Effectiveness of premedication agents administered prior to nitrous oxide/oxygen

Background and objective In paediatric dentistry, when anxiety, fear of dental procedures or behavioural impairment precludes the conduct of dental treatments, sedation procedures are required. However, sedation at the desired level might not be achieved despite administration of various agents. The present study aimed to evaluate the effectiveness of oral premedication with different agents on children scheduled for dental treatment under nitrous oxide/oxygen (N(2)O/O(2)) sedation. Methods The present research was approved by the Ethics Committee of Gazi University Faculty of Medicine. Sixty children aged between 5 and 8 years, ASA I or II, having no mental or motor retardation, requiring at least two-visit dental treatment, having no sedation or general anaesthesia experience, and incompliant with dental treatment (Frankl Behaviour Scale >= 3), were enrolled into the study after obtaining informed parental consent. The children were then randomly assigned to one of four groups. The treatment regimen according to the study groups was as follows: oral administration of 1mg kg(-1) hydroxyzine hydrochloride suspension (Atarax) 1 h preoperatively (group I, n = 15), oral administration of 0.7mgkg(-1) midazolam (Dormicum) 15 min preoperatively (group II, n = 15), oral administration of 3mg kg(-1) ketamine (Ketalar) with 0.25mgkg(-1) midazolam (Dormicum) 15 min preoperatively (group III, n = 15), and no oral premedication administration [group IV (controls), n = 15]. Peripheral oxygen saturation (SpO(2)) and heart rate were monitored with a pulse oximeter during treatment. The sedation level was monitored with the bispectral index. Following premedication, 40% N(2)O and 60% O(2) was administered to all groups by means of a nasal mask. Sedation depth was evaluated using the Ramsay Sedation Scale and data were recorded at 5 min intervals. Sedation success and other sedation-related events were recorded. Results The evaluation of the findings of this study revealed that treatment procedures were completed without any serious complications. Achievement of sedation in terms of satisfactory/mid-level satisfactory/unsatisfactory was as follows: 13.3/53.3/33.3% in group I; 54/20/26% in group II; 33.3/33.3/33.3% in group III, and 6.7/60/33.3% in group IV, respectively. Ramsay Sedation Scale results revealed that the most effective medication was 0.7mgkg(-1) midazolam. Conclusion It is concluded that 0.7mgkg(-1) midazolam is more effective than 0.25mgkg(-1) midazolam with 3mg kg(-1) ketamine and 1mg kg(-1) hydroxyzine hydrochloride in terms of oral premedication prior to N(2)O/O(2) sedation in children scheduled for dental treatments. Eur J Anaesthesiol 2010; 27: 341-346