or oral ketamine-midazolam combinations compared to oral midazolam for outpatient pediatric sedation. PLoS One 2019;14(3):e0213074. DOI: 10.13039/5 01100003593
Ramos-Gomez F, Kinsler J, Askaryar H. Understanding oral health disparities in children as a global public health issue: how dental health professionals can make a difference. Journal of public health policy 2020;41(2):114–124.
World Health Organization. WHO Expert Consultation on Public Health Intervention against Early Childhood Caries: Report of a Meeting, Bangkok, Thailand, 26–28 January 2016. World Health Organization; 2017.
Kawashita Y, Kitamura M, Saito T. Monitoring time-related trends in dental caries in permanent teeth in Japanese national surveys. Int Dent J 2012;62(2):100–105. DOI: 10.1111/j.1875-595X.2011.00097.x
De Grauwe A, Aps JK, Martens LC. Early childhood caries (ECC): what's in a name? Eur J Paediatr Dent 2004;5(2):62–70.
Feldens CA, Giugliani ER, Duncan BB, et al. Long-term effectiveness of a nutritional program in reducing early childhood caries: a randomized trial. Community Dent Oral Epidemiol 2010;38(4): 324–332. DOI: 10.1111/j.1600-0528.2010.00540.x
Ribeiro NM, Ribeiro MA. Breastfeeding and early childhood caries: a critical review. J Pediatr (Rio J) 2004;80(5 Suppl):S199–S210. DOI: 10.2223/1241
Cui L, Li X, Tian Y, et al. Breastfeeding and early childhood caries: a meta-analysis of observational studies. Asia Pac J Clin Nutr 2017;26(5):867–880. DOI: 10.6133/apjcn.082016.09
Seow WK. Biological mechanisms of early childhood caries. Community Dent Oral Epidemiol 1998;26(1 Suppl):8–27. DOI: 10.111 1/j.1600-0528.1998.tb02090.x
Martens L, Vanobbergen J, Willems S, et al. Determinants of early childhood caries in a group of inner-city children. Quintessence Int 2006;37(7):527–536.
Law CSL, Blain S. Approaching the pediatric dental patient: a review of nonpharmacologic behavior management strategies. J Calif Dent Assoc 2003;31(9):703–713.
al-Rakaf H, Bello LL, Turkustani A, et al. Intra-nasal midazolam in conscious sedation of young pediatric dental patients. Int J Pediatr Dent 2001;11(1):33–40. DOI: 10.1046/j.1365-263x.2001.00237.x
Folayan MO, Idehen EE, Ojo OO. The modulating effect of culture on the expression of dental anxiety in children: a literature review. Int J Paediatr Dent 2004;14(4):241–245. DOI: 10.1111/j.1365-263X.2004.00563.x
Skaret E, Soevdsnes EK. Behavioural science in dentistry. The role of the dental hygienist in prevention and treatment of the fearful dental patient. Int J Dent Hyg 2005;3(1):2–6. DOI: 10.1111/j.1601-5037.2004.00109.x
Adair SM, Rockman RA, Schafer TE, et al. Survey of behavior management teaching in pediatric dentistry advanced education programs. Pediatr Dent 2004;26(2):151–158.
American Academy of Pediatric Dentistry. Guideline on behavior guidance for the pediatric dental patient. Pediatr Dent 2011;33:161–173.
Lima ARA, Costa LRRS, Costa PSS. A randomized, controlled, crossover trial of oral midazolam and hydroxyzine for pediatric dental sedation. Pesqui Odontol Bras 2003;17(3):206–211. DOI: 10.1590/s1517-74912003000300002
Heard C, Smith J, Creighton P, et al. A composition of four sedation techniques for pediatric dental surgery. Pediatr Anaesth 2010;20(10):924–930. DOI: 10.1111/j.1460-9592.2010.03402.x
Shapira J, Kupietzky A, Kadari A, et al. Comparison of oral midazolam with and without hydroxyzine in the sedation of pediatric dental patients. Pediatr Dent 2004;26(6):492–496.
Day PF, Power AM, Hibbert SA, et al. Effectiveness of oral midazolam for pediatric dental care: a retrospective study in two specialist centers. Eur Arch Pediatr Dent 2006;7(4):228–235. DOI: 10.1007/BF03262557
Wan K, Jing Q, Zhao JZ. Evaluation of oral midazolam as conscious sedation for pediatric patients in oral restoration. Chin Med Sci J 2006;21(3):163–166.
Astuto M, Disma N, Crimi E. Two doses of oral ketamine, given with midazolam, for premedication in children. Minerva Anestesiol 2002;68(7-8):593–598.
Darlong V, Shende D, Subramanyam MS, et al. Oral ketamine or midazolam or low dose combination for premedication in children. Anaesth Intensive Care 2004;32(2):246–249. DOI: 10.1177/0310057x0403200214
Ghai B, Grandhe RP, Kumar A, et al. Comparative evaluation of midazolam and ketamine with midazolam alone as oral premedication. Pediatr Anaesth 2005;15(7):554–559. DOI: 10.111 1/j.1460-9592.2004.01523.x
Darlong V, Shende D, Singh M, et al. Low- versus high-dose combination of midazolam–ketamine for oral premedication in children for ophthalmologic surgeries. Singapore Med J 2011;52(7):12–16.