title: Improved sedation for oral surgery by combining nitrous oxide and intravenous Midazolam: a randomized, controlled trial.
abstract: The objective is to investigate whether sedation techniques for oral surgery can be improved by combining the use of inhalation of nitrous oxide/oxygen with intravenous Midazolam. Prospective, randomized controlled clinical trial: Patients requiring extractions or surgery were randomly allocated to subgroups receiving either intravenous Midazolam or nitrous oxide/oxygen or a combined technique using nitrous oxide/oxygen and intravenous Midazolam. Safety parameters, amount of sedative agents administered, recovery time and co-operation scores were recorded. Patients receiving the combined sedation technique were initially titrated with 10% nitrous oxide, increasing by increments of 10% up to a maximum of 40% nitrous oxide and 60% oxygen. Midazolam was then titrated (initially 2 mg wait 2 min with increments of 1mg every minute until appropriately sedated) whilst still administering 40% nitrous oxide. When a combined technique of N(2)O/O(2) and Midazolam was used there was a statistically significant reduction in the amount of Midazolam required to achieve effective sedation (P<0.001), an overall significant reduction in recovery time (P<0.001) and a significant improvement in co-operation (P<0.01) and arterial oxygen saturation (P<0.001). This combined technique was found to be safe and reliable, requiring reduced doses of Midazolam and demonstrable improvement in patient recovery and co-operation.
authors.affiliation: Department of Oral and Maxillofacial Surgery, The Dental School, Framlington Place, Newcastle upon Tyne NE2 4BW, UK. gv@acorndentist.co.uk
authors.forename: G R
authors.initials: GR
authors.lastname: Venchard
authors.forename: P J
authors.initials: PJ
authors.lastname: Thomson
authors.forename: R
authors.initials: R
authors.lastname: Boys
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods*; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D009609:Nitrous Oxide / Q000008:administration & dosage*; D019647:Oral Surgical Procedures; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012449:Safety; D014081:Tooth Extraction
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D009609:Nitrous Oxide; D008874:Midazolam; D010100:Oxygen