Abstract：
Dental anxiety is a widespread complication occurring in pediatric patients during dental visits and may lead to undesirable complications. Esketamine may be effective in anxiety.
The objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia.
This is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS). The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2 h after surgery. Secondary outcomes included level of dental anxiety at 1 day and 7 days after surgery, the incidence of dental anxiety at 2 h, 1 day, and 7 days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30 min after the end of study drug delivery.
The dental anxiety in group DS was lower than that in group D at 2 h, 1 day, and 7 days postoperatively (P = 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2 h (53 % vs 76 %, P = 0.03), 1 day (47 % vs 71 %, P = 0.04), and 7 days (44 % vs 71 %, P = 0.02) after surgery. Group DS had a higher success rate of sedation (P = 0.03) but showed a lower MAS score (P = 0.005) and smoother hemodynamics (P < 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (P = 0.03) and postoperative pain intensity (P = 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (P > 0.05).
We did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1 day after surgery were obtained by telephone follow-up.
Compared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia.
The objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia.
This is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS). The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2 h after surgery. Secondary outcomes included level of dental anxiety at 1 day and 7 days after surgery, the incidence of dental anxiety at 2 h, 1 day, and 7 days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30 min after the end of study drug delivery.
The dental anxiety in group DS was lower than that in group D at 2 h, 1 day, and 7 days postoperatively (P = 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2 h (53 % vs 76 %, P = 0.03), 1 day (47 % vs 71 %, P = 0.04), and 7 days (44 % vs 71 %, P = 0.02) after surgery. Group DS had a higher success rate of sedation (P = 0.03) but showed a lower MAS score (P = 0.005) and smoother hemodynamics (P < 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (P = 0.03) and postoperative pain intensity (P = 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (P > 0.05).
We did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1 day after surgery were obtained by telephone follow-up.
Compared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia.
摘要：
背景：牙科焦虑是儿科患者在牙科就诊期间发生的广泛并发症，并可能导致不良并发症。Esketamine可能对焦虑有效。
目的：本研究的目的是比较右美托咪定-艾氯胺酮联合用药与单用右美托咪定对学龄前全麻牙科治疗儿童牙科焦虑的影响。
方法：这是一个前瞻性的，双盲,随机对照试验。共有84例患者在全身麻醉下进行选择性门诊龋齿治疗。患者随机预先给药鼻内右美托咪定（D组）或鼻内右美托咪定-艾氯胺酮（DS组）。主要结果是手术后2小时通过改良儿童牙科焦虑量表（MCDAS）评估的牙科焦虑水平。次要结果包括手术后1天和7天的牙科焦虑水平，2小时牙科焦虑的发生率，1天,手术后7天，镇静起效时间,镇静的整体成功，接受掩模感应，术后疼痛强度，PACU中出现躁动的发生率，不良反应,HR,术前（基线）和研究药物递送结束后10、20和30分钟的SpO2。
结果：2h时，DS组牙科焦虑低于D组，1天,和术后7天（P分别为0.04、0.004和0.006）。在2h时，DS组的牙科焦虑发生率低于D组（53％vs76％，P=0.03),1天（47%vs71%，P=0.04),和7天(44%vs71%，术后P=0.02)。DS组的镇静成功率较高（P=0.03），但用药后的MAS评分较低（P=0.005），血流动力学较平稳（P<0.01）。DS组麻醉恢复期间的苏醒躁动发生率（P=0.03）和术后疼痛强度（P=0.006）明显低于D组。两组不良反应发生情况相似(P>0.05)。
结论：我们没有分析和纠正重复应用MCDAS引起的学习效果，并通过电话随访获得术后1天的MCDAS评分。
结论：与单独使用右美托咪定的术前用药相比，术前滴鼻右美托咪定联合艾氯胺酮可显著改善全身麻醉下接受牙科治疗的学龄前儿童的牙科焦虑。
目的：本研究的目的是比较右美托咪定-艾氯胺酮联合用药与单用右美托咪定对学龄前全麻牙科治疗儿童牙科焦虑的影响。
方法：这是一个前瞻性的，双盲,随机对照试验。共有84例患者在全身麻醉下进行选择性门诊龋齿治疗。患者随机预先给药鼻内右美托咪定（D组）或鼻内右美托咪定-艾氯胺酮（DS组）。主要结果是手术后2小时通过改良儿童牙科焦虑量表（MCDAS）评估的牙科焦虑水平。次要结果包括手术后1天和7天的牙科焦虑水平，2小时牙科焦虑的发生率，1天,手术后7天，镇静起效时间,镇静的整体成功，接受掩模感应，术后疼痛强度，PACU中出现躁动的发生率，不良反应,HR,术前（基线）和研究药物递送结束后10、20和30分钟的SpO2。
结果：2h时，DS组牙科焦虑低于D组，1天,和术后7天（P分别为0.04、0.004和0.006）。在2h时，DS组的牙科焦虑发生率低于D组（53％vs76％，P=0.03),1天（47%vs71%，P=0.04),和7天(44%vs71%，术后P=0.02)。DS组的镇静成功率较高（P=0.03），但用药后的MAS评分较低（P=0.005），血流动力学较平稳（P<0.01）。DS组麻醉恢复期间的苏醒躁动发生率（P=0.03）和术后疼痛强度（P=0.006）明显低于D组。两组不良反应发生情况相似(P>0.05)。
结论：我们没有分析和纠正重复应用MCDAS引起的学习效果，并通过电话随访获得术后1天的MCDAS评分。
结论：与单独使用右美托咪定的术前用药相比，术前滴鼻右美托咪定联合艾氯胺酮可显著改善全身麻醉下接受牙科治疗的学龄前儿童的牙科焦虑。
