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

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.

Complications of IV sedation for dental treatment in individuals with intellectual disability

“…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].…”

Sedation with orally administered midazolam in elderly dental patients with major neurocognitive disorder

“…There are several ways to administer midazolam, including intravenous, nasal, rectal and oral administration . Sweden has a tradition of administering midazolam orally at the dental clinic, especially in children, and all dentists are formally allowed to do this.…”

“…There are several ways to administer midazolam, including intravenous, nasal, rectal and oral administration. [11][12][13][14][15][16] Sweden has a tradition of administering midazolam orally at the dental clinic, especially in children, and all dentists are formally allowed to do this. This type of sedation has been used since the 1990s, and it is well-studied in paediatric dentistry [17][18][19] and among healthy adults before oral surgery.…”

Sedação consciente endovenosa com midazolam no tratamento odontológico de pessoas com deficiência

“…16,29,30 Muitos desses efeitos puderam ser observados entre os 45 episódios (9,7% do total) ocorridos neste estudo, mas, assim como na literatura, em índices muito baixos em relação ao número de procedimentos acompanhados. Ressaltando, mais uma vez, a segurança e eficácia do uso do Midazolam para este fim, assim como a importância de todo o acompanhamento feito ao paciente no CAOE, antes, durante e após o procedimento planejado.…”