Premedication with Nasal Sedation as an Aid for Behaviour Management in Dental Procedures for Children Aktham Shoukry 1* , Assem Moharram 1 , Osama Shahawy 2 , Abla Aly 3 , Heba Morgan 3 and Fayrouz Soliman 3 1 Department of Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Anesthesia, Cairo, Egypt 2 Department of Pediatric Dentistry, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt 3 Department of Pediatric Dentistry, Faculty of Oral and Dental Medicine, Future University, Cairo, Egypt * Corresponding author: Aktham Adel shoukry, Department of Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Anesthesia, Cairo, Egypt, Tel: +002 01009506027- 0020 26934819; E-mail: Aktham.shoukry@med.asu.edu.eg Received date: Jan 13, 2016; Accepted date: Feb 11, 2016; Published date: Feb 18, 2016 Copyright: ©2016 Shoukry A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: In recent times major advancements in techniques, technologies and materials have resulted in benefits in the everyday clinical practice of dentistry, despite these gains, anxiety related to dental treatments in children is a problem suffered by many patients worldwide, and it remains a significant challenge in providing dental care. Patients and methods: One hundred children, aged 5-8 years, presenting for simple extraction procedures were selected to participate in the study and randomly divided into two groups (50 patients each). Control group (the C group): were treated by conventional treatment (non-pharmacological behaviour management) while sedation group (the S group) were premeditated by intranasal sedation (3 mg/kg Ketamine and 0.5 mg/kg Midazolam). Perioperative sedative effects, pain, anxiety level changes were assessed, also Time of procedural were recorded. Results: Children premeditated with intranasal sedation (S group) achieved significantly lower sedation levels (p=0.042), pain score (p=0.032), lower anxiety levels (p=0.036), and easier child-parent separation (p=0.029) than C group also, The S group showed decrease in the mean of the total time of procedural 20 minute ± 3.7 versus 25 min ± 2.8 in C group and this decrease was statistically significant in comparison with the C group (p<0.05). Conclusion: Intranasal sedation using ketamine and midazolam was associated with lower sedation levels, lower anxiety levels, and easier child-parent separation at the time of transferring patients to the operating room than children who were not sedated. Moreover the time needed to perform a simple extraction under intranasal sedation is significantly less than that of regular chair side procedure, which suggests possible balanced cost benefit. Keywords: Dental; Anxiety; Children; Ketamine; Midazolam; Sedation Introduction In recent times major advancements in techniques, technologies and materials have resulted in benefts in the everyday clinical practice of dentistry. Despite these gains, anxiety related to dental treatments in children is a problem sufered by many patients worldwide, and it remains a signifcant challenge in providing dental care [1]. Te prevalence of dental anxiety is 5-20% in most of the populations which is seen more in children and this tends to decrease as age advances [2,3]. Dental anxiety is defned as a feeling of apprehension about dental treatment that is not necessarily connected to a specifc external stimulus [4]. According to Chadwick and Hosey, anxiety is common in children and the symptoms of anxiety are dependent on the age of the child. Toddlers exhibit anxiety by crying, while older children manifest anxiety in other ways. Common anxieties among children include fearing the unknown and being worried about a lack of control both of which can occur with dental examination and treatment [5]. Many non-pharmacological behaviour management techniques have been introduced to manage anxious children such as Tell-show- do, behaviour shaping and positive reinforcement and modeling techniques [6]. Procedural sedation is frequently used for both diagnostic and therapeutic procedures, whether urgent or elective. It provides safe and efective relieve of pain and distress associated with dental procedures .It involves the use of one or more sedative and analgesic agents to relieve pain , anxiety and to control motor activity in patients undergoing diagnostic and therapeutic procedures [7]. Te pre-anesthetic management of children can be a challenge for the anesthesiologist. Premedication should provide efective anxiolytics and conscious sedation to improve the conditions for parental separation [8]. Midazolam and Ketamine have been used as premedicants for children by diferent routes. Te IM route is painful and therefore rarely used in pediatric patients. Rectal and oral application of midazolam [9,10] and ketamine [11] are widely used. With an onset time between 15 and 30 minutes, [11-13] they show a rather slow onset of sedation, and frst pass hepatic metabolism which results in a low and unpredictable systemic availability [14,15]. Furthermore, both Shoukry et al., J Anesth Clin Res 2016, 7:2 DOI: 10.4172/2155-6148.1000604 Research Article Open Access J Anesth Clin Res ISSN:2155-6148-non JACR, an open access journal Volume 7 • Issue 2 • 1000604 J o u r n a l o f A n e s t h e s i a & C l i n i c a l R e s e a r c h ISSN: 2155-6148 Journal of Anesthesia & Clinical Research