Article

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: 3.53). 08/2013; 8(8):e71240. DOI: 10.1371/journal.pone.0071240
Source: PubMed

ABSTRACT 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.

Download full-text

Full-text

Available from: Emmanuel Nicolas, Jul 01, 2015
1 Follower
 · 
105 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hintergrund Um Kinder vor traumatischen Erfahrungen zu bewahren, sind bei schmerzhaften medizinischen Prozeduren pharmakologische Maßnahmen und psychologische Hilfestellung unverzichtbar. Nichtmedikamentöse Maßnahmen Manchmal reicht es bereits aus, wenn den Kindern eine Maßnahme verständlich erklärt oder eine kleine Belohnung nach überstandener Prozedur in Aussicht gestellt und auch überreicht wird. Aber auch Ablenkung und Hypnose sind einfache und erfolgreiche Techniken für den klinischen Alltag, wobei Letztere erlernt werden muss. Pharmakologische Maßnahmen Aufgrund ihrer kurzen Dauer und des Fehlens andauernder Schmerzen ist für viele kleine schmerzhafte Interventionen eine Analgosedierung ausreichend. Die einfache Analgosedierung kann vom Untersucher selbst durchgeführt werden. Lokal kommen lokalanästhetikahaltige Cremes und Pflaster oder eine Vereisung in Betracht, aber auch die direkte Einbringung von Lokalanästhetika in kleine Wunden. Unter Beachten der zulässigen Maximaldosen bleibt auch während einer Lokalanästhesie das Bewusstsein der Kinder vollständig erhalten. Auch mit Lachgas können für viele kleine, aber schmerzhafte Eingriffe eine ausreichende Analgesie und flache Sedierung erzielt werden, eine tiefere Sedierung und Analgesie wird durch Ketamin erreicht. Kurz wirksame Opioide eignen sich zur Schmerzbehandlung bei kleineren Eingriffen. Der Einsatz von Midazolam ist zur Unterbrechung des Circulus vitiosus der gegenseitigen Verstärkung von Angst und Schmerzen geeignet. Die intranasale Applikation dieser Substanzen stellt einen „off-label use“ dar, sollte aber dennoch als eine Alternative berücksichtigt werden.
    Monatsschrift Kinderheilkunde 01/2014; DOI:10.1007/s00112-013-2961-0 · 0.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: The purpose of this study was to compare pre- and postoperative autonomic activities and changes in salivary stress biomarkers between patients who received only local anesthesia and those who received local anesthesia together with intravenous sedation in dental implant surgery. Methods: A total of 21 patients were enrolled in this non-randomized controlled prospective study; 7 subjects underwent implant surgery under local anesthesia with intravenous sedation and 14 subjects underwent surgery under only local anesthesia. Stress was evaluated by measuring salivary levels of chromogranin A (CgA) and a spectral analysis of heart rate variability (HRV) at baseline (on a day other than the day of surgery), 1 h preoperatively, and 1 h postoperatively. HRV analysis yields low- (LF) and high-frequency (HF) components, the LF/HF ratio, and the component coefficient of variance (CCV[HF]), which provide indices of sympathetic and parasympathetic regulatory activity. Results: CgA levels were significantly higher (p < 0.05) at baseline in patients who received sedation than those who did not, but CgA levels did not differ prior to surgery. Also, the values of most parameters, including LF, HF, LF/HF (L/H), and CCV(HF), did not significantly differ between groups or among the three time points. Only Delta L/H and Delta CCV(HF) were significantly lower (p < 0.05) at 1 h preoperatively in patients who received sedation than those who received only local anesthesia. Conclusions: CgA levels were high in both groups immediately before surgery, and thus CgA values immediately before surgery may not be a reliable indicator of the need for intravenous sedation. Also, spectral analysis of HRV, especially Delta L/H and Delta CCV(HF), could be useful for assessing tension and anxiety. (c) 2014 Published by Elsevier Ireland on behalf of Japan Prosthodontic Society.
    Journal of Prosthodontic Research 06/2014; 58(3). DOI:10.1016/j.jpor.2014.03.006
  • Source
    [Show abstract] [Hide abstract]
    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.
    01/2015; 188. DOI:10.1016/j.egja.2014.12.001