Combined sedation with oral chlordemethyldiazepam and midazolam by nasal route in third molar surgery.
OBJECTIVE
This study was performed to evaluate the effects on the cardiocirculatory system, on perioperative anxiety and compliance of sedation with 2 benzodiazepines, chlordemethyldiazepam (CDDZ) a long acting oral drug for presedation and midazolam, a short acting drug, administered by nasal route to induce intraoperative sedation.


METHODS
Fifty randomized patients undergoing third molar extraction at the Dental Clinic, University of Padua, were preoperatively evaluated. Anxiety was evaluated through a visual, analogue, scale (VAS) of 10 cm, a questionnaire of adjectives called interval scale of anxiety response (ISAR) and the Newman test was applied to evaluate the changes in psychomotor functions. All patients were treated with 1 ml of oral CDDZ for presedation and midazolam by the nasal route for intraoperative sedation at doses of 1 mg in Group 1 (25 patients) and 2 mg in Group 2 (25 patients). In all patients preoperative cardiocirculatory parameters were evaluated and in the first 20 min after the beginning of intervention. At the end of intervention the Newman test was reapplied, anxiety and postoperative cardiocirculatory data were reevaluated and the quality of the intervention judged in an interview made 1 week after the intervention (quality of the sedation technique, perioperative pain intensity, assumption of analgesic drugs, swelling, amnesia etc. after intervention).


RESULTS
The treatment with 1 mg CDDZ + 2 mg midazolam by nasal route is the best association to slightly attenuate intra- and postoperative cardiocirculatory response, anxiety and to improve the quality of the treatment without interfering on the psychomotor response of patients at the time of the discharge.


CONCLUSIONS
To conclude, the sedative technique employed is easily applied by the dentist, and is safe, efficacious and well tolerated by patients.
Manani
G
G
Unit of Dental Anesthesia, University of Padua, Padua, Italy. gmanani@supereva.it
Bazzato
M F
MF
Boscolo
I
I
Cordioli
M L
ML
Fabris
E
E
Marino
D
D
Marino
E
E
Mazzuchin
M
M
Parolin
P
P
Vellardi
P
P
D000280:Administration, Inhalation; D000284:Administration, Oral; D000328:Adult; D001569:Benzodiazepines / Q000008:administration & dosage*; D016292:Procedural Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008964:Molar, Third; D003708:Nordazepam / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D014081:Tooth Extraction
D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D003708:Nordazepam; C013434:chlordesmethyldiazepam; D008874:Midazolam