The comparison of dexmedetomidine and ketamine for pediatric dental surgery: A meta-analysis of randomized controlled studies

INTRODUCTION: Dexmedetomidine and ketamine are used for the sedation of pediatric dental surgery. We conduct a systematic review and meta-analysis to compare the sedation of dexmedetomidine and ketamine for pediatric dental surgery. METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched. Randomized controlled trials (RCTs) assessing the influence of dexmedetomidine versus ketamine on pediatric dental surgery are included. Two investigators independently have searched articles, extracted data, and assessed the quality of included studies. This meta-analysis is performed using the random-effect model. RESULTS: Four RCTs involving 163 children are included in the meta-analysis. Compared with ketamine for pediatric dental surgery, dexmedetomidine results in comparable sedation level (very low quality, 2 RCTs, n = 40; Std. MD = −0.26; 95% CI = −0.74 to 0.23; P = .31), intraoperative analgesia scores (very low quality, 2 RCTs, n = 98; Std. MD = 0.17; 95% CI = −0.23 to 0.57; P = .40), postoperative analgesia scores (very low quality, 2 RCTs, n = 98; Std. MD = 0.23; 95% CI = −0.17 to 0.62; P = .27), DBP (very low quality, 3 RCTs, n = 123; Std. MD = −0.38; 95% CI = −1.04 to 0.27; P = .25) and SpO(2) (very low quality, 3 RCTs, n = 123; Std. MD = 0.24; 95% CI = −0.20 to 0.69; P = .28), but significantly decreases heart rate (very low quality, 3 RCTs, n = 123; Std. MD = −1.51; 95% CI = −2.75 to −0.27; P = .02) and SBP (very low quality, 3 RCTs, n = 123; Std. MD = −0.62; 95% CI = −1.16 to −0.08; P = .02), longer recovery time (very low quality, 3 RCTs, n = 138; Std. MD = 1.74; 95% CI = 0.23 to 3.25; P = .02). CONCLUSIONS: Dexmedetomidine and ketamine have similar sedation, analgesia scores, and hemodynamic balance, but very low quality of the evidence (GRADE) is revealed in this meta-analysis.