Comparison between intranasal dexmedetomidine and ketamine as premedication for minor dental pediatric surgeries

Abstract

Preoperative anxiety in pediatric patients can be a significant challenge, particularly in minor dental surgeries where children often experience heightened fear and distress. Sedation and analgesia are commonly employed to ease this process. Intranasal administration of drugs such as dexmedetomidine and ketamine has emerged as an alternative, offering ease of administration, avoiding the need for needles, and reducing first-pass metabolism. This study aimed to compare the sedation levels of intranasal dexmedetomidine and ketamine in children undergoing minor dental surgeries under general anesthesia. Secondary goals included assessing hemodynamics, drug acceptance, ease of separation from parents, venipuncture, and recovery. A randomized, double-blinded study was conducted on 48 children (ages 3–6) scheduled for minor dental surgeries. The children were divided into three groups: dexmedetomidine (1 μg/kg), ketamine (2 mg/kg), and saline control. Sedation, drug acceptance, ease of separation, and venipuncture were assessed. Hemodynamics [heart rate, mean arterial pressure (MAP), oxygen saturation] and recovery outcomes were monitored. Both dexmedetomidine and ketamine provided better sedation than the control group ( P <0.001), with no difference between the two drugs. Hemodynamic stability was maintained, though MAP was lower in the dexmedetomidine group 15 min postadministration. Four dexmedetomidine patients had mild postoperative hypotension. Recovery was faster in the control group, but no significant differences were observed between the drug groups. Intranasal dexmedetomidine and ketamine are effective and safe for pediatric dental surgeries, offering good sedation with minimal side effects. Dexmedetomidine showed lower MAP, while ketamine provided better hemodynamic stability.