The use of intranasal midazolam in the treatment of paediatric dental patients*

Abstract

SummaryThe aim of this study was to assess the use of intranasal midazolam in paediatric dental patients requiring extractions or simple surgical procedures who may otherwise have required a general anaesthetic. Twenty children aged between 2–9 years who required simple surgical procedures were given 0.25 mg.kg−1 midazolam, administered using a MAD® (Mucosal Atomization Device; Wolfe Tory Medical Inc., Salt Lake City, UT, USA). Compliance with the full dose was achieved in 14 patients, 13 of whom completed the treatment. One of two patients who allowed only partial administration completed the treatment and three patients did not comply. The mean time to starting treatment was 13 min (range 6–25 min) and patients were discharged after a mean of 46 min (range 25–67 min). Physiological parameters remained stable throughout with no clinically significant episodes of desaturation. One patient vomited at home postoperatively. Midazolam in a dose of 0.25 mg.kg−1 administered intranasally provided adequate anxiolysis for the majority of children, allowing them to complete their treatment.

Intranasal Midazolam Sedation in a Pediatric Emergency Dental Clinic

“…Midazolam was selected for use in the INS route because it provides some degree of amnesia, it has a short duration of action, and its sedative effect can be quickly and easily reversed. 8 The amnestic property of midazolam allows the child to forget about the unpleasant experience so as to allow future dental treatment to be a positive experience, thereby allowing the child to achieve improved oral health. 9 We did not study amnesia, but amnesia is a common effect of midazolam.…”

“…9 We did not study amnesia, but amnesia is a common effect of midazolam. 8 Amnesia is preferable in young children undergoing unpleasant procedures such as dental extractions, as most extremely anxious children experience psychological trauma in their first dental appointment. 8,10 The level of sedation among children varied after INS administration.…”

“…8 Amnesia is preferable in young children undergoing unpleasant procedures such as dental extractions, as most extremely anxious children experience psychological trauma in their first dental appointment. 8,10 The level of sedation among children varied after INS administration. The reason for this variation could be the midazolam solution's either being swallowed or being expelled during sneezing after INS administration.…”

A reply

“…We wish to congratulate Gilchrist et al for their recent publication [1]. We agree on the efficacy and safety of midazolam in children having procedures who may otherwise have required a general anaesthetic.…”

Uptake of therapeutic hypothermia following out‐of‐hospital cardiac arrest in Scottish Intensive Care Units

“…We believe that in the case of therapeutic hypothermia, where two such trials have been reported, we have a responsibility to embrace this therapy [1,2]. This does not mean that the evidence is overwhelming.…”