Children often feel anxiety before dental surgery—and that can mean a lot of anxiety in England and Wales, where dentists perform 170 extractions each day, reports the Local Government Association. Now, researchers in Sheffield, England, are exploring whether melatonin can be used to calm nervous children who would not otherwise tolerate a general anesthetic in dental and ear, nose, and throat (ENT) procedures.
Clinicians currently use midazolam to calm anxious children before procedures. This £1.65 million National Health Service (NHS) study, though, will see if melatonin has fewer side effects and can be offered as a safer alternative. If melatonin is found to be better, the researchers hope to change NHS policy. Researchers from the Sheffield Teaching Hospitals, Sheffield Children’s Hospital, and the University of Sheffield will lead the study.
Approximately one in five to one in seven children need medication to reduce anxiety before planned dental and ENT surgeries, which are the most common reasons for children to have an anesthetic in the United Kingdom. Melatonin has been shown to have some success in reducing anxiety in adults undergoing general anesthetic for surgery. The study will involve at least 10 sites and more than 600 parents or caregivers across the United Kingdom.
“The hospital anesthetic room can be a worrying place for a child, and reducing preoperative anxiety can have a huge impact on a child’s hospital experience, improving recovery from the anesthetic, reducing pain after surgery, and avoiding the need for unnecessary reappointments and delays to operations,” said Chris Deery, BDS, MSc, pediatric consultant at the University of Sheffield School of Clinical Dentistry.
“Although midazolam is an effective premedication for anxiety, it has many well-known side effects, including loss of coordination and risks to breathing. Through this study, we hope to improve the child’s overall experience by establishing if a safer alternative premedication can be offered,” said Deery, who also consults with the Sheffield Teaching Hospitals Foundation Trust.
Both melatonin and midazolam are given to children as oral liquids 30 to 40 minutes before surgery. The Melatonin for Anxiety Prior to General Anesthesia in Children (MAGIC) trial will open for recruitment in early 2019, with findings expected to be available in late 2020 or early 2021.
“As a pediatric consultant in anesthesia and pain medicine, reducing stress and anxiety in children is my main aim every day,” said Ayman Eissa, MB, BCh, a consultant anesthetist at Sheffield Children’s NHS Foundation Trust and principal investigator. “While the study is based in Sheffield, it will run in many different centers all over the country, and its outcomes could positively impact children nationwide.”