J Dent Anesth Pain Med.  2020 Feb;20(1):1-8. 10.17245/jdapm.2020.20.1.1.

Midazolam use in pediatric dentistry: a review

• Jain SA
• Rathi N
• Thosar N
• Baliga S

• KMID: 2471168
• DOI: http://doi.org/10.17245/jdapm.2020.20.1.1

Abstract

Behaviour management and dental procedures performed in very young, pre-cooperative, highly anxious, or medically disabled children are challenging tasks. Various drugs and methods have, however, been introduced to facilitate treatment for this patient population. Midazolam is a benzodiazepine used as an adjunct to behavior management techniques in the dental treatment of pediatric patients. Midazolam can be used as a safe and effective drug for conscious sedation, general anesthetic premedication, and treatment of seizures during dental procedures. Nevertheless, further research involving pediatric patients would be beneficial.

Keyword

Benzodiazepines; Conscious Sedation; Midazolam; Pediatric Dentistry

MeSH Terms

Benzodiazepines
Conscious Sedation
Disabled Children
Humans
Midazolam*
Pediatric Dentistry*
Premedication
Seizures
Benzodiazepines
Midazolam

Reference

1. Torres-Pérez J, Tapia-García I, Rosales-Berber MA, Hernández-Sierra JF, Pozos-Guillén Ade J. Comparison of three conscious sedation regimens for pediatric dental patients. J Clin Pediatr Dent. 2007; 31:183–186. PMID: 17550044.

2. Nordt SP, Clark RF. Midazolam: a review of therapeutic uses and toxicity. J Emerg Med. 1997; 15:357–365. PMID: 9258787.

3. Craig D, Skelly M. Practical conscious sedation. London: Quintessence publishing;2004.

4. Folayan MO, Faponle A, Lamikanra A. Seminars on controversial issues. A review of the pharmacological approach to the management of dental anxiety in children. Int J Paediatr Dent. 2002; 12:347–354. PMID: 12199894.

5. Payne K, Mattheyse FJ, Liebenberg D, Dawes T. The pharmacokinetics of midazolam in paediatric patients. Eur J Clin Pharmacol. 1989; 37:267–272. PMID: 2612542.

6. McMillan CO, Spahr-Schopfer IA, Sikich N, Hartley E, Lerman J. Premedication of children with oral midazolam. Can J Anaesth. 1992; 39:545–550. PMID: 1643676.

7. Weldon BC, Watcha MF, White PF. Oral midazolam in children: effect of time and adjunctive therapy. Anesth Analg. 1992; 75:51–55. PMID: 1616162.

8. Merritt P, Hirshman E, Hsu J, Berrigan M. Metamemory without the memory: are people aware of midazolam-induced amnesia? Psychopharmacology (Berl). 2005; 177:336–343. PMID: 15290003.

9. Hosey MT, Fayle S. Pharmaceutical prescribing for children. Part 5. Conscious sedation for dentistry in children. Prim Dent Care. 2006; 13:93–96. PMID: 16836809.

10. Massanari M, Novitsky J, Reinstein LJ. Paradoxical reactions in children associated with midazolam use during endoscopy. Clin Pediatr (Phila). 1997; 36:681–684. PMID: 9415834.

11. British National Formulary. 2014. Available from: http://www.bnf.org.

12. Hallonsten AL, Jensen B, Raadal M, Veerkamp J, Hosey MT, Poulsen S. European Academy of Paediatric Dentistry guidelines on conscious sedation in paediatric dentistry. 2003.

13. UK national clinical guidelines in paediatric dentistry. managing anxious children: the use of conscious sedation in paediatric dentistry. Int J Paediatr Dent. 2002; 12:359–372. PMID: 12199898.

14. National Clinical Guideline Centre. Sedation in children and young people: sedation for diagnostic and therapeutic procedures in children and young people. London: Royal College of Physicians (UK);2010.

15. Standing dental advisory committee. Conscious sedation in the provision of dental care: report of an expert group for sedation in dentistry. London: UK Department Of Health;2003.

16. Matharu L, Ashley PF. Sedation of anxious children undergoing dental treatment. Cochrane Database Syst Rev. 2006; (1):CD003877. PMID: 16437466.

17. Fukuta O, Braham RL, Yanase H, Atsumi N, Kurosu K. The sedative effect of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 1. The effect of a 0.2 mg/kg dose. J Clin Pediatr Dent. 1993; 17:231–237. PMID: 8217888.

18. Fukuta O, Braham RL, Yanase H, Kurosu K. The sedative effects of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 2: optimal concentration of intranasal midazolam. J Clin Pediatr Dent. 1994; 18:259–265. PMID: 7811656.

19. Fukuta O, Braham RL, Yanase H, Kurosu K. Intranasal administration of midazolam: pharmacokinetic and pharmacodynamics properties and sedative potential. ASDC J Dent Child. 1997; 64:89–98. PMID: 9188997.

20. Isik B, Baygin O, Bodur H. Effect of drinks that are added as flavoring in oral midazolam premedication on sedation success. Paediatr Anaesth. 2008; 18:494–500. PMID: 18318696.

21. Lourenço-Matharu L, Roberts GJ. Oral sedation for dental treatment in young children in a hospital setting. Br Dent J. 2010; 209:E12. PMID: 20885413.

22. Wilson KE, Welbury RR, Girdler NM. A study of the effectiveness of oral midazolam sedation for orthodontic extraction of permanent teeth in children: a prospective, randomised, controlled, crossover trial. Br Dent J. 2002; 192:457–462. PMID: 12014695.

23. Wilson KE, Girdler NM, Welbury RR. A comparison of oral midazolam and nitrous oxide sedation for dental extractions in children. Anaesthesia. 2006; 61:1138–1144. PMID: 17090232.

24. Fuks AB, Kaufman E, Ram D, Hovav S, Shapira J. Assessment of two doses of intranasal midazolam for sedation of young pediatric dental patients. Pediatr Dent. 1994; 16:301–305. PMID: 7937264.

25. Mazaheri R, Eshghi A, Bashardoost N, Kavyani N. Assessment of intranasal midazolam administration with a dose of 0.5 mg/kg in behavior management of uncooperative children. J Clin Pediatr Dent. 2008; 32:95–99. PMID: 18389672.

26. Hartgraves PM, Primosch RE. An evaluation of oral and nasal midazolam for pediatric dental sedation. ASDC J Dent Child. 1994; 61:175–181. PMID: 8089345.

27. Karl HW, Rosenberger JL, Larach MG, Ruffle JM. Transmucosal administration of midazolam for premedication of pediatric patients. Comparison of the nasal and sublingual routes. Anesthesiology. 1993; 78:885–891. PMID: 8489062.

28. Robb ND, Hosey MT, Leitch JA. Intravenous conscious sedation in patients under 16 years of age. Fact or fiction? Br Dent J. 2003; 194:469–471. PMID: 12835765.

29. Saint-Maurice C, Meistelman C, Rey E, Esteve C, de Lauture D, Olive G. The pharmacokinetics of rectal midazolam for premedication in children. Anesthesiology. 1986; 65:536–538. PMID: 3777487.

30. Roelofse JA, Stegmann DH, Hartshorne J, Joubert JJ. Paradoxical reactions to rectal midazolam as premedication in children. Int J Oral Maxillofac Surg. 1990; 19:2–6. PMID: 2110954.

31. Alderson PJ, Lerman J. Oral premedication for paediatric ambulatory anaesthesia: a comparison of midazolam and ketamine. Can J Anaesth. 1994; 41:221–226. PMID: 8187256.

32. Feld LH, Negus JB, White PF. Oral midazolam preanesthetic medication in pediatric outpatients. Anesthesiology. 1990; 73:831–834. PMID: 2240672.

33. Parnis SJ, Foate JA, van der Walt JH, Short T, Crowe CE. Oral midazolam is an effective premedication for children having daystay anaesthesia. Anaesth Intensive Care. 1992; 20:9–14. PMID: 1609951.

34. Wilton NC, Leigh J, Rosen DR, Pandit UA. Preanesthetic sedation of preschool children using intranasal midazolam. Anesthesiology. 1988; 69:972–975. PMID: 3195771.

35. Weber F, Wulf H, el Saeidi G. Premedication with nasal s-ketamine and midazolam provides good conditions for induction of anesthesia in preschool children. Can J Anaesth. 2003; 50:470–475. PMID: 12734155.

36. Millar K, Asbury AJ, Bowman AW, Hosey MT, Martin K, Musiello T, et al. A randomised placebo-controlled trial of the effects of midazolam premedication on children's postoperative cognition. Anaesthesia. 2007; 62:923–930. PMID: 17697220.

37. Hosey MT, Asbury AJ, Bowman AW, Millar K, Martin K, Musiello T, et al. The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction. Br Dent J. 2009; 207:E2. PMID: 19574992.

38. Kain ZN, Mayes LC, Wang SM, Hofstadter MB. Postoperative behavioral outcomes in children: effects of sedative premedication. Anesthesiology. 1999; 90:758–765. PMID: 10078677.

39. Finley GA, Stewart SH, Buffett-Jerrott S, Wright KD, Millington D. High levels of impulsivity may contraindicate midazolam premedication in children. Can J Anaesth. 2006; 53:73–78. PMID: 16371612.

40. Viitanen H, Annila P, Viitanen M, Yli-Hankala A. Midazolam premedication delays recovery from propofolinduced sevoflurane anesthesia in children 1-3 yr. Can J Anaesth. 1999; 46:766–771. PMID: 10451136.

41. Cox RG, Nemish U, Ewen A, Crowe MJ. Evidence-based clinical update: does premedication with oral midazolam lead to improved behavioural outcomes in children? Can J Anaesth. 2006; 53:1213–1219. PMID: 17142656.

42. Ashrafi MR, Khosroshahi N, Karimi P, Malamiri RA, Bavarian B, Zarch AV, et al. Efficacy and usability of buccal midazolam in controlling acute prolonged convulsive seizures in children. Eur J Paediatr Neurol. 2010; 14:434–438. PMID: 20554464.

43. Holsti M, Dudley N, Schunk J, Adelgais K, Greenberg R, Olsen C, et al. Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med. 2010; 164:747–753. PMID: 20679166.

44. Appleton R, Macleod S, Martland T. Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children. Cochrane Database Syst Rev. 2008; Cd001905. PMID: 18646081.

45. Papineni A, Lourenco-Matharu L, Ashley PF. Safety of oral midazolam sedation use in paediatric dentistry: a review. Int J Paediatr Dent. 2014; 24:2–13.