Effectiveness of dexmedetomidine and midazolam for pediatric dental procedures: A systematic review and meta-analysis.
Main Article Content
Abstract
Background / Introduction: Pediatric dentistry has long been associated to pain, fear, and anxiety. It typically takes a variety of behavioural management techniques that are communicated by the entire dental team to get a child to cooperate with a procedure. Beyond non-pharmacological methods, there are pharmacological methods using sedative agents used in dental practise to provide analgesia and anxiolysis to help children behave appropriately for dental treatment. This makes treatment more patient-friendly and efficient.
Aim: The current study was aimed to determine the efficacy of Dexmedetomidine and Midazolam as sedative agents and the effective route of administration.
Methodology: A thorough literature search was conducted on PubMed, MEDLINE, Google Scholar, and Cochrane’s database for randomized controlled trials that compared sedative efficacy of dexmedetomidine (DEX) with midazolam (MDZ) in children of 0–15 years of age undergoing dental procedures. This systematic review and meta-analysis has been registered at the International Prospective Register of Systematic Review- PROSPERO- CRD42023449821. This review follows the guidelines of preferred reporting items in systematic review and meta-analysis (PRISMA) guidelines. Sedation in children during procedure, when used as a sedative agent, hemodynamic stability, onset time, duration of anesthesia, were evaluated.
Result: Significant difference was noted for onset time with DEX group having a higher mean time, at p=0.005. The duration between the two agents were not significantly different at p=0.43. Dexmedetomidine administered children clearly took greater time to recover as compared to Midazolam group. Blood pressure did not vary between groups, SpO2 was better in Midazolam group, but heart rate was also increased in the Midazolam group.
Conclusion: The nasal route of administration may be the most effective method of drug delivery. The use of midazolam might be more beneficial for short procedures carried out in busy outpatient centers, but the use of dexmedetomidine is more effective for long extensive dental treatment.
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References
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