Oral Midazolam plus Ketamine Versus Midazolam for Conscious Sedation in Paediatric Ambulatory Dentistry: Use And Safety In A Limited Resource Clime

Abstract

Background - Paediatric patients undergoing ambulatory dental procedures require conscious sedation to allay anxiety and provide optimal  conditions to perform the dental procedure. However, ensuring safety is the hallmark, as children are at an increased risk of developing hypoxia from loss of airway reflexes.

Methodology -This was a randomized study of sixty (60) eligible patients aged between 3 and 10 years scheduled for outpatient dental procedures. Group M received midazolam 0.5mg/kg whilst group MK received midazolam 0.25kg/kg plus ketamine 3mg/kg both given orally. Parenteral formulation of both midazolam and ketamine were used, diluted into 0.2ml/kg of a sugar based clear drink (Lucozade boost). Sedation was assessed using Modified Ramsay Sedation Score. Pulse rate, systolic, diastolic blood pressures, peripheral oxygen saturation and respiratory rate were recorded after administration of the study drugs and used as measures of safety

Results - Twenty-five (83.3%) patients and 27 (90.3%) among group M and MK respectively, had satisfactory sedation (P= 0.353). Ten (33.3%) patients in group MK had intraoperative tachycardia, compared to 5 (16.7%) in group M. Hypoxia was seen in 5 patients (16.7%) in group MK and 2 (6.6%) in group M (P=0.023). Five (16.7%) patients in group MK had nausea and vomiting, while only 1(3.3%) patient vomited among group M. Three (10%) patients in group MK had fever as reported by parents and none from group M (P=0.001).
Conclusion - Oral midazolam can provide safe and satisfactory conscious sedation with less complications than when combined with oral ketamine.

Keywords: Conscious sedation, Paediatric ambulatory dentistry, Ketamine, Midazolam