title: The sedative effect of intranasal midazolam administration in the dental treatment of patients with mental disabilities. Part 1. The effect of a 0.2 mg/kg dose.
abstract: The purpose of this study was to determine the sedative effect of a 0.2 mg/kg dose of midazolam, administered intranasally, prior to performing various restorative dental procedures on a group of mentally disabled patients under local anesthesia and nitrous oxide/oxygen analgesia. Twenty-one patients, aged 4 to 21 years, all of whom had previously exhibited highly combative and resistant behavior toward dental treatment under local anesthesia, were sedated with 0.2 mg/kg midazolam. Only patients assessed as ASA anesthesia status I or II were admitted to the study. After administering the midazolam, each patient was allowed to rest before initiating the dental procedures. Behavioral patterns during the various procedures were rated on a behavioral rating scale of 1-7. Each patient served as his or her own control, comparing behavior with or without intranasal midazolam. The results showed a marked improvement in behavioral patterns after administration of intranasal midazolam. Ratings on a scale of 1-7 were noted as "markedly effective" and "effective" for 69.2% of those patients who received infiltration injection anesthesia, 93.8% under rubber dam, 76.2% during cavity preparation, 84.2% for restoration placement and 87.5% during pulpotomy procedures. The majority of patients were discharged within 150 minutes of intranasal instillation. Further studies are indicated to ascertain the most appropriate dose of intranasally administered midazolam.
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, Aichi Gakuin University, Nagoya, Japan.
authors.forename: O
authors.initials: O
authors.lastname: Fukuta
authors.forename: R L
authors.initials: RL
authors.lastname: Braham
authors.forename: H
authors.initials: H
authors.lastname: Yanase
authors.forename: N
authors.initials: N
authors.lastname: Atsumi
authors.forename: K
authors.initials: K
authors.lastname: Kurosu
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000766:Anesthesia, Dental / Q000379:methods*; D001321:Autistic Disorder; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D003730:Dental Care for Persons with Disabilities; D006801:Humans; D008607:Intellectual Disability; D001523:Mental Disorders; D008874:Midazolam / Q000008:administration & dosage*; D009609:Nitrous Oxide; D013997:Time Factors
chemical_list: D009609:Nitrous Oxide; D008874:Midazolam