Preliminary report on the use of ketamine in pediatric dentistry.

Preliminary results indicate that ketamine 3mg/kg combined with diazepam and atropine may be an excellent premedication/sedation for children who require dental treatment procedures 45-60 minutes in duration. Ketamine HCI, 4 mg/kg appears to be effective for procedures lasting less than 30 minutes. Because of transient apnea, noted in two references, 2"3 only dentists trained in airway management should use this drug at the present time. Local, state, and ~ederal regulatory agencies must standardize the definition of conscious sedation, deep sedation, and general anesthesia in order to provide guidelines to practicing dentists, insurance companies, and courts. Further experience is necessary before the procedure can be recommended for office use. Pedodontists have taken different philosophical and practical approaches toward premedication and/or sedation of children for dental care. The use of premedication is as much an art as a science, and has been integrated judiciously with proper psychological approaches to allow treatment of young and problem children on an outpatient basis. Most commonly, the drugs utilized are hypnotics, antianxiety agents, narcotics, or combinations of these drugs. A large number of precooperative and handicapped children are treated in the postdoctoral pediatric dental clinic at UCLA. Most of these children tolerate or enjoy their experience without the aid of premedication. For the minority, however, who cannot tolerate these procedures, the Section of Pediatric Dentistry has used, and continues to use, a variety of sedating agents, routes of administration, and philosophies toward these drugs. One of the most effective drugs for deep sedation was alphaprodine. When alphaprodine was withdrawn from the market in the fall of 1980, it left a gap in the deep sedation protocol at UCLA. In the search for an alternate method of medication, an attempt was made to find a drug or drug combination with as many of the following characteristics as possible: 1. no respiratory depression at clinically workable doses 2. no cardiovascular effects 3. rapid onset of action with a clinically acceptable duration of action 4. rapid recovery with minimal discomfort 5. amnesia, analgesia, coupled with deep sedation* 6. an administration route which was either oral, IM or SQ, or a combination of the two. It was decided to try several drugs and combinations of drugs before relying on any one method. One of the drugs selected for trials was ketamine HCI. This paper will report on the preliminary trials of that drug.