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

Rignell, Lena; Mikati, Mona; Wertsén, Madeleine; Hägglin, Catharina

doi:10.1111/ger.12262

Cited by 6 publications

(6 citation statements)

References 20 publications

(36 reference statements)

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“…The dose range in the current study (0.06 to 0.11 mg/kg) is wide and thus could be expected to have been a significant determinant of sedation depth. Interestingly, a similar disparity in the relationship between weight and response was found by Rignell et al who concluded that “poor and no acceptance were found among women with low weight and men with high weight 14 …”

Section: Discussionsupporting

confidence: 66%

“…Interestingly, a similar disparity in the relationship between weight and response was found by Rignell et al who concluded that “poor and no acceptance were found among women with low weight and men with high weight. 14 ” Lastly, the use of other sedative medication was included as a covariate in the regression model but was also not found to have a significant influence on sedation depth. Many patients in nursing homes use drugs that have interactions with benzodiazepines.…”

Section: Discussionmentioning

confidence: 99%

“…Midazolam (MDZ) is a benzodiazepine which is often used for procedural sedation of anxious patients, and oral administration in geriatric patients has been studied before. 14 The time to maximum effect of midazolam after oral administration may range from 30 to 90 minutes (Dutch National Formulary (Farmacotherapeutisch Kompas, FTK)). 15 This makes it very difficult to gauge when the maximum sedative effect has been reached and whether or not additional sedation is needed.…”

Section: Introductionmentioning

confidence: 99%

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

2021

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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.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2021

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“…But as it has a minimal effect on the cardiovascular system, it is a commonly used sedative in clinical practice [ 8 ], especially in young children. Research finds that Midazolam or a like drug alone is often ineffective [ 9 , 10 ], and therefore it is often used in combination with other drugs. Oral Midazolam in combination with intranasal DEX can largely increase the success rate of sedation and offers a good sedative outcome.…”

Section: Discussionmentioning

confidence: 99%

Combined use of intranasal Dexmedetomidine and an oral novel formulation of Midazolam for sedation of young children during brain MRI examination: a prospective, single-center, randomized controlled trial

Miao

Bai

et al. 2022

BMC Anesthesiol

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Background To evaluate the safety and effectiveness of different dosages of intranasal Dexmedetomidine (DEX) in combination with oral midazolam for sedation of young children during brain MRI examination. Methods Included in this prospective single-blind randomized controlled trial were 156 children aged from 3 months to 6 years and weighing from 4 to 20 Kg with ASA I-II who underwent brain MRI examination between March 2021 and February 2022. Using the random number table method, they were divided into group A (using 3 ug/kg intranasal DEX plus 0.2 mg/Kg oral midazolam) and group B (using 2 ug/kg intranasal DEX plus 0.2 mg/Kg oral Midazolam). The one-time success rate of sedation, sedation onset time, recovery time, overall sedation time, and occurrence of adverse reactions during MRI examination were compared between the two groups. The heart rate (HR), mean arterial pressure (MAP), and percutaneous SpO2before and after drug administration were observed in both groups. Differences in sedation scores between the two groups were compared before intranasal drug administration (T0), 10 min after drug administration (T1), at the time of falling asleep (T2), at the end of examination (T3), and at the time of recovery (T4). Results The one-time success rate of sedation in group A and B was 88.31% and 79.75% respectively, showing no significant difference between the two groups (P>0.05). The sedation onset time in group A was 24.97±16.94 min versus 27.92±15.83 min in group B, and the recovery time was 61.88±22.18 min versus 61.16±28.16 min, both showing no significance difference between the two groups (P>0.05). Children in both groups exhibited good drug tolerance without presenting nausea and vomiting, hypoxia, or bradycardia and hypotension that needed clinical interventions. There was no significant difference in the occurrence of abnormal HR, MAP or other adverse reactions between the two groups (P>0.05). Conclusion 3 ug/kg or 2 ug/kg intranasal DEX in combination with 0.2 mg/kg oral Midazolam both are safe and effective for sedation of children undergoing MRI examination with the advantages of fast-acting and easy application. Trial registration It was registered at the Chinese Clinical Trial Registry (ChiCTR1800015038) on 02/03/2018.

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“…One of the reasons for this phenomenon could be the greater likelihood of restlessness in younger patients. [ 15 ] Other explanations for the combined use of propofol and midazolam for sedation are related to factors such as oral health condition and dental treatments. The disease burden for patients with special needs was generally high.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of propofol alone and propofol combined with midazolam for dental treatments in special needs patients

et al. 2021

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Although dental treatment with sedation is performed increasingly in special needs patients, data on adding midazolam to intravenous propofol sedation are very limited for this group. The purpose of this study was to identify the factors and procedure time associated with the use of intravenous sedation with propofol alone or propofol combined with midazolam in dental patients with special needs. This was a retrospective data analysis. The sedation medications and relevant covariates, including demographic parameters, disability levels, oral health conditions, dental procedures, treatment time, and side effects, of 718 patients with special needs were collected between April 2013 and September 2014. The unfavorable side effects by sedation types were reported. Factors associated with procedure time and the sedation medications were assessed with multiple logistic regression analyses. Of 718 patients, 8 patients experienced unfavorable side effects (vomiting, sleepiness, or emotional disturbance) after the dental procedures; the rate was 0.6% in the 509 patients who received propofol only. In 209 patients who received propofol and midazolam, 2.4% experienced the side effects. Sedation time was associated with body mass index (BMI) < 25 (adjusted odds ratio [aOR] = 1.45, 95% confidence interval [CI]: 1.04–2.04) and the performance of multiple dental procedures (aOR = 1.44, 95% CI: 1.06–1.97) but not associated with the sedation types. A significant odds ratio for the combined use of propofol and midazolam was shown for adolescents (aOR = 2.22, 95% CI: 1.28–3.86), men (aOR = 2.05, 95% CI: 1.41–2.98), patients with cognitive impairment (aOR = 1.99, 95% CI: 1.21–3.29), and patients undergoing scaling procedures (aOR = 1.64, 95% CI: 1.13–2.39). With the acceptable side effects of the use of propofol alone and propofol combined with midazolam, multiple dental procedures increase the sedation time and the factors associated with the combined use of propofol and midazolam are younger age, male sex, recognition problems, and the type dental procedure in the dental treatment of patients with special needs.

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

Abstract: Sedation with orally administered midazolam seems to be effective and safe in dental treatment of uncooperative persons with major neurocognitive disorder.

Cited by 6 publications

References 20 publications

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

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

Combined use of intranasal Dexmedetomidine and an oral novel formulation of Midazolam for sedation of young children during brain MRI examination: a prospective, single-center, randomized controlled trial

A comparative study of propofol alone and propofol combined with midazolam for dental treatments in special needs patients

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