The journal of evidence-based dental practice · 2025
SAFETY AND EFFICACY OF DEXMEDETOMIDINE-KETAMINE COMBINATION VS DEXMEDETOMIDINE ALONE FOR PEDIATRIC DENTAL SEDATION: A SYSTEMATIC REVIEW AND META-ANALYSIS.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Abuokal Ahmad Abdul Kader, Rihan Mouhammed, Hjazi Abdulkarim Albacha, Elemam Abdalla Ibrahem Mohammed Ibrahem, Mohamed Mamdouh Mohamed Ragaey Ahmed Ezzat
Аннотация
BACKGROUND: Dexmedetomidine (D) and ketamine are widely used for pediatric dental sedation, each presenting unique benefits and potential adverse effects. Combining these agents, referred to as DK, was suggested to provide a balanced approach to pediatric sedation. This is the first systematic review and meta-analysis to evaluate the efficacy and safety of DK versus dexmedetomidine alone in pediatric dental procedures.
METHODS: A systematic search was conducted in PubMed, Scopus, Web of Science, Embase, and CENTRAL, identifying randomized controlled trials (RCTs) comparing DK to D alone. Eligible studies were screened, and data were extracted following PRISMA guidelines. Meta-analyses were conducted using random effects models through RevMan software.
RESULTS: Five studies involving 308 pediatric patients were included. Meta-analysis showed no significant difference in onset of sedation time (MD = -0.02 minutes; 95% CI = [-3.27, 3.23]; P = .99; I² = 29%), duration of sedation (MD = -7.39 minutes; 95% CI = [-21.69, 6.91]; P = .31; I² = 95%), or recovery time (MD = 4.71 minutes; 95% CI = [-12.80, 22.23]; P = .60; I² = 92%). Analysis of Anxiety and pain scores favored DK (SMD = -0.67; 95% CI = [-1.20, -0.14]; P = .01; I² = 35%), (MD = -1.11; 95% CI = [-2.04, -0.19]; P = .02; I² = 20%), respectively. Adverse events, including bradycardia, hypotension, and agitation, vomiting, nausea showed no significant differences between groups.
CONCLUSION: The combination of DK does not offer significant advantages over dexmedetomidine alone for pediatric dental sedation. However, DK showed a moderate reduction in anxiety and pain with a favorable safety profile, suggesting it is a viable option in clinical practice.
METHODS: A systematic search was conducted in PubMed, Scopus, Web of Science, Embase, and CENTRAL, identifying randomized controlled trials (RCTs) comparing DK to D alone. Eligible studies were screened, and data were extracted following PRISMA guidelines. Meta-analyses were conducted using random effects models through RevMan software.
RESULTS: Five studies involving 308 pediatric patients were included. Meta-analysis showed no significant difference in onset of sedation time (MD = -0.02 minutes; 95% CI = [-3.27, 3.23]; P = .99; I² = 29%), duration of sedation (MD = -7.39 minutes; 95% CI = [-21.69, 6.91]; P = .31; I² = 95%), or recovery time (MD = 4.71 minutes; 95% CI = [-12.80, 22.23]; P = .60; I² = 92%). Analysis of Anxiety and pain scores favored DK (SMD = -0.67; 95% CI = [-1.20, -0.14]; P = .01; I² = 35%), (MD = -1.11; 95% CI = [-2.04, -0.19]; P = .02; I² = 20%), respectively. Adverse events, including bradycardia, hypotension, and agitation, vomiting, nausea showed no significant differences between groups.
CONCLUSION: The combination of DK does not offer significant advantages over dexmedetomidine alone for pediatric dental sedation. However, DK showed a moderate reduction in anxiety and pain with a favorable safety profile, suggesting it is a viable option in clinical practice.