Conscious Sedation Procedures Using Intravenous Midazolam for Dental Care in Patients with Different Cognitive Profiles: A Prospective Study of Effectiveness and Safety

University of Toronto, Canada
PLoS ONE (Impact Factor: 3.23). 08/2013; 8(8):e71240. DOI: 10.1371/journal.pone.0071240
Source: PubMed


The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N2O/O2 was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N2O/O2), were shown to be safe and effective in patients with intellectual disability when administered by dentists.

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    • "Also minor side effects were recorded for 16.6% of sessions in patients with intellectual disability in the study of Callado and his colleagues, using intravenous Midazolam. The disparity between these results is in part due to differences in defining and recording minor adverse events [23]. "
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    ABSTRACT: Few studies have looked at the incidence of complications performed with IV sedation for dental treatment. The purposes of this study were to (1) delineate the nature and frequency of postdental treatment complications associated with dental treatment under IV sedation in individuals with intellectual disability, and (2) correlate morbidity reports with patient's gender, age, and duration of dental procedures. Materials and methods 28 Patients with intellectual disability, 13 females and 15 males, aged 3-36 years. IV Propofol was given 1 mg/kg IV Propofol bolus Incremental top ups of 0.25 mg/kg Propofol as required. If the patients were dental treated, then postcomplications while recovering in hospital were evaluated. Statistical comparisons of patient complications, gender, age, and duration of dental treatment were made. Results There were no reported serious adverse effects. Minor posttreatment complications occurred in 7 (25%), agitation in 28.6%, sleepiness in 28.6%, drowsiness in 14.3%, and pain in 14.3%, followed by dental bleeding in 14.3%. Gender of the patients was found to be significantly related to post-operative complications, while age and duration of dental treatment showed no significant relationship. Conclusion IV sedation with Propofol for patients with intellectual disability for dental treatment appears to be with minor complications. © 2014 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists.
    Egyptian Journal of Anaesthesia 01/2015; 188(2). DOI:10.1016/j.egja.2014.12.001
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