A Comparative Evaluation of Midazolam, Ketamine and Their Combination as Sedative Agents in Pediatric Dentistry: A Systematic Review and Meta-analysis
,
Abstract
Objectives: This study reviewed the efficacy of midazolam, ketamine, and their combination for sedation of uncooperative pediatric dental patients.
Materials and Methods: Medline, PubMed, Cochrane Central Register of Controlled Trials, and the World Health Organization International Clinical Trials Registry Platform were searched up to August 31, 2023 for randomized controlled trials (RCTs) comparing midazolam, ketamine, and midazolam-ketamine in pediatric patients. Methodological assessment was conducted using the revised Cochrane ROB-2 tool. A dose-response meta-analysis was performed to analyze the effect of oral midazolam dosage on treatment duration (in minutes).
Results: Initially, 2,345 records were identified through database searching. After removing the duplicates, 1,230 records remained. Of which, 941 were excluded after title and abstract screening. Subsequently, 289 full-text articles were reviewed; of which, 269 were excluded for various reasons. The remaining 20 publications underwent detailed screening for qualitative synthesis. Risk of bias assessment categorized eight studies as low risk, six with some concerns, and six as having high risk of bias. The meta-analysis, involving three RCTs with 215 children, indicated an increasing trend in treatment duration up to 0.8 mg/kg dosage of oral midazolam. The combination of midazolam-ketamine was highly successful in providing rapid and effective pain relief and sedation for challenging pediatric patients, outperforming either drug alone, irrespective of the administration method.
Conclusion: The findings of this systematic review suggest that when it comes to ease of treatment and clinical efficacy, using a combination of midazolam and ketamine is superior to midazolam or ketamine alone.
1. Panda S, Quadri MFA, Hadi IH, Jably RM, Hamzi AM, Jafer MA. Does dental fear in children predict untreated dental caries? An analytical cross-sectional study. Children (Basel). 2021 May;8(5):382.
2. Carrillo-Díaz M, Migueláñez-Medrán BC, Nieto-Moraleda C, Romero-Maroto M, González-Olmo MJ. How can we reduce dental fear in children? The importance of the first dental visit. Children (Basel). 2021 Dec;8(12):1167.
3. Alansaari ABO, Tawfik A, Jaber MA, Khamis AH, Elameen EM. Prevalence and socio-demographic correlates of dental anxiety among a group of adult patients attending dental outpatient clinics: A study from UAE. Int J Environ Res Public Health. 2023 Jun 13;20(12):6118.
4. Saba Z, Katirci G. Relationship between dental anxiety levels and oral health among dental patients in Turkey: a cross-sectional study. BMC Oral Health. 2023 May;23(1):328.
5. Zinke A, Hannig C, Berth H. Comparing oral health in patients with different levels of dental anxiety. Head Face Med. 2018 Nov;14(1):25.
6. Stein Duker LI, Grager M, Giffin W, Hikita N, Polido JC. The relationship between dental fear and anxiety, general anxiety/fear, sensory over-responsivity, and oral health behaviors and outcomes: A conceptual model. Int J Environ Res Public Health. 2022 Feb;19(4):2380.
7. Ashley PF, Chaudhary M, Lourenço-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2018 Dec 17;12(12):CD003877.
8. Burgette JM, Quiñonez RB. Cost-effectiveness of treating severe childhood caries under general anesthesia versus conscious sedation. JDR Clin Trans Res. 2018 Oct;3(4):336-45.
9. Ramazani N. Different aspects of general anesthesia in pediatric dentistry: A review. Iran J Pediatr. 2016 Mar 5;26(2):e2613.
10. Mummolo S, Sapio S, Falco A, Vittorini OL, Quinzi V. Management of pedodontic patients in moderate sedation in clinical dentistry: evaluation of behaviour before and after treatment. J Biol Regul Homeost Agents. 2020 Jan-Feb;34(1 Suppl. 1):55-62.
11. Stern J, Agarwal A, Pozun A. Pediatric Procedural Sedation. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 22, 2025.
12. Gao F, Wu Y. Procedural sedation in pediatric dentistry: a narrative review. Front Med (Lausanne). 2023 Apr;10:1186823.
13. Manso MA, Guittet C, Vandenhende F, Granier LA. Efficacy of oral midazolam for minimal and moderate sedation in pediatric patients: A systematic review. Paediatr Anaesth. 2019 Nov;29(11):1094-106.
14. Wang J, Zeng J, Zhao N, Chen S, Chen Z, Liao J, et al. Intranasal esketamine combined with oral midazolam provides adequate sedation for outpatient pediatric dental procedures: a prospective cohort study. Int J Surg. 2023 Jul;109(7):1893-9.
15. Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016 Mar;8:35-50.
16. Janiani P, Gurunathan D, Nuvvula S. Influence of temperament on the acceptance of two conscious sedation techniques in toddlers undergoing dental treatment: A randomised cross over trial. Pain Res Manag. 2023 Aug;2023:6655628.
17. Gazal G, Fareed WM, Zafar MS, Al-Samadani KH. Pain and anxiety management for pediatric dental procedures using various combinations of sedative drugs: A review. Saudi Pharm J. 2016 Jul;24(4):379-85.
18. Preethy NA, Somasundaram S. Sedative and behavioral effects of intranasal midazolam in comparison with other administrative routes in children undergoing dental treatment - A systematic review. Contemp Clin Dent. 2021 Apr-Jun;12(2):105-20.
19. Prommer E. Midazolam: an essential palliative care drug. Palliat Care Soc Pract. 2020 Jan;14:2632352419895527.
20. Vasakova J, Duskova J, Lunackova J, Drapalova K, Zuzankova L, Starka L, et al. Midazolam and its effect on vital signs and behavior in children under conscious sedation in dentistry. Physiol Res. 2020 Sep;69(Suppl 2):S305-14.
21. Papineni A, Lourenço-Matharu L, Ashley PF. Safety of oral midazolam sedation use in paediatric dentistry: a review. Int J Paediatr Dent. 2014 Jan;24(1):2-13.
22. Conway A, Chang K, Mafeld S, Sutherland J. Midazolam for sedation before procedures in adults and children: a systematic review update. Syst Rev. 2021 Mar 5;10(1):69.
23. Choi EJ, Kim CH, Yoon JY, Kim EJ. Ketamine-propofol (ketofol) in procedural sedation: a narrative review. J Dent Anesth Pain Med. 2023 Jun;23(3):123-33.
24. Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesth Essays Res. 2014 Sep-Dec;8(3):283-90.
25. Cohen N, Test G, Pasternak Y, Singer-Harel D, Schneeweiss S, Ratnapalan S, et al. Opioids safety in pediatric procedural sedation with ketamine. J Pediatr. 2022 Apr;243:146-51.e1.
26. Gitlin J, Chamadia S, Locascio JJ, Ethridge BR, Pedemonte JC, Hahm EY, et al. Dissociative and analgesic properties of ketamine are independent. Anesthesiology. 2020 Nov;133(5):1021-8.
27. Cagiran E, Eyigor C, Sipahi A, Koca H, Balcioglu T, Uyar M. Comparison of oral midazolam and midazolam-ketamine as sedative agents in paediatric dentistry. Eur J Paediatr Dent. 2010 Mar;11(1):19-22.
28. Abdollahpour A, Saffarieh E, Zoroufchi BH. A review on the recent application of ketamine in management of anesthesia, pain, and health care. J Family Med Prim Care. 2020 Mar;9(3):1317-24.
29. Uludağ Ö, Doğukan M, Kaya R, Tutak A, Dumlupınar E. Comparison of the effects of midazolam-ketamine or midazolam-propofol combinations on hemodynamic stability, patient comfort, and post-anesthesia recovery in children undergoing sedation for magnetic resonance imaging procedures. Ain-Shams J Anesthesiol. 2020 Jan;12(1):1.
30. Oliveira Filho GLR, Castilhos CM, Kriegl JP, Bianchi GN. Oral preanesthetic medication in children ... comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis. Braz J Anesthesiol. 2023 Jul-Aug;73(4):477-90.
31. Osama NA, Mahmoud SR, Salem AS, Tawfik DS. Intranasal midazolam alone versus midazolam/ketamine combination for preoperative sedation in pediatric patients undergoing ophthalmic procedures: a randomized controlled trial. Ain-Shams J Anesthesiol. 2022 Jan;14(1):12.
32. Fallahinejad Ghajari M, Ansari G, Soleymani AA, Shayeghi S, Fotuhi Ardakani F. Comparison of oral and intranasal midazolam/ketamine sedation in 3-6-year-old uncooperative dental patients. J Dent Res Dent Clin Dent Prospects. 2015 Spring;9(2):61-5.
33. Damle SG, Gandhi M, Laheri V. Comparison of oral ketamine and oral midazolam as sedative agents in pediatric dentistry. J Indian Soc Pedod Prev Dent. 2008 Sep;26(3):97-101.
34. Moreira TA, Costa PS, Costa LR, Jesus-França CM, Antunes DE, Gomes HS, et al. Combined oral midazolam-ketamine better than midazolam alone for sedation of young children: a randomized controlled trial. Int J Paediatr Dent. 2013 May;23(3):207-15.
35. Koirala B, Pandey RK, Saksen AK, Kumar R, Sharma S. A comparative evaluation of newer sedatives in conscious sedation. J Clin Pediatr Dent. 2006 Summer;30(4):273-6.
36. Thakur S, Verma K, Singhal P, Chauhan D. Evaluation of efficacy of oral ketamine and midazolam combination drug in different doses in different groups used for moderate sedation in pediatric dentistry randomized-comparative Trial. Int J Clin Pediatr Dent. 2021;14(Suppl 2):S151-6.
37. Antunes DE, Viana KA, Costa PS, Costa LR. Moderate sedation helps improve future behavior in pediatric dental patients - a prospective study. Braz Oral Res. 2016 Oct;30(1):e107.
38. Rai K, Hegde AM, Goel K. Sedation in uncooperative children undergoing dental procedures: a comparative evaluation of midazolam, propofol and ketamine. J Clin Pediatr Dent. 2007 Fall;32(1):1-4.
39. Somri M, Parisinos CA, Kharouba J, Cherni N, Smidt A, Abu Ras Z, et al. Optimising the dose of oral midazolam sedation for dental procedures in children: a prospective, randomised, and controlled study. Int J Paediatr Dent. 2012 Jul;22(4):271-9.
40. Sado-Filho J, Viana KA, Corrêa-Faria P, Costa LR, Costa PS. Randomized clinical trial on the efficacy of intranasal or oral ketamine-midazolam combinations compared to oral midazolam for outpatient pediatric sedation. PLoS One. 2019 Mar 11;14(3):e0213074.
41. Viana KA, Moterane MM, Green SM, Mason KP, Costa LR. Amnesia after Midazolam and Ketamine Sedation in Children: A Secondary Analysis of a Randomized Controlled Trial. J Clin Med. 2021 Nov 20;10(22):5430.
42. Bhol S, Khan MM, Shrinivas TR, Tiwari RV, Joshi SR, Shaik M. Evaluation of Different Sedatives Used To Achieve Conscious Sedation during Paediatric Dental Procedures: An Original Research. Ann Rom Soc Cell Biol. 2021;25(6):856-60.
43. Mehran M, Tavassoli-Hojjati S, Ameli N, Zeinabadi MS. Effect of intranasal sedation using ketamine and midazolam on behavior of 3-6 year-old uncooperative children in dental office: A clinical trial. J Dent (Tehran). 2017 Jan;14(1):1-6.
44. Bahetwar SK, Pandey RK, Saksena AK, Chandra G. A comparative evaluation of intranasal midazolam, ketamine and their combination for sedation of young uncooperative pediatric dental patients: a triple blind randomized crossover trial. J Clin Pediatr Dent. 2011 Summer;35(4):415-20.
45. urendar MN, Pandey RK, Saksena AK, Kumar R, Chandra G. A comparative evaluation of intranasal dexmedetomidine, midazolam and ketamine for their sedative and analgesic properties: a triple blind randomized study. J Clin Pediatr Dent. 2014 Spring;38(3):255-61.
46. Lökken P, Bakstad OJ, Fonnelöp E, Skogedal N, Hellsten K, Bjerkelund CE, et al. Conscious sedation by rectal administration of midazolam or midazolam plus ketamine as alternatives to general anesthesia for dental treatment of uncooperative children. Scand J Dent Res. 1994 Oct;102(5):274-80.
47. Roelofse JA, Joubert JJ, Roelofse PG. A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients. J Oral Maxillofac Surg. 1996 Jul;54(7):838-6.
48. Flores-Castillo D, Martínez-Rider R, Ruiz-Rodríguez S, Garrocho-Rangel A, Lara-Guevara J, Pozos-Guillén A. Subcutaneous midazolam with and without ketamine for sedation In children undergoing dental treatment: A pilot study. J Clin Pediatr Dent. 2015 Summer;39(4):382-6.
49. Mowafy YN, Wahba NA, Gho Neim TM, Mahmoud GM. Efficacy of buccal versus intranasal route of administration of midazolam spray in behavior management of preschool dental patients. Quintessence Int. 2021 Oct 19;52(10):858-66.
50. Tavassoli-Hojjati S, Mehran M, Haghgoo R, Tohid-Rahbari M, Ahmadi R. Comparison of oral and buccal midazolam for pediatric dental sedation: a randomized, cross-over, clinical trial for efficacy, acceptance and safety. Iran J Pediatr. 2014 Apr;24(2):198-206.
51. Tyagi P, Tyagi S, Jain A. Sedative effects of oral midazolam, intravenous midazolam and oral diazepam in the dental treatment of children. J Clin Pediatr Dent. 2013 Spring;37(3):301-5.
52. Módolo NSP, Lima LC, Cumino DO, Nascimento Júnior PD, de Barros GAM. Is the combination of oral midazolam and ketamine as preanesthetic medication a safe and effective practice? Braz J Anesthesiol. 2023 Jul-Aug;73(4):370-2
2. Carrillo-Díaz M, Migueláñez-Medrán BC, Nieto-Moraleda C, Romero-Maroto M, González-Olmo MJ. How can we reduce dental fear in children? The importance of the first dental visit. Children (Basel). 2021 Dec;8(12):1167.
3. Alansaari ABO, Tawfik A, Jaber MA, Khamis AH, Elameen EM. Prevalence and socio-demographic correlates of dental anxiety among a group of adult patients attending dental outpatient clinics: A study from UAE. Int J Environ Res Public Health. 2023 Jun 13;20(12):6118.
4. Saba Z, Katirci G. Relationship between dental anxiety levels and oral health among dental patients in Turkey: a cross-sectional study. BMC Oral Health. 2023 May;23(1):328.
5. Zinke A, Hannig C, Berth H. Comparing oral health in patients with different levels of dental anxiety. Head Face Med. 2018 Nov;14(1):25.
6. Stein Duker LI, Grager M, Giffin W, Hikita N, Polido JC. The relationship between dental fear and anxiety, general anxiety/fear, sensory over-responsivity, and oral health behaviors and outcomes: A conceptual model. Int J Environ Res Public Health. 2022 Feb;19(4):2380.
7. Ashley PF, Chaudhary M, Lourenço-Matharu L. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2018 Dec 17;12(12):CD003877.
8. Burgette JM, Quiñonez RB. Cost-effectiveness of treating severe childhood caries under general anesthesia versus conscious sedation. JDR Clin Trans Res. 2018 Oct;3(4):336-45.
9. Ramazani N. Different aspects of general anesthesia in pediatric dentistry: A review. Iran J Pediatr. 2016 Mar 5;26(2):e2613.
10. Mummolo S, Sapio S, Falco A, Vittorini OL, Quinzi V. Management of pedodontic patients in moderate sedation in clinical dentistry: evaluation of behaviour before and after treatment. J Biol Regul Homeost Agents. 2020 Jan-Feb;34(1 Suppl. 1):55-62.
11. Stern J, Agarwal A, Pozun A. Pediatric Procedural Sedation. In: StatPearls. Treasure Island (FL): StatPearls Publishing; March 22, 2025.
12. Gao F, Wu Y. Procedural sedation in pediatric dentistry: a narrative review. Front Med (Lausanne). 2023 Apr;10:1186823.
13. Manso MA, Guittet C, Vandenhende F, Granier LA. Efficacy of oral midazolam for minimal and moderate sedation in pediatric patients: A systematic review. Paediatr Anaesth. 2019 Nov;29(11):1094-106.
14. Wang J, Zeng J, Zhao N, Chen S, Chen Z, Liao J, et al. Intranasal esketamine combined with oral midazolam provides adequate sedation for outpatient pediatric dental procedures: a prospective cohort study. Int J Surg. 2023 Jul;109(7):1893-9.
15. Appukuttan DP. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent. 2016 Mar;8:35-50.
16. Janiani P, Gurunathan D, Nuvvula S. Influence of temperament on the acceptance of two conscious sedation techniques in toddlers undergoing dental treatment: A randomised cross over trial. Pain Res Manag. 2023 Aug;2023:6655628.
17. Gazal G, Fareed WM, Zafar MS, Al-Samadani KH. Pain and anxiety management for pediatric dental procedures using various combinations of sedative drugs: A review. Saudi Pharm J. 2016 Jul;24(4):379-85.
18. Preethy NA, Somasundaram S. Sedative and behavioral effects of intranasal midazolam in comparison with other administrative routes in children undergoing dental treatment - A systematic review. Contemp Clin Dent. 2021 Apr-Jun;12(2):105-20.
19. Prommer E. Midazolam: an essential palliative care drug. Palliat Care Soc Pract. 2020 Jan;14:2632352419895527.
20. Vasakova J, Duskova J, Lunackova J, Drapalova K, Zuzankova L, Starka L, et al. Midazolam and its effect on vital signs and behavior in children under conscious sedation in dentistry. Physiol Res. 2020 Sep;69(Suppl 2):S305-14.
21. Papineni A, Lourenço-Matharu L, Ashley PF. Safety of oral midazolam sedation use in paediatric dentistry: a review. Int J Paediatr Dent. 2014 Jan;24(1):2-13.
22. Conway A, Chang K, Mafeld S, Sutherland J. Midazolam for sedation before procedures in adults and children: a systematic review update. Syst Rev. 2021 Mar 5;10(1):69.
23. Choi EJ, Kim CH, Yoon JY, Kim EJ. Ketamine-propofol (ketofol) in procedural sedation: a narrative review. J Dent Anesth Pain Med. 2023 Jun;23(3):123-33.
24. Kurdi MS, Theerth KA, Deva RS. Ketamine: Current applications in anesthesia, pain, and critical care. Anesth Essays Res. 2014 Sep-Dec;8(3):283-90.
25. Cohen N, Test G, Pasternak Y, Singer-Harel D, Schneeweiss S, Ratnapalan S, et al. Opioids safety in pediatric procedural sedation with ketamine. J Pediatr. 2022 Apr;243:146-51.e1.
26. Gitlin J, Chamadia S, Locascio JJ, Ethridge BR, Pedemonte JC, Hahm EY, et al. Dissociative and analgesic properties of ketamine are independent. Anesthesiology. 2020 Nov;133(5):1021-8.
27. Cagiran E, Eyigor C, Sipahi A, Koca H, Balcioglu T, Uyar M. Comparison of oral midazolam and midazolam-ketamine as sedative agents in paediatric dentistry. Eur J Paediatr Dent. 2010 Mar;11(1):19-22.
28. Abdollahpour A, Saffarieh E, Zoroufchi BH. A review on the recent application of ketamine in management of anesthesia, pain, and health care. J Family Med Prim Care. 2020 Mar;9(3):1317-24.
29. Uludağ Ö, Doğukan M, Kaya R, Tutak A, Dumlupınar E. Comparison of the effects of midazolam-ketamine or midazolam-propofol combinations on hemodynamic stability, patient comfort, and post-anesthesia recovery in children undergoing sedation for magnetic resonance imaging procedures. Ain-Shams J Anesthesiol. 2020 Jan;12(1):1.
30. Oliveira Filho GLR, Castilhos CM, Kriegl JP, Bianchi GN. Oral preanesthetic medication in children ... comparison between midazolam alone and in combination with ketamine: a systematic review and meta-analysis. Braz J Anesthesiol. 2023 Jul-Aug;73(4):477-90.
31. Osama NA, Mahmoud SR, Salem AS, Tawfik DS. Intranasal midazolam alone versus midazolam/ketamine combination for preoperative sedation in pediatric patients undergoing ophthalmic procedures: a randomized controlled trial. Ain-Shams J Anesthesiol. 2022 Jan;14(1):12.
32. Fallahinejad Ghajari M, Ansari G, Soleymani AA, Shayeghi S, Fotuhi Ardakani F. Comparison of oral and intranasal midazolam/ketamine sedation in 3-6-year-old uncooperative dental patients. J Dent Res Dent Clin Dent Prospects. 2015 Spring;9(2):61-5.
33. Damle SG, Gandhi M, Laheri V. Comparison of oral ketamine and oral midazolam as sedative agents in pediatric dentistry. J Indian Soc Pedod Prev Dent. 2008 Sep;26(3):97-101.
34. Moreira TA, Costa PS, Costa LR, Jesus-França CM, Antunes DE, Gomes HS, et al. Combined oral midazolam-ketamine better than midazolam alone for sedation of young children: a randomized controlled trial. Int J Paediatr Dent. 2013 May;23(3):207-15.
35. Koirala B, Pandey RK, Saksen AK, Kumar R, Sharma S. A comparative evaluation of newer sedatives in conscious sedation. J Clin Pediatr Dent. 2006 Summer;30(4):273-6.
36. Thakur S, Verma K, Singhal P, Chauhan D. Evaluation of efficacy of oral ketamine and midazolam combination drug in different doses in different groups used for moderate sedation in pediatric dentistry randomized-comparative Trial. Int J Clin Pediatr Dent. 2021;14(Suppl 2):S151-6.
37. Antunes DE, Viana KA, Costa PS, Costa LR. Moderate sedation helps improve future behavior in pediatric dental patients - a prospective study. Braz Oral Res. 2016 Oct;30(1):e107.
38. Rai K, Hegde AM, Goel K. Sedation in uncooperative children undergoing dental procedures: a comparative evaluation of midazolam, propofol and ketamine. J Clin Pediatr Dent. 2007 Fall;32(1):1-4.
39. Somri M, Parisinos CA, Kharouba J, Cherni N, Smidt A, Abu Ras Z, et al. Optimising the dose of oral midazolam sedation for dental procedures in children: a prospective, randomised, and controlled study. Int J Paediatr Dent. 2012 Jul;22(4):271-9.
40. Sado-Filho J, Viana KA, Corrêa-Faria P, Costa LR, Costa PS. Randomized clinical trial on the efficacy of intranasal or oral ketamine-midazolam combinations compared to oral midazolam for outpatient pediatric sedation. PLoS One. 2019 Mar 11;14(3):e0213074.
41. Viana KA, Moterane MM, Green SM, Mason KP, Costa LR. Amnesia after Midazolam and Ketamine Sedation in Children: A Secondary Analysis of a Randomized Controlled Trial. J Clin Med. 2021 Nov 20;10(22):5430.
42. Bhol S, Khan MM, Shrinivas TR, Tiwari RV, Joshi SR, Shaik M. Evaluation of Different Sedatives Used To Achieve Conscious Sedation during Paediatric Dental Procedures: An Original Research. Ann Rom Soc Cell Biol. 2021;25(6):856-60.
43. Mehran M, Tavassoli-Hojjati S, Ameli N, Zeinabadi MS. Effect of intranasal sedation using ketamine and midazolam on behavior of 3-6 year-old uncooperative children in dental office: A clinical trial. J Dent (Tehran). 2017 Jan;14(1):1-6.
44. Bahetwar SK, Pandey RK, Saksena AK, Chandra G. A comparative evaluation of intranasal midazolam, ketamine and their combination for sedation of young uncooperative pediatric dental patients: a triple blind randomized crossover trial. J Clin Pediatr Dent. 2011 Summer;35(4):415-20.
45. urendar MN, Pandey RK, Saksena AK, Kumar R, Chandra G. A comparative evaluation of intranasal dexmedetomidine, midazolam and ketamine for their sedative and analgesic properties: a triple blind randomized study. J Clin Pediatr Dent. 2014 Spring;38(3):255-61.
46. Lökken P, Bakstad OJ, Fonnelöp E, Skogedal N, Hellsten K, Bjerkelund CE, et al. Conscious sedation by rectal administration of midazolam or midazolam plus ketamine as alternatives to general anesthesia for dental treatment of uncooperative children. Scand J Dent Res. 1994 Oct;102(5):274-80.
47. Roelofse JA, Joubert JJ, Roelofse PG. A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients. J Oral Maxillofac Surg. 1996 Jul;54(7):838-6.
48. Flores-Castillo D, Martínez-Rider R, Ruiz-Rodríguez S, Garrocho-Rangel A, Lara-Guevara J, Pozos-Guillén A. Subcutaneous midazolam with and without ketamine for sedation In children undergoing dental treatment: A pilot study. J Clin Pediatr Dent. 2015 Summer;39(4):382-6.
49. Mowafy YN, Wahba NA, Gho Neim TM, Mahmoud GM. Efficacy of buccal versus intranasal route of administration of midazolam spray in behavior management of preschool dental patients. Quintessence Int. 2021 Oct 19;52(10):858-66.
50. Tavassoli-Hojjati S, Mehran M, Haghgoo R, Tohid-Rahbari M, Ahmadi R. Comparison of oral and buccal midazolam for pediatric dental sedation: a randomized, cross-over, clinical trial for efficacy, acceptance and safety. Iran J Pediatr. 2014 Apr;24(2):198-206.
51. Tyagi P, Tyagi S, Jain A. Sedative effects of oral midazolam, intravenous midazolam and oral diazepam in the dental treatment of children. J Clin Pediatr Dent. 2013 Spring;37(3):301-5.
52. Módolo NSP, Lima LC, Cumino DO, Nascimento Júnior PD, de Barros GAM. Is the combination of oral midazolam and ketamine as preanesthetic medication a safe and effective practice? Braz J Anesthesiol. 2023 Jul-Aug;73(4):370-2
| Issue | Vol 22 (Continuously Published Article-Based) | |
| Section | Review Article | |
| Keywords | ||
| Dental Midazolam Ketamine Conscious Sedation Pediatric Dentistry | ||
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How to Cite
1.
Gharavi M, Salem K, Ahmadi SAY, Baradaran HR. A Comparative Evaluation of Midazolam, Ketamine and Their Combination as Sedative Agents in Pediatric Dentistry: A Systematic Review and Meta-analysis. Front Dent. 2025;22.
