J Dent Anesth Pain Med.  2015 Jun;15(2):47-52.

Considerations for submucosal midazolam administration in combination with oral and inhaled medications for sedation of pediatric dental patients

• Baek K

Abstract

Sedation allows patients to maintain their airway independently and respond appropriately to physical stimulation and verbal command while maintaining a minimum depressed level of consciousness. Drugs commonly used for sedation of pediatric dental patients include a combination of chloral hydrate, hydroxyzine, and nitrous oxide-oxygen. Midazolam is a benzodiazepine and currently one of the most commonly used intravenous sedative agents. It can be easily titrated to provide a wide range of sedation, from conscious sedation to deep sedation, and exhibits a wide safety margin without severe respiratory and circulatory depression. At an appropriate dose, it also decreases patient anxiety and induces amnesia. We found that the submucosal administration of midazolam combined with chloral hydrate provided increased sedative effects and decreased the postoperative vomiting response compared with conventional chloral hydrate administration, with no significant difference in physiological responses. The depth of sedation can be titrated using this technique.

Keyword

Benzodiazepine; Conscious sedation; Midazolam; Pediatric dentistry

MeSH Terms

Amnesia
Anxiety
Benzodiazepines
Chloral Hydrate
Conscious Sedation
Consciousness Disorders
Deep Sedation
Depression
Humans
Hydroxyzine
Hypnotics and Sedatives
Midazolam*
Pediatric Dentistry
Physical Stimulation
Postoperative Nausea and Vomiting
Benzodiazepines
Chloral Hydrate
Hydroxyzine
Hypnotics and Sedatives
Midazolam

Figure

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  Fig. 1 Percentage overall behavior scores in the CH and CH-M groups in a previous study [24]. CH: chloral hydrate + hydroxyzine + nitrous oxide-oxygen; CH-M: CH + midazolam.

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  Fig. 2 Distribution of behavior responses in the CH and CH-M groups in a previous study [19]. CH: chloral hydrate + hydroxyzine + nitrous oxide-oxygen; CH-M: CH + midazolam.

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  Fig. 3 Distribution of the bisepctral (BIS) index scores in the CH and CH-M groups in a previous study [19].

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