A randomised, controlled, crossover trial of oral midazolam and nitrous oxide for paediatric dental sedation

Abstract

SummaryA randomised, controlled, crossover trial was designed to assess the safety and effectiveness of oral midazolam sedation for orthodontic extractions. Forty-six ASA physical status I children aged 10-16 years were recruited. Each child required two treatment sessions. Sedation with either oral midazolam 0.5 mg.kg )1 or nitrous oxide in oxygen was used at the first visit, the alternative being used at the second visit. Blood pressure, heart rate, arterial oxygen saturation, and sedation and behavioural scores were recorded every 5 min. Anxiety levels and postoperative satisfaction were also recorded. Blood pressure, heart rate and arterial oxygen saturation in both groups were similar and within acceptable clinical limits. . Seventy-four per cent of subjects were prepared to have oral midazolam sedation again, 54% preferring it. Oral midazolam appears to be a safe and acceptable form of sedation for 10-16-year-old paediatric dental patients.

Oral sedation for dental treatment in young children in a hospital setting

“…3 Considerable interest has been focused on the use of midazolam, a benzodiazepine, for oral sedation in young children. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] One of the diffi culties with oral sedation is that once the bolus of benzodiazepine has been administered, the level of sedation cannot easily be altered. In the unlikely Introduction Conscious sedation for young children is a rapidly developing area of clinical activity.…”

Effects of Midazolam and Nitrous Oxide on Endocrine and Metabolic Measurements in Children

“…All children received 15 ml syrup +/– midazolam to drink 40 min before the i.v. procedure, which is in accord with the onset time for midazolam [18]. …”

“…However, we have previously found EMLA to be insufficient to obtain a satisfactory pain relief [16]. N 2 O and midazolam are also frequently used drugs to facilitate painful procedures [17,18]. N 2 O primarily affects the central nervous system, and its analgesic action is dependent on the inhibition of supraspinal GABA receptors and the activation of spinal GABA receptors [19].…”

The Direction of Pediatric Sedation: A Contemporary and Historical Look at its Science, Art, Strengths and Shortcomings

“…Despite considerable study, [47][48][49][50][51]60] it is considered at best unpredictable with respect to efficacy and duration of action. No consensus appears to exist among clinicians with respect to its dosing.…”