Sedation is frequently desired in young children undergoing day-care dental treatments.Conscious sedation is a safe technique which offers sedation, relief of pain and anxiety with minimal systemic risks. Midazolam is the conventionally used sedative in a wide variety of applications. exmedetomidine is a newer alpha-2 agonist which provides sedation, analgesia and anxiolysis and has been used intravenously for pediatric procedural sedation in a variety of settings such as radiological imaging (MRI, CT Scan), awake craniotomies and cardiac catheterization.We planned this study to compare the efficacy of intranasal Dexmedetomidine with oral Midazolam for sedation in uncooperative children undergoing restorative dental procedures between 2-6 years of age. After institutional ethics committee approval, and written informed consent from parents, uncooperative children aged 2-6years were selected from the outpatient department of Oral Health Centre of our Institute. Only those children who were scheduled for restorative procedures (RCT, tooth extractions, fillings etc.) of less than 45mins of duration were enrolled for the study. Children were randomly assigned to two groups for premedication using computer-generated random number chart 20 mins after EMLA cream application.
Group D received intranasal Dexmedetomidine 2.5mcg/kg, (half the total dose loaded in a 2cc syringe undiluted in each nostril) and 5ml oral honey, as control. Group M received oral Midazolam 0.5mg/kg mixed with 5 ml honey and sterile water nasal drops (in a 2cc syringe equal volume in both nostrils) as control.
IV cannulation was attempted 30 minutes after premedication at the site pre-treated with EMLA cream. The children were then shifted to the dental chair and the child’s behavior during dental procedure was assessed using Houpt’s behavior rating scale of movement. A score of 3 was accepted as favourable. To score the overall behavior and outcome of treatment The Houpt’s overall behavior rating scale was used (Appendix 3).The optimum  score which was to be achieved was >3.A score of 5/6 was  considered as the best score. IV Ketamine boluses 0.5mg/kg were given till optimal sedation for the procedure is achieved. The duration of procedure and the total dose of the Ketamine administered was recorded.Intra-procedural vitals like HR, ECG, NIBP and Oxygen Saturation were monitored continuously at regular 10 minute intervals.The children were kept in observation area for a period of 60minutes after the end of the procedure. At the end of procedure, the dentist’s opinion was obtained for the overall experience in performing the procedure as either Good/Fair/Bad. The children were then discharged according to the modified Aldrette scoring criteria (Appendix 4). A score of 9/10 was considered as the sufficient criteria for discharge. The parents were contacted by making a telephone call in the evening to elicit any untoward effects or abnormality in the behaviour of their child. A note was made of the same, if any of these was present.