The effect of transmucosal 0.2 mg/kg midazolam premedication on dental anxiety, anaesthetic induction and psychological morbidity in children undergoing general anaesthesia for tooth extraction.
BACKGROUND
The project aims were to evaluate the benefit of transmucosal midazolam 0.2 mg/kg pre-medication on anxiety, induction behaviour and psychological morbidity in children undergoing general anaesthesia (GA) extractions.


METHODS
One hundred and seventy-nine children aged 5-10 years (mean 6.53 years) participated in this randomised, double blind, placebo-controlled trial. Ninety children had midazolam placed in the buccal pouch. Dental anxiety was recorded preoperatively and 48 hours later using a child reported MCDAS-FIS scale. Behaviour at anaesthetic induction was recorded and psychological morbidity was scored by the parent using the Rutter Scale preoperatively and again one week later. Subsequent dental attendance was recorded at one, three and six months after GA.


RESULTS
While levels of dental anxiety did not reduce overall, the most anxious patients demonstrated a reduction in anxiety after receiving midazolam premedication (p = 0.01). Neither induction behaviour nor psychological morbidity improved. Irrespective of group, parents reported less hyperactive (p = 0.002) and more pro-social behaviour (p = 0.002) after the procedure; older children improved most (p = 0.048). Post-GA dental attendance was poor and unaffected by premedication.


CONCLUSIONS
0.2 mg/kg buccal midazolam provided some evidence for reducing anxiety in the most dentally anxious patients. However, induction behaviour, psychological morbidity and subsequent dental attendance were not found to alter.
Hosey
M T
MT
Paediatric Dentistry, Kings College London Dental Institute, London, UK. m.t.hosey@kcl.ac.uk
Asbury
A J
AJ
Bowman
A W
AW
Millar
K
K
Martin
K
K
Musiello
T
T
Welbury
R
R
D000278:Administration, Buccal; D000766:Anesthesia, Dental / Q000523:psychology; D000768:Anesthesia, General / Q000523:psychology; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D015331:Cohort Studies; D003299:Cooperative Behavior; D016854:Dental Anxiety / Q000517:prevention & control* / Q000523:psychology; D003729:Dental Care / Q000523:psychology*; D003812:Dentist-Patient Relations; D004311:Double-Blind Method; D004644:Emotions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D009043:Motor Activity / Q000187:drug effects; D010919:Placebos; D011229:Preanesthetic Medication; D011446:Prospective Studies; D011610:Psychosocial Deprivation; D012919:Social Behavior; D014081:Tooth Extraction / Q000523:psychology
D006993:Hypnotics and Sedatives; D010919:Placebos; D008874:Midazolam