CONSCIOUS SEDATION BY RECTAL ADMINISTRATION OF MIDAZOLAM OR MIDAZOLAMPLUS KETAMINE AS ALTERNATIVES TO GENERAL-ANESTHESIA FOR DENTAL TREATMENT OF UNCOOPERATIVE CHILDREN

The trial included 24 children (aged 2-7 yr) referred for dental treat ment under general anesthesia, since conventional behavioral managemen t methods had failed to achieve treatment acceptance. As an alternativ e, they received, on two separate occasions with ''identical'' dental treatment, conscious sedation by rectal administration of either midaz olam (0.3 mg/kg body weight (bwt)) or midazolam (0.3 mg/kg bwt) plus k etamine (1.0 mg/kg bwt). This allowed a double-blind, crossover design . The aims were to assess conscious sedation, combined with local anes thesia, as an alternative to general anesthesia, and further to evalua te the effects obtained by addition of a low dose of ketamine to recta lly administered midazolam. The feasibility of dental treatment was ra ted as excellent or good for 16 of the 24 children when premedicated w ith midazolam, and for 18 of the 24 children when ketamine was added t o midazolam. At least some treatment could be given to all children. V erbal contact was maintained with all children throughout both treatme nt sessions. The children were significantly less anxious when they ar rived for the second session. Amnesia and drowsiness were significantl y increased when ketamine was added to midazolam. The combination also tended to be more efficient in relief of anxiety and prevention of pa in, but there were large variations in the children's responses to the drugs. Midazolam significantly reduced the blood oxygen level, but no t with ketamine added. For most children, both regimens proved to be a ppropriate as alternatives to general anesthesia. From a pharmacologic point of view, the combination of midazolam and ketamine appears to b e reasonable because 1) both drugs have sedative and amnestic properti es, 2) ketamine adds an analgesic component, 3) midazolam counteracts the psychic side-effects of ketamine, and 4) ketamine counteracts the depressive effects of midazolam on vital body functions (respiration a nd circulation).