SAFETY AND EFFICACY OF DEXMEDETOMIDINE-KETAMINE COMBINATION VS DEXMEDETOMIDINE ALONE FOR PEDIATRIC DENTAL SEDATION: A SYSTEMATIC REVIEW AND META-ANALYSIS.

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.