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    The dental literature contains the largest collection of data regarding intranasal medication use for sedation.

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    They used this combination in 20 patients and using an independent observer as well and dentist and parental assessments found it both effective and tolerable with 100% of procedures well tolerated and completed safely.

    Surendar et all compared 3 nasal drugs for efficacy of sedation prior to dental procedures: Dexmedetomidine (D1= 1 mcg/kg, D2 = 1.5 mg/kg), Midazolam (M1= 0.2 mg/kg) and Ketamine (K1 = 5 mg/kg).

    Ten years later Roelofse et al compared combination therapy with intranasal sufentanil plus midazolam (1 mcg/kg plus 0.3 mg/kg) versus intranasal ketamine plus midazolam (5 mg/kg plus 0.3 mg/kg) 20 minutes prior to induction in a dental surgery center.[2] They found both methods easy, effective, safe and rapid in onset.They also added lidocaine to the medication to reduce burning during administration.They delivered 10 mg (0.25 ml) intranasally using a mucosal atomization device to enhance mucosal coverage.They can be used in non-compliant patients such as small children and mentally disabled adults and they have few significant safety issues reported with the exception of over sedation when higher doses of sufentanil (1.5 mg/kg or more) are used.A number of studies exist investigating intranasal medication delivery for minor procedural sedation in the emergency department.

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