J Dent Anesth Pain Med.  2018 Feb;18(1):47-56. 10.17245/jdapm.2018.18.1.47.

Administration order of midazolam/fentanyl for moderate dental sedation

• Lobb D
• Clarke A
• Lai H

• KMID: 2405383
• DOI: http://doi.org/10.17245/jdapm.2018.18.1.47

Abstract

BACKGROUND
The purpose of this study is to investigate the effects of administration order when a sedative drug (midazolam) and an opioid analgesic drug (fentanyl) is applied for moderate intravenous (IV) sedation in dentistry.
METHODS
A retrospective chart review was conducted in one dental clinic during its transition from a midazolam-first to a fentanyl-first protocol for dental procedures requiring moderate IV sedation. Physiological parameters, drug administration times, patient recovery times, drug dosages, and patient recall and satisfaction were investigated for differences.
RESULTS
A total of 76 charts (40 midazolam-first and 36 fentanyl-first administrations), were used in the analysis. Administering midazolam first resulted in an average 4.38 min (52%) decrease in administration times (P < 0.001), and a decrease in procedural recollection immediately following the procedure (P = 0.03), and 24 to 48 hours later (P = 0.009). Administering fentanyl first required an average of 2.43 mg (29%) less midazolam (P < 0.001). No significant differences were found for change in vital signs, minimum oxygen saturation levels, recovery times, and patient satisfaction (P > 0.05). Oxygen saturation levels did not drop below 90% for either group; however, 5 cases in the fentanyl-first group fell to between 90% and 92%, compared with 0 cases in the midazolam-first group.
CONCLUSIONS
The administration order of fentanyl and midazolam may have different effects on patients and the sedation procedure. Findings from this study should be used to facilitate discussion among dental practitioners and to guide additional research investigating this topic.

Keyword

Conscious Sedation; Fentanyl; Midazolam; Moderate Sedation

MeSH Terms

Conscious Sedation
Dental Clinics
Dentistry
Fentanyl
Humans
Midazolam
Oxygen
Patient Satisfaction
Retrospective Studies
Vital Signs
Fentanyl
Midazolam
Oxygen

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