title: Nasal versus oral midazolam sedation for pediatric dental patients.
abstract: OBJECTIVE
  The purpose of this study was to evaluate and compare intranasal (IN) and oral (PO) midazolam for effect on behavior, time of onset, maximum working time, efficacy, and safety for patients requiring dental care.
  
  
  METHODS
  Forty anxious subjects (20 IN, 20 PO, Frankl Scale 3 and 4, ages 2-6 years, ASA I and II) were sedated randomly with either IN (0.3 mg/kg) or PO (0.7 mg/kg) midazolam. The dental procedure under sedation was videotaped and rated by a blinded and calibrated evaluator using Houpt's behavior rating scale.
  
  
  RESULTS
  There was no statistical difference for overall behavior (F3,27 = 0.407; P = .749). The planned contrasts showed significant interactions between time and route (IN vs PO) between 25 and 30 minutes after starting sedation. The time of onset (P = .000) and the working time (P = .007) were significantly different between IN and PO midazolam. There were no statistically significant differences in vital signs (O2 sat, HR, RR, BP) between PO and IN (P = .595). IN subjects showed more movement and less sleep toward the end of the dental procedures, and faster onset time but shorter working time than PO. Vital signs were stable throughout the procedures with no significant differences.
  
  
  CONCLUSIONS
  Mean onset time was approximately 3 times faster with IN administration compared to PO administration. Mean working time was approximately 10 minutes longer with PO administration than it was with IN administration. Overall behavior under PO and IN was similar. However, more movement and less sleep were shown in subjects under IN than those under PO toward the end of the dental session. All vital signs were stable throughout the procedures and showed no significant differences between PO and IN administration.
authors.affiliation: Department of Pediatric Dentistry, University of Illinois at Chicago, Ill, USA.
authors.forename: Su Jun
authors.initials: SJ
authors.lastname: Lee-Kim
authors.forename: Shahrbanoo
authors.initials: S
authors.lastname: Fadavi
authors.forename: Indru
authors.initials: I
authors.lastname: Punwani
authors.forename: Anne
authors.initials: A
authors.lastname: Koerber
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D000766:Anesthesia, Dental / Q000379:methods*; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D016854:Dental Anxiety / Q000517:prevention & control; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D015999:Multivariate Analysis; D016037:Single-Blind Method
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam