Oral Melatonin Versus Midazolam as Premedication for Intravenous Sedation in Pediatric Dental Patients
,
Abstract
Objectives: This study aimed to evaluate the effect of oral melatonin and oral midazolam as premedication for intravenous (IV) sedation of pediatric dental patients.
Materials and Methods: This crossover, double-blind randomized clinical trial was conducted on 23 uncooperative 2-6-year-olds with definitely negative behaviors according to the Frankl's scale. Each child served as their own control. The children were randomly divided into two groups: group I received 0.5mg/kg of oral melatonin one hour before IV sedation, while group II received 0.5mg/kg of oral midazolam 30 minutes before IV sedation on their first visit. Every child received the other premedication on their second visit. The degree of sedation was judged according to the Houpt scale. Physiologic parameters including blood pressure (PB), heart rate (HR), and blood oxygen saturation (SpO2) and side effects including dizziness, nausea, vomiting, and sleepiness were assessed. The parents' and the operator's satisfaction rates were scored. Data were analyzed using paired t-test and Wilcoxon signed-rank test.
Results: There were significant differences in sedation scores between the two sessions (P<0.05). However, there were no significant differences in alterations of physiologic parameters between the two sessions (P>0.05). Nausea and vomiting were more common during the first two hours in the midazolam group (P=0.002). Tremors were more common in the melatonin group (P=0.013). Dizziness was more evident when melatonin was used (P<0.001). The clinician and the parents were more satisfied with the results of midazolam intake (P<0.05).
Conclusions: Premedication with oral midazolam in pediatric patients is superior to that with melatonin with a higher parents' and operator's satisfaction.
References
Sheller B. Challenges of managing child behavior in the 21st century dental setting. Pediatr Dent. 2004 Mar-Apr; 26(2):111-3.
Yamada CJ. New challenges in management of the anxious pediatric dental patient. Hawaii Dent J. 2006 Sep-Oct; 37(5):14-6.
Coté CJ. Preoperative preparation and premedication. Br J Anaesth. 1999 Jul;83(1):16-28.
Coulthard P. Conscious sedation guidance. Evid Based Dent. 2006; 7(4): 90-1.
Folayan MO, Faponle A, Lamikanra A. Seminars on controversial issues. A review of the pharmacological approach to the management of dental anxiety in children. Int J Paediatr Dent. 2002 Sep; 12(5):347-54.
Webb MD, Moore PA. Sedation for pediatric dental patients. Dent Clin North Am. 2002 Oct; 46(4): 803-14.
Thompson RH, Vernon DT. Research on children's behavior after hospitalization: a review and synthesis. J Dev Behav Pediatr. 1993 Feb; 14(1): 28-35.
Roelofse JA. What's new in paediatric conscious sedation in dentistry? SAAD Dig. 2010 Jan; 26: 3-7.
Malamed SF. Sedation: a guide to patient management, 5th ed., China, Elsevier Health Sciences, 2010: 109-130.
Greenblatt DJ. Pharmacology of benzodiazepine hypnotics. J Clin Psychiatry. 1992 Jun; 53 Suppl: 7-13.
Leitch J, Macpherson A. Current state of sedation/analgesia care in dentistry. Curr Opin Anaesthesiol. 2007 Aug; 20(4): 384-7.
Voepel-Lewis T, Mitchell A, Malviya S. Delayed postoperative agitation in a child after preoperative midazolam. J Perianesth Nurs. 2007 Oct; 22(5): 303-8.
Rodello LF. Melatonin in dentistry. In: Watson RR, editor. Melatonin in the promotion of health, 2nd ed., USA, Taylor and Francis Group, 2012: 219-31
Jarratt J. Perioperative melatonin use. Anaesth Intensive Care. 2011 Mar; 39(2): 171-81.
Altun A, Ugur-Altun B. Melatonin: therapeutic and clinical utilization. Int J Clin Pract. 2007 May; 61(5): 835-45.
Isik B, Baygin O, Bodur H. Premedication with melatonin vs midazolam in anxious children. Paediatr Anaesth. 2008 Jul; 18(7): 635-41.
Wassmer E, Fogarty M, Page A, Johnson K, Quin E, Seri S, et al. Melatonin as a sedation substitute for diagnostic procedures: MRI and EEG. Dev Med Child Neurol. 2001 Feb; 43(2): 136.
Johnson K, Page A, Williams H, Wassemer E, Whitehouse W. The use of melatonin as an alternative to sedation in uncooperative children undergoing an MRI examination. Clin Radiol. 2002 Jun; 57(6): 502-6.
Sury MR, Fairweather K. The effect of melatonin on sedation of children undergoing magnetic resonance imaging. Br J Anaesth. 2006 Aug; 97(2): 220-5.
Marseglia L, D'Angelo G, Manti S, Aversa S, Arrigo T, Reiter RJ, et al. Analgesic, anxiolytic and anaesthetic effects of melatonin: new potential uses in pediatrics. Int J Mol Sci. 2015 Jan; 16(1): 1209-20.
Frankl SN, Shiere FR, Fogels HR. Should the parent remain with the child in the dental operatory. J Dent Child. 1962 Apr; 29(2): 150-62.
Houpt MI, Koenigsberg SR, Wiess NJ, Desjardins PJ. Comparison of chloral hydrate with and without Promethazine in sedation of young children. Pediatr Dent. 1985 Mar; 7(1): 41-6.
McCann ME, Kain ZN. The management of preoperative anxiety in children: an update. Anesth Analg. 2001 Jul; 93(1): 98-105.
Bozkurt P. Premedication of the pediatric patient - anesthesia for the uncooperative child. Curr Opin Anaesthesiol. 2007 Jun; 20(3): 211-5.
Lane EA, Moss HB. Pharmacokinetics of melatonin in man: first pass hepatic metabolism. J Clin Endocrinol Metab. 1985 Dec; 61(6): 1214-6.
Gitto E, Aversa S, Reiter RJ, Barberi I, Pellegrino S. Update on the use of melatonin in pediatrics. J Pineal Res. 2011 Jan; 50(1): 21-8.
Patel T, Kurdi MS. A comparative study between oral melatonin and oral midazolam on preoperative anxiety, cognitive, and psychomotor functions. J Anaesthesiol Clin Pharmacol. 2015 Jan-Mar; 31(1): 37-43.
Bajaj P. Melatonin for Anxiolysis in children. Indian J Anaesth. 2009 Jul 1; 53(4): 504.
Yousaf F, Seet E, Venkatraghavan L, Abrishami A, Chung F. Efficacy and safety of melatonin as an anxiolytic and analgesic in the perioperative period: a qualitative systematic review of randomized trials. Anesthesiology. 2010 Oct; 113(4): 968-76.
Acil M, Basgul E, Celiker V, Karagöz AH, Demir B, Aypar U. Perioperative effects of melatonin and midazolam premedication on sedation, orientation, anxiety scores and psychomotor performance. Eur J Anaesthesiol. 2004 Jul; 21(7): 553-7.
Ionescu D, Badescu C, Ilie A, Miclutia I, Iancu C, Ion D, Vasian H, Acalovschi I, Mocan T, Bondor C. Melatonin as premedication for laparoscopic cholecystectomy: a double-blind, placebo-controlled study. Southern African Journal of Anaesthesia and Analgesia. 2008 Jul; 14(4): 8-11.
Samarkandi A, Naguib M, Riad W, Thalaj A, Alotibi W, Aldammas F, et al. Melatonin vs. midazolam premedication in children: a double-blind, placebo-controlled study. Eur J Anaesthesiol. 2005 Mar; 22(3): 189-96.
Kain ZN, MacLaren JE, Herrmann L, Mayes L, Rosenbaum A, Hata J, Lerman J. Preoperative melatonin and its effects on induction and emergence in children undergoing anesthesia and surgery. Anesthesiology. 2009 Jul; 111(1): 44-9.
| Files | ||
| Issue | Vol 15, No 5 (2018) | |
| Section | Original Article | |
| Keywords | ||
| Premedication Midazolam Melatonin Conscious Sedation | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
