Skip to main content
PMC home page
Anesthesia Progress logoLink to Anesthesia Progress
. 2004;51(4):114–121.

Intranasal sufentanil/midazolam versus ketamine/midazolam for analgesia/sedation in the pediatric population prior to undergoing multiple dental extractions under general anesthesia: a prospective, double-blind, randomized comparison.

J A Roelofse 1, E A Shipton 1, C J de la Harpe 1, R J Blignaut 1
PMCID: PMC2007493  PMID: 15675259

Abstract

This article details a double-blind, randomized study evaluating the efficacy and safety of intranasal sufentanil and intranasal midazolam (S/M) when compared with intranasal ketamine and intranasal midazolam (K/M) for sedation and analgesia in pediatric patients undergoing dental surgery. Fifty healthy ASA status 1 children aged 5-7 years, weighing 15-20 kg, and having 6 or more teeth extracted, were randomly allocated to 2 groups of 25 patients each (n = 50). In the S/M group, 25 children received intranasal sufentanil 20 microg, and intranasal midazolam 0.3 mg/kg 20 minutes before the induction of anesthesia. In the K/M group, 25 children received intranasal ketamine 5 mg/kg and intranasal midazolam 0.3 mg/kg 20 minutes before the induction of anesthesia. Sevoflurane in nitrous oxide and oxygen was used for induction and maintenance of anesthesia. This study demonstrated the safety and efficacy of both methods with ease of administration, combined with a rapid onset of action. Both groups were equally sedated. A smooth mask induction of anesthesia was experienced in the majority of children. Effective postoperative analgesia for multiple dental extractions was provided. The intranasal administration of drugs for sedation and analgesia has some promising features in preschool children undergoing multiple dental extractions.

Full text

PDF
114

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acs G., Moore P. A., Shusterman S., Needleman H. L. The extent of trauma and postextraction pain in children. Pediatr Dent. 1988 Sep;10(3):210–214. [PubMed] [Google Scholar]
  2. Aldrete J. A., Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970 Nov-Dec;49(6):924–934. [PubMed] [Google Scholar]
  3. Cheng Y. S., Holmes T. D., Gao J., Guilmette R. A., Li S., Surakitbanharn Y., Rowlings C. Characterization of nasal spray pumps and deposition pattern in a replica of the human nasal airway. J Aerosol Med. 2001 Summer;14(2):267–280. doi: 10.1089/08942680152484199. [DOI] [PubMed] [Google Scholar]
  4. Dale O., Hjortkjaer R., Kharasch E. D. Nasal administration of opioids for pain management in adults. Acta Anaesthesiol Scand. 2002 Aug;46(7):759–770. doi: 10.1034/j.1399-6576.2002.460702.x. [DOI] [PubMed] [Google Scholar]
  5. Dallman J. A., Ignelzi M. A., Jr, Briskie D. M. Comparing the safety, efficacy and recovery of intranasal midazolam vs. oral chloral hydrate and promethazine. Pediatr Dent. 2001 Sep-Oct;23(5):424–430. [PubMed] [Google Scholar]
  6. Davis Stanley S., Illum Lisbeth. Absorption enhancers for nasal drug delivery. Clin Pharmacokinet. 2003;42(13):1107–1128. doi: 10.2165/00003088-200342130-00003. [DOI] [PubMed] [Google Scholar]
  7. Diaz J. H. Intranasal ketamine preinduction of paediatric outpatients. Paediatr Anaesth. 1997;7(4):273–278. doi: 10.1046/j.1460-9592.1997.d01-93.x. [DOI] [PubMed] [Google Scholar]
  8. Engelhardt W. Aufwachverhalten und psychomimetische Reaktionen nach S-(+)-Ketamin. Anaesthesist. 1997 Mar;46 (Suppl 1):S38–S42. doi: 10.1007/pl00002463. [DOI] [PubMed] [Google Scholar]
  9. Fitzgibbon Dermot, Morgan Donna, Dockter Deanna, Barry Chris, Kharasch Evan D. Initial pharmacokinetic, safety and efficacy evaluation of nasal morphine gluconate for breakthrough pain in cancer patients. Pain. 2003 Dec;106(3):309–315. doi: 10.1016/S0304-3959(03)00318-X. [DOI] [PubMed] [Google Scholar]
  10. Goodenough B., Addicoat L., Champion G. D., McInerney M., Young B., Juniper K., Ziegler J. B. Pain in 4- to 6-year-old children receiving intramuscular injections: a comparison of the Faces Pain Scale with other self-report and behavioral measures. Clin J Pain. 1997 Mar;13(1):60–73. doi: 10.1097/00002508-199703000-00009. [DOI] [PubMed] [Google Scholar]
  11. Hasçiçek Canan, Gönül Nurşin, Erk Nevin. Mucoadhesive microspheres containing gentamicin sulfate for nasal administration: preparation and in vitro characterization. Farmaco. 2003 Jan;58(1):11–16. doi: 10.1016/S0014-827X(02)00004-6. [DOI] [PubMed] [Google Scholar]
  12. Helmers J. H., Noorduin H., Van Peer A., Van Leeuwen L., Zuurmond W. W. Comparison of intravenous and intranasal sufentanil absorption and sedation. Can J Anaesth. 1989 Sep;36(5):494–497. doi: 10.1007/BF03005373. [DOI] [PubMed] [Google Scholar]
  13. Henderson J. M., Brodsky D. A., Fisher D. M., Brett C. M., Hertzka R. E. Pre-induction of anesthesia in pediatric patients with nasally administered sufentanil. Anesthesiology. 1988 May;68(5):671–675. doi: 10.1097/00000542-198805000-00003. [DOI] [PubMed] [Google Scholar]
  14. Jensen B., Matsson L. Oral versus rectal midazolam as a pre-anaesthetic sedative in children receiving dental treatment under general anaesthesia. Acta Paediatr. 2002;91(8):920–925. doi: 10.1080/080352502760148649. [DOI] [PubMed] [Google Scholar]
  15. Knoester P. D., Jonker D. M., Van Der Hoeven R. T. M., Vermeij T. A. C., Edelbroek P. M., Brekelmans G. J., de Haan G. J. Pharmacokinetics and pharmacodynamics of midazolam administered as a concentrated intranasal spray. A study in healthy volunteers. Br J Clin Pharmacol. 2002 May;53(5):501–507. doi: 10.1046/j.1365-2125.2002.01588.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Kogan Alexander, Katz Jacob, Efrat Rachel, Eidelman Leonid A. Premedication with midazolam in young children: a comparison of four routes of administration. Paediatr Anaesth. 2002 Oct;12(8):685–689. doi: 10.1046/j.1460-9592.2002.00918.x. [DOI] [PubMed] [Google Scholar]
  17. Kronenberg Robert H. Ketamine as an analgesic: parenteral, oral, rectal, subcutaneous, transdermal and intranasal administration. J Pain Palliat Care Pharmacother. 2002;16(3):27–35. doi: 10.1080/j354v16n03_03. [DOI] [PubMed] [Google Scholar]
  18. Malinovsky J. M., Servin F., Cozian A., Lepage J. Y., Pinaud M. Ketamine and norketamine plasma concentrations after i.v., nasal and rectal administration in children. Br J Anaesth. 1996 Aug;77(2):203–207. doi: 10.1093/bja/77.2.203. [DOI] [PubMed] [Google Scholar]
  19. Manjushree Ray, Lahiri Aparna, Ghosh Bablu Rani, Laha Arpita, Handa Krishna. Intranasal fentanyl provides adequate postoperative analgesia in pediatric patients. Can J Anaesth. 2002 Feb;49(2):190–193. doi: 10.1007/BF03020494. [DOI] [PubMed] [Google Scholar]
  20. Moore P. A., Acs G., Hargreaves J. A. Postextraction pain relief in children: a clinical trial of liquid analgesics. Int J Clin Pharmacol Ther Toxicol. 1985 Nov;23(11):573–577. [PubMed] [Google Scholar]
  21. Newman Stephen P., Pitcairn Gary R., Dalby Richard N. Drug delivery to the nasal cavity: in vitro and in vivo assessment. Crit Rev Ther Drug Carrier Syst. 2004;21(1):21–66. [PubMed] [Google Scholar]
  22. Paik Hae Jung, Ahn Young Mee. Measurement of acute pain after eye surgery in children. Korean J Ophthalmol. 2002 Dec;16(2):103–109. doi: 10.3341/kjo.2002.16.2.103. [DOI] [PubMed] [Google Scholar]
  23. Perrott David A., Goodenough Belinda, Champion G. David. Children's ratings of the intensity and unpleasantness of post-operative pain using facial expression scales. Eur J Pain. 2004 Apr;8(2):119–127. doi: 10.1016/S1090-3801(03)00087-9. [DOI] [PubMed] [Google Scholar]
  24. Petersen Frederik Jacob, Wørts Ole, Schaefer Torben, Sojka Paul E. Design and atomization properties for an inside-out type effervescent atomizer. Drug Dev Ind Pharm. 2004 Mar;30(3):319–326. doi: 10.1081/ddc-120030427. [DOI] [PubMed] [Google Scholar]
  25. Ramsay M. A., Savege T. M., Simpson B. R., Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974 Jun 22;2(5920):656–659. doi: 10.1136/bmj.2.5920.656. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Roelofse J. A., Payne K. A. Oral tramadol: analgesic efficacy in children following multiple dental extractions. Eur J Anaesthesiol. 1999 Jul;16(7):441–447. doi: 10.1046/j.1365-2346.1999.00505.x. [DOI] [PubMed] [Google Scholar]
  27. Roelofse J. A., Payne K. A. Oral tramadol: analgesic efficacy in children following multiple dental extractions. Eur J Anaesthesiol. 1999 Jul;16(7):441–447. doi: 10.1046/j.1365-2346.1999.00505.x. [DOI] [PubMed] [Google Scholar]
  28. Shapira J., Holan G., Botzer E., Kupietzky A., Kupieztky A., Tal E., Fuks A. B. The effectiveness of midazolam and hydroxyzine as sedative agents for young pediatric dental patients. ASDC J Dent Child. 1996 Nov-Dec;63(6):421–425. [PubMed] [Google Scholar]
  29. Ward M., Minto G., Alexander-Williams J. M. A comparison of patient-controlled analgesia administered by the intravenous or intranasal route during the early postoperative period. Anaesthesia. 2002 Jan;57(1):48–52. doi: 10.1046/j.1365-2044.2002.02263.x. [DOI] [PubMed] [Google Scholar]
  30. Weber Frank, Wulf Hinnerk, el Saeidi Ghada. Premedication with nasal s-ketamine and midazolam provides good conditions for induction of anesthesia in preschool children. Can J Anaesth. 2003 May;50(5):470–475. doi: 10.1007/BF03021058. [DOI] [PubMed] [Google Scholar]
  31. Yanagihara Yoshitsugu, Ohtani Michiteru, Kariya Satoru, Uchino Katsuyoshi, Hiraishi Teiko, Ashizawa Naofumi, Aoyama Takao, Yamamura Yoshikazu, Yamada Yasuhiko, Iga Tatsuji. Plasma concentration profiles of ketamine and norketamine after administration of various ketamine preparations to healthy Japanese volunteers. Biopharm Drug Dispos. 2003 Jan;24(1):37–43. doi: 10.1002/bdd.336. [DOI] [PubMed] [Google Scholar]
  32. Zedie N., Amory D. W., Wagner B. K., O'Hara D. A. Comparison of intranasal midazolam and sufentanil premedication in pediatric outpatients. Clin Pharmacol Ther. 1996 Mar;59(3):341–348. doi: 10.1016/S0009-9236(96)80012-9. [DOI] [PubMed] [Google Scholar]
  33. al-Rakaf H., Bello L. L., Turkustani A., Adenubi J. O. Intra-nasal midazolam in conscious sedation of young paediatric dental patients. Int J Paediatr Dent. 2001 Jan;11(1):33–40. doi: 10.1046/j.1365-263x.2001.00237.x. [DOI] [PubMed] [Google Scholar]

Articles from Anesthesia Progress are provided here courtesy of American Dental Society of Anesthesiology

RESOURCES