A prospective study on the effectiveness of ketamine and diazepam used for conscious sedation in paediatric dental patients' management.

Aim The need to manage children using safe, effective and inexpensive conscious sedation materials and techniques in paediatric dentistry is high. This study evaluated the safety and effectiveness of a combination of low dose ketamine (5 mg/kg) and diazepam (0.2 mg/kg) used for conscious sedation in healthy children undergoing paediatric dental procedures at a paediatric dental outpatient clinic over a 3-year period. Materials and methods All children who were scheduled for conscious sedation between 2009 and 2012 were included in the study. All children received ketamine 5 mg/kg body weight in combination with diazepam 0.2 mg/kg body weight in a single oral dose for use as conscious sedation. Patients were considered sedated when the Ramsey Score was 2 or 3. Time of onset and duration of surgical procedures were recorded. Side effects during and after discharge were recorded. Result Twenty five patients participated in the study. The effectiveness of the sedation was 84.0%. The mean time of onset of action was 10.5 + 7.2 minutes. All cases that needed additional sedation needed this after 35−36 minutes. Three cases (12.0%) developed high temperature in the night of the day of the procedure. There was a case (4.0%) of hallucination. Conclusion Ketamine and diazepam as medication for conscious sedation was considered effective. The duration of effectiveness appears to be 35 minutes. The combination is considered safe for use for conscious sedation in healthy paediatric dental outpatients undergoing minor oral surgical procedures. A prospective study on the effectiveness of ketamine and diazepam used for conscious sedation in paediatric dental patients’ management Introduction Methods adopted by dentists to manage dental anxiety in children are primarily aimed at avoiding unpleasant and unproductive confrontations with the child. The intention is to create an environment that will facilitate development of the child’s confidence and allow the dentists to carry out procedures with minimal disruption. Ideally, behavioural management techniques should be used alone to achieve treatment goals and to guide the child to develop most appropriate behaviour. While behaviour management techniques have been found to be effective in some patients [Folayan et al., 2003], analysis show that the use of behavioural management techniques for children was effective for a few noninvasive procedures but not for invasive procedures such as dental extraction [Folayan et al., 2005]. While there have been lots of studies conducted to understand how to best employ behaviour management strategies so as to ensure paediatric dental patients’ cooperation, behaviour management strategies may not be appropriate for all patients: fearful patients who require invasive procedures still come to the clinic. Where fear and pain may result in uncoperative behaviour, sedation in some form may be required. The ideal sedation drug for short potentially painful or fear inducing procedures should provide ease of administration, rapid onset, effective analgesia, adequate immobilisation, minimum cardiac and respiratory effects, stable airway maintainance, a broad margin of safety, and a rapid smooth recovery. Ketamine satisfies most of these criteria [Green et al, 1990; Folayan et al., 2002]. Green and Johnson [1990] extensively reviewed the use of ketamine as a sedative agent in paediatric patients. There are reports that have noted its safe and effective use for dental procedures [Sporel, 1970; Birkhanet al., 1971; Bamber et al., 1973; Kaplan et al., 1975; Cohenour et al., 1978]. It rapidly produces profound sedation and analgesia without cardiorespiratory depressions typically seen with narcotics and benzodiazepines [Young and Epker, 1971;Reich and Silvay, 1989; Folayan et al., 2002]. The extensive review of the safety and efficacy of