Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFG |
dARK ID: | ark:/38995/001300000bp4r |
Texto Completo: | http://repositorio.bc.ufg.br/tede/handle/tede/7091 |
Resumo: | During dental treatment of children, basic or advanced behavior guidance techniques can be used. Advanced techniques, non-pharmacological (protective stabilization) or pharmacological (sedation and general anesthesia), are indicated when there is no success with the basic techniques. Regarding advanced techniques, sedation has been increasingly widespread in pediatric dentistry, although the evidence is still weak about which sedative regime provides the greatest comfort and the lowest risk. In view of this need to identify the best sedative regimen, the objective of this randomized, masked, controlled, parallel-design trial was to evaluate the effectiveness of intranasal sedation with Midazolam and Ketamine in behavioral control of preschool children undergoing dental treatment. Eighty-four preschoolers, aged between 1.5 and 6 years old, with dental caries and non-cooperative behavior in previous dental treatment, were randomized into three groups: (1) Midazolam and Ketamine intranasally (MKI); (2) Midazolam and oral ketamine (MKO); (3) Oral midazolam. In all groups, the sedative was administered by a pediatrician or anesthesiologist, and the children received restorative treatment under local anesthesia and rubber dam isolation. Dental treatment was performed by pediatric dentists who, in the end, classified child behavior through the Frankl scale. The training sessions were videotaped, and the videos were then analyzed by trained and calibrated researchers to assess behavior using the Ohio State University Behavioral Rating Scale (OSUBRS) scale. The need to discontinue care and to use protective stabilization was recorded. The data obtained were organized and analyzed in the software Statistical Package for Social Sciences (SPSS). The statistical analysis involved the description of the data and bivariate tests, considering a level of significance of 5%. Considering as a parameter for sedation success the "positive" or "definitely positive" behavior verified with the Frankl scale, the following rates were observed: MKI - 50.0%; MKO - 64.3% and MO - 28.6%. Success rates differed significantly between MKO compared to MKI and MO (P = 0.03). When comparing the groups in relation to the behavior evaluated by the OSUBRS scale, no statistically significant difference was observed in the frequency of "quiet" (P = 0.22), "movement without crying" (P = 0.69) and "combative (P = 0.30). The groups did not differ in assessing the number of cases in which there was a "quiet" behavior in at least 51.7% (median) of the session duration (P = 0.27) and in the number of cases in which the child was "combative" "In at least 24.5% (median) of the session duration (P = 0.65). The need to suspend treatment (P = 0.69) and use protective stabilization (P = 0.14) did not differ significantly among the three groups. The results of behavior evaluation using the Frankl and OSUBRS scale were strongly correlated (rho = -0.84, P0.01). From these results, it was concluded that the sedative protocol MKO presented a higher success rate in behavioral control when compared to the other groups (MKI and MO). The combination of Midazolam and Ketamine, regardless of route of administration, was more effective in controlling behavior than Midazolam given alone. Therefore, the use of the combination of Midazolam and Ketamine, both orally and intranasally, is an effective alternative for controlling the behavior of non-collaborating preschoolers. |
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Costa, Paulo Sérgio Sucasas dahttp://lattes.cnpq.br/9224543529268366Costa, Luciane Ribeiro de Rezende Sucasas dahttp://lattes.cnpq.br/9906371509661305Costa, Paulo Sérgio Sucasas daFaria, Patrícia Corrêa deMachado, Geovanna de Castro Moraishttp://lattes.cnpq.br/9533265707687664Sado Filho, Joji2017-04-06T15:04:55Z2017-03-13SADO FILHO, J. Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado. 2017. 119 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2017.http://repositorio.bc.ufg.br/tede/handle/tede/7091ark:/38995/001300000bp4rDuring dental treatment of children, basic or advanced behavior guidance techniques can be used. Advanced techniques, non-pharmacological (protective stabilization) or pharmacological (sedation and general anesthesia), are indicated when there is no success with the basic techniques. Regarding advanced techniques, sedation has been increasingly widespread in pediatric dentistry, although the evidence is still weak about which sedative regime provides the greatest comfort and the lowest risk. In view of this need to identify the best sedative regimen, the objective of this randomized, masked, controlled, parallel-design trial was to evaluate the effectiveness of intranasal sedation with Midazolam and Ketamine in behavioral control of preschool children undergoing dental treatment. Eighty-four preschoolers, aged between 1.5 and 6 years old, with dental caries and non-cooperative behavior in previous dental treatment, were randomized into three groups: (1) Midazolam and Ketamine intranasally (MKI); (2) Midazolam and oral ketamine (MKO); (3) Oral midazolam. In all groups, the sedative was administered by a pediatrician or anesthesiologist, and the children received restorative treatment under local anesthesia and rubber dam isolation. Dental treatment was performed by pediatric dentists who, in the end, classified child behavior through the Frankl scale. The training sessions were videotaped, and the videos were then analyzed by trained and calibrated researchers to assess behavior using the Ohio State University Behavioral Rating Scale (OSUBRS) scale. The need to discontinue care and to use protective stabilization was recorded. The data obtained were organized and analyzed in the software Statistical Package for Social Sciences (SPSS). The statistical analysis involved the description of the data and bivariate tests, considering a level of significance of 5%. Considering as a parameter for sedation success the "positive" or "definitely positive" behavior verified with the Frankl scale, the following rates were observed: MKI - 50.0%; MKO - 64.3% and MO - 28.6%. Success rates differed significantly between MKO compared to MKI and MO (P = 0.03). When comparing the groups in relation to the behavior evaluated by the OSUBRS scale, no statistically significant difference was observed in the frequency of "quiet" (P = 0.22), "movement without crying" (P = 0.69) and "combative (P = 0.30). The groups did not differ in assessing the number of cases in which there was a "quiet" behavior in at least 51.7% (median) of the session duration (P = 0.27) and in the number of cases in which the child was "combative" "In at least 24.5% (median) of the session duration (P = 0.65). The need to suspend treatment (P = 0.69) and use protective stabilization (P = 0.14) did not differ significantly among the three groups. The results of behavior evaluation using the Frankl and OSUBRS scale were strongly correlated (rho = -0.84, P0.01). From these results, it was concluded that the sedative protocol MKO presented a higher success rate in behavioral control when compared to the other groups (MKI and MO). The combination of Midazolam and Ketamine, regardless of route of administration, was more effective in controlling behavior than Midazolam given alone. Therefore, the use of the combination of Midazolam and Ketamine, both orally and intranasally, is an effective alternative for controlling the behavior of non-collaborating preschoolers.Durante o atendimento odontológico de crianças, podem ser utilizadas técnicas básicas ou avançadas de controle do comportamento. As técnicas avançadas, não farmacológicas (estabilização protetora) ou farmacológicas (sedação e anestesia geral), são indicadas quando não há sucesso com as técnicas básicas. Em relação às técnicas avançadas, a sedação tem sido cada vez mais difundida na odontopediatria, embora as evidências ainda sejam fracas sobre qual regime sedativo proporciona o maior conforto e menor risco. Diante dessa necessidade de se identificar o melhor regime sedativo, o objetivo deste ensaio clínico randomizado, mascarado, controlado e de delineamento paralelo foi avaliar a eficácia da sedação intranasal com Midazolam e Cetamina no controle comportamental de crianças pré-escolares submetidas a atendimento odontológico. Oitenta e quatro pré-escolares, com idade entre 1,5 e 6 anos, com cárie dentária e comportamento não colaborador em atendimentos odontológicos anteriores, foram randomizados em três grupos: (1) Midazolam e Cetamina por via intranasal (MKI); (2) Midazolam e Cetamina por via oral (MKO); (3) Midazolam por via oral. Em todos os grupos, o sedativo foi administrado por um médico pediatra ou anestesiologista, e as crianças receberam tratamento restaurador sob anestesia local e isolamento absoluto. O tratamento odontológico foi realizado por odontopediatras que, ao final, classificaram o comportamento infantil por meio da escala de Frankl. As sessões de atendimento foram filmadas e, posteriormente, os vídeos foram analisados por pesquisadores treinados e calibrados a fim de se avaliar o comportamento usando a escala Ohio State University Behavioral Rating Scale (OSUBRS). A necessidade de suspender o atendimento e de utilizar estabilização protetora foi registrada. Os dados obtidos foram organizados e analisados no software Statistical Package for Social Sciences (SPSS). A análise estatística envolveu a descrição dos dados e testes bivariados, considerando-se um nível de significância de 5%. Considerando-se como parâmetro para sucesso da sedação o comportamento “positivo” ou “definitivamente positivo” verificado com a escala de Frankl, foram observadas as seguintes taxas: MKI – 50,0%; MKO – 64,3% e MO – 28,6%. As taxas de sucesso diferiram significativamente entre MKO em comparação com MKI e MO (P = 0,03). Ao se comparar os grupos em relação ao comportamento avaliado pela escala OSUBRS, não foi observada diferença estatisticamente significativa na frequência de comportamentos “quieto” (P=0,22), “movimento sem choro” (P=0,69) e “combativo” (P=0,30). Os grupos não diferiram ao se avaliar o número de casos em que houve comportamento “quieto” em pelo menos 51,7% (mediana) da duração da sessão (P=0,27) e número de casos em que a criança ficou “combativa” em, pelo menos, 24,5% (mediana) da duração da sessão (P=0,65). A necessidade de suspender o atendimento (P=0,69) e de utilizar estabilização protetora (P=0,14) não diferiu significativamente entre os três grupos. Os resultados da avaliação do comportamento por meio da escala de Frankl e da OSUBRS foram fortemente correlacionados (rho = -0,84, P≤0,01). A partir destes resultados conclui-se que o protocolo sedativo MKO apresentou maior taxa de sucesso no controle comportamental, quando comparado aos outros grupos (MKI e MO). A combinação de Midazolam e Cetamina, independentemente da via de administração, foi mais eficaz para o controle do comportamento que o Midazolam administrado isoladamente. Sendo assim, o uso da associação Midazolam e Cetamina, tanto por via oral, quanto intranasal, é uma alternativa eficaz para o controle do comportamento de pré-escolares não colaboradores.Submitted by Erika Demachki (erikademachki@gmail.com) on 2017-04-05T21:16:41Z No. of bitstreams: 2 Dissertação - Joji Sado Filho - 2017.pdf: 5994690 bytes, checksum: 2a60faf14b700ecba0cd47970099e8f8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-04-06T15:04:55Z (GMT) No. of bitstreams: 2 Dissertação - Joji Sado Filho - 2017.pdf: 5994690 bytes, checksum: 2a60faf14b700ecba0cd47970099e8f8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Made available in DSpace on 2017-04-06T15:04:55Z (GMT). No. of bitstreams: 2 Dissertação - Joji Sado Filho - 2017.pdf: 5994690 bytes, checksum: 2a60faf14b700ecba0cd47970099e8f8 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-03-13Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPqapplication/pdfporUniversidade Federal de GoiásPrograma de Pós-graduação em Ciências da Saúde (FM)UFGBrasilFaculdade de Medicina - FM (RG)http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessSedação conscienteAdministraçãoIntranasalComportamento infantilAssistência odontológicaConscious sedationAdministrationIntranasalChild behaviorDental care for childrenCIENCIAS DA SAUDEEficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizadoEffectiveness of intranasal sedation with midazolam and ketamine in the behavior management control of children undergoing dental treatment: randomized clinical trialinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesis-100686431261774531060060060060015457724759504863388765449414823306929-2555911436985713659reponame:Repositório Institucional da UFGinstname:Universidade Federal de Goiás (UFG)instacron:UFGLICENSElicense.txtlicense.txttext/plain; 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dc.title.por.fl_str_mv |
Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado |
dc.title.alternative.eng.fl_str_mv |
Effectiveness of intranasal sedation with midazolam and ketamine in the behavior management control of children undergoing dental treatment: randomized clinical trial |
title |
Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado |
spellingShingle |
Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado Sado Filho, Joji Sedação consciente Administração Intranasal Comportamento infantil Assistência odontológica Conscious sedation Administration Intranasal Child behavior Dental care for children CIENCIAS DA SAUDE |
title_short |
Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado |
title_full |
Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado |
title_fullStr |
Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado |
title_full_unstemmed |
Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado |
title_sort |
Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado |
author |
Sado Filho, Joji |
author_facet |
Sado Filho, Joji |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Costa, Paulo Sérgio Sucasas da |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/9224543529268366 |
dc.contributor.advisor-co1.fl_str_mv |
Costa, Luciane Ribeiro de Rezende Sucasas da |
dc.contributor.advisor-co1Lattes.fl_str_mv |
http://lattes.cnpq.br/9906371509661305 |
dc.contributor.referee1.fl_str_mv |
Costa, Paulo Sérgio Sucasas da |
dc.contributor.referee2.fl_str_mv |
Faria, Patrícia Corrêa de |
dc.contributor.referee3.fl_str_mv |
Machado, Geovanna de Castro Morais |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/9533265707687664 |
dc.contributor.author.fl_str_mv |
Sado Filho, Joji |
contributor_str_mv |
Costa, Paulo Sérgio Sucasas da Costa, Luciane Ribeiro de Rezende Sucasas da Costa, Paulo Sérgio Sucasas da Faria, Patrícia Corrêa de Machado, Geovanna de Castro Morais |
dc.subject.por.fl_str_mv |
Sedação consciente Administração Intranasal Comportamento infantil Assistência odontológica |
topic |
Sedação consciente Administração Intranasal Comportamento infantil Assistência odontológica Conscious sedation Administration Intranasal Child behavior Dental care for children CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
Conscious sedation Administration Intranasal Child behavior Dental care for children |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE |
description |
During dental treatment of children, basic or advanced behavior guidance techniques can be used. Advanced techniques, non-pharmacological (protective stabilization) or pharmacological (sedation and general anesthesia), are indicated when there is no success with the basic techniques. Regarding advanced techniques, sedation has been increasingly widespread in pediatric dentistry, although the evidence is still weak about which sedative regime provides the greatest comfort and the lowest risk. In view of this need to identify the best sedative regimen, the objective of this randomized, masked, controlled, parallel-design trial was to evaluate the effectiveness of intranasal sedation with Midazolam and Ketamine in behavioral control of preschool children undergoing dental treatment. Eighty-four preschoolers, aged between 1.5 and 6 years old, with dental caries and non-cooperative behavior in previous dental treatment, were randomized into three groups: (1) Midazolam and Ketamine intranasally (MKI); (2) Midazolam and oral ketamine (MKO); (3) Oral midazolam. In all groups, the sedative was administered by a pediatrician or anesthesiologist, and the children received restorative treatment under local anesthesia and rubber dam isolation. Dental treatment was performed by pediatric dentists who, in the end, classified child behavior through the Frankl scale. The training sessions were videotaped, and the videos were then analyzed by trained and calibrated researchers to assess behavior using the Ohio State University Behavioral Rating Scale (OSUBRS) scale. The need to discontinue care and to use protective stabilization was recorded. The data obtained were organized and analyzed in the software Statistical Package for Social Sciences (SPSS). The statistical analysis involved the description of the data and bivariate tests, considering a level of significance of 5%. Considering as a parameter for sedation success the "positive" or "definitely positive" behavior verified with the Frankl scale, the following rates were observed: MKI - 50.0%; MKO - 64.3% and MO - 28.6%. Success rates differed significantly between MKO compared to MKI and MO (P = 0.03). When comparing the groups in relation to the behavior evaluated by the OSUBRS scale, no statistically significant difference was observed in the frequency of "quiet" (P = 0.22), "movement without crying" (P = 0.69) and "combative (P = 0.30). The groups did not differ in assessing the number of cases in which there was a "quiet" behavior in at least 51.7% (median) of the session duration (P = 0.27) and in the number of cases in which the child was "combative" "In at least 24.5% (median) of the session duration (P = 0.65). The need to suspend treatment (P = 0.69) and use protective stabilization (P = 0.14) did not differ significantly among the three groups. The results of behavior evaluation using the Frankl and OSUBRS scale were strongly correlated (rho = -0.84, P0.01). From these results, it was concluded that the sedative protocol MKO presented a higher success rate in behavioral control when compared to the other groups (MKI and MO). The combination of Midazolam and Ketamine, regardless of route of administration, was more effective in controlling behavior than Midazolam given alone. Therefore, the use of the combination of Midazolam and Ketamine, both orally and intranasally, is an effective alternative for controlling the behavior of non-collaborating preschoolers. |
publishDate |
2017 |
dc.date.accessioned.fl_str_mv |
2017-04-06T15:04:55Z |
dc.date.issued.fl_str_mv |
2017-03-13 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
SADO FILHO, J. Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado. 2017. 119 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2017. |
dc.identifier.uri.fl_str_mv |
http://repositorio.bc.ufg.br/tede/handle/tede/7091 |
dc.identifier.dark.fl_str_mv |
ark:/38995/001300000bp4r |
identifier_str_mv |
SADO FILHO, J. Eficácia da sedação intranasal com midazolam e cetamina no controle comportamental de crianças submetidas a tratamento odontológico: ensaio clínico randomizado. 2017. 119 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2017. ark:/38995/001300000bp4r |
url |
http://repositorio.bc.ufg.br/tede/handle/tede/7091 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.program.fl_str_mv |
-1006864312617745310 |
dc.relation.confidence.fl_str_mv |
600 600 600 600 |
dc.relation.department.fl_str_mv |
1545772475950486338 |
dc.relation.cnpq.fl_str_mv |
8765449414823306929 |
dc.relation.sponsorship.fl_str_mv |
-2555911436985713659 |
dc.rights.driver.fl_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.publisher.program.fl_str_mv |
Programa de Pós-graduação em Ciências da Saúde (FM) |
dc.publisher.initials.fl_str_mv |
UFG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Faculdade de Medicina - FM (RG) |
publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UFG instname:Universidade Federal de Goiás (UFG) instacron:UFG |
instname_str |
Universidade Federal de Goiás (UFG) |
instacron_str |
UFG |
institution |
UFG |
reponame_str |
Repositório Institucional da UFG |
collection |
Repositório Institucional da UFG |
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repository.name.fl_str_mv |
Repositório Institucional da UFG - Universidade Federal de Goiás (UFG) |
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tasesdissertacoes.bc@ufg.br |
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1815172624542597120 |