The Efficacy and Safety of Intranasal Dexmedetomidine Spray Followed by Nitrous Oxide for Paediatric Oral Procedures

The management of uncooperative children requiring complex outpatient oral procedures presents a significant clinical challenge. This study aimed to evaluate the safety and efficacy of intranasal dexmedetomidine (DEX) spray combined with nitrous oxide/oxygen (N₂O/O₂) inhalation sedation for the extraction of impacted supernumerary teeth in paediatric patients.

This retrospective clinical study enrolled uncooperative children aged 6 to 12 years (Frankl Scale score 2-3). Preoperative sedation was achieved using 2 µg/kg intranasal DEX spray. After sedation onset, heart rate (HR), blood pressure (BP), and oxygen saturation (SpO₂) were monitored. Throughout the procedure, N₂O/O₂ inhalation was administered to maintain a moderate sedation level, with HR, BP, SpO₂, and sedation depth recorded at 5-minute intervals. Postoperatively, patients were observed in the recovery room until all discharge criteria were met.

All 63 patients (34 boys and 29 girls) cooperated with nasal hood placement and successfully underwent parental separation. Sixty children (95.24%) completed the procedure successfully, with 56 (88.89%) maintaining moderate sedation depth throughout. There were significant decreases in HR and BP (P < .001), while SpO₂ (P = .120) remained stable during procedures. Adverse events included drowsiness (5 cases, 7.94%), dizziness (2 cases, 3.17%), and hypotension (8 cases, 12.70%). Only one (1.59%) case experienced hypoxemia concurrently presenting with bradycardia and hypotension, which required brief clinical intervention.

The combination of intranasal DEX spray and N₂O/O₂ appears to be a promising sedation technique for impacted supernumerary tooth extraction in paediatric patients, with minimal adverse effects rarely requiring clinical intervention.

This protocol shows promise in addressing the challenge of non-cooperation prior to N₂O administration, and may offer an effective, convenient, and relatively safe approach for managing uncooperative paediatric patients undergoing complex oral surgery.