Recovery Time, Patient Satisfaction, and Safety of Intranasal Sedatives in Pediatric Dentistry: A Systematic Review and Meta-Analysis

Abstract

Background: Intranasal sedation is commonly used in pediatric dentistry to manage dental anxiety and improve patient compliance. This systematic review and meta-analysis aimed to evaluate the recovery time, patient satisfaction, and adverse effects of the intranasal sedatives midazolam, dexmedetomidine, and ketamine in pediatric dental procedures. Methods: A systematic search of PubMed, Scopus, the Web of Science, the Cochrane Library, Embase, and Google Scholar was conducted following the PRISMA 2020 guidelines. Only randomized controlled trials (RCTs) involving intranasal sedation in pediatric patients (≤18 years) were included. The revised Cochrane risk of bias tool (RoB 2) was employed to assess study quality. A meta-analysis using a random-effects model was performed to evaluate the recovery time. Results: Twenty-one RCTs were included in this review. A meta-analysis of seven studies revealed that dexmedetomidine was associated with significantly longer recovery times compared to midazolam and ketamine. Specifically, midazolam demonstrated the shortest recovery time (mean difference: -19.1 min, p < 0.05), followed by ketamine (mean difference: -15.6 min, p < 0.05). A qualitative analysis of adverse effects showed mild to moderate complications, including nasal irritation (midazolam), prolonged sedation (dexmedetomidine), and hypersalivation (ketamine). Patient satisfaction was found to be highest with dexmedetomidine, although midazolam was preferred for its faster onset of sedation. Conclusions: Intranasal sedation in pediatric dentistry is a safe and effective approach, with each agent exhibiting distinct recovery profiles and safety considerations. The findings emphasize the importance of standardized sedation protocols and the need for further research into the long-term outcomes of these sedatives in pediatric populations.

Keywords: adverse effects; dexmedetomidine; intranasal sedation; ketamine; meta-analysis; midazolam; patient satisfaction; pediatric patients; recovery time; systematic review.

Figure 1

PRISMA flow diagram.

Figure 2

Risk of bias (traffic light plot of included studies: parallel-group RCTs) [16,17,18,19,20,21,22,23,24,25,27,28,29,30,31,33,34,36].

Figure 3

Risk of bias (traffic light plot of included studies-Crossover RCTs) [26,32,35].

Figure 4

Forest plot of standardized mean differences (SMDs), with 95% confidence intervals (CIs), comparing outcomes between intervention and control groups across included studies in this systematic review. Each study is represented by a green square (point estimate), with the size of the square indicating the study’s relative weight in the meta-analysis. The horizontal lines denote 95% CIs. The vertical dashed line at an SMD of 0 represents the line of no effect. The pooled effect size is represented by the diamond at the bottom, showing a statistically significant overall effect in favor of the experimental group (SMD = 1.64; 95% CI: 0.43 to 2.85; Z = 2.65; and p = 0.0080). High heterogeneity was observed among the studies (I² = 96.1%; τ² = 3.9865; and p < 0.0001), and the prediction interval (−3.02 to 6.30) indicated substantial variability in potential effects across different settings or populations [16,18,20,28,31,33,36].