Sedation applications in pedodontics procedures: which one should we choose?: a retrospective analysis

The use of sedation in the field of pediatric dentistry is becoming increasingly prevalent. While general anesthesia is perceived as a safer alternative, the appropriate use of sedatives, in conjunction with a well-trained team, can effectively mitigate the risks associated with sedation. Our study aims to identify safe drug combinations for prolonged sedation.

This study was conducted in the Operating Room of the Faculty of Dentistry at Akdeniz University. It encompassed 126 patients, classified as ASA 1-2, aged between 3 and 12 years, who underwent dental treatment with sedation support in the Department of Pedodontics from May to December 2022. The patients were categorized into three groups: (1) Ketamine, (2) Propofol-Ketamine (PK), and (3) Dexmedetomidine-Ketamine (DK). During the procedures, vital signs, the requirement for additional doses, complications, and interventions were meticulously documented. Additionally, the Ramsay Sedation Score (RSS), dentist satisfaction during the procedure, recovery time, and Aldrete scores for the postoperative 1st and 2nd hours were also recorded.

There were no statistically significant differences between the groups in terms of age, gender, mean weight, and ASA. The minimum requirement for additional doses was recorded in the DK group. Respiratory depression, apnea, hypoxia, and related maneuvers were most frequently observed in the PK group. DK group had minimum requirement for airway suction event. Hypertension and tachycardia were most frequently observed in the K group, while hypotension and bradycardia were most frequently recorded in the DK group. PONV were most common in the K group in which high ketamine doses were administered. RSS was highest in the DK group. The longest recovery times were observed in the DK group. 1st hour Aldrete scores were lower in the DK group. Dentists reached the highest level of satisfaction in the DK group.

This retrospective study provides comparative insights into three sedation regimens for pediatric dental procedures. The dexmedetomidine-ketamine combination demonstrated superior intraoperative stability and fewer respiratory complications, though recovery was prolonged. These findings may guide clinicians in selecting appropriate sedation strategies to improve safety and procedural outcomes in cases involving shared airway management.