Nasopharyngeal airway-assisted sedation enhances oxygenation and reduces perioperative adverse events in pediatric dental surgery: A comparative clinical study

Abstract

Graphical abstract

The role of NPA in perioperative management of pediatric dental surgery under intravenous sedation

Perioperative airway management during pediatric dental procedures remains challenging, particularly in balancing oxygenation stability with procedural safety under intravenous sedation. This randomized trial compared nasopharyngeal airway (NPA)-assisted intravenous sedation (n = 30) versus traditional nasal cannula oxygenation (n = 30) in 60 children aged 6–12 years undergoing dental surgery. Both groups received standardized midazolam-propofol sedation and perioperative monitoring. Primary outcomes encompassed oxygen saturation (SpO₂), adverse events (aspiration, choking, mucosal bleeding), sedation efficacy, and surgeon satisfaction. The NPA group demonstrated superior SpO₂ maintenance at key procedural stages (p < 0.05), with a 78% reduction in hypoxemia episodes compared to controls. Notably, aspiration and choking incidents decreased significantly (p < 0.05), yielding a fourfold lower overall adverse event rate (6.67% vs 30.00%, p = 0.001). Sedation quality metrics revealed enhanced behavioral cooperation (p < 0.001) and optimal sedation depth (Ramsay scores: p < 0.001) in the NPA cohort, though pain perception remained comparable between groups (p > 0.05). Surgeons reported 93.33% satisfaction with NPA-assisted cases versus 33.33% with conventional methods (p < 0.001), correlating with fewer procedural interruptions. These findings establish NPA as a clinically superior modality for pediatric dental sedation, offering dual benefits of improved oxygenation stability and procedural workflow efficiency. The technology addresses critical gaps in perioperative safety while maintaining hemodynamic equilibrium, positioning it as a viable optimization strategy for high-risk pediatric populations.