Intranasal midazolam for the sedation of geriatric patients with care‐resistant behaviour during essential dental treatment: An observational study

Abstract

Objectives To describe the efficacy and safety of intranasal midazolam for sedation during essential dental treatment of geriatric patients with major neurocognitive disorder (MND) and care‐resistant behaviour (CRB). Background Dental treatment is often impossible in geriatric MND patients with CRB. Intranasal midazolam may provide a non‐invasive sedation method, but there is currently no information on its use in geriatric patients. Methods In this observational study, we included geriatric patients with severe MND and CRB needing urgent dental treatment. Each patient received 5 mg midazolam intranasally. Agitation/sedation levels, heart rate, respiration rate and oxygen saturation were recorded at 5‐minute intervals. Results Thirty two patients were included. Mean age was 84 (±7) years. Mean (SD) time to treatment start was 13 (±5) minutes, and mean time to maximum sedation 17 (±11) minutes. Sedation was sufficient to enable dental treatment to be completed in 31 (97%) patients. Anxiolysis/light sedation occurred in 16 (50%) patients, and moderate to deep sedation occurred in 16 (50%) patients. No patients suffered from apnoea, although 3 patients required a chin‐lift manoeuvre. Hypoxaemia occurred in 1 of these patients and in 2 other patients without airway obstruction. All patients recovered uneventfully. In a regression model, age, weight and other sedative medication use were found not to be associated with maximum sedation depth. Conclusions Of 5 mg intranasal midazolam facilitates treatment of geriatric patients with MND in the comfort of their own environment. More information is needed to guide titration to balance the desired sedation level and patient safety.

Pharmacokinetic and Pharmacodynamic Changes in the Elderly

“…13 In an observational study of the use of intranasal midazolam administration in elderly patients with major neurocognitive disorder and care-resistant behavior (mean age 84 years), the time to maximum sedation was 17 minutes. 14 The results of a recent study of the PKs of intranasally administered midazolam in elderly volunteers are not yet available.…”

What’s New in Intravenous Anaesthesia? New Hypnotics, New Models and New Applications

“…Newer midazolam formulations designed specifically for intranasal administration have recently been developed and the pharmacokinetics of intranasal midazolam have been studied for a number of formulations and dosages [ 87 , 88 , 89 ]. For the intranasal use of midazolam in adults, most information comes from neurological literature where seizure control is the primary indication [ 84 ], but the use of intranasal midazolam in surgical and dental adult patients has also been described [ 83 , 84 , 90 ].…”

“…While dexmedetomidine is often preferred over midazolam for procedural sedation because of the supposed benefit of less respiratory depression, in the published studies on intranasal midazolam respiratory depression was rare [ 89 , 90 , 91 ].…”