A Comparative Evaluation of Drops versus Atomized Administration of Intranasal Ketamine for the Procedural Sedation of Young Uncooperative Pediatric Dental Patients: A Prospective Crossover Trial

Objective: The objective of this study was to compare and evaluate the efficacy and safety of drops and atomized administration of intranasal ketamine (INK) in terms of behavioral response for agent acceptance during administration and for agent efficacy and safety for the sedation of young uncooperative pediatric dental patients. Study design: Thirty Four uncooperative ASA grade-1 children, requiring dental treatment were randomly assigned to receive INK as drops and atomized spray in one of the subsequent visit. This was a two stage cross-over trial and each child received INK by both modes of administration. The vital signs were monitored continuously during each visit. Results: A statistically significant difference in patients acceptance (P<0.0001) was observed in the atomized administration when compared to drops administration for the procedural event of drug administration. Moreover, there were also significant differences (P<0.05) between onset of sedation and recovery time between two groups. All the vital signs were within normal physiological limits and there were no significant adverse effects in either group. Conclusions: INK is safe and effective by either mode of intranasal (IN) drug administration for moderate sedation in facilitating dental care for anxious and uncooperative pediatric dental patients. Moreover, INK when administered with the mucosal atomization device, the acceptance of the drug was associated with less aversive reaction, rapid onset and recovery of sedation, as compared to the drop administration of the same agent. Keywords: Moderate sedation, intranasal ketamine, intranasal drops and spray.